Better nephron sparing option for patients with cT1 stage renal masses: Comparison of open, laparoscopic partial nephrectomy and radiofrequency ablation

Objective: The aim of this study is to assess the safety and feasibility of the transperitoneal laparoscopic approach during nephron sparing surgery in patients with previous abdominal surgery. Patients and methods: We retrospectively analyzed patients undergoing transperitoneal laparoscopic partial nephrectomy for renal masses. All patients had received a diagnosis of cT1a renal exophytic mass (⩽5 cm). Patients were divided into two groups, those with and without previous abdominal surgery. Patients with solitary kidney or major previous abdominal surgery were excluded in this study. The operative time, estimated blood loss, length of stay, surgical complications, and positive surgical margins were recorded to compare outcomes among two groups. Results: Of the 157 patients who were included in our study, 71 (45.3%) had a history of abdominal surgery (Group 1), while the remaining 86 (54.7%) had not (Group 2). Cholecystectomy was the most common previous surgery performed near the renal fossa. Patients with previous abdominal surgery experienced increased operative time (111.5 vs 83.2 min; p = 0.001). However, no statistically significant difference was found in estimated blood loss (122.1 vs 114.4 mL; p = 0.363), length of stay (4.1 vs 3.8 days; p = 0.465), rate of conversion to open surgery (2.8% vs 2.3%; p = 0.234), and rate of complications ( p = 0.121). However, operative time ( p = 0.003) and length of stay ( p < 0.001) were greater in patients with versus those without previous open cholecystectomy. Conclusion: Our results suggest that laparoscopic partial nephrectomy after minor previous abdominal surgery is safe and feasible in selected patients affected by renal masses with low nephrometry score. However, previous cholecystectomy results in an increased risk of conversion to open surgery and longer hospital stay in patients undergoing right laparoscopic partial nephrectomy.

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24 NEPHRON SPARING SURGERY FOR THE TREATMENT OF SMALL RENAL MASSES: COMPARISON BETWEEN OPEN PARTIAL NEPHRECTOMY, LAPAROSCOPIC PARTIAL NEPHRECTOMY AND LAPAROSCOPIC CRYOABLATION

European Urology Supplements ◽

10.1016/s1569-9056(09)60032-4 ◽

2009 ◽

Vol 8 (4) ◽

pp. 126 ◽

Cited By ~ 3

Author(s):

G. Lughezzani ◽

A. Cestari ◽

N.M. Buffi ◽

E. Scapaticci ◽

F. Fabbri ◽

...

Keyword(s):

Partial Nephrectomy ◽

Laparoscopic Partial Nephrectomy ◽

Nephron Sparing Surgery ◽

Small Renal Masses ◽

Renal Masses ◽

Open Partial Nephrectomy ◽

Nephron Sparing

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Split renal function after treatment of small renal masses: comparison between radiofrequency ablation and laparoscopic partial nephrectomy

Acta Radiologica ◽

10.1177/0284185120956281 ◽

2020 ◽

pp. 028418512095628

Author(s):

Vanessa Acosta Ruiz ◽

Sarah Båtelsson ◽

Elina Onkamo ◽

Lisa Wernroth ◽

Thomas Nilsson ◽

...

Keyword(s):

Renal Function ◽

Radiofrequency Ablation ◽

Partial Nephrectomy ◽

Ct Images ◽

Laparoscopic Partial Nephrectomy ◽

Renal Tumors ◽

Small Renal Masses ◽

Renal Masses ◽

Split Renal Function ◽

Pre Treatment

Background Radiofrequency ablation (RFA) and laparoscopic partial nephrectomy (LPN) are used to treat small renal masses (SRM; ≤4 cm), although there are conflicting results in the changes in creatinine and estimated glomerular filtration rate (eGFR) after treatment. On contrast-enhanced computed tomography (CE-CT) images, the quantity and quality of renal function can be evaluated by calculating the split renal function (SRF). Purpose To compare renal function after RFA or LPN treatment of SRMs through evaluation of the SRF in the affected kidney. Material and Methods Single T1a renal tumors successfully treated with RFA (n = 60) or LPN (n = 31) were retrospectively compared. The SRF was calculated on pre-treatment CE-CT images and the first follow-up exam after completed treatment. Serum creatinine and eGFR values were collected simultaneously. To compare renal function outcomes, Student’s t-test and multivariable linear regression models (adjusted to RFA/LPN treatment, pre-treatment SRF/eGFR, BMI, age, tumor characteristics, and Charlson Comorbidity Index) were used. Results SRF was reduced in both groups, although reduction was greater in the LPN group (LPN –5.7%) than in the RFA group (RFA –3.5%; P = 0.013). After adjusted analysis, the LPN group still had greater SRF reduction (difference 3.2%, 95% confidence interval 1.3–1.5; P = 0.001). There was no difference between groups in the change of creatinine/eGFR after treatment. Conclusion Both RFA and LPN are nephron-sparing when treating SRMs. However, in this series, reduction of SRF in the affected kidney was smaller after RFA, having a more favorable preservation of renal function than LPN.

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Off-Clamp Laparoscopic Partial Nephrectomy for a Fat-Poor Angiomyolipoma Arising from the Renal Capsule: A Case Report

Case Reports in Urology ◽

10.1155/2012/484790 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Koichi Kodama ◽

Yasukazu Takase ◽

Isamu Motoi ◽

Katsuhiko Saito

Keyword(s):

Partial Nephrectomy ◽

Renal Damage ◽

Left Kidney ◽

Surgical Margin ◽

Magnetic Resonance Images ◽

Laparoscopic Partial Nephrectomy ◽

Renal Capsule ◽

Renal Masses ◽

Nephron Sparing ◽

Exophytic Tumor

Renal function can be significantly preserved after nephron-sparing surgery by decreasing the intraoperative ischemic duration or by performing off-clamp surgery. We report the case of a 56-year-old woman diagnosed with a minimal-fat angiomyolipoma arising from the renal capsule, which was successfully treated by retroperitoneoscopic partial nephrectomy without hilar clamping. Computed tomography revealed a 16 × 13 mm homogenous lenticular mass protruding from the lateral aspect of the left kidney. On both T1- and T2-weighted magnetic resonance images, the mass exhibited homogenous low-signal intensity and well-defined margins. Laparoscopic magnification indicated that the exophytic tumor was attached to the renal cortex by a small peduncle. The tumor was resected completely with negative surgical margin. The estimated glomerular filtration rate after surgery was nearly equal to that before surgery. Off-clamp laparoscopic partial nephrectomy is a feasible surgical option to prevent ischemic renal damage in select patients presenting with small, exophytic, and peripheral renal masses.

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Nephron-Sparing Surgery: Laparoscopic Partial Nephrectomy

Renal Cell Cancer ◽

10.1007/978-1-84628-763-3_22 ◽

2008 ◽

pp. 221-227

Author(s):

Georges-Pascal Haber ◽

Jose R. Colombo ◽

Inderbir S. Gill

Keyword(s):

Partial Nephrectomy ◽

Laparoscopic Partial Nephrectomy ◽

Nephron Sparing Surgery ◽

Nephron Sparing

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Comparison of Video-Assisted Minilaparotomy, Open, and Laparoscopic Partial Nephrectomy for Renal Masses

Yonsei Medical Journal ◽

10.3349/ymj.2012.53.1.151 ◽

2012 ◽

Vol 53 (1) ◽

pp. 151 ◽

Cited By ~ 7

Author(s):

Hwang Gyun Jeon ◽

Kyung Hwa Choi ◽

Kwang Hyun Kim ◽

Koon Ho Rha ◽

Seung Choul Yang ◽

...

Keyword(s):

Partial Nephrectomy ◽

Laparoscopic Partial Nephrectomy ◽

Renal Masses ◽

Video Assisted

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Oncological outcomes of partial nephrectomy for tumours larger than 4 cm: A systematic review

Canadian Urological Association Journal ◽

10.5489/cuaj.1682 ◽

2014 ◽

Vol 8 (1-2) ◽

pp. 61 ◽

Cited By ~ 3

Author(s):

Tarek H El-Ghazaly ◽

Ross J Mason ◽

Ricardo A Rendon

Keyword(s):

Systematic Review ◽

Partial Nephrectomy ◽

Survival Rates ◽

Cancer Specific Survival ◽

Renal Masses ◽

Oncological Outcomes ◽

Medical Associations ◽

Nephron Sparing ◽

Pubmed Search ◽

Exact Size

Introduction: Many medical associations recommend nephron-sparing surgery (NSS) for tumours larger than 4 cm amenable to partial nephrectomy (PN). These recommendations are, however, mostly based on isolated reports. We systematically review the oncological outcomes of partial nephrectomy procedures performed for tumours larger than 4-cm.Methods: A PubMed search was carried out using keywords “partial nephrectomy” and “nephron sparing” for records dating back to 1995. In total, 2136 abstracts were analyzed; from these, 174 studies were scrutinized. We identified 32 manuscripts reporting size-specific cancer-specific survival rates for masses greater than 4 cm. From each of these studies, we recorded the number of PN, tumour diameter, follow-up duration, 5- and 10-year recurrence, overall and cancer-specific survival rates (OS, CSS). We also calculated weighted OS and CSS rates.Results: This systematic review includes 2445 patients with renal tumours larger than 4 cm who underwent PN: 1858 patients with tumours between 4 to 7 cm, 410 patients with tumours larger than 7 cm and 177 patients with tumours greater than 4 cm (exact size unknown). Our analysis revealed weighted 5-year CSS rates of 95.4%, 86.2% and 93.9% for tumours 4 to 7 cm, >7 cm, and all tumours >4 cm, respectively. The respective 5-year OS rates were 84.7%, 76.4%, and 84.7%.Conclusions: We found excellent 5-year CSS and OS rates for patients with tumours 4 to 7 cm treated with PN. These outcomes compare favourably to those reported in historical radical nephrectomy (RN) series for similarly sized tumours. Thus, PN is an acceptable and often preferred treatment for renal masses >4 cm which are amenable to nephron-sparing procedures.

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Intraoperative ultrasound in robot-assisted partial nephrectomy: State of the art

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2018.3.195 ◽

2018 ◽

Vol 90 (3) ◽

pp. 195-198 ◽

Cited By ~ 3

Author(s):

Giacomo Di Cosmo ◽

Enrica Verzotti ◽

Tommaso Silvestri ◽

Andrea Lissiani ◽

Roberto Knez ◽

...

Keyword(s):

Partial Nephrectomy ◽

State Of The Art ◽

Short Review ◽

Robot Assisted ◽

Small Renal Masses ◽

Renal Masses ◽

Ischemia Time ◽

Oncological Safety ◽

Nephron Sparing ◽

Operative Ultrasound

Introduction: Nephron-sparing surgery (NSS) is of one of the most studied fields in urology due to the balancing between renal function preservation and oncological safety of the procedure. Aim of this short review is to report the state of the art of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during robotassisted partial nephrectomy (RAPN). Material and methods: We performed a literature review by electronic database on Pubmed about the use of intra-operative US in RAPN to evaluate the usefulness and the feasibility of this procedure. Results: Several studies analyzed the use of different US probes during RAPN. Among them some focused on using contrastenhanced ultra sonography (CEUS) for improving the dynamic evaluation of microvascular structure allowing the reduction of ischemia time (IT). We reported that nowaday the use of intraoperative US during RAPN could be helpful to improve the preservation of renal tissue without compromising oncological safety. Moreover, during RAPN there is no need for assistant to hand the US probe increasing surgeon autonomy. Conclusions: The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument during this key step of the partial nephrectomy procedure. Moreover US could be useful to reduce ischemia time (IT). The advantages of nephron-sparing surgery over radical nephrectomy is well established with a pool of data providing strong evidence of oncological and survival equivalency. With the progressive growth of robot-assisted partial nephrectomy (RAPN) techniques, the use of several tools has been progressively developed to help the surgeon in the identification of masses and its vascular net. In this short review we tried to analyze the current use of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during RAPN.

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