Feasibility and oncological outcome of transperitoneal laparoscopic partial nephrectomy for renal tumors with RENAL nephrometry score ⩽9 in absence of intraoperative ultrasound

Abstract

Introduction:

Partial nephrectomy is the gold standard treatment for incidentally detected small renal tumors. To optimize the outcomes, use of intra operative imaging techniques like ultrasound (IOUS), OCT (optical coherence technique) and fluorescence along with augmented reality is indicated. However, these are not available in all the centers and may also not be needed for predominantly exophytic tumors with low RENAL nephrometry scores.

Aim and objective:

To evaluate the oncological outcomes and efficacy of transperitoneal laparoscopic partial nephrectomy (LPN) in patients with RENAL nephrometry score of ⩽9 without the use of IOUS.

Material and methods:

This was a single centered, single surgeon, retrospective, descriptive, record-based study carried out from January 2013 till December 2018 at postgraduate department of Urology GMC Jammu with a follow up 5 years. After initial evaluation by CECT abdomen with CT renal angio the patients were subjected to transperitoneal LPN and outcomes were recorded in the patient data sheet. Demographic, intra and post op data including RENAL nephrometry score and follow up was retrieved from the patient chart after taking the due clearance from Institutional Ethics Committee.

Results:

Sixty-five patients were included in the study and the average age was 52.6 ± 8 years of 40 were males and 25 were females with average BMI of 23.84 ± 5. Right sided tumors accounted for 62% of cases with upper polar 38%. Total operative time was 100 ± 20 with an average warm ischemia time of 21.55 ± 2. Average size of the tumor in our series was 4.1 ± 2 cms. One patient required blood transfusion. Surgical margins were negative in all. Average follow up in our series was 5.5 ± 1 years.

Conclusion:

Transperitoneal laparoscopic partial nephrectomy for low to intermediate RENAL nephrometry score (score ⩽9) without the use of IOUS is feasible and safe with acceptable surgical and oncological outcomes on long term follow up.