982 NO IMPACT OF TUMOR LOCATION ON THE RESIDUAL RENAL FUNTION AFTER NEPHRON-SPARING SURGERY IN THE PATIENTS WITH RENAL TUMORS

Abstract

You have accessJournal of UrologyKidney Cancer: Localized II1 Apr 2010982 NO IMPACT OF TUMOR LOCATION ON THE RESIDUAL RENAL FUNTION AFTER NEPHRON-SPARING SURGERY IN THE PATIENTS WITH RENAL TUMORS Jumpei Iizuka, Tsunenori Kondo, Yasunobu Hashimoto, Hirohito Kobayashi, and Kazunari Tanabe Jumpei IizukaJumpei Iizuka More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , Yasunobu HashimotoYasunobu Hashimoto More articles by this author , Hirohito KobayashiHirohito Kobayashi More articles by this author , and Kazunari TanabeKazunari Tanabe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1951AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nephron-sparing surgery (NSS) has become a golden standard for small renal masses. Ninety-five percent of tumors of 4cm or less are resected with NSS in our department at present. In this study, we analyzed residual renal function after NSS according to the tumor location. We also examined the surgical difficulty of NSS as well. METHODS From July 2003 until April 2009, 599 patients underwent curative surgery for renal tumor. Of these, 193 patients who underwent NSS were the subjects of this study. The indication for NSS was elective in 125 patients and imperative in 68. Tumor location was categorized with three factors, including the circumferential location (anterior, posterior, inner-side and outer-side), the location along the long axis (upper, mid, lower), the depth (exophytic, endophytic), and the hilar location. We compared operation time, blood loss, total ischemic time□@(TIT), perioperative complications, and reduction rate of renal function 1-year after surgery according to the tumor location. Renal function was assessed using the estimated glomerular filtration rate (e-GFR) calculated using the MDRD equation recently modified for Japanese patients, as regulated by The Japanese Society of Nephrology. RESULTS The all tumors were excised completely without a positive surgical margin. There was no local recurrence found after NSS. Mean tumor size was 33.2□}21.6 mm (range, 8-200 mm). Twenty-tree patients underwent laparoscopic NSS and 160 patients underwent open NSS included ex-vivo NSS followed by autotransplantation. Histological study showed RCC in 171 patients and benign tumors in 22. With respect to operation results, the operation time and the blood loss were higher in inner-side tumors than the other circumferential locations (p<0.05). Hilar or endophtic tumors resulted in the prolonged operation time, and TIT, and increased blood loss. Buried tumors enhanced the surgical difficulty. In contrast to surgical results, any location factors did not negatively influence the residual renal function. CONCLUSIONS Hilar or inner-side tumors increase the technical difficulty of NSS but did not compromise the residual renal function. Thus the indication of NSS should be extended aggressively to the hilar, buried, or inner-side tumors. Tokyo, Japan© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e381-e382 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jumpei Iizuka More articles by this author Tsunenori Kondo More articles by this author Yasunobu Hashimoto More articles by this author Hirohito Kobayashi More articles by this author Kazunari Tanabe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...