Abstract
BackgroundTo assess the safety, tumor control and renal function preservation of the emergency retroperitoneal laparoscopic partial nephrectomy (LPN) for ruptured renal angiomyolipoma (AML) and summarize our single-center initial experience.MethodsWe performed a retrospective analysis of 15 patients pathologically confirmed renal AML treated with emergency retroperitoneal LPN between January 2016 and May 2019. The patient demographics, operation time, blood loss, transfusion requirements, complications and other surgical parameters were analyzed. Follow-up was performed by serum creatinine and imaging modalities.ResultsFifteen patients were performed with emergency LPN with the median age 41.6 years. The mean size of the renal AMLs was 7.8 cm. The mean size of the retroperitoneal hematomas was 8.5 cm. All the emergency surgeries were performed successfully without any conversion to nephrectomy or open surgery. The mean operative time was 101 min. The mean warm ischemia time was 28 min. The mean estimated blood loss was 311 ml. Five patients required intraoperative blood transfusion (33.3%, 5/15). The mean transfused RBC was 4 U (range 2-6 U), and the mean transfused plasma was 200 ml (range 200-400 ml). The mean drainage duration was 3 days (range 2–5 days). The mean postoperative hospitalization was 4.7 days. No patients experienced intraoperative complications. The mean serum creatine was slightly higher after surgery (53.1 vs. 55.9 μmol/L). One patient had postoperative perirenal fluid collection. No patients needed dialysis. No recurrence was observed in the patients at the median follow-up of 24.1 months.ConclusionsOur initial experience shows that the emergency retroperitoneal LPN is a safe, minimally invasive procedure for emergency patients with ruptured renal AMLs. It could be considered as an effective alternative to renal artery embolization in selected emergency patients.
Highlights
To assess the safety, tumor control and renal function preservation of the emergency retroperitoneal laparoscopic partial nephrectomy (LPN) for ruptured renal angiomyolipoma (AML) and summarize our single-center initial experience
About 80% of renal AMLs are sporadic, and the remaining 20% of cases are diagnosed as tuberous sclerosis complex (TSC), which is an autosomal dominant disorder characterized by a series of benign tumors involving multiple systems [2]
We retrospectively reviewed our institutional registry to identify patients treated with emergency LPN for ruptured renal AMLs over the period of January 2016 to May 2019
Summary
Tumor control and renal function preservation of the emergency retroperitoneal laparoscopic partial nephrectomy (LPN) for ruptured renal angiomyolipoma (AML) and summarize our single-center initial experience. Renal angiomyolipoma (AML) is a common benign mesenchymal tumor consisting of variable proportions of three elements: peculiar blood vessels, smooth muscle fibers and adipocyte clusters; the incidence is 0.4% in the general population, accounting for ~ 3% of renal masses [1]. About 80% of renal AMLs are sporadic, and the remaining 20% of cases are diagnosed as tuberous sclerosis complex (TSC), which is an autosomal dominant disorder characterized by a series of benign tumors involving multiple systems [2]. The blood vessels in the tumors lack the internal elastic lamina, and the smooth muscle is disrupted, leading the renal AMLs to be prone to aneurysm formation and rupture [3]. Prophylactic or therapeutic treatment strategies are available spanning the spectrum of conservative, embolization or surgery based on the presence of symptoms and the lesion size
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