Comparison of early experience laparoscopic versus open partial nephrectomy in terms of clinical, oncological and renal functional outcomes

Abstract

Objective: Although laparoscopic partial nephrectomy (LPN) is minimally invasive, it is also a technically challenging procedure. Currently, open partial nephrectomy (OPN) remains the only alternative in many centers for T1 kidney tumors. We reported our initial experience of LPN compared to OPN regarding clinical, oncological findings and renal functions .

Material and Methods: Between 2004-2013, 81 patients who underwent OPN (n=55) or LPN (n=26) for clinically T1 renal tumors were included. Perioperative and postoperative data were compared, retrospectively. Follow-up times for OPN and LPN groups were 72.9± 41.1 and 47.6± 32.4 months, respectively (p<0,05).

Results: The mean tumor size and RENAL nephrometry scores were similar for both groups. Zero-ischemia was performed in all of the LPN and 15% of the OPN procedures. Estimated blood loss and perioperative transfusion rates were higher in OPN group. Complications including grade < 3 and ≥ 3 did not differ significantly between the groups. The decrease in creatinine-clearance at 6th month was statistically significant in OPN group, while stable in LPN. Positive surgical margin rates were 5.5% for OPN and 11.5% for LPN, p=0,380. One patient in LPN developed local recurrence and underwent nephrectomy. In OPN group,one local recurrence and one distant metastasis were observed in two independent patients. Both patients recieved tyrosine kinase inhibitor.

Conclusion: Although LPN is accepted as a technically challenging procedure, LPN provided comparable outcomes to OPN including clinical, oncological findings and renal functions, even in the early learning phase. Zero-ischemia technique for LPN was feasible and safe with favorable perioperative and renal functional outcomes. 

Keywords

• laparoscopy
• learning curve
• partial nephrectomy
• renal cancer
• surgical margins

Laparoskopik parsiyel nefrektomi erken dönem deneyiminin, açık parsiyel nefrektomi ile klinik, onkolojik ve renal fonksiyonlar açısından karşılaştırılması

Abstract

Amaç: Laparoskopik parsiyel nefrektomi (LPN) minimal invaziv olmasına rağmen teknik olarak zor bir prosedürdür. Günümüzde halen birçok merkezde, T1 evre böbrek tümöründe açık parsiyel nefrektomi (APN) tek seçenek olarak sunulmaktadır. Biz bu çalışmamızda LPN’deki erken dönem tücrebelerimizi klinik, onkolojik bulgular ve böbrek fonksiyonları açısından açık yöntemle karşılaştırarak sunmayı hedefledik.

Gereç ve Yöntemler: 2004-2013 yılları arasında klinik T1 evre böbrek tümörü nedeniyle APN (n = 55) veya LPN (n = 26) uygulanan 81 hasta çalışmaya dahil edildi. Perioperatif ve postoperatif veriler retrospektif olarak karşılaştırıldı. APN ve LPN grupları için takip süreleri sırasıyla 72.9 ± 41.1 ve 47.6 ± 32.4 aydı (p <0,05).

Bulgular: Ortalama tümör boyutu ve RENAL nefrometri skorları her iki grup için benzerdi. APN prosedürlerinin % 15'inde, LPN’lerin ise tamamında sıfır iskemi uygulandı. Tahmini kan kaybı ve perioperatif transfüzyon oranları APN grubunda daha yüksekti. Komplikasyon oranları her iki grupta benzerdi. Altıncı ayda kreatinin klirensindeki azalma APN grubunda istatistiksel olarak anlamlı iken LPN'de stabildi. Pozitif cerrahi sınır oranları APN için % 5.5 ve LPN için% 11.5 idi, p = 0,380. LPN yapılan bir hastada lokal nüks gelişti ve nefrektomi yapıldı. APN yapılan bir hastada lokal nüks ve bir başkasında ise uzak metastaz gözlendi. Her iki hastada da tirozin kinaz inhibitörü ile tedavi edildi.

Sonuç: LPN teknik olarak zor bir prosedür olmasına karşın öğrenme evresinde klinik, onkolojik bulgular ve böbrek fonksiyonları açısından APN'ye benzer sonuçlar göstermiştir. Sıfır iskemi yöntemi ile kabul edilebilir perioperatif ve renal fonksiyonel sonuçlar elde edilerek LPN'nin erken dönem deneyimlerinde dahi güvenilirliği ve uygulanabilirliği gösterilmiştir.

Keywords

• laparoskopi
• öğrenme eğrisi
• parsiyel nefrektomi
• böbrek kanseri
• cerrahi sınır

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