Laparoscopic partial nephrectomy for renal masses: effect of tumor location
Ramakrishna Venkatesh1, Kyle Weld, Caroline D Ames
1Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA. venkateshr@wudosis.wustl.edu
Objectives:
To report our single institutional experience of laparoscopic partial nephrectomy (LPN) for enhancing renal masses and evaluate outcomes and histopathologic findings with respect to the location of the renal mass.
Methods:
A retrospective review of LPN for 123 renal masses completed by 7 urologists was performed. Of these lesions, 49 (40%) were exophytic, 19 (15.5%) endophytic, 47 (38%) mesophytic, and 8 (6.5%) were hilar. We defined exophytic as more than 60%, mesophytic as 40% to 60%, and endophytic as less than 40% of the renal mass protruding off the surface of the kidney on radiologic imaging studies. Hilar lesions were those located within 5 mm of the renal hilar structures, regardless of the surface characteristics.
Results:
The mean tumor size was 2.6 cm (range 1 to 9). Hilar vessel clamping was performed during 55 procedures (44.7%); the mean warm ischemia time was 27 minutes (range 12 to 52). On final histopathologic examination, 3 patients (2.5%) had positive tumor resection margins. Overall, 26 (20.6%) complications occurred. The complication rate was significantly less for patients who underwent LPN for an exophytic (10%) or a mesophytic (12.8%) mass than for those with an endophytic (47%) or a hilar (50%) mass. Histopathologic examination of the renal masses revealed malignant pathologic features in 86 (69%) and benign findings in 37 (31%). In our series, only 55% of exophytic tumors were malignant and, if malignant, were invariably low grade (96%).
Conclusions:
The complications of LPN and the malignancy rate of the renal lesions were related to the tumor location within the kidney.
