Retroperitoneoscopic tumorectomy – a standard in organ sparing radical treatment of kidney tumors? A single centre experience
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Piotr Petrasz, Marcin Słojewski, Andrzej Sikorski

Klinika Urologii PAM w Szczecinie

summary

Introduction.

Tumorectomy (nephron sparing surgery – NSS) is a procedure of proved efficacy in radical, surgical treatment of low stage kidney tumors. Laparoscopic techniques are still rarely used to operate on these patients, mainly due to high level of difficulty of surgical technique. According to EAU Guidelines – laparoscopic resection of kidney tumor (laparoscopic nephron sparing surgery – LNSS) may be considered as alternative method for open surgery only in selected cases and only in centers with suitable laparoscopic expertise. Within the last a few years the number of performed laparoscopic tumorectomies is still increasing in our department. During last eleven months there was no open operation performed in patients with T1a kidney tumor.

Objectives.

We present the analysis of our material of laparoscopic tumorectomies performed in cases of T1a kidney neoplasms.

Materials and methods.

Between June 2004 and January 2008 we performed 43 LNSS operations. The number of surgeries done in years 2004, 2005, 2006 and 2007 was 2, 6, 12 and 23 respectively. Mean age of operated patients was 56.1 years (range 31-76 ). In all cases the stage of lesion was assessed basing on CT as T1a. Retroperitoneoscopic approach was applied for all operations rather with use of three troacars (28 cases), than four ports (15 cases). The reason to introduce an additional troacar was mostly the necessity of temporary clamping of renal vessels in order to control the hemostasis after tumor resection. The hemostasis was performed with mono, bipolar, or seldom argon coagulation. In one case hemostatic suture was necessary.

Results.

We didn’t notice any serious intraoperative complications. Four patients (9,3%) were converted to an open surgery. The reasons of conversion were massive bleeding from lodge and failure of laparoscopic device in 3 (6.97%) and 1 case (2.33%) respectively. Average time of operation was 89 minutes (range 45-180) and mean blood loss was 221 ml (min. 0, max. 1800). The size of resected tumors ranged from 10 to 50 mm (mean 30.1 mm). Pathology report revealed clear cell cancer, papillary cancer and chromophobic cancer in 27 (63%), 9 (21%) and 2 (5%) cases respectively. In the remaining 5 patients (11%) benign lesions were found. In all cases surgical margins were negative. One postoperative complication occurred - prolonged urinary leakage. Mean postoperative hospital stay was 4.5 days (range 2-12). Moreover we noted in our department a tendency for decreasing the number of open surgeries and increasing number of laparoscopic tumorectomies which has lasted since 2004. The relation between the number of performed NSS/LNSS in years 2004, 2005, 2006 and 2007 was 20/2, 17/6, 3/12 and 1/23 respectively.

Conclusions.

1. Laparoscopic resection of kidney tumor is a safe method which allows to achieve very good oncologic results with small blood loss, short hospital stay and minimal surgical trauma in cases of low stage kidney neoplasm. 2. Retroperitoneoscopic tumorectomy is technically challenging, but in centers with suitable laparoscopic experience may be considered as method of choice in the treatment of patients with T1a kidney tumor.