Laparoscopic partial nephrectomy (LPN) for totally intrarenal tumours

Abstract

Objective• To evaluate the feasibility and outcomes of laparoscopic partial nephrectomy (LPN) for totally intrarenal tumours (TIT). Patients and Methods• TIT were defined as completely intraparenchymatic masses, without any exophytic element. Identification of such a tumour necessitates guidance of intraoperative laparoscopic ultrasonography. Results• Among 458 patients who underwent LPN, 41 had TIT. The mean (SD) tumour size was 2.6 (0.8) cm, mean WIT was 22.6 (13.8) min and blood loss was 279 (210) mL. The RN rate was significantly higher in the TIT group compared with the remaining cohort of LPNs (9.7% vs 5.3%). The intra-and postoperative complications, open conversion and positive margin rates were similar between the two groups. Malignant tumours were found in 84.2% and 78.2%, respectively. Conclusions• LPN for a TIT is technically feasible. TIT carry a significantly higher RN rate due to tumour involvement of vital kidney structures. This aspect should be discussed with the patient preoperatively but TIT should not be considered a definitive indication for RN.

Comparison of robot‐assisted and open partial nephrectomy for completely endophytic renal tumours: a single centre experience

“…In prior studies, the rate of positive surgical margins for endophytic AVF, arteriovenous fistula. tumours has ranged between 0% and 12.5% for minimally invasive PN, while the true rate for OPN is poorly characterised [10][11][12]20,21]. In our present study of endophytic tumours, positive margin rates for RAPN and OPN were 5.4% and 8.7%, respectively, consistent with the literature.…”

“…There was no significant difference in overall or major postoperative complications between groups; however, sample size limitations may have influenced our ability to detect a difference. With regard to intraoperative complications for endophytic tumours, there was no significant difference between approaches (RAPN, 1.1% vs OPN, 1.7%), which is comparable to the results from other LPN and RAPN series.…”

“…Based on the best available data, which still may not have a sufficiently long follow‐up; there is no difference in recurrence‐free survival or overall survival rates between endophytic and non‐endophytic tumours . In prior studies, the rate of positive surgical margins for endophytic tumours has ranged between 0% and 12.5% for minimally invasive PN, while the true rate for OPN is poorly characterised . In our present study of endophytic tumours, positive margin rates for RAPN and OPN were 5.4% and 8.7%, respectively, consistent with the literature.…”

“…Endophytic localisation, as a component of overall tumour complexity, is associated with a higher rate of postoperative complications [22]. Previous reports have described the rate of postoperative complications after minimally invasive PN for endophytic tumours to be between 6.7% and 47% [11,12,20,21,23]. The rates of complications for OPN in this setting are poorly characterised.…”

Comparison of robot‐assisted and laparoscopic partial nephrectomy for complex renal tumours with a RENAL nephrometry score ≥7: peri‐operative and oncological outcomes

“…As the application of PN continues to expand, the vast majority of patients presenting with a renal mass may eventually be offered some form of nephron‐sparing surgery. Although LPN represents a feasible, safe and effective treatment for selected patients diagnosed with endophytic hilar masses for advanced laparoscopic expertise , LPN is technically demanding and can be particularly challenging for more complex tumours. The advent of robot technology appears to be particularly important for a further expansion of the indications of minimally invasive nephron‐sparing surgery, allowing a safer and more precise excision of larger tumours.…”