Laparoscopic partial nephrectomy for centrally located renal tumors

LPN is frequently reserved for small, peripherally located tumors. Centrally located tumors typically require complex intracorporeal suturing and reconstruction with hilar clamping, which is a laparoscopically advanced maneuver given the constraints of renal ischemia. We retrospectively compared our experience with central vs peripheral tumors treated with LPN.

Between January 2001 and March 2004, 363 patients underwent LPN for tumor. The tumor was located centrally in 154 patients and peripherally in 209. Central tumors were defined as tumors centrally extending into the kidney in direct contact with or invading into the pelvicaliceal system and/or renal sinus on preoperative 3-dimensional computerized tomography. Lesions with no contact with the pelvicaliceal system were classified as peripheral. Preoperative, intraoperative, postoperative and pathological data were compared.

Central tumors were larger (median 3 vs 2.4 cm, p < 0.001) and had larger specimens at surgery (median 43 vs 22 gm, p < 0.001) than peripheral tumors. Although blood loss was similar (median 150 cc), central tumors required longer warm ischemia time (median 33.5 vs 30 minutes, p < 0.001), operative time (median 3.5 vs 3 hours, p = 0.008) and hospital stay (median 67 vs 60 hours, p < 0.001). A positive cancer margin occurred in 1 patient per group. Median postoperative serum creatinine was similar (1.2 vs 1.1 mg/dl). Intraoperative and late postoperative complications were comparable. However, more early postoperative complications occurred in the central group (6% vs 2%, p = 0.05).

LPN for central tumors can be performed safely by an experienced laparoscopic surgeon with perioperative outcomes comparable to those of peripheral tumors. Given the requisite laparoscopic expertise, indications for LPN should be expanded to include centrally located tumors.