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Laparoscopic Partial Nephrectomy for T1 Renal Cell Carcinoma: Comparison of Two Resection Techniques in a Multi-institutional Propensity Score-Matching Analysis

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Enucleoresection is defined as presence of a minimal paratumor parenchyma that allows for clear visualization of the tumor’s contours during partial nephrectomy (PN). Because there is variability in published reports regarding resection techniques during PN before the surface–intermediate–base (SIB) margin score reporting system, the association between postoperative outcomes and resection techniques are rarely reported. This study was designed to compare the perioperative, oncologic, and functional outcomes between laparoscopic enucleoresection (LER) (SIB score 1 + 1 + 1 = 3) and traditional laparoscopic partial nephrectomy (TLPN) (SIB score 1 + 2 + 2 = 5).

Methods

Data from 270 consecutive patients who underwent laparoscopic partial nephrectomy for single T1 RCC at 3 medical centers were prospectively collected. Propensity score matching was performed on age, gender, body mass index, American Society of Anesthesiologists score, preoperative estimated glomerular filtration rate (eGFR), tumor size, RENAL nephrometry score, Charlson score, and solitary kidney status. Normal parenchyma width of each patient was evaluated right after the surgery, and SIB score was assigned retrospectively. Ninety-eight matched patients undergoing LER or TLPN were compared for perioperative, oncologic, and functional outcomes.

Results

After matching, warm ischemia time (WIT) and operative time were significantly shorter in LER than TLPN group (20.8 vs. 23.8 min, P = 0.003 and 130.8 vs. 152.1 min, P = 0.005, respectively). Estimated blood loss (EBL) also was lower in LER than TLPN group (50 vs. 90 mL, P = 0.045). Complication rates, positive surgical margin rates, and local recurrence rates were comparable between groups (P = 0.3, P = 0.62, and P = 1.0, respectively). At last follow-up, the eGFRs also were comparable in both groups (P = 0.6).

Conclusions

LER has similar oncologic, functional outcomes and complication rates with the advantage of a shorter WIT, operative time, and lower EBL compared with TLPN.

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Acknowledgments

This work was supported by the Chinese National Scientific Grants (Grant Nos. 81101935, U1301221, 81372729, 81372883, 81272808, 81172431), Guangdong Province Natural Scientific Foundation (Grant Nos. S2013020012671, 07117336, 10151008901000024), Specialized Research Fund for the Doctoral Program of Higher Education (20130171110073), Sun Yat-Sen University Clinical Research 5010 Program (Grant No. 2007018) and National Clinical Key Specialty Construction Project for Department of Urology and Department of Oncology.

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    Authors and Affiliations

    1. Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

      Wen Dong MD, Tianxin Lin MD, Kaiwen Li MD, Kewei Xu MD, Chun Jiang MD, Jinli Han MD, Hai Huang MD, Hao Liu MD, Xinxiang Fan MD, Caixia Zhang MD, Wenlian Xie MD, Yousheng Yao MD, Qiuping Ma MD, Yuechun Chen MD, Zhongyu Huang MD & Jian Huang MD

    2. Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China

      Fei Li PhD & Wanlong Tan MD

    3. Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

      Yong Fang PhD, Chi Zhang PhD & Wei Chen MD

    4. Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

      Lijuan Bian MD

    5. Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

      Xiaofeng Lin MD

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    Correspondence to Wei Chen MD, Wanlong Tan MD or Jian Huang MD.

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    Wen Dong, Tianxin Lin, Fei Li, and Yong Fang have contributed equally to this work.

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    Dong, W., Lin, T., Li, F. et al. Laparoscopic Partial Nephrectomy for T1 Renal Cell Carcinoma: Comparison of Two Resection Techniques in a Multi-institutional Propensity Score-Matching Analysis. Ann Surg Oncol 23, 1395–1402 (2016). https://doi.org/10.1245/s10434-015-4985-2

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