Comparison of perioperative and short-term functional outcomes of laparoscopic partial nephrectomy in patients with cT1aN0M0 and cT1b-T2aN0M0 tumors

S V Kotov,S A Pulbere,A A Nemenov,R I Guspanov,A G Yusufov,A O Prostomolotov

doi:10.17650/1726-9776-2021-17-4-38-46

Abstract

Background. Since partial nephrectomy and radical nephrectomy demonstrate comparable oncological safety, nephronsparing surgery is the method of choice in patients with stage T1-T2aN0M0 renal cell carcinoma.Objective: to compare the main perioperative parameters and short-term functional outcomes of treatment for localized stage cT1aN0M0 and cT1b-T2aN0M0 renal cell carcinoma.Materials and methods. A total of 148 laparoscopic partial nephrectomies were performed at N.I. Pirogov City Clinical Hospital No. 1, N.I. Pirogov Russian National Research Medical University between 2016 and 2020. Study participants were divided into two groups. Group 1 included patients with stage cT1aN0M0 tumors (n = 89; 60.1 %), whereas group 2 comprised patients with stage T1b-T2aN0M0 tumors (n = 59; 39.9 %).Results. The duration of surgery was 120 min (range: 90-150 min) in group 1 and 145 min (range: 120-170 min) in group 2 (p = 0.001). The median time of warm ischemia was 13 min (range: 7-17) and 15 min (range: 12-19 min) in groups 1 and 2, respectively (p = 0.002). Seven individuals from group 1 (7.9 %) and 12 individuals from group 2 (22.3 %) had their pelvicalyceal system lanced. The median glomerular filtration rate calculated using the MDRD (Modification of Diet in Renal Disease) formula was 56.4 mL/min/1.73 m2 in group 1 and 54.3 mL/min/1.73 m2 in group 2 (p = 0.252). Three patients in group 1 (3.4 %) had positive resection margin. The median follow-up time was 21 months.Conclusion. Nephron-sparing surgeries are an acceptable option for patients with stage cT1b-T2aN0M0 tumors in terms of their oncological and functional safety. Tumors exceeding 4 cm were associated with an increased risk of disease progression.

Highlights

Since partial nephrectomy and radical nephrectomy demonstrate comparable oncological safety, nephronsparing surgery is the method of choice in patients with stage T1–T2aN0M0 renal cell carcinoma
Нужна ли технически сложная резекция больным опухолями почечной паренхимы с нормальной контралатеральной почкой? Онкоурология 2019;15(4):39–49. [Volkova M.I., Ridin V.A., Cherniayev V.A. et al Is technically complicated partial nephrectomy justified in renal cell carcinoma patients with normal contralateral kidney? Onkourologiya = Cancer Urology 2019;15(4):39–49. (In Russ.).]

Summary

Background

Since partial nephrectomy and radical nephrectomy demonstrate comparable oncological safety, nephronsparing surgery is the method of choice in patients with stage T1–T2aN0M0 renal cell carcinoma. Objective: to compare the main perioperative parameters and short-term functional outcomes of treatment for localized stage сТ1аN0M0 and сT1b–T2аN0M0 renal cell carcinoma. Nephron-sparing surgeries are an acceptable option for patients with stage сT1b–T2аN0M0 tumors in terms of their oncological and functional safety. For citation: Kotov S.V., Nemenov A.A., Yusufov A.G. et al Comparison of perioperative and short-term functional outcomes of laparoscopic partial nephrectomy in patients with cТ1аN0M0 and сT1b–T2аN0M0 tumors. Основные характеристики обеих групп пациентов до начала оперативного лечения Table 1. Main characteristics of both groups before treatment

Характеристика Characteristic

Findings

Показатель Parameter