Laparoscopic versus open partial nephrectomy for the management of highly complex renal tumors with PADUA score ⩾10: A single center analysis.

Abstract

Introduction: The aim of this study was to compare laparoscopic and open partial nephrectomy (PN) for renal tumors of high surgical complexity (PADUA score ⩾10). Methods: We retrospectively evaluated 93 consecutive patients who underwent PN at our department from January 2015 to September 2019. 21 patients underwent open partial nephrectomy (OPN) (Group A) and 72 underwent laparoscopic partial nephrectomy (LPN) (Group B). All OPNs were performed with a retroperitoneal approach, while all LPNs were performed with a transperitoneal approach by a single surgical team. Post-operative complications were classified according to the Clavien-Dindo system. Results: The two groups showed no difference in terms of patients’ demographics as well as tumor characteristics in all variables. Group A was found to be similar to group B in terms of operation time ( p = 0.781), conversion to radical nephrectomy ( p = 0.3485), and positive surgical margins ( p = 0.338) while estimated blood loss ( p = 0.0205), intra-operative ( p = 0.0104), and post-operative ( p = 0.0081) transfusion rates, drainage time ( p = 0.0012), pain score at post-operative day 1 (<0.0001) were significantly lower in Group B. The rate of enucleation and enucleoresection/polar resection was similar ( p = 0.1821) among the groups. Logistic regression analysis indicated that preoperative factors were not independently associated with the surgical approach. There was a statistically significant difference in complication rate (<0.0001) between the two groups even if no significant difference in terms of grade ⩾3 post-operative complications ( p = 0.3382) was detected. Discussion: LPN represents a feasible and safe approach for high complex renal tumors if performed in highly experienced laparoscopic centers. This procedure offers good intraoperative outcomes and a low rate of post-operative complications.

Perioperative outcomes between laparoscopic versus open versus robotic partial nephrectomy: Current Review

“…20,38 One study noted a lower rate of overall postoperative complications in LPN compared to OPN (15.3% vs 57.1%). 33 Three studies demonstrated lower rates of overall complications 21,34,35 in RPN, and similar findings were noted in a review by Bravi et al 24 when evaluating the major complications against the three surgical approaches. High-grade complications are commonly seen in OPN.…”

“…Bravi et al 24 noted a statistical significance in the CR between LPN and RPN, accounting for seven and one case respectively ( p = 0.002). Chiancone et al 33 noted a total of 4 out of 72 LPN cases which required conversion to open approach. Similar results were demonstrated in Pazeto et al 25 with reported three LPN cases requiring conversion to OPN, although this was statistically not significant ( p = 0.07).…”

Perioperative, functional, and oncologic outcomes of laparoscopic partial nephrectomy versus open partial nephrectomy for complex renal tumors: a systematic review and meta-analysis

“…The meta-analysis encompassed six studies that provided data on operative time. Additionally, the results demonstrated that there was no statistically significant distinction in operative time between the groups that underwent LPN and OPN (WMD 3.84 mins, 95% CI -3.57 to 11.26; p = 0.31) ( 15 – 18 , 20 , 21 ). After pooling data from seven separate studies, the LPN cohort demonstrated a shorter duration of hospitalization in comparison to their OPN counterparts (WMD -2.06 days, 95% CI -2.62 to -1.50; p < 0.00001) ( Figure 2 ) ( 15 – 21 ).…”

“…The collective findings indicated that LPN was linked to lower blood loss compared to OPN (WMD: -34.05 mL, 95% CI: -55.61 to -12.48; p = 0.002). Nevertheless, no significant distinction was observed in the transfusion rate prevalence between LPN and OPN (OR 0.33, 95% CI 0.11, 0.98; p = 0.05) (three studies; Figure 3 ) ( 15 , 20 , 21 ). The analysis revealed that a discernible disparity in the prevalence of warm ischemia time between LPN and OPN was not evident (WMD 4.03 mins, 95% CI -1.72 to 9.78; p = 0.17) (based on findings from six studies; Figure 4 ) ( 15 – 19 , 21 ).…”

“…Furthermore, the rates of major complications were 4.5% (15 out of 332 cases) for LPN and 6.9% (27 out of 390 cases) for OPN. However, no statistically noteworthy disparities in the occurrence of significant complications between LPN and OPN were detected (OR 0.80, 95% CI 0.41, 1.57; p = 0.52) ( Figure 5 ) ( 15 , 16 , 20 , 21 ).…”