While traditionally employed for absolute indications (single kidney, bilateral tumors, renal insufficiency) and only reserved for elective indications where the primary tumor was 4 cm or less in the presence of a normal contralateral kidney, more recent reports suggest that large and locally advanced tumors can be electively managed effectively with nephron sparing techniques. Laparoscopic partial nephrectomy (LPN) has been touted as an effective alternative to open approaches, in experienced hands, and here, the group from Cleveland Clinic report on their experience with LPN for locally advanced renal tumors.

The authors report on 21 patients, which represent 4% of their total LPN series of 525 patients. Of these, 1 was T2, 19 were T3a, and 1 was T3b. Mean tumor size was 3.7 cm (range 1.8-7.4), mean age was 61, and mean follow-up was 29 months (range 1-58). Twenty patients had renal cell carcinoma and one had an oncocytoma invading the perinephric fat. Regarding perioperative data, mean blood loss was 199 ml (range 100-800), mean warm ischemia time was 29 minutes (range 15-55), mean OR time was 3 hours (range 2.2-5), and mean length of stay was 3.3 days (range 1-9). The authors report a major complication rate of 19% and no patient had a positive margin. Cancer specific survival was 95%. In re-reviewing the preoperative scans to determine whether the locally advanced nature of the lesions could be predicted preoperatively, none of the scans demonstrated convincing evidence that predicted the final pathology of the lesions.

LPN, in experienced hands, can be employed electively in the setting of locally advanced (greater than or equal to T2) renal tumors with oncologic outcomes that mirror those obtained with open approaches.

Ukimura O, Haber GP, Remer EM, Gill IS

Urology: 68(5):976-982

Urologic Surgical Interventions Corner

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