PURPOSE: Open partial nephrectomy (OPN) is now the preferred treatment for most T1a and selected T1b tumours. Laparoscopic partial nephrectomy (LPN), created to reduce the morbidity associated with OPN, is now a viable option when performed by experienced laparoscopic surgeons. We retrospectively review our LPN experience and propose a new parameter, the LPN utilization rate (LPN-UR), defined as the probability of any referred patient with a T1 tumour undergoing LPN before the surgeon's knowledge of its imaging characteristics, to define the role of LPN at our institution. METHODS: Between March 2003 and August 2008, 47 consecutive patients underwent LPN for T1 tumours. All patients underwent transient en bloc vascular occlusion of the renal hilum for cold-scissor tumour excisions. Preoperative, intraoperative, postoperative and pathological data were collected. The LPN-URs for 2005, 2006, 2007 and 2008 were calculated. RESULTS: There were 31 nonhilar tumours and 16 hilar tumours. All procedures were completed laparoscopically. Mean tumour size was 3.8 (range 1.5-7.2) cm. Mean operating time was 2.8 (range 1.2-4.5) hours. Mean hospital stay was 5.2 (range 2.0-15.0) days. Mean warm ischemic time (WIT) was 32.7 (range 14.2-50.4) minutes. Six patients (12.8%) received blood transfusions and 1 patient required an emergency nephrectomy for bleeding. One patient developed urinary leakage. One patient developed a late calyceal stricture. Mean postoperative differential renal function was 35%:50%. Median follow-up was 18 months. Pathological examination of all tumours revealed 38/47 (80.9%) malignant tumours with 2 positive surgical margins (4.3%). The LPN-URs for 2005, 2006, 2007 and 2008 were 50%, 54%, 63% and 93%, respectively, for all T1 tumours. CONCLUSION: Laparoscopic partial nephrectomy can be safely performed and used for treatment of most T1 tumours referred to our institution. Long-term follow-up will be required to determine the oncological efficacy of LPN. Every effort should be made to further reduce the WIT. The LPN-UR is a useful parameter for consulting referring physicians and patients.
PURPOSE: Open partial nephrectomy (OPN) is now the preferred treatment for most T1a and selected T1b tumours. Laparoscopic partial nephrectomy (LPN), created to reduce the morbidity associated with OPN, is now a viable option when performed by experienced laparoscopic surgeons. We retrospectively review our LPN experience and propose a new parameter, the LPN utilization rate (LPN-UR), defined as the probability of any referred patient with a T1 tumour undergoing LPN before the surgeon's knowledge of its imaging characteristics, to define the role of LPN at our institution. METHODS: Between March 2003 and August 2008, 47 consecutive patients underwent LPN for T1 tumours. All patients underwent transient en bloc vascular occlusion of the renal hilum for cold-scissor tumour excisions. Preoperative, intraoperative, postoperative and pathological data were collected. The LPN-URs for 2005, 2006, 2007 and 2008 were calculated. RESULTS: There were 31 nonhilar tumours and 16 hilar tumours. All procedures were completed laparoscopically. Mean tumour size was 3.8 (range 1.5-7.2) cm. Mean operating time was 2.8 (range 1.2-4.5) hours. Mean hospital stay was 5.2 (range 2.0-15.0) days. Mean warm ischemic time (WIT) was 32.7 (range 14.2-50.4) minutes. Six patients (12.8%) received blood transfusions and 1 patient required an emergency nephrectomy for bleeding. One patient developed urinary leakage. One patient developed a late calyceal stricture. Mean postoperative differential renal function was 35%:50%. Median follow-up was 18 months. Pathological examination of all tumours revealed 38/47 (80.9%) malignant tumours with 2 positive surgical margins (4.3%). The LPN-URs for 2005, 2006, 2007 and 2008 were 50%, 54%, 63% and 93%, respectively, for all T1 tumours. CONCLUSION: Laparoscopic partial nephrectomy can be safely performed and used for treatment of most T1 tumours referred to our institution. Long-term follow-up will be required to determine the oncological efficacy of LPN. Every effort should be made to further reduce the WIT. The LPN-UR is a useful parameter for consulting referring physicians and patients.
Authors: William C Huang; Andrew S Levey; Angel M Serio; Mark Snyder; Andrew J Vickers; Ganesh V Raj; Peter T Scardino; Paul Russo Journal: Lancet Oncol Date: 2006-09 Impact factor: 41.316
Authors: Brian R Lane; Mary K Samplaski; Brian R Herts; Ming Zhou; Andrew C Novick; Steven C Campbell Journal: J Urol Date: 2007-11-13 Impact factor: 7.450
Authors: Inderbir S Gill; Louis R Kavoussi; Brian R Lane; Michael L Blute; Denise Babineau; J Roberto Colombo; Igor Frank; Sompol Permpongkosol; Christopher J Weight; Jihad H Kaouk; Michael W Kattan; Andrew C Novick Journal: J Urol Date: 2007-05-11 Impact factor: 7.450