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Mini-flank supra-12th rib incision for open partial nephrectomy for renal tumor with RENAL nephrometry score ≥10: an innovation of traditional open surgery.

Wang H, Sun LA, Wang Y, Xiang Z, Zhou L, Guo J, Wang G - Medicine (Baltimore) (2015)

Bottom Line: MI-OPN was successfully performed in all cases.Postoperative complications were found in 3 patients (5.5%).The mean pre- and postoperative estimated glomerular filtration rate (eGFR) were 91.5 (range: 34-133) and 82.5 (range: 22-126.5), respectively with significant difference (P = 0.024).

View Article: PubMed Central - PubMed

Affiliation: From the Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.

ABSTRACT
The skill of supra-12th rib mini-flank approach for open partial nephrectomy (MI-OPN) provides an advanced operative method for renal tumor. Compared with laparoscopic and robotic surgery, it may be a feasible selection for the complex renal tumors. We describe our techniques and results of MI-OPN in complex renal tumors with high RENAL nephrometry score (RENAL nephrometry score ≥10). Fifty-five patients diagnosed with renal tumors between January 2009 and July 2013 were included in this study. Eligibility criteria comprised of patients with complex renal tumor (RENAL score ≥10) being candidates for partial nephrectomy (PN). All patients received MI-OPN and all surgeries were performed by a single urologist. The preoperative workup comprised of medical history, physical examination, and routine laboratory tests. Serum creatinine was recorded preoperatively and 2 to 3 months after operation. Operative time, ischemia time, blood loss, operative and postoperative complications, renal function, and pathology parameters were recorded. MI-OPN was successfully performed in all cases. Mean tumor size was 4.7 cm (range: 2.5-8.1). Mean warm ischemia time was 28.1 minutes (range: 21-39), mean operative time was 105 minutes (range: 70-150) and mean estimated blood loss was 68 mL (range: 10-400). Mean postoperative hospital stay was 6.5 days (range: 5-12). Postoperative complications were found in 3 patients (5.5%). The mean pre- and postoperative serum creatinine levels were 76.2 μmol/L (range: 47-132) and 87.1 μmol/L (range: 61-189) with significant difference (P = 0.004). The mean pre- and postoperative estimated glomerular filtration rate (eGFR) were 91.5 (range: 34-133) and 82.5 (range: 22-126.5), respectively with significant difference (P = 0.024). In an average follow-up of 19.9 months (range: 8-50), no local recurrence or systemic progression occurred. In conclusion, MI-OPN can combine the benefits of both minimal invasive and traditional open partial nephrectomy (OPN) techniques with a smaller incision. It is an innovation of traditional OPN and suitable for the complex renal tumors with high RENAL nephrometry score safely and effectively.

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Different cases with high RENAL nephrometry score. (A) RENAL nephrometry score = 12. (B) RENAL nephrometry score = 11. (C) RENAL nephrometry score = 10.
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Figure 2: Different cases with high RENAL nephrometry score. (A) RENAL nephrometry score = 12. (B) RENAL nephrometry score = 11. (C) RENAL nephrometry score = 10.

Mentions: MI-OPN surgeries were successfully completed in all 55 cases. Age of patients ranged from 26 to 75 yd with an average of 52.9 years. Demographic and clinical characteristics of patients were shown in Table 1 and surgical features of these patients were shown in Table 2. Mean warm ischemia time was 28.1 minutes (range: 21–39). Mean tumor size was 4.7 cm (range: 2.5–8.1), mean operative time was 105 minutes (range:70–150), and mean estimated blood loss was 68 mL (range: 10–400). Pelvicalyceal entry repair was performed in 50 patients (90.1%). No patient received intraoperative or postoperative blood transfusion. No intraoperative complication occurred. Mean postoperative hospital stay was 6.5 days (range:5–12). Incision with fat liquefaction occurred on 2 patients and local effusion was found in 1 patient (5.5%). No severe complication was observed, including delayed renal hemorrhage or urinary leakage. Tumors of 50 patients (90.1%) were confirmed as renal cell carcinoma by histopathology and the other 5 cases were angiomyolipoma. Negative surgical margins were confirmed by frozen section analysis for all malignant cases in the operation. The mean pre- and postoperative serum creatinine levels were 76.2 μmol/L (range: 47–132) and 87.1 μmol/L (range: 61–189) with significant difference (P = 0.004). The mean pre- and postoperative eGFR were 91.5 (range: 34–133) and 82.5 (range: 22–126.5), respectively, with significant difference (P = 0.024) too. The RENAL nephrometry scores of all patients were above 9 (Figure 2A,B,C).


Mini-flank supra-12th rib incision for open partial nephrectomy for renal tumor with RENAL nephrometry score ≥10: an innovation of traditional open surgery.

Wang H, Sun LA, Wang Y, Xiang Z, Zhou L, Guo J, Wang G - Medicine (Baltimore) (2015)

Different cases with high RENAL nephrometry score. (A) RENAL nephrometry score = 12. (B) RENAL nephrometry score = 11. (C) RENAL nephrometry score = 10.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554027&req=5

Figure 2: Different cases with high RENAL nephrometry score. (A) RENAL nephrometry score = 12. (B) RENAL nephrometry score = 11. (C) RENAL nephrometry score = 10.
Mentions: MI-OPN surgeries were successfully completed in all 55 cases. Age of patients ranged from 26 to 75 yd with an average of 52.9 years. Demographic and clinical characteristics of patients were shown in Table 1 and surgical features of these patients were shown in Table 2. Mean warm ischemia time was 28.1 minutes (range: 21–39). Mean tumor size was 4.7 cm (range: 2.5–8.1), mean operative time was 105 minutes (range:70–150), and mean estimated blood loss was 68 mL (range: 10–400). Pelvicalyceal entry repair was performed in 50 patients (90.1%). No patient received intraoperative or postoperative blood transfusion. No intraoperative complication occurred. Mean postoperative hospital stay was 6.5 days (range:5–12). Incision with fat liquefaction occurred on 2 patients and local effusion was found in 1 patient (5.5%). No severe complication was observed, including delayed renal hemorrhage or urinary leakage. Tumors of 50 patients (90.1%) were confirmed as renal cell carcinoma by histopathology and the other 5 cases were angiomyolipoma. Negative surgical margins were confirmed by frozen section analysis for all malignant cases in the operation. The mean pre- and postoperative serum creatinine levels were 76.2 μmol/L (range: 47–132) and 87.1 μmol/L (range: 61–189) with significant difference (P = 0.004). The mean pre- and postoperative eGFR were 91.5 (range: 34–133) and 82.5 (range: 22–126.5), respectively, with significant difference (P = 0.024) too. The RENAL nephrometry scores of all patients were above 9 (Figure 2A,B,C).

Bottom Line: MI-OPN was successfully performed in all cases.Postoperative complications were found in 3 patients (5.5%).The mean pre- and postoperative estimated glomerular filtration rate (eGFR) were 91.5 (range: 34-133) and 82.5 (range: 22-126.5), respectively with significant difference (P = 0.024).

View Article: PubMed Central - PubMed

Affiliation: From the Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.

ABSTRACT
The skill of supra-12th rib mini-flank approach for open partial nephrectomy (MI-OPN) provides an advanced operative method for renal tumor. Compared with laparoscopic and robotic surgery, it may be a feasible selection for the complex renal tumors. We describe our techniques and results of MI-OPN in complex renal tumors with high RENAL nephrometry score (RENAL nephrometry score ≥10). Fifty-five patients diagnosed with renal tumors between January 2009 and July 2013 were included in this study. Eligibility criteria comprised of patients with complex renal tumor (RENAL score ≥10) being candidates for partial nephrectomy (PN). All patients received MI-OPN and all surgeries were performed by a single urologist. The preoperative workup comprised of medical history, physical examination, and routine laboratory tests. Serum creatinine was recorded preoperatively and 2 to 3 months after operation. Operative time, ischemia time, blood loss, operative and postoperative complications, renal function, and pathology parameters were recorded. MI-OPN was successfully performed in all cases. Mean tumor size was 4.7 cm (range: 2.5-8.1). Mean warm ischemia time was 28.1 minutes (range: 21-39), mean operative time was 105 minutes (range: 70-150) and mean estimated blood loss was 68 mL (range: 10-400). Mean postoperative hospital stay was 6.5 days (range: 5-12). Postoperative complications were found in 3 patients (5.5%). The mean pre- and postoperative serum creatinine levels were 76.2 μmol/L (range: 47-132) and 87.1 μmol/L (range: 61-189) with significant difference (P = 0.004). The mean pre- and postoperative estimated glomerular filtration rate (eGFR) were 91.5 (range: 34-133) and 82.5 (range: 22-126.5), respectively with significant difference (P = 0.024). In an average follow-up of 19.9 months (range: 8-50), no local recurrence or systemic progression occurred. In conclusion, MI-OPN can combine the benefits of both minimal invasive and traditional open partial nephrectomy (OPN) techniques with a smaller incision. It is an innovation of traditional OPN and suitable for the complex renal tumors with high RENAL nephrometry score safely and effectively.

Show MeSH
Related in: MedlinePlus