Zero ischemia laparoscopic partial nephrectomy after superselective transarterial tumor embolization for tumors with moderate nephrometry score: long-term results of a single-center experience.

PURPOSE

To describe a 7-year experience with zero-ischemia laparoscopic partial nephrectomy (LPN) after superselective transarterial tumor embolization (STE) and to report oncologic and functional results of the first 210 consecutive patients.

PATIENTS AND METHODS

Between August 2003 and January 2010, 210 consecutive patients with nephrometry scores ≥ 6 underwent STE and LPN. Angiographic and surgical procedures were performed consequently. The follow-up schedule included serum creatinine levels at 3-month intervals and technetium 99m Tc diethylenetetramine pentacetic acid renal scintigraphy 3 months and 1 year postoperatively, CT scan and chest radiography together with abdominal ultrasonography alternatively performed at 6-month intervals in cases of renal-cell carcinoma (RCC), and abdominal ultrasonography 6 months postoperatively and yearly thereafter in cases of benign tumors.

RESULTS

Median tumor size was 4.2 cm(range 2.5-6.5 cm). Median operative time was 62 minutes (35-220 min), median blood loss was 150 mL (20-800 mL), and median hospital stay was 3 days (2-12 d). In one patient, radical nephrectomy (RN) was necessary because of an unexpected total intraparenchymal growth of the tumor. Postoperative complications included urinary fistulas successfully managed with a Double-J stent placement (n=4); hematoma (n=6, 1 managed with percutaneous drainage), delayed hematuria successfully managed with pseudoaneurysm embolization (n=2). At a median follow-up of 46 months, one patient underwent RN for locally recurrent RCC and one patient died of cancer. At 3-month and 1-year follow-up, the median increase of serum creatinine levels was 0.3 mg/dL and 0.24 mg/dL, respectively, and the median decrease of split renal function was 9% and 5%, respectively.

CONCLUSIONS

STE allowed us to perform a zero-ischemia LPN for tumors with moderate nephrometry score and provided excellent functional results with low complications rate and adequate oncologic results. STE significantly simplifies LPN and combines the advantages of excellent bleeding control without any ischemia and thus without time thresholds within which to perform tumor excision.