Abstract
ObjectivesTo compare simple enucleation (SE) and standard partial nephrectomy (SPN) in terms of surgical results in a multicenter dataset (RECORd Project). Materials and methodspatients treated with nephron sparing surgery (NSS) for clinical T1 renal tumors between January 2009 and January 2011 were evaluated. Overall, 198 patients who underwent SE were retrospectively matched to 198 patients who underwent SPN. The SPN and SE groups were compared regarding intraoperative, early post-operative and pathologic outcome variables. Multivariable analysis was applied to analyze predictors of positive surgical margin (PSM) status. ResultsSE was associated with similar WIT (18 vs 17.8 min), lower intraoperative blood loss (177 vs 221 cc, p = 0.02) and shorter operative time (121 vs 147 min; p < 0.0001). Surgical approach (laparoscopic vs. open), tumor size and type of indication (elective/relative vs absolute) were associated with WIT >20 min. The incidence of PSM was significantly lower in patients treated with SE (1.4% vs 6.9%; p = 0.02). At multivariable analysis, PSM was related to the surgical technique, with a 4.7-fold increased risk of PSM for SPN compared to SE. The incidence of overall, medical and surgical complications was similar between SE and SPN. ConclusionsType of NSS technique (SE vs SPN) adopted has a negligible impact on WIT and postoperative morbidity but SE seems protective against PSM occurrence.
Highlights
In the last decades, a net increase in the detection of small incidental renal masses has been observed and nephron-sparing surgery (NSS), aimed to preserve the largest amount of healthy renal tissue while obtaining similar oncologic outcomes of radical nephrectomy (RN), has become more popular.[1,2] Standard partial nephrectomy (SPN) consisting in the tumor removal with an adequate safety margin of health parenchyma is still considered as the gold standard technique.[3]
198 patients that underwent SPN were matched with 198 patients that underwent simple enucleation (SE)
Hilar clamping was done in 122 patients (61.7%) in the SPN group and in 138 patients (69.7%) in the SE group
Summary
A net increase in the detection of small incidental renal masses has been observed and nephron-sparing surgery (NSS), aimed to preserve the largest amount of healthy renal tissue while obtaining similar oncologic outcomes of radical nephrectomy (RN), has become more popular.[1,2] Standard partial nephrectomy (SPN) consisting in the tumor removal with an adequate safety margin of health parenchyma is still considered as the gold standard technique.[3] In the last decades, some Authors demonstrated that healthy parenchyma surrounding the tumor can be limited to a few millimeters without compromising the oncologic safety of partial nephrectomy (PN).[4] the mean thickness of the safety margin surrounding the tumor ranges from 2.5 mm to 5 mm, some studies clearly demonstrated that the minimum values of thickness of the safety margin ranges between 0 mm and 1 mm above all at the bottom of the tumor.[1] This variability of the thickness of the safety margin might be influenced by several anatomical and topographic tumor features. The objective of present study was to compare intraoperative and early post-operative outcomes observed in two recent cohort of patients who underwent SE or SPN for parenchymal renal masses
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