Abstract
ABSTRACTObjective:This study aims to compare renal functional outcomes of access techniques in patients who underwent off-clamp (Off-C) laparoscopic partial nephrectomy (LPN).Materials and Methods:Thirty-four Off-C LPNs in patients with functioning contralateral kidney from March 2011 to June 2018 were included in the study. Twenty-two patients underwent transperitoneal, 12 patients underwent retroperitoneal Off-C LPN. The primary outcome was glomerular filtration rate changes over time, postoperatively. The secondary outcome was the evaluation of trifecta and pentafecta rate.Results:Preoperative demographics, tumor size (26.59 vs. 22.83mm, p=0.790), RENAL score (5.45 vs. 5.33, p=0.990), operation time (79.95 vs. 81.33 min, p=0.157), blood loss (170.23 vs. 150.83mL, p=0.790) were similar in both groups. Although preservation of renal function was better in group 2 in the early period, similar results were found in both groups at the end of the first year, postoperatively. No positive surgical margin and postoperative major complications were detected in any patient. While trifecta goals were achieved in all the patients in the cohort, pentafecta rates were 90.9% and 91.7% in the transperitoneal and retroperitoneal groups, respectively.Conclusions:Transperitoneal and retroperitoneal access were found to have similar outcomes in terms of preservation of renal function at the end of the first year postoperatively. Off-C LPN may be considered as a safe and effective treatment option in patients having non-complex renal tumors.
Highlights
It is generally accepted that partial nephrectomy (PN) is a standard procedure due to having equal oncological and better functional outcomes when compared to radical nephrectomy (RN) in patients with cT1 renal tumors, whenever it is technically feasible [1]
We aimed to investigate the effect of the surgical approach on functional and oncological outcomes of Off-C laparoscopic partial nephrectomy (LPN)
The perioperative, postoperative and renal functional outcomes are demonstrated in Table-2
Summary
Preoperative baseline renal function (RF), renal parenchyma preserved, and warm ischemia time (WIT) are strongly associated with renal functional recovery after PN. Minimizing or even eliminating the ischemia time as well as preserving the quantity of remnant renal parenchyma are the crucial modifiable factors that would have a positive effect on renal functional recovery after PN [2]. While a definite cut-off value for the duration of global ischemia that should not be exceeded during PN in humans has not yet to be defined, various techniques including selective (minimal) or off-clamp (Off-C) have been described to reduce the negative effect of global ischemia on RF [2]. We aimed to investigate the effect of the surgical approach on functional and oncological outcomes of Off-C LPN. There is no study available to evaluate the impact of transperitoneal vs retroperitoneal Off-C LPN on both surgical and oncological outcomes
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