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

Abstract

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.

Laparoscopic vs open partial nephrectomy for T1 renal tumours: evaluation of long‐term oncological and functional outcomes in 340 patients

“…When we applied this system to the present data, although not significantly different, the number of grade 3 complications was slightly higher in the OPN group because of a higher frequency of ureteric stenting. The overall complication rates for LPN range from 5 to 33% and for OPN from 4.1 to 38.6% . These values are similar to the complication rates in the present study.…”

“…Fergany et al [9] reported a 10-year CSS of 100% in patients who underwent NSS for localized RCC. Lesage et al [10] concluded that a better health-related quality of life is achieved after PN than after RN and LPN has now emerged as an attractive minimally invasive treatment alternative for selected patients with small renal tumours [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

“…Lesage et al. concluded that a better health‐related quality of life is achieved after PN than after RN and LPN has now emerged as an attractive minimally invasive treatment alternative for selected patients with small renal tumours .…”

Retroperitoneal laparoscopic partial nephrectomy for unilateral synchronous multifocal renal carcinoma with different pathological types: A case report

“…PN is relatively difficult for multiple lesion resection and renal reconstruction. For unilateral multifocal renal tumors, laparoscopic partial nephrectomy (LPN) has been proven safe and feasible with acceptable oncological results and complication rates in selected patients[ 6 , 7 ]. For USMRC cT1 stage, PN can prevent unnecessary renal unit damage and achieve the same effect as RN, and postoperative quality of life in patients is better[ 8 - 10 ].…”

Laparoscopic Partial Nephrectomy – Current State of the Art

“…As laparoscopic experience increased, the use of LPN was expanded to technically challenging tumors, such as tumors invading deeply into the parenchyma up to the collecting system or renal sinus, intrarenal tumors, tumors abutting the renal hilum, tumors in solitary kidneys, or tumors substantial enough to require heminephrectomies. Recent series include larger, Stage T1b tumours [9][10][11]; endophytic tumours near the hilum and upper pole [12]; bilateral tumors [13]; multiple ipsilateral tumors [14]; and stage T1a tumours presenting in select patients over the age of 70 [15].…”