Laparoscopic partial nephrectomy: a comprehensive evaluation of single-centre perioperative outcomes

Česká verzia

Authors: Petr Macek ^1,2; Květoslav Novák ¹; Michael Pešl ¹; Maria Stevens ¹; Tomáš Hradec ¹; Vojtěch Fiala ¹; Rodrigo Gouveia ¹; Lenka Plincelnerová ¹; Lucie Vávřová ¹; Lenka Bauerová ³; Tomáš Hanuš ¹
Authors place of work: Urologická klinika 1. LF UK a VFN v Praze ¹; Department of Urology, Institut Montsouris, Université Paris Descartes, Paris, France ²; Ústav patologie 1. LF UK a VFN v Praze ³
Published in the journal: Ces Urol 2019; 23(3): 221-229
Category: Original Articles

Summary

Aim: Assessment of perioperative and oncological results of laparoscopic nephron-sparing procedures for renal tumors.

Material a methods: We evaluate data from a prospectively collected database in one center between 1/2013 and 6/2018. Operations were performed by 3 surgeons. There were 174 patients available for final analysis. The cohort included also 1 one-stage bilateral case, 9 cases of multiple one-stage partial nephrectomy (PN) (2–5 lesions) and in 8 cases PN of solitary kidney. Altogether, 190 renal masses were resected (left side 102×, right side 88×), in 64 women and 110 men. Cohort medians (IQR = interquartile range) were: age 64 (55–70) years, Charleson comorbidity index 3 (2–4), creatinine 78 (68–95) μmol/L, lesion diameter 27 (20–35) mm, PADUA score 8 (7–9).

Results: Length of surgery median 118 (IQR 88– 150) min, blood loss median 150 (IQR 80–300) ml, no warm ischemia (WI) used in 51 of 190 lesions, in other length of WI median 15 (IQR 12–17) min, in 2 patients conversion to open PN was needed and in 2 patients conversion to laparoscopic nephrectomy (1× bleeding; 1× renal vein tumor thrombus). There were 44 complications according to Clavien-Dindo (CD) classification within 30 post-operative days: 17× grade 1, 13× grade 2, 10× grade 3, 1× grade 4, 3× grade 5, i.e. CD ≥ 3 in 8 % of patients. Symptomatic pseudoaneurysm was diagnosed in 4 pts – all treated by selective embolization. Post-operative hospital stay was median 6 (IQR 5–7) days. Histology found 45 benign and 145 malignant lesions, of the latter 122× pT1a, 16× pT1b, 3× pT2a and 4× pT3a. Positive margin rate was 11%. Only 1 patient underwent new PN via open approach, others were monitored. We detected 1 local kidney recurrence (in R0 surgery), 1 rapid distant progression (cerebral metastases) and 1 combined local (in perirenal fat) and distant (lungs) recurrence (in R0 surgery). Trifecta based on Montsouris (R0 + WI ≤ 25min + absence of CD ≥ 3 complication) was 74,1%, based on Khalifeh et al. (R0 + WI ≤ 25 min + no complication) was 59,2% and based on Porpiglia et al. (R0 + WI ≤ 20 min + absence of CD ≥ 3 complication) was 69 %.

Conclusion: Laparoscopic PN is a standard management option of solid renal masses providing favorable outcomes. Trifecta rate was comparable to published results. The work was supported by a grant project MZ ČR – RVO VFN64165.

Keywords:

Partial nephrectomy – laparoscopy – trifecta

Zdroje

1. Richter I, Dvořák J. Úvod do problematiky léčby zhoubných nádorů ledvin. Klin onkol 2018; 31(2): 110–116.

2. Ljungberg BL, Albiges K, Bensalah A, et al. Eau guidelines on renal cell carcinoma 2019 [online]. 2019. Dostupné z: https://uroweb.org/guideline/renal-cell-carcinoma/#7.

3. Macek P, Stevens M, Novák K, Pešl M, Hanuš T. Nefrometrická skóre první a druhé generace pro predikci peri- a pooperačních výsledků resekci ledvin. Ces Urol 2017; 21(2): 154–160.

4. Nyman U, Bjork J, Lindstrom V, Grubb A. The lund-malmo creatinine-based glomerular filtration rate prediction equation for adults also performs well in children. Scandinavian journal of clinical and laboratory investigation 2008; 68(7): 568–576.

5. Charleson Comorbidity Calculator. Dostupné z: http://touchcalc.com/calculators/cci_js.

6. Ficarra V, Novara G, Secco S, et al. Preoperative aspects and dimensions used for an anatomical (padua) classification of renal tumours in patients who are candidates for nephron-sparing surgery. European urology 2009; 56(5): 786–793.

7. Sobin lHM, Gospodariwicz A, Wittekind C. Renal neoplasms. In: l.h. sobin, m. Gospodariwicz a c. Wittekind, ed. Tnm classification of malignant tumors. 7th vyd. B.m.: Wiley-Blackwell 2009: 255–257.

8. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery 2004; 240(2): 205–213.

9. Carneiro A, Sivaraman A, Sanchez-Salas R, et al. Evolution from laparoscopic to robotic nephron sparing surgery: a high-volume laparoscopic center experience on achieving „trifecta" outcomes. World journal of urology 2015; 33(12): 2039–2044.

10. Khalifeh A, Autorino R, Hillyer SP, et al. Comparative outcomes and assessment of trifecta in 500 robotic and laparoscopic partial nephrectomy cases: a single surgeon experience. The journal of urology 2013; 189(4): 1236–1242.

11. Porpiglia F, Bertolo R, Amparore D, Fiori C. Margins, ischaemia and complications rate after laparoscopic partial nephrectomy: impact of learning curve and tumour anatomical characteristics. Bju International 2013; 112(8): 1125–1132.

12. Vachek J, Zakiyanov O, Tesař V. Chronické onemocnění ledvin. Internal medicine for practice 2012; 14(3): 107–110.

13. Cacciamani GE, Gill T, Medina L, et al. Impact of host factors on robotic partial nephrectomy outcomes: comprehensive systematic review and meta-analysis. Journal of urology 2018; 200(4): 716–730.

14. Kang M, Gong IH, Park HJ, et al. Predictive factors for achieving superior pentafecta outcomes following robot-assisted partial nephrectomy in patients with localized renal cell carcinoma. Journal of endourology 2017; 31(12): 1231–1236.

15. Rosen DC, Kannappan M, Kim Y, et al. The impact of obesity in patients undergoing robotic partial nephrectomy. Journal of endourology 2019; 33(6): 431–437.

16. Dagenais J, Bertolo R, Garisto J, et al. Variability in partial nephrectomy outcomes: does your surgeon matter? European urology 2019; 75(4): 628–634.

17. Khene ZE, Peyronnet B, Bernhard JCH, et al. A preoperative nomogram to predict major complications after robot assisted partial nephrectomy (uroccr-57 study). Urologic oncology 2019.

18. Garisto J, Bertolo RJ. Robotic versus open partial nephrectomy for highly complex renal masses: comparison of perioperative, functional, and oncological outcomes. Urologic oncology 2018; 36(10): 471.e1–471.e9.

19. Ficarra V, Rossanese M, Gnech M, Novara G, Mottrie A. Outcomes and limitations of laparoscopic and robotic partial nephrectomy. Current opinion in urology 2014; 24(5): 441–447.

20. Long JA, Yakoubi R, Lee B, et al. Robotic versus laparoscopic partial nephrectomy for complex tumors: comparison of perioperative outcomes. European urology 2012; 61(6): 1257–1262.

21. Mehra K, Manikandan R, Dorairajan LN, et al. Trifecta outcomes in open, laparoscopy or robotic partial nephrectomy: does the surgical approach matter? Journal of kidney cancer and vhl 2019; 6(1): 8–12.

22. Chang KD, Raheem AA, Kim KH, et al. Functional and oncological outcomes of open, laparoscopic and robot-assisted partial nephrectomy: a multicentre comparative matched-pair analyses with a median of 5 years’ follow-up. Bju international 2018; 122(4): 618–626.

23. Alimi Q, Peyronnet B, Sebe P, et al. Comparison of short-term functional, oncological, and perioperative outcomes between laparoscopic and robotic partial nephrectomy beyond the learning curve. Journal of laparoendoscopic advanced surgical techniques. Part a 2018; 28(9): 1047–1052.

24. Marconi L, Desai MM, Ficarra V, Porpiglia F, Poppel HV. Renal preservation and partial nephrectomy: patient and surgical factors. European urology focus 2016; 2(6): 589–600.