Does tumour size really affect the safety of laparoscopic partial nephrectomy?

• Published in: BJU international Vol. 108; no. 2; pp. 268 - 273
• Main Authors: Porpiglia, Francesco, Fiori, Cristian, Bertolo, Riccardo, Scarpa, Roberto Mario
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2011; Wiley-Blackwell
• Subjects: Biological and medical sciences; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - surgery; Epidemiologic Methods; Female; Humans; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Kidneys; Laparoscopy; large masses; Male; Medical sciences; Middle Aged; Nephrectomy - adverse effects; Nephrectomy - methods; Nephrology. Urinary tract diseases; partial nephrectomy; renal cell carcinoma; Treatment Outcome; Tumor Burden; Tumors of the urinary system; Kidney disease; Endoscopic surgery; Nephrology; Urinary system disease; Carcinoma; Toxicity; Size; large masses; Laparoscopy; Malignant tumor; partial nephrectomy; Urology; renal cell carcinoma; Treatment; Nephrectomy; Partial; Kidney cancer; Grawitz tumor; Endoscopy; Cancer
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/j.1464-410X.2010.09788.x

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Partial nephrectomy is the standard treatment for the management of small renal masses, and laparoscopy has been widely used in this setting as it has all the principles of open procedures combined with the advantages of minimal invasiveness. Laparoscopic partial nephrectomy is feasible and has acceptable pathological results not only for small renal masses but also for large tumours, even if complication rate and ischemia time are still matters of debate. OBJECTIVE •  To investigate the perioperative safety of laparoscopic partial nephrectomy (LPN) for large renal masses (>4 cm). PATIENTS AND METHODS •  After Institutional Review Board approval, data from 100 consecutive patients who had undergone transperitoneal or retroperitoneal LPN at our institution from January 2005 to June 2009 were obtained from our prospectively maintained database. •  The patients were divided into two groups according to radiological tumour size: group A (67 patients) with tumours ≤4 cm and group B (33 patients) with tumours >4 cm. •  Demographic, perioperative and pathological data were evaluated. RESULTS •  The two groups were comparable in terms of demographic data. Mean tumour size was 2.4 and 5 cm (P= 0.0001) for groups A and B, respectively. Group B tumours were more complex, as reflected by significantly more with a central location (P= 0.002), and by significantly more transperitoneal LPNs, pelvicalyceal repairs and longer warm ischaemia time (WIT; 19 vs 28 min). •  Complications were recorded in nine group A patients (13.4%) and nine group B patients (27.2%) (P= 0.09). •  There was no difference between preoperative and postoperative serum creatinine levels in either group, while a significant difference was found in postoperative estimated glomerular filtration rate between groups (P= 0.004). •  The incidence of carcinoma was comparable between the two groups. •  The incidence of positive surgical margins (PSMs) was 3.9% in group A, whereas no PSM was recorded in group B (P= 0.3). CONCLUSIONS •  Laparoscopic partial nephrectomy for large tumours is feasible and has acceptable pathological results. However, the complication rate, in particular WIT, remains questionable. •  Further studies are required to better clarify the role of LPN in the management of tumours of this size.