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[Application of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma patients with intermediate risk
Dong-xu Zhang1, Xun-gang Li, Xin-gang Cui
1Department of Urology, Second Military Medical University, Shanghai, China.
Objective:
To study the application of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma patients with intermediate risk PADUA score.
Methods:
From April 2005 to June 2011, 79 cases (48 males and 31 females) of intermediate risk PADUA score (range from 8 to 9 score) renal cell carcinoma were retrospectively analyzed. Mean age was (54 ± 9) years, mean tumor size was (2.8 ± 0.8) cm in diameter, with 37 cases on the left side and 42 cases on the right side. Tumor located anteriorly in 35 cases, and 44 cases were located posteriorly. Preoperative imaging examinations showed tumor invasion of the collecting system was dislocated or infiltrated by tumor invasion were in 13 cases, renal sinus were involved in 5 cases, tumor located near the renal hilum were in 10 cases. All of the 79 patients received retroperitoneal laparoscopic partial nephrectomy.
Results:
The 79 cases were operated successfully without conversion to open surgery, no severe perioperative complications. The mean operation time was (105 ± 24) minutes, and the median of operation time was 115 minutes (range from 80 - 180 minutes), and mean warm ischemia time (WIT) was (20 ± 5) minutes, and mean blood loss was (24 ± 8) ml; mean postoperative hospital stay was (5.2 ± 1.5) days. Postoperative urinary leakage in 3 cases, symptoms disappeared one week after indwelling catheterization and ureteral catheter. Serum creatinine transient increased in 7 cases after surgery, and fell to normal range within 6 weeks. In a mean follow up for (34 ± 12) months (range from 10 to 84 months), estimated glomerular filtration rate (eGFR) 6 months after operation was no statistical significance compared with preoperation in 77 cases, another 2 patients' eGFR decreased by 30% and 35%. Postoperative renal function remained in CKD3 period and CKD2 period were in 2 cases respectively, none of these cases were treated with hemodialysis, and the remaining patients with normal renal function after surgery, no tumor recurrence and metastasis during follow-up in all cases.
Conclusions:
Treatment of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma patients with intermediate risk PADUA score is safe and effective, but its long-term effects still need to study with large samples compare and long-term follow-up.
