EAU 2017: Debate on Kidney Cancer – partial nephrectomy is better done with the robot - Con

London, England (UroToday.com) In this session, Dr. Van Poppel elucidated the places where partial nephrectomy should be done open. Despite no overall survival benefit in his own trial (EORTC) favoring partial nephrectomy over radical nephrectomy in masses less than 5 cm, Dr. Van Poppel acquiesced that we should be doing partial nephrectomy because it is in the guidelines. He focused the talk on oncologic cure, preservation of renal function, and complications.

For oncologic cure, open partial nephrectomy provides good exposure of the kidney and benefits from full dissection through which multiple tumors can be handled. Excellent visualization of the resection bed is achieved through short duration hilar clamping. The open approach is particularly useful for hilar tumors, giant hamartomas such as angiomyolipoma, bilateral Wilms’ tumors, multifocal masses, and central cancers.

Regarding preservation of function, Dr. Van Poppel advocated for avoiding kidney loss in the resection itself, minimizing ischemic volume due to the renorrhaphy, and reducing intraoperative ischemia. In his mind, anything less than 25 minutes of warm ischemia time represents an acceptable operation. He believes that open surgery results in optimal nephron-sparing, minimizes ischemic loss of nephrons through meticulous renorrhaphy, allows for warm ischemia times below 25 minutes, and generates a setting where the most technically challenging tumors can be handled.

The only disadvantage to open partial nephrectomy is pain, neuralgia, and cosmesis (e.g. flank bulge). However, bleeding in his hands is minimal and he has never had an arteriovenous fistula. The hospital stay is approximately 5 days, which he deems appropriate.

In conclusion, Dr. Van Poppel agrees that easy nephron-sparing surgery can be done with minimally invasive techniques. However, he prefers open surgery for complex and technically demanding tumors.

Presented by: Hein Van Poppel

Written by: Benjamin T. Ristau, MD, SUO Fellow, Fox Chase Cancer Center, Philadelphia, PA.

at the #EAU17 -March 24-28, 2017- London, England
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