Open partial nephrectomy with modified technique: Comparison to results from contemporary laparoscopic series.

Abstract

473 Background: To evaluate the surgical and oncological outcome of patients undergoing a modified procedure of open partial nephrectomy which was done with a new technique leaving out selective suturation of renal calices and vessels. Methods: We analyzed 120 consecutive open partial nephrectomies (2005-2010) which were performed with a modified technique at a mid-volume center. This technique included the use of an absorbable non-woven textile consisting of polyglycolic acid, extra-large needles and argon plasma coagulation. The surgical and oncological outcome was evaluated by statistical analysis of the medical records. Results: The mean patient age was 62.8 years (52.6% male). Mean pathological tumor size was 3.0 cm (± 1.4 cm), 53.3% of the tumors were renal cell carcinoma. The mean operative time was 101.7 minutes (±33.6 min) and the mean blood loss was 283.9 ml (±368.5 ml). Ischemia was performed in 23.1% with a mean warm ischemia time of 13.3 minutes ( ± 6.4 min). The operative complication rate was 1.7 %. Topical hemostatic agents were used in 20.2 %. The most frequent postoperative complications were bleeding (5%), pleural effusion (4.2%), urinoma (2.5%), pneumonia (2.5%), wound infection (2.5%) and acute renal failure (2.5%). Five-year cancer specific survival rate was 94.1%. Conclusions: The modified technique of open partial nephrectomy can be performed with high surgical and oncologic safety. Duration of the procedure and ischemia time are short. Due to the rare use of hemostatic agents, the costs can be reduced. Open partial nephrectomy with this technique achieve better results than reported from contemporary reported laparoscopic series, especially regarding warm ischemia and time needed for surgery.