Laparoscopic partial nephrectomy: the University of Saskatchewan (Regina division) experience

Abstract

Open partial nephrectomy (OPN) is now the preferred treatment for most T1a and selected T1b tumours. Laparoscopic partial nephrectomy (LPN), created to reduce the morbidity associated with OPN, is now a viable option when performed by experienced laparoscopic surgeons. We retrospectively review our LPN experience and propose a new parameter, the LPN utilization rate (LPN-UR), defined as the probability of any referred patient with a T1 tumour undergoing LPN before the surgeon's knowledge of its imaging characteristics, to define the role of LPN at our institution. Between March 2003 and August 2008, 47 consecutive patients underwent LPN for T1 tumours. All patients underwent transient en bloc vascular occlusion of the renal hilum for cold-scissor tumour excisions. Preoperative, intraoperative, postoperative and pathological data were collected. The LPN-URs for 2005, 2006, 2007 and 2008 were calculated. There were 31 nonhilar tumours and 16 hilar tumours. All procedures were completed laparoscopically. Mean tumour size was 3.8 (range 1.5-7.2) cm. Mean operating time was 2.8 (range 1.2-4.5) hours. Mean hospital stay was 5.2 (range 2.0-15.0) days. Mean warm ischemic time (WIT) was 32.7 (range 14.2-50.4) minutes. Six patients (12.8%) received blood transfusions and 1 patient required an emergency nephrectomy for bleeding. One patient developed urinary leakage. One patient developed a late calyceal stricture. Mean postoperative differential renal function was 35%:50%. Median follow-up was 18 months. Pathological examination of all tumours revealed 38/47 (80.9%) malignant tumours with 2 positive surgical margins (4.3%). The LPN-URs for 2005, 2006, 2007 and 2008 were 50%, 54%, 63% and 93%, respectively, for all T1 tumours. Laparoscopic partial nephrectomy can be safely performed and used for treatment of most T1 tumours referred to our institution. Long-term follow-up will be required to determine the oncological efficacy of LPN. Every effort should be made to further reduce the WIT. The LPN-UR is a useful parameter for consulting referring physicians and patients.