Nephron sparing surgery for small renal tumor: complication and 3 years follow-up / 中华泌尿外科杂志

ABSTRACT

Objective To evaluate the safety and efficacy of nephron sparing surgery for small renal tumor. Methods A total of 43 patients with small renal tumor underwent nephron sparing surgery (NSS). Of the 43 patients, 27 were male and 16 were female, with an average age of 46.0(21-79)years. The mean diameter of the tumors was 3.1 (1.2- 4. 0)cm. Eighteen cases received open NSS, other 25 cases received retroperitoneal laparoscopic NSS. The perioperative data and renal function, postoperative complications and tumor recurrence were evaluated. Results The procedure was successful in all 43 patients, though 2 cases occurred serious bleeding during operation. The average operating time was 158. 0(69- 277) and 150. 0(60-226) min in open NSS and laparoscopic NSS groups. The average warm ischemia time was 23. 2(20-31) and 25.8(23-35) min. The average blood loss was 590.8(120-3000) and 468. 5(50-1600) ml. The average pre-operation creatinine was (65.9±22. 8)and(68.4±25.0)μmol/L. The average creatinine at the end of follow-up was(82. 2±24.1)and(85. 3±25.9)μmol/L. The average hospital stay was 19.2(11-47) and 12.5(10- 16) (P＜0.05). The histological results showed 25 cases of renal cell carcinoma (RCC, Tla) and 18 cases of benign lesions. Sixteen cases(37%)of minor complications were observed. Comparing the open NSS versus laparoscopic NSS group, perirenal hematoma rate was 6 % vs 12 % (P＜0.05), flank numbness rate was 11.1% vs 0(P＜0.05). During the mean 25-60(37. 4±7.2)months follow-up, 1 case with RCC relapsed in 20 months and received radical nephrectomy. 1 case with harmatoma was found a new lesion apart from the original site in 6 months and CT scan confirmed harmatoma, and then received active surveillance. The 3-year recurrence-free survival for all tumors in 2 groups was 94%, 96%, and that for RCC was 100% and 93%, separately. Conclusions Comparing with open NSS, laparoscopic NSS for small renal tumor has a shorter hospital stay and lower flank numbness rate, though has higher perirenal hematoma rate. There was no significant difference in other complications between the 2 groups. No irreversible renal function damage was observed in two groups. The tumor recurrencefree survival and RCC recurrence-free survival were no significant difference between two groups.