Laparoscopic partial nephrectomy of the renal hilum tumor

Sergeev V.P., Sergeeva A.A., Kochkin A.D., Martov A.G.

1) Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia (Head – corresponding member of RAS, Ph.D., MD, professor A.G. Martov), Moscow, Russia; 2) Medical Scientific and Educational Center of Lomonosov Moscow State University (Director – academician of RAS, Ph.D., MD, professor A.A. Kamalov), Moscow, Russia; 3) Urologic Center (chief – corresponding member of RAS, Ph.D., MD, professor A.G. Martov) of FBU "Central Clinical Hospital of Civil Aviation" (Chief – Ph.D., MD N.B. Zabrodina), Moscow, Russia; 4) Department of Urology, Faculty of Postgraduate Education “Privolzhskiy Research Medical University” (Head – Ph.D., MD A.D. Kochkin), Nizhny Novgorod, Russia

Aim. To discuss the feasibility, safety, and efficiency of conventional laparoscopic partial nephrectomy (LPN) for patients with renal hilar tumors. Material and methods. A single-center retrospective comparative study of perioperative results included 166 patients who have undergone LPN. Patients were divided into two groups. In the group 1, there were 44 patients with hilar tumor of any R.E.N.A.L. index, while the control group consisted of 122 patients with cortical tumors of R.E.N.A.L. >7. Perioperative factors and results were studied and compared. The rate and structure of intra- and postoperative complications, reasons for conversion, volume of blood loss and ischemia time, duration of the procedure and length of stay, as well as changes of glomerular filtration rate and creatinine were assessed. Results. There were no conversions to open approach or nephrectomy, as well as positive surgical margins. The RENAL score was higher for hilar tumor group (9 vs 8; p<0.001). No significant difference was obtained according to the frequency of complications, blood loss volume, warm ischemia time and length of stay (p>0.05 for all values). The average drop of hemoglobin level and glomerular filtration rate were also similar (p>0.05 for all values). Therefore, there were no any significant differences between groups except for three parameters. Among all patients with left-sided hilar tumors transmesocolic approach was used more often (31.6% vs 6.8%; p=0.025). Unlike standard procedures, about a third of hilar interventions were completed without renorrhaphy (8.2% vs 27.3% for the control and main groups, respectively; p=0.001). In the group 1, benign lesions were identified in 20.5%, while in the control group in 4.9% cases (p=0.002). Conclusion. Our study showed that conventional LPN is safe and efficient procedure even in cases of “complex” renal hilar tumors.

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About the Authors

Corresponding author: V.P. Sergeev – assistant at the Department of Urology and Andrology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Head of the Department of Oncourology of A.I. Burnazyan SRC FMBC, FMBA of Russia, Moscow, Russia; e-mail: garivas@yandex.ru

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