Qun Lu1, Xiaozhi Zhao1, Changwei Ji1, Suhan Guo2, Guangxiang Liu1, Shiwei Zhang1, Xiaogong Li1, Weidong Gan1, Hongqian Guo3. 1. Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China. 2. School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China. 3. Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China. dr.guohongqian@gmail.com.
Abstract
OBJECTIVES: To compare modified laparoscopic simple enucleation (MLSE) and standard laparoscopic partial nephrectomy (SLPN) for treating localized renal cell carcinoma in our large institutional experience. METHODS: We evaluated 385 consecutive patients who underwent MLSE or SLPN for renal tumors in our institution from January 2013 to December 2015 in terms of perioperative pathological and oncologic outcome variables. During MLSE, the single-layer suture technique was performed for renal reconstruction. RESULTS: In total, 280 patients underwent MLSE and 105 underwent SLPN. Mean operative time was 182.1 and 192.8 min, respectively (p = 0.078). Warm ischemic time was significantly lower in the MLSE than SLPN group (23.2 vs 25.4 min; p = 0.004). The estimated blood loss was similar (p = 0.537). Tumor bed suturing was performed in 9.3 and 82.9% of MLSE and SLPN cases (p = 0.000). No hilar clamping was needed for 29 MLSE patients (10.4%) and 4 SLPN patients (3.8%) (p = 0.041). Grade III complications were reported in 5 (1.8%) MLSE patients and 7 (6.6%) SLPN patients (p = 0.034). The incidence of positive surgical margins was comparable between the MLSE and SLPN groups (1.8 and 5.7%, p = 0.086). After a median follow-up of 18 months, recurrence did not differ between the 2 groups: 9 (3.2%) MLSE patients and 4 (3.8%) SLPN patients (p = 1.000). CONCLUSIONS: MLSE may confer shorter warm ischemic time, almost no need for tumor bed suturing and less grade III complications than SLPN, with similar oncologic outcomes. MLSE may be safe and acceptable for patients undergoing partial nephrectomy.
OBJECTIVES: To compare modified laparoscopic simple enucleation (MLSE) and standard laparoscopic partial nephrectomy (SLPN) for treating localized renal cell carcinoma in our large institutional experience. METHODS: We evaluated 385 consecutive patients who underwent MLSE or SLPN for renal tumors in our institution from January 2013 to December 2015 in terms of perioperative pathological and oncologic outcome variables. During MLSE, the single-layer suture technique was performed for renal reconstruction. RESULTS: In total, 280 patients underwent MLSE and 105 underwent SLPN. Mean operative time was 182.1 and 192.8 min, respectively (p = 0.078). Warm ischemic time was significantly lower in the MLSE than SLPN group (23.2 vs 25.4 min; p = 0.004). The estimated blood loss was similar (p = 0.537). Tumor bed suturing was performed in 9.3 and 82.9% of MLSE and SLPN cases (p = 0.000). No hilar clamping was needed for 29 MLSE patients (10.4%) and 4 SLPN patients (3.8%) (p = 0.041). Grade III complications were reported in 5 (1.8%) MLSE patients and 7 (6.6%) SLPN patients (p = 0.034). The incidence of positive surgical margins was comparable between the MLSE and SLPN groups (1.8 and 5.7%, p = 0.086). After a median follow-up of 18 months, recurrence did not differ between the 2 groups: 9 (3.2%) MLSE patients and 4 (3.8%) SLPN patients (p = 1.000). CONCLUSIONS: MLSE may confer shorter warm ischemic time, almost no need for tumor bed suturing and less grade III complications than SLPN, with similar oncologic outcomes. MLSE may be safe and acceptable for patients undergoing partial nephrectomy.
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