Laparoscopic partial nephrectomy for tumors 7cm and above. Perioperative outcomes

Abstract

Purpose:To assess and report the outcomes of laparoscopic partial nephrectomy) LPN) for T2 renal masses.Materials and Methods:Retrospective review of patients undergoing LPN for clinically localized renal masses ≥7cm between the years 2005-2016. Descriptive analyses were generated for demographics, lesion characteristics, perioperative variables (operative time, warm ischemia time (WIT), estimated blood loss (EBL), intra-operative and postoperative complications (IOC and POC) and pathologic variables (pathology, subtype and Fuhrman grade).Results:A total of 27 patients underwent LPN for a T2 renal mass at our institution between 2005 and early 2016 of which 19 were males. The mean age was 66 (52-72). All procedures were transperitoneal with 16 on the right and 11 on the left. Median operative time was 200 minutes (IQR 181-236) and median WIT 19 minutes (IQR 16-23). EBL was 125mL (IQR 75-175). One case was converted to laparoscopic radical nephrectomy due to suspected tumor thrombus in the renal vein. Surgical margins were positive in one renal tumor in a patient with multiple tumors. There was a total of 2 IOC (7.4%) and 3 POC (11%) classified as Clavien grade 3.Conclusions:To our knowledge, this series is the first to describe the outcomes of LPN for cT2 renal masses. In our series, LPN for larger renal masses appears feasible with favorable perioperative outcomes. Additional data are needed to further explore the benefits of minimally invasive surgical approaches to larger renal masses.

Partial versus radical nephrectomy in clinical T2 renal masses

“…The rates of overall (19%) and severe (4%) complications after PN in the present study compare favorably with prior reports 3,6,7,9,10,16 . Increased complication rates associated with PN, as compared with RN, are not surprising given generally increased surgical complexity.…”

“…The rates of overall (19%) and severe (4%) complications after PN in the present study compare favorably with prior reports. 3,6,7,9,10,16 Increased complication rates associated with PN, as compared with RN, are not surprising given generally increased surgical complexity. For example, the excision of a tumor might require incision of the collecting system, and the renorrhaphy might put the patient at risk for a pseudoaneurysm.…”

“…1 With further technical expertise and emphasis on renal function preservation, the application of nephron-sparing techniques has been extended to renal tumors >7 cm by some urologists. Outcomes have been encouraging when PN is carried out by experienced surgeons on well-selected patients, [2][3][4][5][6][7][8][9][10] although sample sizes in some published series are relatively small or lack comparative analyses (PN vs RN). [6][7][8][10][11][12][13][14] Mir et al summarized the available literature in two separate meta-analyses comparing PN and RN in renal masses >7 cm.…”

“…Outcomes have been encouraging when PN is carried out by experienced surgeons on well-selected patients, [2][3][4][5][6][7][8][9][10] although sample sizes in some published series are relatively small or lack comparative analyses (PN vs RN). [6][7][8][10][11][12][13][14] Mir et al summarized the available literature in two separate meta-analyses comparing PN and RN in renal masses >7 cm. 4,5 They both concluded PN has comparable oncologic outcomes with superior preservation of renal function, but higher postoperative morbidity, as compared with RN.…”

Minimal Invasive Treatments for Renal Cell Carcinoma

“…LPN is technically difficult surgery, therefore, it was limited to patients with two kidneys, normal renal function and small, exophytic, peripheral tumours in one decade ago [13]. Furthermore, the studies showed that partial nephrectomy can be alternative to radical nephrectomy for renal tumors <7cm [36][37][38]. Now it is recommended at stage T1a, and if it is feasible favoured at stage T1b over radical nephrectomy.…”