Abstract
PurposeThe purpose of this study was to report our approach of partial nephrectomy (PN) using a supra-12th rib mini-flank incision. We compared mini-incision open partial nephrectomy (MI-OPN) with open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN) to verify whether MI-OPN can be an alternative to OPN and LPN.MethodsThis was a retrospective single-center study including 194 patients who underwent partial nephrectomy (PN) between February 2005 and December 2010. Demographic, perioperative, and complication data were compared among the MI-OPN group, OPN group and LPN group.ResultsNo statistical differences were reported in either group for age, sex, BMI, tumour side (right or left kidney), RENAL nephrometry scores, PADUA score and preoperative eGFR. The operative time was longer in LPN group when compared with MI-OPN and OPN group (all P<0.001). The warm ischemia time of LPN group was longer than MI-OPN group (P = 0.032) and OPN group (P = 0.005). The length of stay of LPN group was shorter than OPN group (P = 0.018), but was similar to MI-OPN group (P = 0.094). The incidence of renal artery clamping was lower in OPN group when compared with MI-OPN and LPN group (all P<0.001). More estimated blood loss was found in OPN group when compared with MI-OPN group (p = 0.003) and LPN group (P = 0.014). The overall incidence of postoperative complications was similar.ConclusionsThe approach of MI-OPN can couple the benefits of both minimally invasive and open partial nephrectomy techniques with less estimated blood loss, shorter operative time, shorter length of stay, less postoperative complications, and a smaller incision. MI-OPN may be an effective alternative to laparoscopic or traditional open approaches, which maybe more suitable for the tumors with high RENAL nephrometry score or PADUA score.
Highlights
Partial nephrectomy (PN) for localised renal cell carcinoma (RCC) has an oncologic outcome similar to that of radical surgery [1]
mini-incision open partial nephrectomy (MI-open partial nephrectomy (OPN)) may be an effective alternative to laparoscopic or traditional open approaches, which maybe more suitable for the tumors with high RENAL nephrometry score or PADUA score
We compared miniincision open partial nephrectomy (MI-OPN) with open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN) to verify whether MI-OPN can be an alternative to OPN and LPN
Summary
Partial nephrectomy (PN) for localised renal cell carcinoma (RCC) has an oncologic outcome similar to that of radical surgery [1]. Patients with low-stage RCC (T1) should undergo nephronsparing surgery rather than radical nephrectomy whenever possible [2]. Laparoscopic partial nephrectomy (LPN) has been increasingly performed for selected small renal masses, because it has been shown to provide similar oncologic outcomes to that of open partial nephrectomy (OPN) [3,4]. LPN has a higher complication rate compared with open surgery [5]. Open partial nephrectomy currently remains as a standard of care for partial nephrectomy [2]. Three flank approaches have been used for open PN or RN, including subcostal, supracostal, and through the bed of a resected rib
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