Functional results of partial nephrectomy depending on the use of various intraoperative techniques

Abstract

Background. A lot of techniques are utilized in order to improve functional results of partial nephrectomy. Many questions regarding this issue remain controversial.Aim. To evaluate the influence of various techniques on the functional results of partial nephrectomy.Materials and methods. The retrospective study included 904 patients with renal cell carcinoma who underwent open partial nephrectomy between 2010 and 2019. The functional results were assessed according to the trifecta and pentafecta criteria. The effect on the functional results of the following techniques was assessed: a) enucleation of the tumor; b) coagulation of the bed without suture; c) preventive seams; d) hemostatic suture of the parenchyma;e) earlier removal of the clamp from the kidney vessels; f) use of intraoperative ultrasound; g) selective clamping of a branch of the renal artery. The effect of the studied characteristics on functional outcomes was assessed using univariate analysis by determining the odds ratio (OR) with 95 % confidence interval (CI). The difference was considered significant at the significance level of p <0.05.Results. Two techniques significantly improved the likelihood of achieving the “trifecta”: enucleation (OR with 95 % CI 2.27 (1.36–3.81), p <0.001) and preventive sutures (OR with 95 % CI 1.97 (1.22–2.83), p <0.001). The univariate analysis showed a statistically significant increase in the probability of achieving the pentafecta for three techniques: enucleation (OR with 95 % CI 2.28 (1.33–3.82), p <0.001), preventive sutures (OR with 95 % CI 2.22 (1.27–3.61), p <0.001), and coagulation of the bed without sutures (OR with 95 % CI 2.24 (1.29–3.76), p <0.001). When considering all techniques, a significant increase in the frequency of achieving the trifecta (OR with 95 % CI 2.31 (1.41–3.28), p <0.001) and pentafecta (OR with 95 % CI 2.41 (1.45–3.77), p <0.001) was observed.Conclusion. Tumor enucleation, preventive sutures and coagulation of the removed tumor bed without suturing allow, even when used as a single technique, to significantly improve the functional results of partial nephrectomy. Other technical maneuvers we evaluated also provide improved functional results when used in combination, thus creating a new concept of nephron-sparing surgery.