2022, Number 3
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Rev Mex Urol 2022; 82 (3)
Laparoscopic enucleation of renal masses
González-León T, García-Morales I, López-Chacón A, López-Rodríguez I
Language: English
References: 29
Page:
PDF size: 291.80 Kb.
ABSTRACT
Introduction: Tumor Enucleation (TE) of renal masses as an alternative
of nephron-sparing surgery has increased in the past years.
Objectives: To describe the perioperative, oncological and functional
outcomes of laparoscopic TE in a series of patients with renal masses.
Material and method: A descriptive and retrospective study of 71
patients who underwent laparoscopic TE surgery for renal mass in
La Habana, Cuba at the Centro Nacional de Cirugía de Mínimo Acceso,
(CNCMA) between 2010 and 2019. Clinical-epidemiological and perioperative
variables, complications, Clavien-Dindo grade and oncological
variables were considered. The SPSS program, version 23.0 was utilized.
Frequencies, mean percentages, standard deviation and Student´s
t- test (p‹0.05) were estimated. Survival was appraised by using the
Kaplan Meier curve.
Results: Mean age was 58 years. Male patients prevailed (60.6%), with
comorbidities (87.3%), incidental diagnosis (73.2%), low complexity
tumors (64.8%). Mean tumor size and RENAL score was 33.6 mm and
6.1, respectively. Hand-assisted transperitoneal approach was performed
(92.9%), mean bleeding was 335.9 ml and length of hospital stay
5.2 days. Postoperative renal function was preserved (p=0.082). Postoperative
complications prevailed (14.1%), bleeding (8.4%) and grade
II and IV (4.2%, respectively). Most masses were malignant (71.8%),
ccRC prevailed (52.1%), pT1a (78.4%), overall survival and cancer specific
survival was 100% and 96.0%, respectively. Mean follow-up time
was 7.4 years.
Conclusions: Laparoscopic TE is a feasible alternative for treating select
renal masses, with satisfactory perioperative, oncological and functional
outcomes.
REFERENCES
Bray F, Ferlay J, Soerjomataram I, Siegel RL,Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence andmortality worldwide for 36 cancers in 185countries. CA: A Cancer Journal for Clinicians.2018;68(6):394–424. doi: https://doi.org/10.3322/caac.21492
Capitanio U, Bensalah K, Bex A, BoorjianSA, Bray F, Coleman J, et al. Epidemiologyof Renal Cell Carcinoma. Eur Urol. 2019Jan;75(1):74–84. doi: https://doi.org/10.1016/j.eururo.2018.08.036
Motzer RJ, Jonasch E, Michaelson MD,Nandagopal L, Gore JL, George S, et al.NCCN Guidelines Insights: Kidney Cancer,Version 2.2020. J Natl Compr Canc Netw.2019 Nov 1;17(11):1278–85. doi: https://doi.org/10.6004/jnccn.2019.0054
Jiang Y-L, Peng C-X, Wang H-Z, Qian L-J.Comparison of the long-term follow-up andperioperative outcomes of partial nephrectomyand radical nephrectomy for 4 cm to 7 cm renalcell carcinoma: a systematic review and metaanalysis.BMC Urology. 2019 Jun 7;19(1):48. doi:https://doi.org/10.1186/s12894-019-0480-6
Leppert JT, Lamberts RW, Thomas I-C, ChungBI, Sonn GA, Skinner EC, et al. Incident CKDafter Radical or Partial Nephrectomy. J Am SocNephrol. 2018 Jan;29(1):207–16. doi: https://doi.org/10.1681/asn.2017020136
García AG, León TG. Simple Enucleation forRenal Tumors: Indications, Techniques, andResults. Curr Urol Rep. 2016 Jan;17(1):7. doi:https://doi.org/10.1007/s11934-015-0560-4
Dong W, Chen X, Huang M, Chen X,Gao M, Ou D, et al. Long-Term OncologicOutcomes After Laparoscopic and RoboticTumor Enucleation for Renal Cell Carcinoma.Frontiers in Oncology. 2021;10. doi: https://doi.org/10.3389/fonc.2020.595457
General Assembly of the World MedicalAssociation. World Medical AssociationDeclaration of Helsinki: ethical principles formedical research involving human subjects. JAm Coll Dent. 2014;81(3):14–8.
Minervini A, Vittori G, Lapini A, Tuccio A,Siena G, Serni S, et al. Morbidity of tumourenucleation for renal cell carcinoma (RCC):results of a single-centre prospective study.BJU Int. 2012 Feb;109(3):372–7; discussion378. doi: https://doi.org/10.1111/j.1464-410x.2011.10360.x
Zhao X, Lu Q, Campi R, Ji C, Guo S, LiuG, et al. Endoscopic Robot-assisted SimpleEnucleation Versus Laparoscopic SimpleEnucleation With Single-layer Renorrhaphy inLocalized Renal Tumors: A Propensity ScorematchedAnalysis From a High-volume Centre.Urology. 2018 Nov;121:97–103. doi: https://doi.org/10.1016/j.urology.2018.08.015
Manno S, Dell’Atti L, Cicione A, SpasariA. Safety and efficacy of transperitoneallaparoscopic nephron sparing surgery inpatients with previous abdominal surgery. Urologia.2021 Feb;88(1):14–20. doi: https://doi.org/10.1177/0391560320921728
Porpiglia F, Mari A, Amparore D, Fiori C, AntonelliA, Artibani W, et al. Transperitonealvs retroperitoneal minimally invasive partialnephrectomy: comparison of perioperativeoutcomes and functional follow-up in a largemulti-institutional cohort (The RECORD 2Project). Surg Endosc. 2021 Aug;35(8):4295–304. doi: https://doi.org/10.1007/s00464-020-07919-4
Matos AC, Dall´Oglio MF, Colombo JR, CrippaA, Juveniz JAQ, Argolo FC. Predicting outcomesin partial nephrectomy: is the renal scoreuseful? Int Braz J Urol. 2017;43(3):422–31.doi: https://doi.org/10.1590%2FS1677-5538.IBJU.2016.0315
Shin SJ, Ko KJ, Kim TS, Ryoo HS, Sung HH,Jeon HG, et al. Trends in the Use of Nephron-Sparing Surgery over 7 Years: An Analysis Usingthe R.E.N.A.L. Nephrometry Scoring System.PLOS ONE. 2015 Nov 24;10(11):e0141709. doi:10.1371/journal.pone.0141709
Konstantinidis C, Trilla E, Serres X,Montealegre C, Lorente D, Castellón R, et al.Association among the R.E.N.A.L. nephrometryscore and clinical outcomes in patients withsmall renal masses treated with percutaneouscontrast enhanced ultrasound radiofrequencyablation. Cent European J Urol. 2019;72(2):92–9. doi: https://doi.org/10.5173/ceju.2019.1833
Tsivian M, Tsivian E, Stanevsky Y, BassR, Sidi AA, Tsivian A. Laparoscopic partialnephrectomy for tumors 7cm and above.Perioperative outcomes. Int Braz J Urol.2017 Oct;43(5):857–62. doi: https://doi.org/10.1590/s1677-5538.ibju.2016.0642
Rinott Mizrahi G, Freifeld Y, Klein I, BoyarskyL, Zreik R, Orlin I, et al. Comparison of Partialand Radical Laparascopic Nephrectomy:Perioperative and Oncologic Outcomes forClinical T2 Renal Cell Carcinoma. J Endourol.2018 Oct;32(10):950–4. doi: https://doi.org/10.1089/end.2018.0199
Dell’Atti L, Scarcella S, Manno S, Polito M,Galosi AB. Approach for Renal Tumors WithLow Nephrometry Score Through UnclampedSutureless Laparoscopic Enucleation Technique:Functional and Oncologic Outcomes. Clin GenitourinCancer. 2018 Dec;16(6):e1251–6. doi:https://doi.org/10.1016/j.clgc.2018.07.020
George Rahota R, Valean D, Dobrota F, AndrasI, Rahota AC, Maghiar TT, et al. Is 3Dlaparoscopic off clamp simple enucleation afeasible alternative for clinical T1 renal tumors?Outcomes from a single center experience. JBUON. 2021 Jun;26(3):1088–93.
Xu C, Lin C, Xu Z, Feng S, Zheng Y. TumorEnucleation vs. Partial Nephrectomy for T1Renal Cell Carcinoma: A Systematic Review andMeta-Analysis. Frontiers in Oncology. 2019;9.doi: https://doi.org/10.3389/fonc.2019.00473
Blackwell RH, Li B, Kozel Z, Zhang Z, ZhaoJ, Dong W, et al. Functional Implications ofRenal Tumor Enucleation Relative to StandardPartial Nephrectomy. Urology. 2017 Jan1;99:162–8. doi: https://doi.org/10.1016/j.urology.2016.07.048
Tonolini M, Ierardi AM, Varca V, IncarboneGP, Petullà M, Bianco R. Multidetector CTimaging of complications after laparoscopicnephron-sparing surgery. Insights Imaging.2015 Aug;6(4):465–78. doi: https://doi.org/10.1007%2Fs13244-015-0413-1
Minervini A, Campi R, Di Maida F, MariA, Montagnani I, Tellini R, et al. Tumorparenchymainterface and long-term oncologicoutcomes after robotic tumor enucleation forsporadic renal cell carcinoma. Urol Oncol. 2018Dec;36(12):527.e1-527.e11. doi: https://doi.org/10.1016/j.urolonc.2018.08.014
Dominique I, Dariane C, Fourniol C, LeGuilchet T, Hurel S, Fontaine E, et al. Performingan early systematic Doppler-ultrasound failsto prevent hemorrhagic complications aftercomplex partial nephrectomy. Ther Adv Urol.2019 Dec;11:1756287219828966. doi: https://doi.org/10.1177/1756287219828966
Chen J, Yang M, Wu P, Li T, Ning X, PengS, et al. Renal Arterial Pseudoaneurysm andRenal Arteriovenous Fistula Following PartialNephrectomy. Urol Int. 2018;100(3):368–74.doi: https://doi.org/10.1159/000443700
Ren W, Xue B, Qu J, Liu L, Li C, Zu X. Localizedchromophobe renal cell carcinoma: preoperativeimaging judgment and laparoscopic simpleenucleation for treatment. Int Braz J Urol.2018 Oct;44(5):922–32. doi: https://doi.org/10.1590/s1677-5538.ibju.2017.0519
Wang L, Hughes I, Snarskis C, Alvarez H,Feng J, Gupta GN, et al. Tumor enucleationspecimens of small renal tumors morefrequently have a positive surgical marginthan partial nephrectomy specimens, but thisis not associated with local tumor recurrence.Virchows Arch. 2017 Jan;470(1):55–61. doi:https://doi.org/10.1007/s00428-016-2031-9
Cao D-H, Liu L-R, Fang Y, Tang P, Li T, Bai Y, etal. Simple tumor enucleation may not decreaseoncologic outcomes for T1 renal cell carcinoma:A systematic review and meta-analysis. UrolOncol. 2017 Nov;35(11):661.e15-661.e21. doi:https://doi.org/10.1016/j.urolonc.2017.07.007
Minervini A, Campi R, Lane BR, De CobelliO, Sanguedolce F, HatzichristodoulouG, et al. Impact of Resection Technique onPerioperative Outcomes and Surgical Marginsafter Partial Nephrectomy for Localized RenalMasses: A Prospective Multicenter Study. J Urol.2020 Mar;203(3):496–504. doi: https://doi.org/10.1097/ju.0000000000000591