Mohamed Abdelhafez1,2, Amend Bastian1, Steffen Rausch1, Arnulf Stenzl1, Jens Bedke3, Stephan Kruck1. 1. Department of Urology, Eberhard Karls University, Tuebingen, Germany. 2. Department of Urology, Assiut University, Assiut, Egypt. 3. Department of Urology, Eberhard Karls University, Tuebingen, Germany jens.bedke@med.uni-tuebingen.de.
Abstract
BACKGROUND: At experienced centers, laparoscopic partial nephrectomy (LPN) can achieve similar results to those of open surgery (OPN). However, the role of LPN for complex tumors and imperative indications is under debate. PATIENTS AND METHODS: A total of 356 cases (186 LPN and 170 OPN) between 2005-2012 were reviewed. Clinical, surgical, pathological and radiological data, including PADUA classification were analyzed. RESULTS: In overall analysis, OPN was associated with higher tumor complexity (p≤0.03). Subgroup analysis of PADUA >8 tumors (n=85) showed no significant difference between LPN and OPN. In patients with unfavorable treatment characteristics (imperative indication/multifocal tumors, n=71) LPN was beneficial. In this subgroup, LPN led to better perioperative (p≤0.02) and postoperative (p≤0.04) outcome. CONCLUSION: Use of LPN is associated with favorable tumor characteristics. Although no advantage was shown for LPN for tumors with higher complexity (PADUA>8), this large series confirmed the superiority of LPN for imperative indication or multifocal tumors. Copyright
BACKGROUND: At experienced centers, laparoscopic partial nephrectomy (LPN) can achieve similar results to those of open surgery (OPN). However, the role of LPN for complex tumors and imperative indications is under debate. PATIENTS AND METHODS: A total of 356 cases (186 LPN and 170 OPN) between 2005-2012 were reviewed. Clinical, surgical, pathological and radiological data, including PADUA classification were analyzed. RESULTS: In overall analysis, OPN was associated with higher tumor complexity (p≤0.03). Subgroup analysis of PADUA >8 tumors (n=85) showed no significant difference between LPN and OPN. In patients with unfavorable treatment characteristics (imperative indication/multifocal tumors, n=71) LPN was beneficial. In this subgroup, LPN led to better perioperative (p≤0.02) and postoperative (p≤0.04) outcome. CONCLUSION: Use of LPN is associated with favorable tumor characteristics. Although no advantage was shown for LPN for tumors with higher complexity (PADUA>8), this large series confirmed the superiority of LPN for imperative indication or multifocal tumors. Copyright
Authors: Joseph A Baiocco; Mark W Ball; Asha K Pappajohn; Kareem N Rayn; Gennady Bratslavsky; Shawna L Boyle; William M Linehan; Adam R Metwalli Journal: Urol Oncol Date: 2019-03-20 Impact factor: 3.498