Partial Nephrectomy, a Comparison between Different Modalities: A Tertiary Care Center Experience.

Ahmed Al Asker,Saeed Bin Hamri,Mohammed Alghamdi,Saud Alawad,Abdulmalik Addar,Abdullah Alkhayal,Mohammed Alharbi,Nasser Albqami,Khaled Alrabeeah

doi:10.15586/jkcvhl.v8i2.179

Abstract

Kidney cancer, with 4% of all malignancies, is one of the most common malignancies occurring among in adults. In Saudi Arabia, kidney cancer comprises 2.3% of all cancers, and its incidence has increased by 33%. Partial nephrectomy (PN) is considered as the gold standard for T1 renal masses.In this retrospective study, we did a chart review for all patients who underwent PNs between April 2013 and February 2019. Data comprised presentation, tumor size, type of procedure (open vs. laparoscopic vs. robotic), and intra- and post-operative complications. Chi-square, ANOVA, and cross-tabulation were done using SPSS software. P > 0.05 was considered significant. Approval was obtained from the institutional review board of King Abdullah International Medical Research Center.In all, 69 patients were identified: 26 (37.7%) males and 43 (62.3%) females, with mean age = 54.53 ± 13.21 years; mean body mass index = 32.36 ± 7.03, and mean tumor size = 3.7 ± 1.72 cm. In terms of presentation, most patients (50, 72.4%) presented incidentally as opposed to symptomatic presentation. Of these patients, 18 (26.1%) underwent open partial nephrectomy (OPN), 29 (42%) laparoscopic partial nephrectomy (LPN), and 22 (31.9%) robotic partial nephrectomy (RPN). On comparing minimally invasive surgery (MIS) PN with OPN, we found that OPN had more blood loss and a longer hospital stay but a shorter operating room (OR) time.Results of PN irrespective of the procedure type, whether it was OPN, LPN, or RPN, were similar if performed by experienced surgeons. However, open procedures involved a higher blood loss, more operative time, and longer hospital stay when compared with minimally invasive techniques.

Highlights

In managing organ-confined tumors, radical resection has been the preferred management
8 (11.6%) laparoscopic partial nephrectomy (LPN) procedures were converted to open partial nephrectomy (OPN); no robotic partial nephrectomy (RPN) was converted to OPN (Table 1)
We found that OPN had more blood loss and a longer hospital stay but a shorter operating room (OR) time when compared with minimally invasive surgery (MIS) partial nephrectomy (PN), this observation was not statistically significant (P > 0.05)

Summary

Introduction

In managing organ-confined tumors, radical resection has been the preferred management. In renal cell carcinoma (RCC), radical nephrectomy was the gold standard in approaching solid renal masses. With the development of minimally invasive surgery (MIS), laparoscopic and robotic approaches have been used for treating RCC [1]. Partial nephrectomy (PN), has emerged in treating solid renal masses of 4–7 cm in diameter or clinical T1a and T1b renal masses. According to current guidelines of the American Urological Association and European Urological Association, PN is the standard of care for small renal masses, with robotic partial nephrectomy (RPN) and laparoscopic partial nephrectomy (LPN) being valid MIS options [2,3,4]. PN has the advantage of preserving renal function, and decreasing the risk of developing metabolic and cardiovascular disorders [5]

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Conclusion