MAAUA: 2007 Abstracts - Laparoscopic Nephron-Sparing Surgery for Presumed Renal Cell Carcinoma: Applications in Clinical Practice.

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Laparoscopic Nephron-Sparing Surgery for Presumed Renal Cell Carcinoma: Applications in Clinical Practice.
Lewis E Harpster, Matthew G Kaag, William Caraway
Penn State Milton Hershey Medical Center, Hershey, PA

Introduction: Nephron-sparing surgery (NSS) is equally efficacious to radical nephrectomy in the treatment of small renal cell carcinomas. The role of laparoscopic nephron-sparing surgery (LNSS) in this setting continues to be defined. We report our experience utilizing LNSS for the management of suspicious renal lesions.
Methods: Since October 2001, 70 patients underwent NSS for renal mass by one surgeon at our institution. Open NSS and LNSS were considered for suspicious lesions up to 7.0 cm. Retrospective analysis was done to identify factors influencing choice of procedure and to assess clinical and oncologic outcomes.
Results: Sixty-one patients were scheduled for LNSS. Four patients were converted to open. Nephrectomy was done in 4 patients. Mean tumor size was 3.0 cm. (range 1.2-7.0 cm). Mean operative time was 241 minutes (range 125-362 minutes). Vascular occlusion was necessary in 44 patients. Mean warm ischemia time was 28 minutes (range 9-46 minutes). Collecting system repair was required in 31 patients. Average blood loss was 256 ml. (range 50-2200 ml). Two patients had a solitary kidney. Mean length of stay was 3 days (range 1-9 days). Pathology revealed carcinoma in 46 lesions. Postoperative hemorrhage occurred in 2 patients. There were no urinomas. One patient had tumor recurrence 30 months following LNSS. No patient has developed metastatic disease.
Conclusions: LNSS can be utilized for the majority of T1 renal lesions amenable to NSS. Continued follow-up is needed to determine if LNSS can provide long-term cancer control similar to open NSS.

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