Laparoscopic Retroperitoneal Enucleation-Separation Surgery for Renal Angiomyolipoma: Perioperative and Oncologic Outcomes Based on a Randomized Controlled Trial.

Abstract

To report a novel technique of laparoscopic retroperitoneal enucleation-separation surgery for specifically located renal angiomyolipoma (RAML) treated in our institute. We prospectively analyzed 40 patients who were randomized and received laparoscopic simple enucleation (Group 1) or enucleation-separation (Group 2) from January 2011 to February 2013. Patient characteristics, perioperative outcomes, renal function, and oncologic outcomes were compared between the groups. Average age, body mass index, sex distribution, tumor location and size, and operative time showed no significant difference between the two groups (p > 0.05). Average warm ischemia time in Group 1 was longer than that in Group 2 (25.3 minutes vs 17.6 minutes, p = 0.001). No complications except for one postoperative hemorrhage that occurred in Group 1 were observed. An improved early affected renal function recovery was observed in the Group 2 (percentage of glomerular filtration rate reduction for Group 1 vs Group 2, 24.3% vs 18.3%; p = 0.001). No local recurrences were found during the follow-up period. Laparoscopic simple enucleation and enucleation-separation technique are safe, efficient, and minimally invasive therapies for selected patients with RAMLs. In addition, the enucleation-separation appears to significantly minimize the warm ischemia injury and results in superior short-term renal function preservation, which could be a nephron-sparing alternative for the treatments of RAMLs.