Laparoscopic Partial Nephrectomy in T1a/T1b Stage Renal Tumors: Where We Are?

Year 2020, Volume: 12 Issue: 1, 24 - 30, 30.01.2020

Mehmet Salih Boğa Murat Savaş Mahmut Ekrem İslamoğlu , Mehmet Giray Sönmez , Kayhan Yılmaz Mahmut Taha Ölçücü Kaan Kıramık Çağatay Özsoy Mutlu Ateş

Abstract

Aim: To report the demografics, operative and postoperative outcomes of laparoscopic partial nephrectomy (LPN)

in T1a/T1b stage renal tumors.

Matherials and Methods: In total of 60 patients were evaluated, retrospectively who underwent LPN with a

normal contralateral kidney, between May 2015 and October 2018. Demographics, perioperative and postoperative

outcomes were evaluated and discussed with the literature.

Result: 42 patients were included in the study. The mean age, tumor size and RENAL scores were 60.52 (± 10.51) years,

3.58 (± 1.55) cm and 6.548 (± 1.17), respectively. The duration of warm ischemia time was 26,88 (± 6,27) minutes. The

mean operative time, estimated blood loss, length of hospital stay time were 162.26 (± 38.97) min, 166.79 (± 98.32)

mL and 3.45 (± 0.89) days, respectively. Preoperative and postoperative estimated glomerular filtration rate (eGFR)

were 76.83 (± 18.36) and 71.93 (± 20,12) mL/min/1.73 m2, respectively. eGFR decrease was 4.9 (6.38%) mL/min/1.73

m2 at the 3 months postoperative. The rate of postoperative complications, surgical margin status and eGFR decrease

were similer to literature. The mean follow-up time was 21.02 (± 13.26) months.

Conclusion: Although LPN has long learning curve, it is a safe PN method that can be applied in selected renal

tumor cases with excellent oncological and functional results with acceptable complication rates.

Keywords

laparoscopic partial nephrectomy, minimally invasive surgery, renal tumor

T1a/T1b Evre Renal Tümörlerde Laparoskopik Parsiyel Nefrektomi: Biz Neredeyiz?

Abstract

Amaç: T1a / T1b evre böbrek tümörlerinde laparoskopik parsiyel nefrektomi yapılan hastalara ait (LPN) demografik

verileri, perioperatif ve postoperatif sonuçları rapor etmeyi amaçladık.

Gereç ve Yöntem: Retrospektif olarak Mayıs 2015 - Ekim 2018 arasında normal kontralateral böbreği olan ve LPN

yapılan 60 hasta değerlendirildi. Demografik, perioperatif ve postoperatif sonuçlar literatür ile değerlendirildi ve

tartışıldı.

Bulgular: Çalışmaya 42 hasta dahil edildi. Ortalama yaş, tümör boyutu ve RENAL skorları sırasıyla 60.52 (± 10.51),

3.58 (± 1.55) cm ve 6.548 (± 1.17) idi. Sıcak iskemi süresi 26,88 (± 6,27) dakika idi. Ortalama ameliyat süresi, tahmini

kan kaybı, hastanede kalış süresi, 162.26 (± 38.97) dk, 166.79 (± 98.32) mL ve 3.45 (± 0.89) gündü. Preoperatif ve

postoperatif tahmini glomerüler filtrasyon hızı (eGFR) sırasıyla 76.83 (± 18.36) ve 71.93 (± 20,12) mL / dak / 1.73 m2

idi. eGFR azalması ameliyat sonrası 3 ayda 4.9 (% 6.38) mL / dak / 1.73 m2 idi. Postoperatif komplikasyon oranı, cerrahi

sınır durumu ve eGFR azalması literatür ile benzer olarak bulundu. Ortalama takip süresi 21.02 (± 13.26) aydı.

Sonuç: Her ne kadar LPN uzun bir öğrenme eğrisine sahip olsa da, seçilmiş renal tümör vakalarında mükemmel

onkolojik ve fonksiyonel sonuçlarla kabul edilebilir komplikasyon oranları ile uygulanabilen güvenli bir PN yöntemidir.

Keywords

laparoskopik parsiyel nefrektomi, minimal invaziv cerrahi, böbrek tümörü

References

• 1. Ljungberg B, Albiges L, Abu-Ghanem, Y, et al. European association of urology guidelines on renal cell carcinoma: the 2019 update. European urology, 2019; 75(5): 799-810.
• 2. Campbell S, Uzzo RG, Allaf ME, et al. Renal mass and localized renal cancer: AUA guideline. J Urol 2017 Sep;198(3):520-9.
• 3. Maurice MJ, Zhu H, Kim SP, Abouassaly R. Increased use of partial nephrectomy to treat high-risk disease. BJU Int 2016 Jun;117(6B):E75-86.
• 4. Carneiro A, Sivaraman A, Sanchez‐Salas R et al. Evolution from laparoscopic to robotic nephron sparing surgery: a high‐volume laparoscopic center experience on achieving “trifecta” outcomes. World J Urol 2015; 33: 2039–44.
• 5. Khalifeh A, Autorino R, Hillyer SP et al. Comparative outcomes and assessment of trifecta in 500 robotic and laparoscopic partial nephrectomy cases: a single surgeon experience. J Urol 2013; 189: 1236–42.
• 6. Thompson RH, Lane BR, Lohse CM, et al. Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol 2010;58(3):340–345.
• 7. Yu HY, Hevelone ND, Lipsitz SR, Kowalczyk KJ, Hu JC. Use, costs and comparative effectiveness of robotic assisted, laparoscopic and open urological surgery. J Urol 2012;187:1392–1398.
• 8. Kutikov A, Uzzo RG. The R.E.N.A.L. Nephrometry Score: A comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 2009;182:844-53.
• 9. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-13.
• 10. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130(6):461-70.
• 11. Go AS, Chertow GM, Fan D, McCullochCE, HsuCY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296–1305.
• 12. Klatte T, Shariat SF, Remzi M. Systematic review and meta-analysis of perioperative and oncologic outcomes of laparoscopic cryoablation versus laparoscopic partial nephrectomy for the treatment of small renal tumors. J. Urol 2014;191(5):1209e1217.
• 13. Hyams E, Pierorazio P, Mullins JK, et al. A comparative cost analysis of robot-assisted versus traditional laparoscopic partial nephrectomy. J. Endourol 2012;26 (7): 843e847.
• 14. Ng AM, Shah PH, Kavoussi LR. Laparoscopic partial nephrectomy: A narrative review and comparison with open and robotic partial nephrectomy. Journal of endourology 2017;31(10): 976-984.
• 15. Marszalek M, Meixl H, Polajnar M, Rauchenwald M, Jeschke K, Madersbacher S. Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. European urology 2009; 55(5): 1171-1178.
• 16. Kızılay F, Turna B, Apaydın E, Semerci B. Comparison of long‐term outcomes of laparoscopic and robot‐assisted laparoscopic partial nephrectomy. The Kaohsiung journal of medical sciences, 2019; 35(4): 238-243.
• 17. Mehra K, Manikandan R, Dorairajan LN, Sreerag S, Jain A, Bokka SH. Trifecta Outcomes in Open, Laparoscopy or Robotic Partial Nephrectomy: Does the Surgical Approach Matter?. Journal of kidney cancer and VHL 2019;6(1): 8-12.
• 18. Xu H, Ding Q, Jiang HW. Fewer complications after laparoscopic nephrectomy as compared to the open procedure with the modified Clavien classification system—a retrospective analysis from southern China. World J Surg Oncol 2014;12:242.
• 19. Shiroki, R., Fukami, N., Fukaya, K. Et al. Robot‐assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy. International Journal of Urology 2016;23(2): 122-131.
• 20. Gong EM, Orvieto MA, Zorn KC, Lucioni A, Steinberg GD, Shalhav AL. Comparison of laparoscopic and open partial nephrectomy in clinical T1a renal tumors. J. Endourol 2008; 22: 953–7.
• 21. Gill IS, Kamoi K, Aron M, Desai MM. 800 Laparoscopic partial nephrectomies: a single surgeon series. The Journal of urology 2010; 183(1): 34-42.
• 22. Wang AJ, Bhayani SB. Robotic partial nephrectomy versus laparoscopic partial nephrectomy for renal cell carcinoma: single-surgeon analysis of> 100 consecutive procedures. Urology 2009;73(2): 306-310.
• 23. Pavan N, Derweesh IH, Mir CM, et al. Outcomes of laparoscopic and robotic partial nephrectomy for large (> 4 cm) kidney tumors: systematic review and meta-analysis. Annals of surgical oncology 2017; 24(8): 2420-2428.
• 24. Benway BM, Bhayani SB, Rogers CG et al. Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J. Urol 2009; 182: 866–72.
• 25. Kural AR, Atug F, Tufek I, Akpinar H. Robot-assisted partial nephrectomy versus laparoscopic partial nephrectomy: comparison of outcomes.  Journal of endourology, 2009;23(9):1491-1497.
• 26. Tachibana H, Takagi T, Kondo T, Ishida H, Tanabe K. Robot‐assisted laparoscopic partial nephrectomy versus laparoscopic partial nephrectomy: A propensity score‐matched comparative analysis of surgical outcomes and preserved renal parenchymal volume. International Journal of Urology 2018;25(4):359-364.
• 27. Boga MS and Sönmez MG. "Long-term renal function following zero ischemia partial nephrectomy." Research and reports in urology 2019;11: 43.