Department of Urology, Hospital Universitario Son Espases, Palma de Mallorca, Illes Balears, Spain.
Int Braz J Urol. 2020 May-Jun;46(3):485-486. doi: 10.1590/S1677-5538.IBJU.2019.0074.
: To show our single-center experience in retroperitoneoscopic approach for highly complex posterior hilar tumors. Minimally invasive nephron sparing surgery for renal hilar tumors is extremely challenging due to their anatomic location, close to the main renal vessels and the collecting system (1). Transperitoneal approach is feasible, but highly complex because the anterior disposition of the vasculature. Retroperitoneal approach can easily provide access to the posterior hilar structures and the posterolateral surface of the kidney(2, 3).
: We retrospectively reviewed our hilar renal tumor database and analyzed those in which a retroperitoneoscopic approach was chosen. The RENAL score was then calculated, and operative and ischemia times were recorded. We also collected the mean hospital stay and the presence of complications. Pathology reports and follow-up were also gathered.
: Five of our twelve highly complex hilar renal tumor patients were treated using a retroperitoneoscopic approach. Mean RENAL score was 10. Mean operative time was 135 minutes. Mean warm ischemia time was 14 minutes. Mean hospital stay was 4 days. We have recorded 2 complications. One patient required a transfusion and another presented with an urinary fistula which was treated by double J stent placement. The pathology report showed a clear cell renal cell carcinoma pT1a in most of the cases. Only one patient had a positive margin. To date, no recurrences have been noticed.
: The treatment of complex renal hilar tumors in a minimally invasive fashion is highly challenging even in experienced hands. Retroperitoneal partial nephrectomy is feasible, safe and effective for the treatment of such lesions. Long-term oncologic outcomes of this approach are awaited.
展示我们在经腹膜后入路治疗高度复杂后肾门肿瘤方面的单中心经验。由于肾门肿瘤的解剖位置靠近主肾血管和集合系统，因此对肾门肿瘤进行微创保留肾单位手术极具挑战性（1）。经腹腔途径是可行的，但由于血管的前位，手术难度极大。经腹膜后入路可以轻松到达后肾门结构和肾脏的后外侧表面（2、3）。
我们回顾性地审查了我们的肾门肿瘤数据库，并分析了选择经腹膜后入路的病例。然后计算 RENAL 评分，并记录手术和缺血时间。我们还收集了平均住院时间和并发症的发生情况。同时收集了病理报告和随访结果。
我们的 12 例高度复杂的肾门肿瘤患者中有 5 例采用经腹膜后入路治疗。平均 RENAL 评分为 10 分。平均手术时间为 135 分钟。平均热缺血时间为 14 分钟。平均住院时间为 4 天。我们记录了 2 例并发症。1 例患者需要输血，另 1 例出现尿瘘，通过放置双 J 支架进行治疗。病理报告显示大多数病例为透明细胞肾细胞癌 pT1a。只有 1 例患者有阳性切缘。迄今为止，尚未发现复发。
即使在经验丰富的医生手中，微创治疗复杂的肾门肿瘤也是极具挑战性的。腹膜后部分肾切除术对于此类病变的治疗是可行的、安全且有效的。这种方法的长期肿瘤学结果仍有待观察。
