Wen Deng1, Zhengtao Zhou2, Jian Zhong3, Junhua Li4, Xiaoqiang Liu5, Luyao Chen6, Jingyu Zhu7, Bin Fu8, Gongxian Wang9. 1. Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China; Jiangxi Institute of Urology, Nanchang City, Jiangxi Province, China. Electronic address: urodeng@126.com. 2. Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China; Jiangxi Institute of Urology, Nanchang City, Jiangxi Province, China. Electronic address: 1792396974@qq.com. 3. Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China; Department of Urology, Nankang Chinese Medicine Hospital, Ganzhou City, Jiangxi Province, China. Electronic address: zjian139@126.com. 4. Department of Urology, Third Hospital of Hangzhou, Hangzhou City, Zhejiang Province, China. Electronic address: lijunhua7016@163.com. 5. Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China; Jiangxi Institute of Urology, Nanchang City, Jiangxi Province, China. Electronic address: shaw177@163.com. 6. Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China. Electronic address: chenluyao301@163.com. 7. Department of Urology, Third Hospital of Hangzhou, Hangzhou City, Zhejiang Province, China. Electronic address: zhujingyu0309@126.com. 8. Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China; Jiangxi Institute of Urology, Nanchang City, Jiangxi Province, China. Electronic address: urofbin@163.com. 9. Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, China; Jiangxi Institute of Urology, Nanchang City, Jiangxi Province, China. Electronic address: urowgx@163.com.
Abstract
INTRODUCTION: To assess the safety and efficiency of retroperitoneal laparoscopic partial nephrectomy (RLPN) and retroperitoneal laparoscopic radical nephrectomy (RLRN) for large (≥4 cm) renal tumors with a RENAL nephrometry score ≥7. MATERIALS AND METHODS: We retrospectively identified and analyzed the data of 254 patients who underwent RLPN or RLRN for large (≥4 cm) and anatomically complex renal tumors between 2008 and 2017. Propensity score matching (PSM) (1:1) method was conducted to adjust for preoperative clinical characteristics. Preoperative, renal functional, and oncological outcomes were compared. RESULTS: Finally, no significant differences in the baseline characteristics existed between the two groups after PSM. Within the well-balanced matched cohort, longer operating time (OT) and higher estimated blood loss (EBL) were found in RLPN group (p = 0.015 and p = 0.019, respectively), and RLPN trended to protect renal function better at a higher risk of low-grade complications (-10.9 vs -16.8 ml/min, p = 0.001; 23.0% vs 10.8%, p = 0.048, respectively). The patients in the RLPN group had a better overall survival (OS) than those in RLRN group, but cancer-specific survival and progression-free survival didn't differ significantly between the two groups. CONCLUSION: For patients with large (≥4 cm) and anatomically complex renal tumors, RLPN by highly experienced hands has an evident tendency to a better protection of renal function and a longer OS without waiving oncological control in comparison with RLRN, but at the expense of longer OT, a higher EBL and a higher risk of low-grade complications.
INTRODUCTION: To assess the safety and efficiency of retroperitoneal laparoscopic partial nephrectomy (RLPN) and retroperitoneal laparoscopic radical nephrectomy (RLRN) for large (≥4 cm) renal tumors with a RENAL nephrometry score ≥7. MATERIALS AND METHODS: We retrospectively identified and analyzed the data of 254 patients who underwent RLPN or RLRN for large (≥4 cm) and anatomically complex renal tumors between 2008 and 2017. Propensity score matching (PSM) (1:1) method was conducted to adjust for preoperative clinical characteristics. Preoperative, renal functional, and oncological outcomes were compared. RESULTS: Finally, no significant differences in the baseline characteristics existed between the two groups after PSM. Within the well-balanced matched cohort, longer operating time (OT) and higher estimated blood loss (EBL) were found in RLPN group (p = 0.015 and p = 0.019, respectively), and RLPN trended to protect renal function better at a higher risk of low-grade complications (-10.9 vs -16.8 ml/min, p = 0.001; 23.0% vs 10.8%, p = 0.048, respectively). The patients in the RLPN group had a better overall survival (OS) than those in RLRN group, but cancer-specific survival and progression-free survival didn't differ significantly between the two groups. CONCLUSION: For patients with large (≥4 cm) and anatomically complex renal tumors, RLPN by highly experienced hands has an evident tendency to a better protection of renal function and a longer OS without waiving oncological control in comparison with RLRN, but at the expense of longer OT, a higher EBL and a higher risk of low-grade complications.