1085: Development of an Exophytic Tumor Model for Laparoscopic Partial Nephrectomy: Technique and Initial Experience (original) (raw)

2005, The Journal of Urology

INTRODUCTION AND OBJECTIVE: Laparoscopic nephron-sparing surgery (LNSS) is frequently reserved for smaller peripherally located tumors. Centrally located tumors typically require complex intra-corporeal suturing and reconstruction which is often difficult within the constraints of minimizing warm or cold ischemia. Our objective was to compare our experience with central and peripheral tumors treated with LNSS. METHODS: We identified 154 and 209 patients with central and peripheral tumors treated with LNSS, respectively. Central tumors were defined as tumors touching, abutting, or directly invading the collecting system and/or hilar vasculature. Lesions with no contact with the hilar structures were classified as peripheral. Preoperative and pathologic characteristics as well as intraoperative, early postoperative (while hospitalized), and late postoperative (following dismissal) complications were compared between the groups using chi-square and Wilcox rank sum tests. RESULTS: A retroperitoneal approach was used in 29.9% of central and 31.9% of peripheral lesions. All patients in the central group required a collecting system repair. Central tumors were larger on preoperative imaging (median 3.0 vs. 2.4 em, p<O.OOl) and had larger specimens at surgery (median 43 vs. 22 gm, p<O.OOl) than peripheral tumors. Central tumors required slightly longer operative times (210 vs. 180 minutes, p=0.008) warm ischemia times (33.5 vs. 30.0 minutes, p<O.OOI), and hospital stays (67 vs. 60 hours, p<O.OOI), although these differences were not clinically significant. The incidence of margin positivity was 0.8% vs. 1.7% (p=0.502) for the central and peripheral groups. The median estimated blood loss was the same in both groups at ISO cc. The median postoperative creatinine was 1.2 and 1.1 mg/dL for central and peripheral lesions, respectively. There were more intraoperative and early postoperative complications in the central group compared with the peripheral group (I 0.4% vs. 6.2% and 22.6% vs. 16.1%, respectively), although these differences were not statistically significant. The incidence of late complications in the two groups was approximately 13.0%. The most common early and late postoperative complication in the central group was hemorrhage at 3%. CONCLUSIONS: LNSS for centrally located tumors is a technically challenging procedure. However, it can be performed safely with complication rates that are comparable to those achieved with peripheral tumors. Indications for LNSS should be expanded to include centrally located tumors.