Laparoscopic partial nephrectomy: An experience in 227 cases

Abstract

ObjectiveTo evaluate our long-term experience with laparoscopic partial nephrectomy (LPN) and to review the literature. Material and methodsWe performed a retrospective chart review, evaluating 227 consecutives laparoscopic partial nephrectomies performed between June 1995 and June 2010. Perioperative data were recorded along with clinical a oncological outcomes. ResultsMean age was 56.4years (18–87) and clinical stages were T1a, T1b and T2 in 90.74% (206/227), 7.48% (17/227) and 1.76% (4/227), respectively. Median blood loss was 250ml (10–1800). The mean operative time was 108.42min (30–240) and median warm ischemia time was 25min (10–60). The intraoperative complication rate was 2.64% (6/227), 5 (2.2%) secondary to bleeding. The postoperative complication rate was 5.72% (13/227) and bleeding is also the most frequent in 3% (7/227) of the cases. According to the Clavien classification, 1.32% (3/227), 0.88% (2/227) and 3.52% (8/227) were grade i, ii and iiib, respectively. The mean hospital stay was 3.66 days (1–12).Clear cell carcinoma was the most common histological finding in 74.6% (150patients). TNM classification was T1a, T1b and T2 in 90.74% (206/227), 7.48% (17/227) and 1.76% (4/227), respectively. No conversion or mortality was reported. Positive surgical margins were found in 4 patients (2.7%), with no local recurrence after long-term follow-up. At a mean follow up of 27months, one patient had port site and peritoneal recurrence. ConclusionLaparoscopic partial nephrectomy is a safe and viable alternative to open partial nephrectomy, providing equivalent oncologic outcomes and comparable morbidity to the traditional approach in experienced centers.