Laparoscopic Partial Nephrectomy for Multiple Ipsilateral Renal Tumors Using a Tailored Surgical Approach

Flum, Andrew S.; Wolf, J. Stuart

doi:10.1089/end.2009.0452

Cited by 16 publications

(6 citation statements)

References 18 publications

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“…Generally, 30 min of warm ischaemia time has been considered to be safe and cold ischaemia has been recommended when a longer time is expected [19]. We had a favourable mean warm ischaemia time in comparison to other series for multiple tumours [20][21][22], with similar renal function outcomes. Table 4 displays data of previous series of laparoscopic and robotic partial nephrectomy for multifocal renal tumours.…”

Section: Discussionmentioning

confidence: 60%

Robot‐assisted partial nephrectomy for sporadic ipsilateral multifocal renal tumours

et al. 2011

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Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Although laparoscopic excision of ipsllateral multifocal renal tumours is feasible, the average warm ischemia time is prolonged. Robotic partial nephrectomy in this subset of patients using blunt dissection to enucleate the tumour is feasible and safe. This study demonstrates further that robot‐assisted partial nephrectomy with a small margin of normal tissue is feasible and safe with an acceptable range of warm ischemia time in patients with sporadic ipsilateral multifocal renal tumours. This study also suggest that robotic partial nephrectomy for this particular group of patients may better preserve renal function compared to laparoscopic approach, however this needs to be confirmed with prospective comparative studies. OBJECTIVE • To report our short‐term results of robot‐assisted partial nephrectomy for treating sporadic multiple ipsilateral renal tumours. METHODS • Over a 3‐year period, eight patients with two or more ipsilateral renal masses underwent nine robotic partial nephrectomies in our institution. • We evaluated the PADUA and R.E.N.A.L. nephrometry scores, intraoperative outcomes, histopathological characteristics, complications according to Clavien classification and renal function outcomes. RESULTS • In total, 19 tumours were removed from eight patients in nine procedures. Mean operative time was 199 ± 47 min (median 200; range 150–300). Mean size of the dominant lesion was 3.0 ± 1.1 cm (2.7; 1.6–4.8) and overall mean tumour size was 2.2 ± 1.2 cm (1.9; 0.4–4.8). Mean number of tumours removed per patient was 2.4. • Median PADUA and R.E.N.A.L. scores were 7 and 6 (with the predominance of an anterior, non‐hilar position), respectively. • Excluding the six off‐clamp resected tumours, the mean warm ischaemia time was 21 ± 9.2 min (21; 10–35). Mean estimated blood loss was 250 ± 154 mL (200; 100–500) and no patient required transfusion. There were no intraoperative complications or conversion to open surgery. One patient had atrial fibrillation, resolved with anti‐arrhythmic drugs. Mean length of stay was 4.2 ± 0.97 days. • Sixteen of the nineteen tumours were malignant, most of papillary type and Fuhrman grade II. • The mean decrease in glomerular filtration rate was 4%, with a mean follow‐up of 14 months. CONCLUSIONS • Robotic partial nephrectomy for sporadic ipsilateral multifocal renal tumours is feasible and safe. • Off‐clamp resection of multiple tumours can also be safely performed in carefully selected lesions.

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Section: Discussionmentioning

confidence: 60%

Robot‐assisted partial nephrectomy for sporadic ipsilateral multifocal renal tumours

et al. 2011

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“…This was performed in four patients in the present series. Flum and Wolf reported using no clamping in four out of seven patients in their series, whereby in cases requiring hilar clamping the average WIT was 42 min [10]. In our experience, WIT time is minimized by the fact that parenchymal defect closure is standardized and the required materials are prepared before tumour excision.…”

Section: Discussionmentioning

confidence: 60%

“…Boris and colleagues [9] have recently reported their results with robotic assistance in treating nine patients with multiple tumours. A recent series by Flum and Wolf reported on seven patients with multiple tumours treated by hand‐assisted and a pure laparoscopic technique [10]. To date, we could not find a direct comparison of peri‐operative outcomes between LPN for multiple vs single renal masses.…”

Section: Discussionmentioning

confidence: 81%

Laparoscopic partial nephrectomy for multiple tumours: feasibility and analysis of peri‐operative outcomes

Tsivian

Benjamin

et al. 2010

BJU International

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Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Laparoscopic nephron‐sparing procedures have been increasingly utilized. However, in the presence of multiple tumours the procedure choice is usually shifted to radical nephrectomy. In view of favourable perioperative outcomes, the benefits of minimally‐invasive, nephron‐sparing surgery in experienced hands could be safely extended to patients presenting with multiple ipsilateral renal masses. OBJECTIVE To describe our experience with laparoscopic partial nephrectomy (LPN) for multiple kidney tumours and compare the outcomes with LPN performed for single masses. PATIENTS AND METHODS Retrospective analysis of medical records of patients undergoing LPN at our institution between 2005 and 2009 was performed. The cohort was divided in two groups based on tumour focality: group 1, LPN for a single tumour (n= 99) and group 2, LPN for multiple ipsilateral tumours (n= 12). The groups were compared with regards to demographic and peri‐operative variables. RESULTS Demographic variables were not different between the groups. Median dominant tumour size was 3.1 cm (interquartile range [IQR] 2.4–4.0) and 4.0 cm (2.3–5.9) in groups 1 and 2, respectively. Median secondary tumour size in group 2 was 1.0 cm (1.0–1.8). Operative times were longer in group 2 compared with group 1 (220 vs 160 min, P= 0.009). Warm ischaemia times (WIT) (23 vs 22 min) and estimated blood loss (EBL) (100 vs 85 mL) were similar. CONCLUSIONS LPN is a viable option for the treatment of multiple ipsilateral renal tumours. Peri‐operative outcomes are similar to standard LPN with the exception of longer operative time. In experienced hands, the advantages of minimally invasive surgery may be extended to select patients with ipsilateral multifocal renal tumours.

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“…With regards to treating multiple tumours with LPN, Flum and Wolf [ 4 ] have described managing seven patients with a mean WIT of 42 min (in cases where clamping was used), an EBL of 417 mL and an average OT of 225 min. Similarly, LPN for multiple renal masses was described in a series by Steinberg et al .…”

Section: Discussionmentioning

confidence: 99%

“…Multifocality, tumour size and difficult mass location have been traditionally considered as contraindications to nephron‐sparing surgery (NSS). However, several studies have emerged indicating the possibility to extend safely the benefit of minimally invasive NSS to a broader spectrum of patients presenting with more complex tumours [3–9].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic partial nephrectomy: beyond the straightforward T1a

Tsivian

Stanevsky

et al. 2012

BJU International

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Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Complex tumour features (e.g. size, hilar location, multifocality) are generally considered contraindicative for LPN and only a handful of studies reporting encouraging outcomes with more complex tumours. Herein we suggest that in experience hands the benefits of minimally‐invasive surgery may be safely extended to patients with more complex renal masses. OBJECTIVE To report on our experience in extending the indications for LPN beyond the single, T1a renal mass assessing the perioperative outcomes in a comparative fashion. PATIENTS AND METHODS Retrospective review of consecutive patients undergoing LPN for a renal mass in an academic centre between 2005–2010. 150 patients were divided into two groups based on tumours characteristics: straightforward T1a (group 1: single, <4 cm, n = 84) and complex (group 2: multiple and/or hilar and/or ≥4 cm, n = 66). Comparison of demographic, clinical, radiographic and perioperative outcomes (operative times, blood loss, warm ischemia times, intra‐ and postoperative complications). RESULTS In group 2, 19 tumours were hilar, 15 were multifocal and 44 measured ≥4 cm; 2 of these criteria were present in 7, and all three in 3 cases. Warm ischemia times and blood loss were comparable (medians of 21 vs 20 min, and 100 vs 100 mL). Operative times were longer in group 2 (190 vs 140min, P < 0.001). Complications occurred in 11.9% and 12.1% of patients in group 1 and 2, with Clavien grade 3 events in 8.3 and 10.9%, respectively (P = 1.00 and P = 0.547). There were 4 conversions to laparoscopic radical nephrectomy (1 in group 1, 3 in group 2). CONCLUSION With adequate laparoscopic expertise, the indications for LPN can be safely extended beyond the single, small, peripheral T1a renal mass. In this series, more complex masses were effectively treated with LPN combining the advantages of minimally‐invasive surgery to those of nephron‐sparing approach.

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Laparoscopic Partial Nephrectomy for Multiple Ipsilateral Renal Tumors Using a Tailored Surgical Approach

Cited by 16 publications

References 18 publications

Robot‐assisted partial nephrectomy for sporadic ipsilateral multifocal renal tumours

Robot‐assisted partial nephrectomy for sporadic ipsilateral multifocal renal tumours

Laparoscopic partial nephrectomy for multiple tumours: feasibility and analysis of peri‐operative outcomes

Laparoscopic partial nephrectomy: beyond the straightforward T1a

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