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01.08.2010 | Original Article

Laparoscopic partial nephrectomy for large renal masses: results of a European survey

verfasst von: Francesco Porpiglia, Cristian Fiori, Thierry Piechaud, Richard Gaston, Giorgio Guazzoni, Vito Pansadoro, Alexander Bachmann, Gunter Janetschek

Erschienen in: World Journal of Urology | Ausgabe 4/2010

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Abstract

Objective

To evaluate the perioperative effectiveness of laparoscopic partial nephrectomy (LPN) for large (4–7 cm) renal masses, with a review of the experience of six European advanced laparoscopic centres.

Patients and methods

A survey was planned; data were extracted from each institutional data base to obtain information about patients who had undergone LPN for renal masses larger than 4 cm. Demographic, radiological growth patterns of the tumours and intraoperative data were collected. Post-operative complications and pathological data were also recorded. All data were processed through statistical software.

Results

Data on 63 patients were collected. Radiological tumour size was 4.7 cm (4.1–7), growth pattern was cortical in 33 cases and cortico-medullar in 30 cases. Warm ischemia time (WIT) was 25.7 min in 7.3% cases bleeding occurred intra-operatively, post-operative surgical complications occurred in 14.6% cases. Pathological analyses revealed malignant lesion in 73% and positive margins in 6.5%. Complications and positive margins are more frequent for cortico-medullar lesions.

Conclusions

This survey confirms that LPN for tumours 4–7 cm in size is feasible in experienced hands. WIT and overall complication rate remain questionable points.

Hafez KS, Fergany AF, Novick AC (1999) Nephron sparing surgery for localized renal cell carcinoma: impact of tumour size on patient survival, tumour recurrence, and TNM staging. J Urol 162:1930–1933CrossRefPubMed

Pasticier G, Timsit M-O, Badet L et al (2006) Nephron-sparing surgery for renal cell carcinoma: detailed analysis of complications over a 15-year period. Eur Urol 49:485–490CrossRefPubMed

Patard J-J, Pantuck AJ, Crepel M et al (2007) Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication. Eur Urol 52:148–154CrossRefPubMed

Ljungberg B, Hanbury DC, Kuczyk MA et al (2007) Renal cell carcinoma guidelines. Eur Urol 51:1502–1510CrossRefPubMed

Patard JJ, Shvarts O, Lam JS et al (2004) Safety and efficacy of partial nephrectomy for all T1 tumours based on an international multicenter experience. J Urol 171:2181–2185CrossRefPubMed

Pahernik S, Roos F, Rohrig B, Wiesner C, Thuroff JWE (2008) lective nephron-sparing surgery for renal cell carcinoma larger than 4 cm. J Urol 179:71–74CrossRefPubMed

Leibovich BC, BluteML ChevilleJC, Lohse CM, Weaver AL, Zincke H (2004) Nephron-sparing surgery for appropriately selected renal cell carcinoma between 4 cm and 7 cm results in outcome similar to radical nephrectomy. J Urol 171:1066–1070CrossRefPubMed

Becker F, Siemer S, Hack M, Humke U, Ziegler M, Stockle M (2006) Excellent long-term cancer control with elective nephron-sparing surgery for selected renal cell carcinomas measuring more than 4 cm. Eur Urol 49:1058–1064CrossRefPubMed

Dash A, Vickers AJ, Schachter LR, Bach AM, Snyder ME, Russo P (2006) Comparison of outcomes in elective partial versus radical nephrectomy for clear cell renal cell carcinoma of 4–7 cm. BJU Int 97:939–945CrossRefPubMed

10.

Antonelli A, Cozzoli A, Nicolai M, Simeone C et al (2008) Nephron-sparing surgery versus radical nephrectomy in the treatment of intracapsular renal cell carcinoma up to 7 cm. Eur Urol 53(4):803–809CrossRefPubMed

11.

Lin J, Knight EL, Hogan ML, Singh AK (2003) A comparison of prediction equations for estimating glomerular filtration rate in adults without kidney disease. J Am Soc Nephrol 14:2573–2580CrossRefPubMed

12.

Levey AS, Coresh J, Balk E et al (2003) National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 139:137–147PubMed

13.

Huang WC, Levey AS, Serio AM et al (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7:735–740CrossRefPubMed

14.

Haber G-P, Gill IS (2006) Laparoscopic partial nephrectomy: contemporary technique and outcomes. Eur Urol 49:660–665CrossRefPubMed

15.

Rassweiler J, Tsivian A, Kumar AV et al (2003) Oncological safety of laparoscopic surgery for urological malignancy: experience with more than 1, 000 operations. J Urol 169(6):2072–2075CrossRefPubMed

16.

Porpiglia F, Volpe A, Billia M, Scarpa RM (2008) Laparoscopic versus open partial nephrectomy: analysis of the current literature. Eur Urol 53(4):732–742CrossRefPubMed

17.

Porpiglia F, Volpe A, Billia M, Renard J, Scarpa RM (2008) Assessment of risk factors for complications of laparoscopic partial nephrectomy. Eur Urol 53:590–593CrossRefPubMed

18.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–210CrossRefPubMed

19.

Sobin LH, Wittekind C (2003) TNM Classification of Malignant Tumours UICC International Union Against Cancer, 6th edn. Wiley-Liss, New York, pp 193–195

20.

Lerner SE, Hawkins CA, Blute ML et al (1996) Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery. J Urol 155:1868–1873CrossRefPubMed

21.

Carini M, Minervini A, Lapini A, Masieri L, Serni S (2006) Simple enucleation for the treatment of renal cell carcinoma between 4 and 7 cm in greatest dimension: progression and long-term survival. J Urol 175(6):2022–2026CrossRefPubMed

22.

Campbell SC, Novick AC, Streem SB, Klein E, Licht M (1994) Complications of nephron-sparing surgery for renal tumours. J Urol 151:1177–1180PubMed

23.

Stephenson AJ, Hakimi AA, Snyder ME, Russo P (2004) Complications of radical and partial nephrectomy in a large contemporary cohort. J Urol 171:130–134CrossRefPubMed

24.

Thompson RH, Leibovich BC, Lohse CM, Zincke H, Blute ML (2005) Complications of contemporary open nephron sparing surgery: a single institution experience. J Urol 174:855–858CrossRefPubMed

25.

Gill IS, Kavoussi LR, Lane BR et al (2007) Comparison of 1, 800 laparoscopic and open partial nephrectomies for single renal tumours. J Urol 178:41–46CrossRefPubMed

26.

Nguyen MM, Gill IS (2008) Halving ischemia time during laparoscopic partial nephrectomy. J Urol 179:627–632CrossRefPubMed

27.

Simmons MN, Chung BI, Gill IS (2009) Perioperative efficacy of laparoscopic partial nephrectomy for tumors larger than 4 cm. Eur Urol 55(1):199–207

28.

Gill IS, Abreu SC, Desai MM et al (2003) Laparoscopic ice slush renal hypothermia for partial nephrectomy: the initial experience. J Urol 170:52–56CrossRefPubMed

29.

Janetschek G, Abdelmaksoud A, Bagheri F, Al-Zahrani H, Leeb K, Gschwendtner M (2004) Laparoscopic partial nephrectomy in cold ischemia: renal artery perfusion. J Urol 171:68–71CrossRefPubMed

Titel: Laparoscopic partial nephrectomy for large renal masses: results of a European survey
verfasst von: Francesco Porpiglia
Cristian Fiori
Thierry Piechaud
Richard Gaston
Giorgio Guazzoni
Vito Pansadoro
Alexander Bachmann
Gunter Janetschek
Publikationsdatum: 01.08.2010
Verlag: Springer-Verlag
Erschienen in: World Journal of Urology / Ausgabe 4/2010
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-010-0518-6

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