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

Yıl 2025, Cilt: 18 Sayı: 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

Öz

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.

Anahtar Kelimeler

Laparoskopi, parsiyel nefrektomi, böbrek tümörleri

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

Öz

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.

Anahtar Kelimeler

Laparoscopy, partial nephrectomy, renal tumors

Etik Beyan

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

Kaynakça

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