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Laparoscopic partial nephrectomy without clamping the renal pedicle

  • Alexandre Stievano CarlosEmail author
  • Igor Nunes-Silva
  • Hamilton de Campos Zampolli
  • Fernando Meyer
  • Eliney Ferreira Faria
  • Marcos Tobias-Machado
Article
  • 22 Downloads

Abstract

Introduction

Renal cell carcinoma (RCC) accounts for about 2–3% of all malignancies in adults and 90–95% of renal neoplasms. Curative treatment is eminently surgical, the first reports describing the laparoscopic partial nephrectomy (LPN) date from the beginning of the 1990s since then LPN has been consolidated as a safe and reproducible procedure. In order to improve the results of the LPN in relation to the postoperative renal function, while retaining the benefits of minimally invasive surgery, some surgeons began to implement the technique of laparoscopic partial nephrectomy without renal pedicle clamping (LPNWRPC) in selected cases.

Objective

To compare the perioperative, oncological and functional results of patients submitted to LPN with renal pedicle clamping (LPNRPC) and LPNWRPC in the hospitals linked to our institution.

Material and method

All patients’ charts were submitted to LPN from January 2000 to January 2016. Data were collected and analyzed retrospectively, patients were divided into two groups: LPNRPC (RPC group) and LPNWRPC (WRPC group).

Results

Data from 177 patients submitted to LPN for renal neoplasms were collected, 88 patients (49.7%) in the RPC group and 89 (50.3%) in the WRPC group. Surgical margins were positive in 2.56% of patients in the RPC group and 3.70% in the WRPC group. There was no significant difference despite the technique applied. Clavien 3 or 4 postoperative complications occurred in five cases (5.68%) in the RPC group and three cases in the WRPC group (3.7%), with no significant difference between the groups. Patients in the RPC group developed higher levels of creatinine in the postoperative period (creatinine 1.01 ± 0.16 preoperative vs. 1.12 ± 0.18 postoperatively, p = 0.031) and worsened filtration rate (EGFR) (preoperative 79.18 ± 16.28 × 74.43 ± 21.06 post-operative, p = 0.017).

Discussion

Our casuistry agrees with the results of previous studies with regard to major bleeding in patients submitted to LPNWRPC when compared to those submitted to LPNWRPC. However, although bleeding and surgical time were higher in the WRPC group, there was no impact on patients’ postoperative evolution regarding both the need for transfusion of blood products and serious complications. In the high-complexity tumors, the mean warm ischemia time (WIT) in the RPC group was higher, this was probably responsible for a better response in the WRPC group evolving patients with lower creatinine levels and better postoperative glomerular filtration rates.

Conclusion

LPNWRPC has been shown to be equally effective, safe, feasible, with low blood transfusion rates and postoperative complications comparable to LPNRPC, and has similar oncological results. Main impact factor in long-term renal dysfunction is WIT, which can be completely eliminated with the use of LPNWRPC.

Keywords

Renal neoplasms Nephrectomy Laparoscopy Hot ischemia 

Notes

Compliance with ethical standards

Disclosures

Drs. Alexandre Stievano Carlos, Igor Nunes-Silva, Hamilton de Campos Zampolli, Fernando Meyer, Eliney Ferreira Faria and Marcos Tobias-Machado have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.ABC Medical SchoolSanto AndréBrazil
  2. 2.Doctor Arnaldo Vieira de Carvalho Cancer InstituteSão PauloBrazil
  3. 3.Cajuru Universitary HospitalCuritibaBrazil
  4. 4.Barretos Cancer HospitalBarretosBrazil
  5. 5.São PauloBrazil

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