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Objective To evaluate the clinical value of R. E. N. A. L. scoring system in analyzing the tumor anatomical feature and indication characteristics of patients undergoing robotic laparoscopic partial nephrectomy (RPN). Methods The clinical data of 70 consecutive RPNcases done between March 2012 and September 2013 by the same surgeon at our institution were analyzed in this study. The 70 patients (47 males and 23 females) had a mean age of (52. 8 ± 10. 3) years, a mean body mass index (BMI) of (24. 8 ± 3. 25) kg/m2, a mean ASA score of 2. 0 ± 0. 4, and a mean age-weighted Charlson comorbidity index of (0. 7 ± 1. 03). Therewere 38 cases on the left (with 1 case of solitary kidney) and 32 cases on the right (also with 1 case of solitary kidney). All the tumors were solitary ones, with the maximal diameter being (3. 7 ± 1. 31) cm and a mean R. E. N. A. L. score of (8. 1 ± 1. 31). The patients were divided into three groups according to the R. E. N. A. L. scores, and the clinical variables were compared between groups. Results One patient was transferred to open surgery due to intraoperative hemorrhage and the rest were successfully completed. The operative time was (230 ± 48. 3) min, estimated blood loss was (154 ± 135. 9) mL, renal ischemia timewas (23. 0 ± 9. 30) min, and the mean postoperative hospital stay was (11. 4 ± 4. 44) days. The overall transfusion ratewas 8. 5 7 % (6/70) and the complication rate was 17. 1% (12/70). Pathological examination revealed no positive surgical margin; there were 58 cases with renal carcinoma, 4 with angiomyolipoma and 8 with other benign renal lesions. All patients were alive and had no local recurrence or distant metastasis at the latest follow-up. Nevertheless, the estimatedglomerular filtration rate (eGFR) was significantly different before and after operation (P = 0. 003). Significant differences were also found among the low, moderate and high tumor complexity groups (according to R. E. N. A. L. scores) regarding the cases finished in the first ten cases (50. 0% vs 10. 9% vs 11. 1%, P = 0. 033), operative time ([213 ± 35. 5] vs [225 ± 48. 9] vs [269 ± 31.7] min, P = 0. 008), estimated blood loss ([86 ± 31.3] vs [158 ± 148. 5] vs [172. 0 ± 66. 7] mL, P = 0. 032), and renal ischemia time ([18. 9 ± 7. 54] vs [22. 2 ± 8. 88] vs [30. 4 ± 9. 76] min, P = 0. 019). Conclusion R. E. N. A. L. nephrometry score is closely correlated with the surgical outcomes of RPN. Preoperative application of R. E. N. A. L. scoring system to identify tumor complexity can help to guide the clinical use of da Vinci surgical system for partial nephrectomy.
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To compare clinical outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy for renal cell carcinoma (RCC) and to identify the indicators for each approach. Methods A total of 258 patients underwent transperitoneal(n=116) or retroperitoneal (n=142) laparoscopic radical nephrectomy for RCC. The operation time, blood loss during operation, fasting period after surgery and hospital stay were compared between the two groups. Results The operation time was 80-315 min(a mean of [167±66.8] min) for transperitoneal approach and 85-280 min(a mean of [152± 48.8] min) for retroperitoneal approach (P=0.034). The blood loss was 50-1,000 ml (a mean of [181±140.4] ml) for transperitoneal approach and 50-800 ml(a mean of [171±132.9] ml) for retroperitoneal approach(P=0.544). The fasting period of surgery was 1-5 d (a mean of [2.8±1.3] d) for transperitoneal approach and 1-5 d (a mean of [2.9±1.2] d) for retroperitoneal approach(P=0.801). The hospital stay was 3-9 d (a mean of [6.6±1.5] d) for transperitoneal approach and 3-8 d (a mean of [6.5±1.6] d) for retroperitoneal approach(P = 0. 477). Conclusion Transperitoneal and retroperitoneal approaches both can yield satisfactory surgical outcomes in laparoscopic radical nephrectomy. The transperitoneal approach is suitable for tumors with a larger size.
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Objective To compare the surgical characteristics and clinical outcomes of laparoscopic nephron-sparing surgery (LNSS) andopen nephron-sparing surgery (NSS) for T1a stage renal cell carcinoma. Methods We retrospectively analyzed the clinical data of 115 patients with T1a stage renal cell carcinoma, who were treated with NSS. Fifty-five patients received LNSS and 60 received open NSS. The operation time, renal ischemia time, blood loss, hospital stay, complications and renal function recovery were compared between the two groups. Results The mean operation time periods in LNSS and open NSS group were 165-255 min (a mean of [212. 0±45. 3] min) and 95-138 min (a mean of [140. 7±25. 6] min, P = 0. 000), the renal ischemia time periodswere 25-45 min (a mean of [41. 3±5. 4] min) and 15-26 min ([24. 4±5. 7] min, P = 0. 000), the blood losseswere 100-250 ml (a mean of [168. 8 ± 51. 7] ml) and 200-550 (a mean of [285. 3±77. 9] ml, P = 0. 000), the periods of hospital stay were 6-10 d (a mean of [6. 2±0. 5] d) and 7-15 d(a mean of [7. 1±0. 6] d, P = 0. 001), and the complication rates were 7. 3%(4/55) and 18. 3%(11/60, P=0. 044), respectively. The patients were followed up for a median of 18(6-32) months. Except for the cases who were lost to follow-up or dead because of other reasons, there were no local recurrence or distant metastasis. The postoperative double glomerular filtration rates were not statistically different between the two groups(P = 0. 105). Conclusion LNSS has less blood loss, shorter hospital stay and less complication than open NSS, and longer operation time and renal ischemia time have little influence on renal function and long-term prognosis.
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Objective:To investigate the differential expression of VEGF165b in the renal cell carcinoma (RCC) and normal renal tissues and its role in the development of RCC. Methods: S-P immunohistochemistry was used to detect the expression of VEGF165b protein in 30 specimens of paraffin-embedded RCC tissues and 29 specimens of paraffin-embedded normal renal tissues. RT-PCR was performed to detect the expression of VEGF165b mRNA in 32 specimens of fresh RCC tissues and 30 specimens of fresh normal renal tissues. Results: Among 29 of normal renal tissues,28 specimens had positive expression of VEGF165b protein,with the positive rate of 96.55%(28/29) that was significantly higher than 20.00%(6/30)in RCC tissues(P