[Laparoscopic nephron-sparing surgery for treatment of complex cystic renal lesions]

To evaluate the feasibility, efficacy and safety of laparoscopic partial nephrectomy for complex renal cystic lesions.

A retrospective cohort study was conducted on the clinical data of 27 patients with complex renal cystic lesions treated by laparoscopic partial nephrectomy from May 2008 to April 2011 in Peking University Third Hospital. According to the Bosniak classification, 7 cases were lesions of grade IIF, 11 of grade III, and 9 of grade IV. The mean diameter of cystic lesions was (3.58±0.75) cm, and 4 lesions were larger than 4.0 cm.

All procedures were performed through retroperitoneal approach and successful. The mean operative time was (123.1±16.8) min, ranging from 100 min to 160 min, and the mean renal warm ischemia time was (29.7±3.5) min, ranging from 25 min to 40 min. Blood loss in the operations was from 50 mL to 110 mL, the mean being (75.5±21.8) mL. The postoperative hospital stay was 4 to 6 days, and the mean was (5.11±0.85) days. Postoperative pathological results included 10 simple renal cysts (37.0%), 2 cases of adult cystic nephroma (7.4%), 1 mixed epithelial and stromal tumor (3.7%), 13 cases of renal cell carcinoma with cystic change (48.1%), and 1 multilocular cystic renal cell carcinoma (3.7%). The results showed that 14.3% of cystic lesions of grade IIF, 45.5% of grade III and 88.9% of grade IV were malignant. In the follow-up ranging from 12 to 48 months (median 24 months), there was no case of recurrence.

The differentiation between benign and malignant renal cystic lesions before surgery remains difficult. According to the Bosniak classification, radiological diagnostic findings are standardized, but still limited in the accuracy to determine the dignity of pathological entity. Laparoscopic partial nephrectomy is feasible to treat complex renal cystic lesions, and is a safe and effective minimally invasive option.