Anatomik olarak kompleks böbrek tümörleri için laparoskopik ve açik parsiyel nefrektomi (böbrek skoru ≥7)

Year 2025, Volume: 18 Issue: 3, 3 - 3

Sinan Çelen , Mesut Berkan Duran , Kürşat Küçüker , Alper Şimşek , Salih Bütün , Yunus Yaz , Mehmet Kırdar , Yusuf Özlülerden

https://doi.org/10.31362/patd.1525970

Abstract

Amaç: Bu çalışmanın amacı, RENAL nefrometri skoru ≥7 olan kompleks böbrek tümörlerinde laparoskopik parsiyel nefrektomi (LPN) ve açık parsiyel nefrektomi (APN) yöntemlerinin güvenlik ve etkinliğini karşılaştırmaktı.
Gereç ve yöntemler: 2016-2022 yılları arasında RENAL nefrometri skoru ≥7 olan böbrek tümörleri için LPN (n=32) veya APN (n=31) uygulanan 63 hastanın verilerini retrospektif olarak değerlendirdik. Gruplar arasında preoperatif, fonksiyonel ve onkolojik sonuçları karşılaştırdık. İskemik sıcaklık süresi (İSS) <25 dakika, cerrahi komplikasyon olmaması ve negatif cerrahi marjlar trifekta olarak tanımlandı.
Bulgular: Tümör çapı (4,15±1,28cm, 5,62±2,84cm, p=0,552), patolojik evre ve median RENAL nefrometri skoru (8,00 [7-10], 8 [7-11], p=0,257) açısından APN ve LPN grupları arasında fark gözlenmedi. Trifekta sonuçları, ameliyat süresi, tahmini kan kaybı, İSS, komplikasyon oranları ve hastanede kalış süresi açısından gruplar arasında fark yoktu. Erken ve son takiplerde glomerüler filtrasyon hızındaki yüzde azalma benzerdi. LPN ve APN sonrası ortalama takip süreleri benzerdi (sırasıyla 13,69±7,46 ay, 18,68±2,28 ay, p=0,55).
Sonuç: Anatomik olarak kompleks böbrek tümörlerinde LPN, fonksiyonel ve onkolojik sonuçları tehlikeye atmadan böbrek fonksiyonlarının korunmasında APN ile benzer sonuçlar göstermektedir. Bu nedenle, kompleks böbrek tümörlerinde parsiyel nefrektomi için laparoskopik yaklaşım da güvenlidir.

Keywords

Laparoskopi, parsiyel nefrektomi, böbrek tümörleri

Laparoscopic versus open partial nephrectomy for anatomically complex renal tumors (renal score ≥7

Abstract

Purpose: The aim of this study was to compare the safety and efficiency of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) for complex renal tumors with a RENAL nephrometry score of ≥7.
Materials and methods: We evaluated the data of 63 patients who had undergone LPN (n=32) or OPN (n=31) for renal tumors with a RENAL nephrometry score of ≥7 between 2016 and 2022, retrospectively. We compared the preoperative, functional and oncological outcomes among the groups. The warm ischemia time (WIT) of <25 minutes, no surgical complications and negative surgical margins were defined as trifecta.
Results: No differences in the diameter of the tumor (4.15±1.28cm, 5.62±2.84cm, p=0.552), in the pathological stage and the median RENAL nephrometry score (8.00 [7-10], 8 [7-11], p=0.257) were observed between the OPN and the LPN groups. There were no differences regarding the trifecta outcomes, the operative time, the estimated blood loss, WIT, the complication rates, and the length of hospital stay among the groups. The percentage decrease in glomerular filtration rate at the early and the last follow-up were similar. The mean follow-ups after LPN and OPN were similar (13.69±7.46 months, 18.68±12.28 months, p=0.55, respectively).
Conclusions: The laparoscopic approach has a similar protection of renal function without compromising functional and oncological results in comparison with OPN for anatomically complex renal tumors. Therefore, laparoscopic approach is also safe with partial nephrectomy for complex renal tumors.

Keywords

Laparoscopy, partial nephrectomy, renal tumors

Ethical Statement

The study was approved by the local ethics committee (Approval number: 60116787-020/31829).

References

• Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7-30. doi:10.3322/caac.21442
• Gill IS, Aron M, Gervais DA, Jewett MA. Clinical practice. Small renal mass. N Engl J Med. 2010;362(7):624-634. doi:10.1056/NEJMcp0910041
• Patard JJ, Shvarts O, Lam JS, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol. 2004;171(6 Pt 1):2181-2435. doi:10.1097/01.ju.0000124846.37299.5e
• MacLennan S, Imamura M, Lapitan MC, et al. Systematic review of oncological outcomes following surgical management of localised renal cancer [published correction appears in Eur Urol. 2012 Jul;62(1):193]. Eur Urol. 2012;61(5):972-993. doi:10.1016/j.eururo.2012.02.039
• Van Poppel H, Da Pozzo L, Albrecht W, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2011;59(4):543-552. doi:10.1016/j.eururo.2010.12.013
• Bravi CA, Larcher A, Capitanio U, et al. Perioperative Outcomes of Open, Laparoscopic, and Robotic Partial Nephrectomy: A Prospective Multicenter Observational Study (The RECORd 2 Project). Eur Urol Focus. 2021;7(2):390-396. doi:10.1016/j.euf.2019.10.013
• Chang KD, Abdel Raheem A, Kim KH, et al. Functional and oncological outcomes of open, laparoscopic and robot-assisted partial nephrectomy: a multicentre comparative matched-pair analyses with a median of 5 years' follow-up. BJU Int. 2018;122(4):618-626. doi:10.1111/bju.14250
• 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(12):2039-2044. doi:10.1007/s00345-015-1552-1
• Peyronnet B, Seisen T, Oger E, et al. Comparison of 1800 Robotic and Open Partial Nephrectomies for Renal Tumors. Ann Surg Oncol. 2016;23(13):4277-4283. doi:10.1245/s10434-016-5411-0
• Celen S, Simsek A, Duran MB, et al. Prediction of complications after laparoscopic partial nephrectomy: feasibility of E PASS score. Int Urol Nephrol. Published online October 20, 2024. doi:10.1007/s11255-024-04246-8
• Rosevear HM, Gellhaus PT, Lightfoot AJ, Kresowik TP, Joudi FN, Tracy CR. Utility of the RENAL nephrometry scoring system in the real world: predicting surgeon operative preference and complication risk. BJU Int. 2012;109(5):700-705. doi:10.1111/j.1464-410X.2011.10452.x
• 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(3):844-853. doi:10.1016/j.juro.2009.05.035
• Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187-196. doi:10.1097/SLA.0b013e3181b13ca2
• 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):461-470. doi:10.7326/0003-4819-130-6-199903160-00002
• Zargar H, Allaf ME, Bhayani S, et al. Trifecta and optimal perioperative outcomes of robotic and laparoscopic partial nephrectomy in surgical treatment of small renal masses: a multi-institutional study. BJU Int. 2015;116(3):407-414. doi:10.1111/bju.12933
• Fergany AF, Hafez KS, Novick AC. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol. 2000;163(2):442-445. doi:10.1016/S0022-5347(05)67896-2
• Weight CJ, Larson BT, Fergany AF, et al. Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol. 2010;183(4):1317-1323. doi:10.1016/j.juro.2009.12.030
• MacLennan S, Imamura M, Lapitan MC, et al. Systematic review of perioperative and quality-of-life outcomes following surgical management of localised renal cancer. Eur Urol. 2012;62(6):1097-1117. doi:10.1016/j.eururo.2012.07.028
• Porpiglia F, Mari A, Bertolo R, et al. Partial Nephrectomy in Clinical T1b Renal Tumors: Multicenter Comparative Study of Open, Laparoscopic and Robot-assisted Approach (the RECORd Project). Urology. 2016;89:45-51. doi:10.1016/j.urology.2015.08.049
• Becker F, Van Poppel H, Hakenberg OW, et al. Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol. 2009;56(4):625-634. doi:10.1016/j.eururo.2009.07.016
• Lifshitz DA, Shikanov SA, Deklaj T, Katz MH, Zorn KC, Shalhav AL. Laparoscopic partial nephrectomy for tumors larger than 4 cm: a comparative study. J Endourol. 2010;24(1):49-55. doi:10.1089/end.2009.0348
• Simmons MN, Chung BI, Gill IS. Perioperative efficacy of laparoscopic partial nephrectomy for tumors larger than 4 cm. Eur Urol. 2009;55(1):199-207. doi:10.1016/j.eururo.2008.07.039
• Tsivian M, Tsivian E, Stanevsky Y, Bass R, Sidi AA, Tsivian A. Laparoscopic partial nephrectomy for tumors 7cm and above. Perioperative outcomes. Int Braz J Urol. 2017;43(5):857-862. doi:10.1590/S1677-5538.IBJU.2016.0642
• Long JA, Yakoubi R, Lee B, et al. Robotic versus laparoscopic partial nephrectomy for complex tumors: comparison of perioperative outcomes. Eur Urol. 2012;61(6):1257-1262. doi:10.1016/j.eururo.2012.03.012
• Liu Z, Zhang X, Lv P, Wu B, Bai S. Functional, oncological outcomes and safety of laparoscopic partial nephrectomy versus open partial nephrectomy in localized renal cell carcinoma patients with high anatomical complexity. Surg Endosc. 2022;36(10):7629-7637. doi:10.1007/s00464-022-09225-7
• Kartal I, Karakoyunlu N, Çakici MÇ, Karabacak O, Sağnak L, Ersoy H. Oncological and functional outcomes of open versus laparoscopic partial nephrectomy in T1b tumors: A single-center analysis. Int Braz J Urol. 2020;46(3):341-350. doi:10.1590/S1677-5538.IBJU.2018.0865
• Chiancone F, Fabiano M, Meccariello C, Fedelini M, Persico F, Fedelini P. Laparoscopic versus open partial nephrectomy for the management of highly complex renal tumors with PADUA score ⩾10: a single center analysis. Urologia. 2021;88(4):343-347. doi:10.1177/03915603211001677
• Rais-Bahrami S, Romero FR, Lima GC, et al. Elective laparoscopic partial nephrectomy in patients with tumors >4 cm. Urology. 2008;72(3):580-583. doi:10.1016/j.urology.2008.05.027
• Çelen S, Özlülerden Y, Mete A, Başer A, Tuncay ÖL, Zümrütbaş AE. Laparoscopic radical prostatectomy: a single surgeon’s experience in 80 cases after 2 years of formal training. Afr J Urol. 2021;27:1-6. doi:10.1186/s12301-021-00159-5
• 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(4):1236-1242. doi:10.1016/j.juro.2012.10.021
• Ghavimi S, Saarela O, Pouliot F, et al. Achieving the "trifecta" with open versus minimally invasive partial nephrectomy. World J Urol. 2021;39(5):1569-1575. doi:10.1007/s00345-020-03349-y