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2. Laparoscopic versus open partial nephrectomy for the management of highly complex renal tumors with PADUA score ⩾10: A single center analysis.

Author

Chiancone, Francesco, Fabiano, Marco, Meccariello, Clemente, Fedelini, Maurizio, Persico, Francesco, and Fedelini, Paolo

Subjects
NEPHRECTOMY, SURGICAL margin, KIDNEY tumors, SURGICAL complications, BLOOD loss estimation, LAPAROSCOPIC surgery
Abstract

Introduction: The aim of this study was to compare laparoscopic and open partial nephrectomy (PN) for renal tumors of high surgical complexity (PADUA score ⩾10). Methods: We retrospectively evaluated 93 consecutive patients who underwent PN at our department from January 2015 to September 2019. 21 patients underwent open partial nephrectomy (OPN) (Group A) and 72 underwent laparoscopic partial nephrectomy (LPN) (Group B). All OPNs were performed with a retroperitoneal approach, while all LPNs were performed with a transperitoneal approach by a single surgical team. Post-operative complications were classified according to the Clavien-Dindo system. Results: The two groups showed no difference in terms of patients' demographics as well as tumor characteristics in all variables. Group A was found to be similar to group B in terms of operation time (p = 0.781), conversion to radical nephrectomy (p = 0.3485), and positive surgical margins (p = 0.338) while estimated blood loss (p = 0.0205), intra-operative (p = 0.0104), and post-operative (p = 0.0081) transfusion rates, drainage time (p = 0.0012), pain score at post-operative day 1 (<0.0001) were significantly lower in Group B. The rate of enucleation and enucleoresection/polar resection was similar (p = 0.1821) among the groups. Logistic regression analysis indicated that preoperative factors were not independently associated with the surgical approach. There was a statistically significant difference in complication rate (<0.0001) between the two groups even if no significant difference in terms of grade ⩾3 post-operative complications (p = 0.3382) was detected. Discussion: LPN represents a feasible and safe approach for high complex renal tumors if performed in highly experienced laparoscopic centers. This procedure offers good intraoperative outcomes and a low rate of post-operative complications. [ABSTRACT FROM AUTHOR]

Published
2021
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3. Perioperative and renal functional outcomes of laparoscopic partial nephrectomy (LPN) for renal tumours of high surgical complexity: a single-institute comparison between clampless and clamped procedures

Author

Vincenzo Mirone, Maurizio Fedelini, Roberto La Rocca, Paolo Verze, Francesco Chiancone, Alessandro Palmieri, Clemente Meccariello, Vito Cucchiara, Paolo Fedelini, Verze, Paolo, Fedelini, Paolo, Chiancone, Francesco, Cucchiara, Vito, LA ROCCA, Roberto, Fedelini, Maurizio, Meccariello, Clemente, Palmieri, Alessandro, and Mirone, Vincenzo

Subjects
Male, Nephrology, medicine.medical_treatment, Blood Loss, Surgical, 030232 urology & nephrology, Nephron-sparing surgery, Kidney Function Tests, Nephrectomy, chemistry.chemical_compound, Postoperative Complications, 0302 clinical medicine, Medicine, Warm Ischemia, R.E.N.A.L. N.S, Outcome, Middle Aged, Constriction, Kidney Neoplasms, Treatment Outcome, Carcinoma, Clampless, Laparoscopic partial nephrectomy, Outcomes, Urology, Creatinine, 030220 oncology & carcinogenesis, Female, Glomerular Filtration Rate, Adult, medicine.medical_specialty, Clample, Operative Time, Renal function, 03 medical and health sciences, Blood loss, Internal medicine, Humans, Limited evidence, Carcinoma, Renal Cell, Aged, Retrospective Studies, business.industry, Nephrons, Perioperative, Length of Stay, medicine.disease, Surgery, chemistry, Laparoscopy, business, Organ Sparing Treatments
Abstract

In recent times there has been a trend in mininvasive renal tumour surgery. Very limited evidence can be found in literature of the outcomes of laparoscopic partial nephrectomy (LPN) for highly complex renal tumours. The aim of the present study was to assess the feasibility and safety of LPN for renal tumours of high surgical complexity in our single-institutional experience, comparing perioperative and functional data between clampless and clamped procedures. We enrolled 68 patient who underwent a clampless LPN (Group A) and 41 patients who underwent a clamped LPN (Group B) for a renal tumour with a R.E.N.A.L. NS ≥ 10. Intraoperative and post-operative complications have been classified and reported according to international criteria. Kidney function was evaluated by measuring serum creatinine concentration and eGFR. Group A was found to be similar to Group B in all variables measured except for WIT (P = 0) and blood loss (P = 0.0188). In group A the mean creatinine levels were not significantly increased at the third post-operative (P = 0.0555) day and at the 6-month follow-up (P = 0.3047). Otherwise, in the group B the creatinine levels were significantly increased after surgery (P = 0.0263), but decreased over time, showing no significant differences at 6 month follow-up (P = 0.7985) compared to preoperative values. The same trend was seen for eGFR. Optimal Trifecta outcomes were achieved in both groups. Clampless LPN represents a feasible and safe procedure, even for tumours with high surgical complexity, in highly experienced laparoscopic centers. When compared to clamped LPN, it results in better preservation of immediate post-operative renal function.

Published
2016

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