Tsivian Matvey, Tsivian Efrat, Stanevsky Yury, Bass Roman, Sidi A Ami, Tsivian Alexander
Division of Urology and Department of Surgery, Duke University Medical Center Durham, NC.
Department of Urologic Surgery, The E. Wolfson Medical Center, Holon and Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel.
Int Braz J Urol. 2017 Sep-Oct;43(5):857-862. doi: 10.1590/S1677-5538.IBJU.2016.0642.
To assess and report the outcomes of laparoscopic partial nephrectomy )LPN) for T2 renal masses.
Retrospective review of patients undergoing LPN for clinically localized renal masses ≥7cm between the years 2005-2016. Descriptive analyses were generated for demographics, lesion characteristics, perioperative variables (operative time, warm ischemia time (WIT), estimated blood loss (EBL), intra-operative and post-operative complications (IOC and POC) and pathologic variables (pathology, subtype and Fuhrman grade).
A total of 27 patients underwent LPN for a T2 renal mass at our institution between 2005 and early 2016 of which 19 were males. The mean age was 66 (52-72). All procedures were transperitoneal with 16 on the right and 11 on the left. Median operative time was 200 minutes (IQR 181-236) and median WIT 19 minutes (IQR 16-23). EBL was 125mL (IQR 75-175). One case was converted to laparoscopic radical nephrectomy due to suspected tumor thrombus in the renal vein. Surgical margins were positive in one renal tumor in a patient with multiple tumors. There was a total of 2 IOC (7.4%) and 3 POC (11%) classified as Clavien grade 3.
To our knowledge, this series is the first to describe the outcomes of LPN for cT2 renal masses. In our series, LPN for larger renal masses appears feasible with favorable perioperative outcomes. Additional data are needed to further explore the benefits of minimally invasive surgical approaches to larger renal masses.
评估并报告腹腔镜下肾部分切除术（LPN）治疗T2期肾肿瘤的疗效。
回顾性分析2005年至2016年间因临床局限性肾肿瘤≥7cm而接受LPN治疗的患者。对人口统计学、病变特征、围手术期变量（手术时间、热缺血时间（WIT）、估计失血量（EBL）、术中及术后并发症（IOC和POC））以及病理变量（病理、亚型和Fuhrman分级）进行描述性分析。
2005年至2016年初，我院共有27例患者因T2期肾肿瘤接受LPN治疗，其中19例为男性。平均年龄为66岁（52 - 72岁）。所有手术均经腹腔进行，右侧16例，左侧11例。中位手术时间为200分钟（四分位间距181 - 236），中位WIT为19分钟（四分位间距16 - 23）。EBL为125mL（四分位间距75 - 175）。1例因怀疑肾静脉肿瘤血栓而转为腹腔镜根治性肾切除术。1例多肿瘤患者的1个肾肿瘤手术切缘阳性。共有2例IOC（7.4%）和3例POC（11%）被分类为Clavien 3级。
据我们所知，本系列是首个描述LPN治疗cT2期肾肿瘤疗效的研究。在我们的系列研究中，LPN治疗较大肾肿瘤似乎可行，围手术期疗效良好。需要更多数据进一步探索微创外科手术治疗较大肾肿瘤的益处。
