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 研究目的：评估并报告腹腔镜部分肾切除术（laparoscopic partial nephrectomy, LPN）治疗T2期肾占位的临床结局。 材料与方法：对2005年至2016年间接受LPN治疗的临床局限性、直径≥7cm肾占位患者开展回顾性分析。对患者人口统计学特征、病灶特点、围手术期指标（手术时长、热缺血时间（warm ischemia time, WIT）、估计失血量（estimated blood loss, EBL）、术中及术后并发症（IOC、POC））以及病理指标（病理类型、亚型及Fuhrman分级（Fuhrman grade））进行描述性统计分析。 结果：2005年至2016年初，本中心共有27例患者因T2期肾占位接受LPN治疗，其中男性19例。患者平均年龄66岁（范围52~72岁）。所有手术均采用经腹腔入路，右侧病灶16例，左侧病灶11例。中位手术时长为200分钟（四分位间距181~236分钟），中位热缺血时间为19分钟（四分位间距16~23分钟），估计失血量为125mL（四分位间距75~175mL）。1例患者因疑似肾静脉瘤栓，术中转为腹腔镜根治性肾切除术。1例多发肾肿瘤患者的1枚病灶手术切缘阳性。共发生术中并发症2例（7.4%）、术后并发症3例（11%），均为Clavien分级（Clavien grade）3级并发症。 结论：据我们所知，本研究系列是首个报道LPN治疗临床T2期肾占位预后的研究。在本队列中，针对较大肾占位的LPN治疗具备可行性，且围手术期结局良好。未来仍需更多研究数据进一步探索微创外科术式在较大肾占位治疗中的获益。