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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