THE ADVISABILITY AND SAFETY OF TRANSPERITONEAL LAPAROSCOPIC NEPHRECTOMY FOR RENAL PARENCHYMAL TUMORS

Objective: to assess the advisability and safety of transperitoneal laparoscopic nephrectomy for renal parenchymal tumors.

Subjects and methods. The investigation enrolled 163 patents with clinically localized renal parenchymal tumors that had been resected through laparoscopic (n = 81 (49.7 %)) and open (n = 82 (50.3 %) accesses). The groups of patients operated on via laparoscopic and laparotomic accesses were matched for demographic characteristics, somatic status, baseline renal function, and nephrometric signs of tumor nodules, except the involved side (7 patients in the laparoscopic group had bilateral renal tumors). Renal resection was carried out in all the patients; a contralateral kidney tumor was also removed in 7 patients with a bilateral lesion (nephrectomy and kidney resection were done in 3 and 4 patients, respectively). Histological examination verified benign tumors in 15 (9.2 %) cases, renal cell carcinoma in 148 (90.8 %), including all bilateral renal tumors [рТ1а (n = 135 (91.2 %) cases; рТ1b (n = 4 (2.7 %); рТ3а (n = 9 (6.1 %)]; according to the pT category, the distribution of patients in the laparoscopic and open resection groups was even (p = 0.586). No additional treatment was performed in any case. The median follow-up was 48.2 ± 11.8 months.

Results. The use of the laparoscopic access significantly increased the frequency of intraoperative complications (6.1 and 16.0 %; p = 0.037), but failed to affect that of postoperative complications (13.0 and 18.3 %, respectively; p = 0.291) versus the open access. Laparoscopic versus conventional techniques did not cause any reduction in 5-year overall, specific, and relapse-free survival rates (93.3, 100.0, 80.0 % and 97.1, 100.0, 98.5 %, respectively; р > 0.05 for all). The rate of acute renal dysfunction and its distribution by the RIFLE classes, the rate and level of a decrease in glomerular filtration rate in the late postoperative period did not depend on the surgical access (p > 0.05) for all). Questioning has shown that the laparoscopic versus laparotomic access significantly improves quality of life within one month after renal resection.

Conclusion. Transperitoneal laparoscopic nephrectomy is a safe alternative to open surgery, which can improve quality of life in the patients with clinically localized kidney tumors within one month after surgical intervention.

1. Kutikov A., Uzzo R. G. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 2009;182(3):844–53.

2. Ficarra V., Novara G., Secco S. et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol 2009;56:786–93.

3. K / DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39:1–266.

4. Bellomo R., Ronco C., Kellum J. A. et al. Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8 (4):204–12.

5. Peycelon M., Hupertan V., Comperat E. et al. Long-term outcomes after nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urology 2009;181 (1):35–41.

6. Алексеев Б. Я., Русаков И. Г., Поляков В. А. и др. Лапароскопическая резекция почки. Рос онкол журн 2006; (6):16–20.

7. Русаков И. Г., Теплов А. А., Алексеев Б. Я. и др. Подходы к органосохраняющему лечению локализованного рака почки. Рос онкол журн 2003;(4):48–50.

8. Алексеев Б. Я., Калпинский А. С., Поляков В. А., Андрианов А. Н.. Лапароскопическая резекция почки с применением радиочастотной термоабляции. Онкоурология 2012; (2):21–7.

9. Crйpel M., Jeldres C., Perrotte P. et al. Nephron-sparing surgery is equally effective to radical nephrectomy for T1BN0M0 renal cell carcinoma: a population-based assessment. Urology 2010;75 (2):271–5.

10. Simmons M. N., Weight C. J., Gill S. Laparoscopic radical versus partial nephrectomy for tumors >4 cm: intermediateterm oncologic and functional outcomes. Urology 2009;73 (5):1077–82.

11. Becker F., Siemer S., Hack M. et al. Excellent long-term cancer control with elective nephron-sparing surgery for selected renal cell carcinomas measuring more than 4 cm. Eur Urol 2006;49(6):1058–64.

12. Medina-Polo J., Romero-Otero J., Rodrнguez-Antolнn A. et al. Can partial nephrectomy preserve renal function and modify survival in comparison with radical nephrectomy? Scand J Urol Nephrol 2011;45 (2)143–50.

13. Becker F., Siemer S., Humke U. et al. Elective nephron sparing surgery should become standard treatment for small unilateral renal cell carcinoma: long-term survival data of 216 patients. Eur Urology 2006;49 (2):308–13.

14. Castilla E. A., Liou L. S., Abrahams N. A. et al. Prognostic importance of resection margin width after nephron-sparing surgery for renal cell carcinoma. Urology 2002;60:993–7.

15. Gill I. S., Kavoussi L. R., Lane B. R. et al.Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumours. J Urol 2007;178:41–6.

16. Marszalek M., Meixl H., Polajnar Met al. Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur Urol 2009;55:1171–8.

17. Gong E. M., Orvieto M. A., Zorn K. C. et al. Comparison of laparoscopic and open partial nephrectomy in clinical T1a renal tumours. J Endourol 2008;22:953–7.

18. Porpiglia F., Fiori C., Terrone C. et al. Assessment of surgical margins in renal cell carcinoma after nephron sparing: a comparative study: laparoscopy vs open surgery. J Urol 2005;173:1098–101.

19. Permpongkosol S., Colombo Jr J. R., Gill I. S., Kavoussi L. R. Positive surgical parenchymal margin after laparoscopic partial nephrectomy for renal cell carcinoma: oncological outcomes. J Urol 2006;176:2401–4.

20. Yossepowitch O., Thompson R. H., Leibovich B. C. et al. Positive surgical margins at partial nephrectomy: predictors and oncological outcomes. J Urol 2008;179:2158–63.

21. Zigeuner R., Quehenberger F., Pummer K. et al. Longterm results of nephron-sparing surgery for renal cell carcinoma in 114 patients: risk factors for progressive disease. BJU Int 2003;92: 567–71.

22. Timsit M. O., Bazin J. P., Thiounn N. et al. Prospective study of safety margins in partial nephrectomy: intraoperative assessment and contribution of frozen section analysis. Urology 2006;67:923–6.

23. Breda A., Stepanian S. V., Lam J. S. et al. Use of haemostatic agents and glues during laparoscopic partial nephrectomy: a multi-institutional survey from the United States and Europe of 1347 cases. Eur Urol 2007;52:798–803.

24. Simmons M. N., Gill I. S. Decreased complications of contemporary laparoscopic partial nephrectomy: use of a standardized reporting system. J Urol 2007;177:2067–73, discussion 2073.

25. Ramani A. P., Desai M. M., Steinberg A. P. et al. Complications of laparoscopic partial nephrectomy in 200 cases. J Urol 2005;173:42–7.

26. Knight S., Johns E. J. Renal functional r esponses to ischaemia-reperfusion injury in normotensive and hypertensive rats following non-selective and selective cyclo-oxygenase inhibition with nitric oxide donation. Clin Exper Pharmacol Physiol 2008;35 (1):11–6.

27. Thompson R. H., Leibovich B. C., Lohse C. M. et al. Complications of contemporary open nephron sparing surgery: a single institution experience. J Urol 2005;174: 855–8.

28. Becker F., Van Poppel H., Hakenberg O. W. et al. Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol 2009;56:625–35.

29. Jeldres C., Bensalah K., Capitanio U. et al. Baseline renal function, ischaemia time and blood loss predict the rate of renal failure after partial nephrectomy. BJU Int 2009;103:1632–5.

30. Montag S., Waingankar N., Sadek M. A. Reproducibility and fidelity of the R. E.N.A. L. nephrometry score. J Endourol 2011;25 (12):1925–8.

31. Zhang Z. Y., Tang Q., Li X. S. Сlinical analysis of the PADUA and the RENAL scoring systems for renal neoplasms: A retrospective study of 245 patients undergoing laparoscopic partial nephrectomy. Int J Urol 2013 May 15. doi: 10.1111 / iju. 12192. [Epub ahead of print].