Лапароскопическая резекция почки при опухолях R.E.N.A.L.10 и больше

Abstract

OBJECTIVE To discuss the feasibility, safety, and effectiveness of conventional laparoscopic partial nephrectomy for patients with kidney tumors R.E.N.A.L. score 10 and higher. MATERIALS AND METHODS Retrospective comparative study. Everyone who has been treated from I 2015 to I 2020 by one surgeon in our department by lap partial nephrectomy was included. Patients were randomized by criteria of R.E.N.A.L. score in two groups: 40 those who had this index 10 or more (R10+), and 69 - all the rest (R less or equal 9). Perioperative factors and results were studied and compared. Video presentation of the surgical technique is available at: https://youtu.be/1254WSFMxJ0. RESULTS No conversions to open surgery or nephrectomy & any complications Clavien >III were detected. Of all patients, benign lesions were identified in 21(19,3%). Up stage from 1-2 to 3 occurred in 6 (6,82%) cases. Intraop complications: 4,3% vs 2,5% (p=0,6) and the same values of postop Clavien III rate for R less or equal 9 & R10+ groups respectively. There were no any significant differences between the two groups except for three parameters: OR time, estimated blood loss & warm ischemia time. In R10+ cohort these values were 170 [130; 210] min, 250 [162; 337] ml & 20,1+/-5,7 min. And in R less or equal 9 - 130 [100; 180] min, 200 [150; 300] ml & 15,9+/-4,5 min respectively (p<0.05 for all). Oncological results were comparable and nephrometric index had no effect on them. CONCLUSION conventional lap partial nephrectomy is safe and efficient even in cases of complex tumors with R.E.N.A.L. score 10 and higher.