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Laparoscopic partial nephrectomy for centrally located renal tumors.

Igor Frank1, Jose R Colombo, Mauricio Rubinstein

  • 1Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

The Journal of Urology
|February 14, 2006
PubMed
Summary

Laparoscopic partial nephrectomy (LPN) is safe for central kidney tumors, offering comparable outcomes to peripheral tumors. Experienced surgeons can expand LPN indications to include these complex cases.

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Nephrology

Background:

  • Laparoscopic partial nephrectomy (LPN) is typically reserved for small, peripheral renal tumors.
  • Centrally located tumors often necessitate complex intracorporeal suturing and reconstruction, posing challenges during laparoscopic procedures due to renal ischemia constraints.

Purpose of the Study:

  • To retrospectively compare the perioperative outcomes of laparoscopic partial nephrectomy (LPN) for centrally located versus peripherally located renal tumors.

Main Methods:

  • A retrospective review of 363 patients who underwent LPN between January 2001 and March 2004.
  • Patients were categorized into central (n=154) or peripheral (n=209) tumor groups based on 3D CT scans, defining central tumors as those invading the pelvicaliceal system or renal sinus.

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  • Preoperative, intraoperative, postoperative, and pathological data were compared between the two groups.

    • Main Results:

    • Central tumors were larger (median 3 cm vs 2.4 cm) and resulted in larger surgical specimens (median 43 gm vs 22 gm) compared to peripheral tumors.
    • While blood loss was similar, central tumors required longer warm ischemia time (33.5 min vs 30 min), operative time (3.5 hours vs 3 hours), and hospital stay (67 hours vs 60 hours).
    • Cancer margins were similar (1 per group), postoperative creatinine levels were comparable, and intraoperative/late complications were similar, though early postoperative complications were higher in the central group (6% vs 2%).

    Conclusions:

    • Laparoscopic partial nephrectomy (LPN) can be performed safely for central renal tumors by experienced surgeons.
    • Perioperative outcomes for LPN of central tumors are comparable to those of peripheral tumors.
    • The indications for LPN should be broadened to encompass centrally located tumors, given the necessary laparoscopic expertise.