Laparoscopic partial nephrectomy for tumors 7cm and above. Perioperative outcomes

ABSTRACT Purpose: To assess and report the outcomes of laparoscopic partial nephrectomy) LPN) for T2 renal masses. Materials and Methods: Retrospective review of patients undergoing LPN for clinically localized renal masses ≥7cm between the years 2005-2016. Descriptive analyses were generated for demographics, lesion characteristics, perioperative variables (operative time, warm ischemia time (WIT), estimated blood loss (EBL), intra-operative and postoperative complications (IOC and POC) and pathologic variables (pathology, subtype and Fuhrman grade). Results: A total of 27 patients underwent LPN for a T2 renal mass at our institution between 2005 and early 2016 of which 19 were males. The mean age was 66 (52-72). All procedures were transperitoneal with 16 on the right and 11 on the left. Median operative time was 200 minutes (IQR 181-236) and median WIT 19 minutes (IQR 16-23). EBL was 125mL (IQR 75-175). One case was converted to laparoscopic radical nephrectomy due to suspected tumor thrombus in the renal vein. Surgical margins were positive in one renal tumor in a patient with multiple tumors. There was a total of 2 IOC (7.4%) and 3 POC (11%) classified as Clavien grade 3. Conclusions: To our knowledge, this series is the first to describe the outcomes of LPN for cT2 renal masses. In our series, LPN for larger renal masses appears feasible with favorable perioperative outcomes. Additional data are needed to further explore the benefits of minimally invasive surgical approaches to larger renal masses.

摘要
目的：评估并报告腹腔镜部分肾切除术（laparoscopic partial nephrectomy, LPN）治疗T2期肾肿物的临床结局。
材料与方法：回顾性分析2005年至2016年间于本院接受LPN治疗的临床局限性肾肿物（直径≥7cm）患者资料。对患者的人口统计学特征、病灶特征、围手术期变量（包括手术时间、热缺血时间（WIT）、估计失血量（EBL）、术中及术后并发症（IOC与POC））以及病理变量（病理类型、亚型及弗尔曼分级（Fuhrman grade））开展描述性统计分析。
结果：2005年至2016年初，本院共有27例T2期肾肿物患者接受LPN治疗，其中男性19例。患者平均年龄为66岁（年龄范围52~72岁）。所有手术均采用经腹腔入路，其中右侧手术16例，左侧手术11例。中位手术时间为200分钟（四分位距181~236分钟），中位热缺血时间为19分钟（四分位距16~23分钟），中位估计失血量为125mL（四分位距75~175mL）。1例患者因疑似肾静脉瘤栓，中转行腹腔镜根治性肾切除术。1例多发肾肿物患者的1枚肾肿瘤切缘呈阳性。共计发生2例术中并发症（占比7.4%）与3例术后并发症（占比11%），所有并发症均为Clavien 3级。
结论：据我们所知，本研究系列是首个报道LPN治疗临床T2期肾肿物临床结局的研究。在本队列中，针对较大肾肿物的LPN治疗具备可行性，且围手术期结局良好。未来尚需更多研究数据，进一步探讨微创外科手段治疗较大肾肿物的临床获益。