Laparoscopic partial nephrectomy: a comprehensive evaluation of single-centre perioperative outcomes

Czech version

Authors: Petr Macek ^1,2; Květoslav Novák ¹; Michael Pešl ¹; Maria Stevens ¹; Tomáš Hradec ¹; Vojtěch Fiala ¹; Rodrigo Gouveia ¹; Lenka Plincelnerová ¹; Lucie Vávřová ¹; Lenka Bauerová ³; Tomáš Hanuš ¹
Authors‘ workplace: Urologická klinika 1. LF UK a VFN v Praze ¹; Department of Urology, Institut Montsouris, Université Paris Descartes, Paris, France ²; Ústav patologie 1. LF UK a VFN v Praze ³
Published in: Ces Urol 2019; 23(3): 221-229
Category: Original Articles

Overview

Aim: Assessment of perioperative and oncological results of laparoscopic nephron-sparing procedures for renal tumors.

Material a methods: We evaluate data from a prospectively collected database in one center between 1/2013 and 6/2018. Operations were performed by 3 surgeons. There were 174 patients available for final analysis. The cohort included also 1 one-stage bilateral case, 9 cases of multiple one-stage partial nephrectomy (PN) (2–5 lesions) and in 8 cases PN of solitary kidney. Altogether, 190 renal masses were resected (left side 102×, right side 88×), in 64 women and 110 men. Cohort medians (IQR = interquartile range) were: age 64 (55–70) years, Charleson comorbidity index 3 (2–4), creatinine 78 (68–95) μmol/L, lesion diameter 27 (20–35) mm, PADUA score 8 (7–9).

Results: Length of surgery median 118 (IQR 88– 150) min, blood loss median 150 (IQR 80–300) ml, no warm ischemia (WI) used in 51 of 190 lesions, in other length of WI median 15 (IQR 12–17) min, in 2 patients conversion to open PN was needed and in 2 patients conversion to laparoscopic nephrectomy (1× bleeding; 1× renal vein tumor thrombus). There were 44 complications according to Clavien-Dindo (CD) classification within 30 post-operative days: 17× grade 1, 13× grade 2, 10× grade 3, 1× grade 4, 3× grade 5, i.e. CD ≥ 3 in 8 % of patients. Symptomatic pseudoaneurysm was diagnosed in 4 pts – all treated by selective embolization. Post-operative hospital stay was median 6 (IQR 5–7) days. Histology found 45 benign and 145 malignant lesions, of the latter 122× pT1a, 16× pT1b, 3× pT2a and 4× pT3a. Positive margin rate was 11%. Only 1 patient underwent new PN via open approach, others were monitored. We detected 1 local kidney recurrence (in R0 surgery), 1 rapid distant progression (cerebral metastases) and 1 combined local (in perirenal fat) and distant (lungs) recurrence (in R0 surgery). Trifecta based on Montsouris (R0 + WI ≤ 25min + absence of CD ≥ 3 complication) was 74,1%, based on Khalifeh et al. (R0 + WI ≤ 25 min + no complication) was 59,2% and based on Porpiglia et al. (R0 + WI ≤ 20 min + absence of CD ≥ 3 complication) was 69 %.

Conclusion: Laparoscopic PN is a standard management option of solid renal masses providing favorable outcomes. Trifecta rate was comparable to published results. The work was supported by a grant project MZ ČR – RVO VFN64165.

Keywords:

Partial nephrectomy – laparoscopy – trifecta

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