Transperitoneal and retroperitoneal approach in laparoscopic partial nephrectomy for posterior cT1 renal tumors: A retrospective, two-centers, comparative study

Objectives: To compare perioperative, oncological and functional outcomes of Laparoscopic Transperitoneal Partial Nephrectomy (LTPN) and Retroperitoneal Laparoscopic Partial Nephrectomy (LRPN) for posterior, cT1 renal masses (RMs). Materials and methods: Databases of two urologic institutions applying different laparoscopic surgical approaches on posterior cT1 RMs between June 2016 and November 2018 were retrospectively evaluated. Data on patient demographics, perioperative data and tumor histology were collected and further analyzed statistically. Results: Each group consisted of 15 patients. Baseline characteristics were comparable in each group. When compared to LTPN, LRPN was associated with significantly shorter operative time (OT) (115 min versus 199 min, p < 0.05). No significant differences were detected in the other outcomes. Conclusions: LRPN is associated with a significantly shorter OT compared to LTPN for posterior cT1 RMs. Both surgical approaches are safe, feasible and credible, demonstrating optimal results.

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Efficacy of Partial Nephrectomy for Renal Tumors >4 cm: Comparison With Renal Tumors ≤4 cm

International Surgery ◽

10.9738/intsurg-d-15-00226.1 ◽

2016 ◽

Vol 101 (1-2) ◽

pp. 7-13

Author(s):

Ohseong Kwon ◽

Seok-Soo Byun ◽

Sung Kyu Hong ◽

Ja Hyeon Ku ◽

Cheol Kwak ◽

...

Keyword(s):

Partial Nephrectomy ◽

Functional Outcomes ◽

Survival Rates ◽

Renal Tumors ◽

Recurrence Free Survival ◽

Renal Masses ◽

Ischemic Time ◽

Free Survival ◽

Kaplan Meier ◽

Computed Tomography Image

Partial nephrectomy has become a treatment of choice for clinical T1a renal masses. Some international guidelines suggest that partial nephrectomy can be applied also in clinical T1b tumors. The aim of this study was to evaluate the feasibility of partial nephrectomy for tumors larger than 4 cm. We reviewed the medical records of 1280 patients who underwent partial nephrectomy and had pathologically confirmed malignancy. Patients were categorized into two groups by the size of tumors on computed tomography image, with a cutoff value of 4 cm. The oncologic and functional outcomes were compared between the two groups. Recurrence-free survival after surgery was estimated using the Kaplan-Meier method. Of the 1280 patients, 203 patients (15.9%) had renal tumors larger than 4 cm. There were significantly more exophytic tumors (P < 0.001) and the R.E.N.A.L. scores were significantly higher (P < 0.001) in partial nephrectomy >4 cm. Mean ischemic times were significantly different (P < 0.001). After 24 months, mean creatinine level between partial nephrectomy >4 cm and partial nephrectomy ≤4 cm was not different significantly (P = 0.554). And the percent changes of glomerular filtration rate after partial nephrectomy were not different at last follow-up (P = 0.082). The 5-year recurrence-free survival rates were 96.6% in partial nephrectomy ≤4 cm, and 94.5% in partial nephrectomy >4 cm (P = 0.416). Based on the present findings, partial nephrectomy for tumors larger than 4 cm showed comparable feasibility and safety to partial nephrectomy for tumors ≤4 cm considering oncologic and functional outcomes, despite longer operative and ischemic time.

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Safety and efficacy of transperitoneal laparoscopic nephron sparing surgery in patients with previous abdominal surgery

Urologia Journal ◽

10.1177/0391560320921728 ◽

2020 ◽

pp. 039156032092172

Author(s):

Stefano Manno ◽

Lucio Dell’Atti ◽

Antonio Cicione ◽

Angelo Spasari

Keyword(s):

Length Of Stay ◽

Abdominal Surgery ◽

Partial Nephrectomy ◽

Operative Time ◽

Laparoscopic Partial Nephrectomy ◽

Renal Masses ◽

Conversion To Open Surgery ◽

Previous Abdominal Surgery ◽

Estimated Blood Loss ◽

Nephron Sparing

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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Renal functional outcomes after surgery for renal cortical tumors

Journal of Kidney Cancer and VHL ◽

10.15586/jkcvhl.2015.26 ◽

2015 ◽

Vol 2 (2) ◽

pp. 45-54 ◽

Cited By ~ 1

Author(s):

Danny Lascano ◽

Julia B Finkelstein ◽

G. Joel DeCastro ◽

James M McKiernan

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

Partial Nephrectomy ◽

Functional Outcomes ◽

Surgical Techniques ◽

Renal Tumors ◽

Renal Masses ◽

Nephron Sparing ◽

Surgically Induced

Historically, radical nephrectomy represented the gold standard for the treatment of small (? 4cm) as well as larger renal masses. Recently, for small renal masses, the risk of ensuing chronic kidney disease and end stage renal disease has largely favored nephron-sparing surgical techniques, mainly partial nephrectomy. In this review, we surveyed the literature on renal functional outcomes after partial nephrectomy for renal tumors. The largest randomized control trial comparing radical and partial nephrectomy failed to show a survival benefit for partial nephrectomy. With regards to overall survival, surgically induced chronic kidney disease (GFR < 60 ml/min/ 1.73m2) caused by nephrectomy might not be as deleterious as medically induced chronic kidney disease. In evaluating patients who underwent donor nephrectomy, transplant literature further validates that surgically induced reductions in GFR may not affect patient survival, unlike medically induced GFR declines. Yet, because patients who present with a renal mass tend to be elderly with multiple comorbidities, many develop a mixed picture of medically, and surgically-induced renal disease after extirpative renal surgery. In this population, we believe that nephron sparing surgery optimizes oncological control while protecting renal function.

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Laparoscopic Radical Versus Laparoscopic Partial Nephrectomy for Clinical T1bN0M0 Renal Tumors: Comparison of Perioperative, Pathological, and Functional Outcomes

Journal of Endourology ◽

10.1089/end.2009.0312 ◽

2010 ◽

Vol 24 (10) ◽

pp. 1603-1607 ◽

Cited By ~ 26

Author(s):

Tom Deklaj ◽

David A. Lifshitz ◽

Sergey A. Shikanov ◽

Mark H. Katz ◽

Kevin C. Zorn ◽

...

Keyword(s):

Partial Nephrectomy ◽

Functional Outcomes ◽

Laparoscopic Partial Nephrectomy ◽

Renal Tumors

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Cost comparison of laparoscopic partial nephrectomy and robot-assisted laparoscopic partial nephrectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.402 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 402-402

Author(s):

R. L. O'Malley ◽

T. Kowalik ◽

M. H. Hayn ◽

T. B. Collins ◽

H. L. Kim ◽

...

Keyword(s):

Minimally Invasive ◽

Operating Room ◽

Partial Nephrectomy ◽

Laparoscopic Partial Nephrectomy ◽

Cost Comparison ◽

Oncologic Outcomes ◽

Perioperative Outcomes ◽

Surgical Approaches ◽

Robot Assisted ◽

Renal Masses

402 Background: Although nephron-sparing surgery is the standard of care for the treatment of small renal masses, partial nephrectomy (PN) remains under-utilized. A potential reason for the discrepancy is the desire for minimally invasive surgical approaches but limitation of the advanced laparoscopic techniques needed to perform PN. Robot-assisted surgery has eased the transition to minimally invasive prostate surgery and may also do so for PN, although some believe costs may be prohibitive. The purpose of this investigation was to quantify the cost of robot-assisted PN (RAPN) compared to laparoscopic PN (LPN). Methods: An institutional renal tumor database was used to identify consecutive patients with normal renal function who underwent RAPN for a localized renal mass by a single surgeon who had performed < 25 previously. The 35 RAPN patients were compared to the last 35 similar patients who underwent LPN by a surgeon who had performed > 150 previous LPNs. Surgical outcomes were compared. Because room time, length of stay and Cxs were similar, cost was compared based only on the total operating room charges (ORC). Total ORC included surgeon and anesthesia fees, as well as labor and supply costs. The depreciation of the robot was included in the ORC as a higher per unit time charge than for LPN. Data on charges were available for the first 29 RAPN patients which were then compared to the last 29 LPN patients. Results: Dates of operation ranged from October 2008 to July 2009 for LPN and January 2010 to August 2010 for RAPN. Patient and tumor characteristics were similar between groups, except tumor size, which was larger in the RAPN group (3.6 ± 1.8 cm vs. 2.7 ± 0.9 cm, p = 0.007). Cxs, surgical and oncologic outcomes were similar. Mean ORC (IQR) for the LPN group was $28,606 (4,796) and for the RAPN group was $30,874 (20,389) representing a difference of $2,269. If you subtract an additional $858 for the average yearly inflation rate (3%), the difference is $1,411. Conclusions: RAPN is a safe option with perioperative outcomes similar to those of LPN performed by an experienced surgeon. A cost difference of $2,269 per procedure as estimated using ORC may decrease as the experience of the operating room staff and surgeon increase. No significant financial relationships to disclose.

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Surgical management of T2 renal tumors: Perioperative and functional outcomes of laparoscopic partial nephrectomy

European Urology Supplements ◽

10.1016/s1569-9056(18)32466-7 ◽

2018 ◽

Vol 17 (4) ◽

pp. e2057

Author(s):

R.M. Scarpa ◽

C. Fiori ◽

M. Manfredi ◽

R.G. Bertolo ◽

D. Amparore ◽

...

Keyword(s):

Partial Nephrectomy ◽

Surgical Management ◽

Functional Outcomes ◽

Laparoscopic Partial Nephrectomy ◽

Renal Tumors

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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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