Comparison of Open and Minimally Invasive Partial Nephrectomy for Renal Tumors 4–7 Centimeters

Sprenkle, Preston; Power, Nicholas; Ghoneim, T.; Touijer, Karim; Dalbagni, Guido; Russo, Paul; Coleman, Jonathan

doi:10.1016/j.eururo.2011.11.040

Cited by 87 publications

(47 citation statements)

References 38 publications

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“…At contrary, RPN seemed to be a more reproducible technique, able to bridge the technical difficulties of LPN in favor of a broader diffusion of minimally invasive PN. A few well-designed comparative studies have investigated the perioperative outcomes of RPN versus those of LPN [6][7][8], while to date no prospective studies comparing RPN and OPN are available, but only few retrospective series with limited cases [9][10][11]. The aim of the present study is to compare the perioperative results and surgical complications of RPN and OPN.…”

Section: Introductionmentioning

confidence: 99%

Open versus robotic-assisted partial nephrectomy: a multicenter comparison study of perioperative results and complications

et al. 2013

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Purpose To compare surgical results, morbidity and positive surgical margins rate of patients undergoing robotic partial nephrectomy (RPN) versus open partial nephrectomy (OPN). Methods This is an observational multicenter study promoted by the ''Associazione GIovani Laparoscopisti Endoscopisti'' (AGILE) no-Profit Foundation, which involved six Italian urologic centers. All clinical, surgical, and pathological variables of patients treated with OPN or RPN for renal tumors were gathered in a prospectively maintained database. Tumor nephrometry was measured with PADUA score, and complications were stratified with modified Clavien system. Differences between RPN and OPN group were assessed with univariate analysis. Perioperative variables independently associated with complications were assessed with multivariate analysis. Results A total of 198 and 105 patients were enrolled in OPN and RPN group, respectively. Both had similar demographics, indications to surgery, tumor nephrometry, renal function, WIT (18.7 vs. 18.2 min; p = NS), positive margin rate (5.6 vs. 5.7 %; p = NS), intraoperative complications, and postoperative medical complications. Compared to OPN, RPN group was significantly more morbid (p = 0.04), included tumors with smaller size (p = 0.002), had longer operative time (p \ 0.001), lower blood loss, surgical postoperative complications (5.7 vs. 21.2 %, p \ 0.001), Clavien 3-4 surgical complications (1 vs. 9.1 %, p = 0.001), and shorter hospitalization. The surgical approach resulted independently correlated with surgical complications on multivariate analysis. Conclusion In the present series, RPN was associated with a significant reduction of blood loss, surgical complications, including the reintervention rate for urinary fistula and postoperative bleeding, and with a shorter hospitalization.

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Section: Introductionmentioning

confidence: 99%

Open versus robotic-assisted partial nephrectomy: a multicenter comparison study of perioperative results and complications

et al. 2013

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“…1,4,5 The understanding of increased risk of chronic kidney disease (CKD) with radical nephrectomy as well as recent data highlighting the association between CKD and cardiovascular morbidity and mortality have led to the desire to preserve as much normal renal parenchyma as possible. 6 Several factors are thought to impact postoperative renal function, including patient-related factors such as age, comorbidities, and preoperative renal function.…”

Section: Discussionmentioning

confidence: 99%

Factors That Affect Proportional Glomerular Filtration Rate After Minimally Invasive Partial Nephrectomy

Hakimi

Ghavamian

Williams

et al. 2013

Journal of Endourology

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Background and Purpose: Several factors have been shown to impact the overall glomerular filtration (GFR) rate after partial nephrectomy. Change in overall GFR, however, does not necessarily reflect the impact of these factors on the operated kidney. Using preoperative and postoperative renal scintigraphy, we sought to assess the impact of patient, tumor, and operative factors on GFR of the affected kidney (proportional GFR). Patients and Methods: We identified 73 patients who underwent minimally invasive partial nephrectomy with preoperative and postoperative renal scans from two institutions. Patient, tumor, and operative characteristics were recorded. We used multiple linear regression to determine the patient and clinical factors predictive of postoperative proportional GFR in the operated kidney. We tested for an interaction between preoperative proportional GFR and nephrometry score and ischemia. We further fitted two separate linear models to compare the proportion of variance (R 2 ) explained by ischemia time in change in renal function in the operated kidney with the change in renal function in both kidneys. Results: Surgical parameters (procedure approach, ischemia time, and estimated blood loss) and preoperative proportional GFR were significantly associated with postoperative proportional GFR. Preoperative proportional GFR (b = 5.93, 95% confidence interval [CI]: 3.88, 7.97, P < 0.0005) and procedure approach (b = 8.67, 95% CI: 4.50, 12.80, P < 0.0005) were strongly associated with outcome while ischemia time (b = -1.80, 95% CI: -3.48, -0.11, P = 0.04) and estimated blood loss (b = -1.15, 95% CI: -0.29, -0.01, P = 0.04) just reached statistical significance. The interaction term between preoperative proportional GFR and nephrometry score or ischemia time was not statistically significant (nephrometry, P = 0.2 continuous or P = 0.6 categorical, and ischemia, P = 0.7, respectively). Conclusion: Lower preoperative proportional GFR, longer ischemia times, and higher blood loss all negatively impact postoperative proportional GFR while tumor complexity as gauged by morphometry scoring does not. Larger studies are needed to determine whether renal scintigraphy is a more accurate method of measuring the impact of the ischemia time on postoperative proportional GFR.

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“…Nephron-sparing surgery in multiple renal cancer: a case report for Adverse Events grading system [14]. Sprenkle et al reported complications rate of 13% approximately as well [15]. Sidana et al, in a sample of 162 patients undergone to PCA, LCA, or open CA, reported complication rates higher, up to 23.5% (complications were categorized using the Clavien-Dindo system).…”

Section: Discussionmentioning

confidence: 99%

Nephron-sparing surgery in multiple renal cancer: a case report

Regis

Mauro

Russo

et al. 2017

CMI

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BACKGROUND: In the last decade, nephron-sparing surgery has largely supplanted the radical approach for the treatment of small renal masses. More recently, ablative technologies have been discussed as alternative in patients that are not eligible for surgical approach.CASE SUMMARY: A 54-year-old Caucasian man was referred to our Urology Clinic for multiple renal masses. A computed tomography (CT) scan revealed three contrast-enhanced lesions located in the upper pole, middle renal, and in the lower pole of the left kidney 20 mm, 25 mm, and 45 mm long, respectively. The patient underwent laparoscopic tumorectomy of two lesions and cryoablation of the left renal mass by the transperitoneal approach, performed without clamping the renal vessels. At the end of the procedure the operator posed a reno-ureteral ipsilateral stent to tutor the urinary tract. Tumor enucleation and cryoablation were chosen to preserve renal function.CONCLUSION: This case report shows that in young patients with multiple renal tumors, cryoablation treatment is feasible and outcomes are promising as well. However, risk of complications should be considered and discussed with patients.

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Comparison of Open and Minimally Invasive Partial Nephrectomy for Renal Tumors 4–7 Centimeters

Abstract: OPN and MIPN procedures performed in patients with tumors>4-7 cm offer acceptable and comparable results in terms of operative, functional, and convalescence measures, regardless of approach.

Cited by 87 publications

References 38 publications

Open versus robotic-assisted partial nephrectomy: a multicenter comparison study of perioperative results and complications

Open versus robotic-assisted partial nephrectomy: a multicenter comparison study of perioperative results and complications

Factors That Affect Proportional Glomerular Filtration Rate After Minimally Invasive Partial Nephrectomy

Nephron-sparing surgery in multiple renal cancer: a case report

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