Experiences of laparoscopic partial nephrectomy for T1a kidney tumours: Results of two hundred and fifteen patients

Abstract

Objective: The best therapeutic option for renal tumours smaller than 7 cm is partial nephrectomy. The aim of this study was to compare the positive surgical margin (PSM) rates, recurrence rates and oncological outcomes between laparoscopic partial nephrectomies and open partial nephrectomies at a single tertiary referral centre.

Materials and Methods: We included patients with renal tumours treated with partial nephrectomies between January 2008 and December 2016 in the study. We retrospectively reviewed the patients' demographic data, surgical reports, clinical charts, laboratory results and histopathological reports. Binary regression analysis was used to assess the impact of the tumour diameter, laterality, polarity and localization for PSM.

Results: We included a total of 215 patients in the study. The mean preoperative and postoperative haemoglobin and creatinine levels, blood loss, time of surgery and follow-up periods was similar between the two groups. The mean ischaemic time in the open partial nephrectomy group was significantly lower than that of the laparoscopic partial nephrectomy group (p<0.05). Local recurrence was seen in a patient with a PSM in the laparoscopic partial nephrectomy group. However, recurrences were also seen in the negative surgical margin patients in both the open partial nephrectomy and laparoscopic partial nephrectomy groups.

Conclusion: The presence of a PSM is not associated with an increased risk of distant metastases or local recurrences. However, higher PSM rates were associated with the early learning curve for a laparoscopic procedure. Finally, an open partial nephrectomy is associated with shorter warm ischaemia time compared to laparoscopic partial nephrectomy group.