Laparoscopic partial nephrectomy for hilar tumors: evaluation of short-term oncologic outcome.

摘要

OBJECTIVES: To present our experience performing laparoscopic partial nephrectomy (LPN) for hilar renal tumors and demonstrate the feasibility and short-term oncologic efficacy. METHODS: The patients who had undergone LPN for excision of a hilar tumor, defined as a renal tumor that came in direct contact with the renal artery and/or vein, were identified. The clinicopathologic parameters, perioperative course, complications, and oncologic outcomes were analyzed. RESULTS: A total of 18 patients with a hilar renal mass (4.4%) underwent elective LPN. The mean tumor size was 3.24 cm (range 1.3 to 8), and the mean preoperative creatinine was 1.04 mg/dL (range 0.6 to 1.8). The mean operating room and warm ischemia time was 173 minutes (range 93 to 337) and 29.4 minutes (range 17 to 50), respectively. The pelvicaliceal system was entered and repaired in 10 patients (55.6%), and the median estimated blood loss was 394.4 mL (range 100 to 1500). The mean hospital stay was 3 days (range 2 to 5). Histopathologic examination confirmed renal cell carcinoma in 13 patients (72.2%). The surgical margins and frozen sections of the tumor base were negative in all cases. The tumor stage was pT1 in 11 patients (85%), pT2 in 1 patient (7.7%), and pT4 in 1 patient (7.7%). The mean postoperative creatinine was 1.2 mg/dL (range 0.6 to 2.3). Postoperative transfusion was required in 4 patients (22.2%), including 1 patient who required intraoperative transfusion (5.5%) and 1 who required angioembolization (5.5%). During a mean follow-up of 12.3 months (range 0.2 to 66), no patient had evidence of local recurrence or metastatic disease. CONCLUSIONS: Experienced laparoscopic surgeons can safely perform LPN for hilar renal tumors. The short-term oncologic results have been promising; however, long-term follow-up is necessary.