Abstract
Objective To explore the situation of 61 patients with renal tumors who underwent retroperitoneal laparoscopic nephron-sparing surgery (RLNSS) and the factors affecting postoperative renal function. Methods A total of 61 patients with renal tumors who underwent RLNSS in our hospital from January 2018 to January 2021 were included in this study. All patients were treated with RLNSS. The clinical data of patients were recorded. Before operation and 3 months after operation, the change value of glomerular filtration rate (ΔGFR) was measured by the Gates method. Multivariate linear regression was used to analyze the related factors affecting postoperative renal function. Results All 61 patients successfully completed the operation. The mean operative time was 60–150 min‚ average (98.75 ± 14.38) min. The estimated intraoperative blood loss was 20–310 ml‚ average (107.93 ± 68.55) ml. Intraoperative warm ischemia time (WIT) was 0–39 min, with an average of (21.16 ± 6.47) min. All patients' pathological margins were negative after operation. In all patients, there were 5 postoperative complications, including 2 cases of renal wound bleeding (3.28%), 1 case of hematuria (1.64%), 1 case of urinary fistula (1.64%), and 1 case of subcutaneous emphysema (1.64%). There were significant differences in tumor diameter, preoperative GFR, operation time and WIT (P < 0.05). Multivariate analysis showed that tumor diameter, preoperative GFR, and WIT were all factors affecting the postoperative renal function of patients with RLNSS (P < 0.05). Conclusion RLNSS has a good curative effect on patients with renal tumor, and tumor diameter, preoperative GFR, and WIT were all factors affecting the postoperative renal function of patients with RLNSS.
Highlights
There were 2 cases with 0 ischemia time: 1 case had the largest tumor diameter of 1.5 cm, and the tumor was located at the upper pole of the kidney
CT showed that the tumor was superficial, and according to the intraoperative situation, the renal artery was not blocked; in another patient, the largest tumor diameter was 3.2 cm, and the tumor was located at the inferior pole of the kidney
With the increasing diameter of renal tumor, the change of glomerular filtration rate (GFR) value became larger, and the GFR value of the affected renal decreased more after operation. e possible reason is that the larger the diameter of the renal tumor, the less the nephrons can be retained after the complete resection of the renal tumor, and the larger the diameter of the tumor increases the difficulty of the operation, resulting in prolonged resection and suture time and warm ischemia time (WIT), which in turn leads to poor renal function after the operation [16]
Summary
A total of 61 patients with renal tumors who underwent RLNSS in our hospital from January 2018 to January 2021 were included in this study. All patients were examined by abdominal ultrasound, abdominal CT, renal CTA, intravenous urography, chest radiograph, or lung CT before operation, so as to make clear the renal occupation. 42 cases of renal cell carcinoma were diagnosed before operation, including 22 cases of T1aN0M0, cases of T1bN0M0, and 2 cases of T2aN0M0; there were cases of renal hamartoma. E tumor was 1.3–6.0 cm in diameter, with an average diameter of (3.73 ± 1.02) cm. Tumor lesion site: 41 cases on the left side and 20 cases on the right side. SPSS22.0 software was used for statistical analysis. P < 0.05 was the difference with statistical significance
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