Laparoscopic Partial Nephrectomy for cT1 Tumors

Samsun Liv Hospital292 enrolled

Overview

The aim of the study is to evaluate trifecta and pentafecta outcomes for laparoscopic partial nephrectomy (LNP) in patients with clinical T1N0M0 renal tumor.

From November 2009 to August 2018 a total of 292 patients who underwent LPN by global ischemia were included in the study. The patients were allocated into two groups according to the tumor size; T1a (≤ 40 mm, n=215), T1b (41-70 mm, n=77). Demographics features, clinical tumor characteristics, intraoperative and postoperative outcomes were analyzed. A negative surgical margin, warm ischemia time (WIT) \< 20 min and no postoperative complications (Clavien-Dindo ≥ grade 3) were accepted to achieve the trifecta outcomes. Pentafecta has defined as trifecta criteria plus \>90% preservation of estimated glomerular filtration rate (eGFR) and no stage upgrade of chronic kidney disease 12 months after LPN. Univariable and multivariable analysis were used to identify factors predicting trifecta and pentafecta achievement.

Study Type

OBSERVATIONAL

Enrollment

292

Conditions

Renal Cancer Renal Neoplasm Renal Cell Carcinoma Surgery Surgery--Complications Renal Functional Abnormality

Eligibility

Sex: ALLMin age: 18 YearsMax age: 82 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Functioning contraleteral kidney * Patients with complete data * Patients with single renal tumor on the effected side * Patients who approved the written consent form Exclusion Criteria: * The patients with bilateral renal tumors (n=8, 16 LPNs) * solitary kidney (n=8) * horseshoe kidney (n=4) * pelvic ectopic kidney (n=2) * graft kidney (n=2) * those with multiple renal tumors in a single kidney (n=3) or with \> 7 cm renal tumor (n=6) * Patients who were operated on for colon cancer (n=4), prostate cancer (n=2), endometrial cancer (n=1) or adrenal mass (n=2) within the first year after LPN

Locations (2)

Liv hospital samsun

Samsun, Turkey (Türkiye)

Ondokuz Mayıs University

Samsun, Turkey (Türkiye)

Outcomes

Primary Outcomes

Operation time

time from onset to complete of surgery

Time frame: at the end of the surgery

Blood loss

amount of bleeding during surgery (mL)

Time frame: at the end of the surgery

warm ischemia time

The clamp time of the renal artery and vein which is required to complete tumor excision and renorrhaphy

Time frame: at the and of the surgery

intraoperative complication

abnormal problmes that may be seen during surgery

Time frame: at the end of the surgery

Postoperative complication

abnormal problmes that may be seen after surgery and require additional intervention, treatment or follow-up

Time frame: up to 3 months

functional outcomes

serum creatinine level and estimated glomerular filtration rate

Time frame: up to 1 year postoperatively

surigcal margin status

presence or absence of tumors at the surgical margin

Time frame: up to 1 month postoperatively

Relative decrease in renal function

Comparison of preoperative and postoperative renal functions according to numerical and percentile values

Time frame: up to 1 year postoperatively

CKD stage upgrading

evaluation of preoperative and postoperative renal functions according to chronic kidney disease stages

Time frame: up to 1 year postoperatively

Oncological outomes

Presence or absence of local and/or distal tumor recurrence

Time frame: up to the last clinical control (months)