Laparoscopic partial nephrectomy: a comprehensive evaluation of single-centre perioperative outcomes
Abstract
Aim: Assessment of perioperative and oncological results of laparoscopic nephron-sparing procedures for renal tumors. Material a methods: We evaluate data from a prospectively collected database in one center between 1/2013 and 6/2018.
Operations were performed by 3 surgeons. There were 174 patients available for final analysis.
The cohort included also 1 one-stage bilateral case, 9 cases of multiple one-stage partial nephrectomy (PN) (2-5 lesions) and in 8 cases PN of solitary kidney. Altogether, 190 renal masses were resected (left side 102x, right side 88x), in 64 women and 110 men.
Cohort medians (IQR = interquartile range) were: age 64 (55-70) years, Charleson comorbidity index 3 (2-4), creatinine 78 (68-95) µmol/L, lesion diameter 27 (20-35) mm, PADUA score 8 (7-9). Results: Length of surgery median 118 (IQR 88-150) min, blood loss median 150 (IQR 80-300) ml, no warm ischemia (WI) used in 51 of 190 lesions, in other length of WI median 15 (IQR 12-17) min, in 2 patients conversion to open PN was needed and in 2 patients conversion to laparoscopic nephrectomy (1x bleeding; 1x renal vein tumor thrombus).
There were 44 complications according to Clavien-Dindo (CD) classification within 30 post-operative days: 17x grade 1, 13x grade 2, 10x grade 3, 1x grade 4, 3x grade 5, i.e. CD >= 3 in 8 % of patients.
Symptomatic pseudoaneurysm was diagnosed in 4 pts - all treated by selective embolization. Post-operative hospital stay was median 6 (IQR 5-7) days.
Histology found 45 benign and 145 malignant lesions, of the latter 122x pT1a, 16x pT1b, 3x pT2a and 4x pT3a. Positive margin rate was 11%.
Only 1 patient underwent new PN via open approach, others were monitored. We detected 1 local kidney recurrence (in R0 surgery), 1 rapid distant progression (cerebral metastases) and 1 combined local (in perirenal fat) and distant (lungs) recurrence (in R0 surgery).
Trifecta based on Montsouris (R0 + WI = 3 complication) was 74,1%, based on Khalifeh et al. (R0 + WI = 3 complication) was 69 %. Conclusion: Laparoscopic PN is a standard management option of solid renal masses providing favorable outcomes.
Trifecta rate was comparable to published results.