Introduction & Objectives: We report oncologic and functional results of 210consecutive patients treated with laparoscopic partial nephrectomy(LPN) followingtransarterial superselective tumor embolisation(STE).Materials & Methods: Between August 2003 and January 2010 210 consecutivepatients underwent LPN following STE. Inclusion criteria were tumor diameter>4cm or intraparenchymal depth >1.5cm. Mean patients age 62 years (range 34to 80), mean tumor size was 4.2cm(2.5 to 6.5 cm). Preoperative serum creatininelevels and renal scintigraphy were compared to 3 and 12 month ones to evaluatethe preservation of renal function. CT scan and chest X ray together with abdominalultrasound were alternatively performed at 6 month intervals.Results: Postoperative complications included four cases of urinary fistulas thatwere solved by placing a Double-J stent, six cases of hematoma, one of whichinfected and treated with percutaneous drainage, and two cases of delayedhematuria successfully treated with embolisation of the arterial pseudoaneurysm.Pathologic analysis found benign tumors in 63 patients and renal cell carcinomain 147 patients (58 pT1a, 74 pT1b, 8 pT2 and 7 pT3a). At a median follow-upof 46 months one patient underwent laparoscopic radical nephrectomy for locallyrecurrent renal cell carcinoma and one patient died of cancer. Disease free survivalwas 97.3%.The median increase of serum creatinine levels was 0.27 mg/dL andno patients experienced chronic kidney disease (defined as GFR<60 mL/min/1.73m2) during follow-up. When matching preoperative with 3 month and 1-yr renalscintigraphy there was a progressive recovery of renal function, the percentdecrease of split renal function being 9% at 3 month and 5% at 1-yr evaluation.Conclusions: SAE provides an effective hemostasis, allowing to perform LPNwithout hilar vessel clamping and so without warm ischemia threshold time.This technique represents a rationale and effective solution of major technicalchallenges of LPN which remains bleeding control and warm ischemia timethreshold. Oncologic results compare favourably with literature results and renalfunction can be effectively preserved. SAE may be widely reproduced and couldbe a starting point to perform LPN out of experienced centres.
LAPAROSCOPIC PARTIAL NEPHRECTOMY FOLLOWING TRANSARTERIAL SUPERSELECTIVE TUMOR EMBOLISATION
Papalia R.;Buscarini M;
2011-01-01
Abstract
Introduction & Objectives: We report oncologic and functional results of 210consecutive patients treated with laparoscopic partial nephrectomy(LPN) followingtransarterial superselective tumor embolisation(STE).Materials & Methods: Between August 2003 and January 2010 210 consecutivepatients underwent LPN following STE. Inclusion criteria were tumor diameter>4cm or intraparenchymal depth >1.5cm. Mean patients age 62 years (range 34to 80), mean tumor size was 4.2cm(2.5 to 6.5 cm). Preoperative serum creatininelevels and renal scintigraphy were compared to 3 and 12 month ones to evaluatethe preservation of renal function. CT scan and chest X ray together with abdominalultrasound were alternatively performed at 6 month intervals.Results: Postoperative complications included four cases of urinary fistulas thatwere solved by placing a Double-J stent, six cases of hematoma, one of whichinfected and treated with percutaneous drainage, and two cases of delayedhematuria successfully treated with embolisation of the arterial pseudoaneurysm.Pathologic analysis found benign tumors in 63 patients and renal cell carcinomain 147 patients (58 pT1a, 74 pT1b, 8 pT2 and 7 pT3a). At a median follow-upof 46 months one patient underwent laparoscopic radical nephrectomy for locallyrecurrent renal cell carcinoma and one patient died of cancer. Disease free survivalwas 97.3%.The median increase of serum creatinine levels was 0.27 mg/dL andno patients experienced chronic kidney disease (defined as GFR<60 mL/min/1.73m2) during follow-up. When matching preoperative with 3 month and 1-yr renalscintigraphy there was a progressive recovery of renal function, the percentdecrease of split renal function being 9% at 3 month and 5% at 1-yr evaluation.Conclusions: SAE provides an effective hemostasis, allowing to perform LPNwithout hilar vessel clamping and so without warm ischemia threshold time.This technique represents a rationale and effective solution of major technicalchallenges of LPN which remains bleeding control and warm ischemia timethreshold. Oncologic results compare favourably with literature results and renalfunction can be effectively preserved. SAE may be widely reproduced and couldbe a starting point to perform LPN out of experienced centres.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
