BERKELEY, CA (UroToday.com) - This is the first prospective study that investigates the morbidity of tumor enucleation (TE) technique for renal cancer.
Over the last year, this procedure has received a wider acceptance in several urological centers worldwide in the treatment of localized renal-cell carcinoma (RCC). It is an alternative to the standard partial nephrectomy (PN), and it is currently used both in the open as well in the laparoscopic and robotic-assisted nephron sparing approach. The main difference between TE and PN is the width of the rim of healthy parenchyma removed with the tumor. Surgeons involved in PN struggle to remove a visible rim of normal parenchyma around the tumor, while those involved in TE excise the tumor using the cleavage plane that is present just outside the tumor capsule without leaving a visible rim of normal parenchyma around it. This variation reflects a different way to approach to the demolitive phase. In PN, the healthy parenchyma is incised and resected with the tumor, while in TE, the plane between the tumor pseudocapsule and healthy parenchyma is developed and followed by blunt excision.
The TE provides long-term oncological result similar to those reported after PN, and several previous studies demonstrated its therapeutic safety from a clinical and pathological perspective (level of evidence 2b). Our belief is that TE is technically easier, faster to perform, and results in a lower incidence of postoperative complications in comparison to PN. The theoretical rationale is that TE involves a minimal deepening of the excision in the parenchyma, and the damage of major vessels and urinary calices can be less frequent. This technique, however, like PN, involves also a reconstructive phase with suturing of the structures opened during tumor excision. Certainly, in order to investigate this issue further, prospective comparative studies on surgical results and the morbidity of PN and TE are needed. The present series may only represent the first step to shed light on this controversial topic. Our results show a limited, warm ischemia time, and a low incidence of urinary fistulas, which compared favorably with those reported after standard PN. These initial results have encouraged us to continue with further studies, which will also take into account validated instruments like the RENAL or PADUA score, and will involve patients treated with laparoscopic and robotic-assisted TE in our department.
Gianni Vittori, Andrea Minervini, and Marco Carini as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.