Open partial nephrectomy when a non-flank approach is required: indications and outcomes

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Open partial nephrectomy (OPN) is a standard treatment for renal tumors.
• Non-flank surgical approaches for OPN are less common and their outcomes are not well-documented.
• This study aims to compare outcomes of OPN using flank versus non-flank approaches.

Purpose of the Study:

• To evaluate the indications and outcomes of open partial nephrectomy (OPN) when non-flank surgical approaches are necessary.
• To compare these outcomes with patients managed via a traditional flank approach.

Main Methods:

• Retrospective review of 2747 OPN cases (1999-2015), with 76 (2.8%) requiring a non-flank approach.
• Comparison group included 1467 patients who underwent flank OPN during odd years within the same timeframe.
• Data collected included tumor characteristics, operative details, complications, and functional outcomes.

Main Results:

• Non-flank OPN patients had larger tumors and higher clinical/pathologic stage, with indications including locally advanced disease and need for simultaneous surgery.
• Operative times, blood loss, positive margins, and functional decline were modestly increased in the non-flank group.
• Intraoperative and genitourinary complications were more frequent in non-flank OPN but were manageable, with no mortalities or need for long-term dialysis.

Conclusions:

• Non-flank OPN is associated with increased complexity and generally less favorable outcomes compared to flank OPN.
• Despite challenges, complications encountered with non-flank OPN are manageable and patient outcomes are typically favorable.
• Findings provide valuable insights for counseling patients when a non-flank incision is required for OPN.