Laparoscopic partial nephrectomy for >4 cm renal masses.

INTRODUCTION: Laparoscopic partial nephrectomy (LPN) is frequently used to manage cT1a renal masses. While data on safety and long-term oncological outcomes of LPN for T1a tumours are widely available, it is limited for >T1a lesions. We report our experience with LPN for >4 cm renal masses from a Canadian tertiary centre.
METHODS: Between January 2003 and July 2011, 52 consecutive LPN for >4 cm renal masses were performed. Demographic, pathological and clinical data were obtained from a prospectively maintained database.
RESULTS: The mean patient age was 60 years (62% male). Median tumour size was 4.8 (range: 4.2-11) cm. The median surgical time was 145 minutes, and the median estimated blood loss was 100 mL. The median warm ischemia time was 24 minutes. Four (7.7%) cases required conversion to open surgery. One case was converted to total nephrectomy for clinical and pathological evidence of T3 disease. The surgical margin was positive in 1 case (1.9%). Four (7.7%) patients developed a urine leak postoperatively; 3 of them managed with a ureteric stent. Four (7.7%) patients developed postoperative bleeding requiring selective angioembolization. The median hospital stay was 4 days. There was no statistically significant difference between preoperative and postoperative estimated glomerular filtration rate and mean arterial blood pressure (p = 0.5, p = 0.1, respectively).
CONCLUSION: This series demonstrates that LPN although technically challenging has acceptable short-term surgical outcomes. Long-term assessment of oncological outcomes is required. Laparoscopic partial nephrectomy >4 cm renal tumours should not be considered a standard of care, but excellent results can be achieved in well-selected patients and in experienced hands with no impact in renal function or blood pressure.