Preoperative superselective transarterial embolization in laparoscopic partial nephrectomy: technique, oncologic, and functional outcomes.

INTRODUCTION: We report the mid-term oncologic and functional results of a series of 110 patients treated with transperitoneal laparoscopic partial nephrectomy (LPN) after superselective arterial embolization (SEA).
MATERIALS AND METHODS: Between August 2003 and August 2007, 110 patients underwent LPN after SEA for T1 renal tumors. All data were collected in a prospectively maintained database. Mean age of patients was 61 (range 37-80), and mean tumor size was 4.4 cm (range 2.5-6.5). Angiographic procedure was performed by a single experienced radiologist, and surgical procedure was performed by a single experienced surgeon. Perioperative data were collected and analyzed. Renal function was evaluated by preoperative and 3- and 12-month postoperative (99m)Tc diethylenetetramine pentacetic acid renal scans.
RESULTS: Mean operative time was 58 minutes (range 35-220), and mean blood loss was 106 mL (range 20-800). No conversion to open surgery occurred; in one patient radical nephrectomy was necessary because of the total intraparenchymal growth of the tumor. Mean hospital stay was 3.2 days (range 2-12). Pathologic analyses found 33 benign tumors in 31 patients and renal cell carcinoma in 79 cases (26 pT1a, 45 pT1b, 6 pT2, and 2 pT3a). At a median follow-up of 41 months, computed tomography scan revealed two local recurrences, one of which not confirmed by pathologic evaluation after radical nephrectomy. One patient died of disease 1 year after surgery. When matching preoperative and 1-year postoperative renal scan, median decrease of glomerular filtration rate was 5% (range 0%-9%).
CONCLUSIONS: Preoperative SEA allows us to perform LPN without clamping hilum vessels and so without time threshold related to ischemic damage. Oncological outcome is comparable to that of open surgery, and functional results are encouraging, thanks to the optimal preservation of renal function.