Retroperitoneal laparoscopic renal tumour enucleation with local hypotension on demand

Purpose Laparoscopic partial nephrectomy is the standard treatment for peripheric cT1 renal tumours and is usually performed under warm ischaemia. However, it is important to reduce ischaemia time as much as possible to avoid renal damage. The aim of our study was to investigate the feasibility and...

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Veröffentlicht in:World journal of urology 2015-03, Vol.33 (3), p.427-432
Hauptverfasser: Pansadoro, Alberto, Cochetti, Giovanni, D’amico, Francesco, Barillaro, Francesco, Del Zingaro, Michele, Mearini, Ettore
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container_end_page 432
container_issue 3
container_start_page 427
container_title World journal of urology
container_volume 33
creator Pansadoro, Alberto
Cochetti, Giovanni
D’amico, Francesco
Barillaro, Francesco
Del Zingaro, Michele
Mearini, Ettore
description Purpose Laparoscopic partial nephrectomy is the standard treatment for peripheric cT1 renal tumours and is usually performed under warm ischaemia. However, it is important to reduce ischaemia time as much as possible to avoid renal damage. The aim of our study was to investigate the feasibility and safety of our technique and to evaluate short-term functional and oncological results. Materials and methods From June 2010 to December 2012, 54 consecutive patients with T1a–T1b renal tumour were enrolled in a high-volume tertiary institution. All patients underwent laparoscopic enucleation with controlled selective hypotension on demand. Karnofsky performance status scale, R.E.N.A.L. Nephrometry Score and Clavien–Dindo Classification were used to assess patients’ status, to stratify patients according to kidney disease and to evaluate complications, respectively. Renal function was evaluated with serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) preoperative and 3, 5, 7 and 90 days postoperatively. Results All the procedures were completed laparoscopically. Renal hypotension was necessary in 3/54 cases. Mean intraoperatively blood loss was 210 ± 98 ml. Renal carcinoma was found in 87 % patients. Margins revealed to be positive in 5.5 % cases. Mean hospital stay was 7.2 days. Grade IIIa and IIIb postoperative complications were 5.5 and 11 %, respectively. At 3 months, increase for sCr was 0.04 mg/dL; eGFR reduction was 1.2 ml/min. At a median follow-up of 20 months, there was one local recurrence that happened in a positive margin case. Conclusions Our preliminary results proved laparoscopic enucleation with controlled selective local hypotension on demand to be a feasible, safe and effective technique for T1 renal tumours.
doi_str_mv 10.1007/s00345-014-1325-2
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However, it is important to reduce ischaemia time as much as possible to avoid renal damage. The aim of our study was to investigate the feasibility and safety of our technique and to evaluate short-term functional and oncological results. Materials and methods From June 2010 to December 2012, 54 consecutive patients with T1a–T1b renal tumour were enrolled in a high-volume tertiary institution. All patients underwent laparoscopic enucleation with controlled selective hypotension on demand. Karnofsky performance status scale, R.E.N.A.L. Nephrometry Score and Clavien–Dindo Classification were used to assess patients’ status, to stratify patients according to kidney disease and to evaluate complications, respectively. Renal function was evaluated with serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) preoperative and 3, 5, 7 and 90 days postoperatively. Results All the procedures were completed laparoscopically. Renal hypotension was necessary in 3/54 cases. Mean intraoperatively blood loss was 210 ± 98 ml. Renal carcinoma was found in 87 % patients. Margins revealed to be positive in 5.5 % cases. Mean hospital stay was 7.2 days. Grade IIIa and IIIb postoperative complications were 5.5 and 11 %, respectively. At 3 months, increase for sCr was 0.04 mg/dL; eGFR reduction was 1.2 ml/min. At a median follow-up of 20 months, there was one local recurrence that happened in a positive margin case. Conclusions Our preliminary results proved laparoscopic enucleation with controlled selective local hypotension on demand to be a feasible, safe and effective technique for T1 renal tumours.</description><identifier>ISSN: 0724-4983</identifier><identifier>EISSN: 1433-8726</identifier><identifier>DOI: 10.1007/s00345-014-1325-2</identifier><identifier>PMID: 24903348</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Blood Loss, Surgical - statistics &amp; numerical data ; Carcinoma, Renal Cell - pathology ; Carcinoma, Renal Cell - surgery ; Feasibility Studies ; Female ; Follow-Up Studies ; Glomerular Filtration Rate - physiology ; Humans ; Hypotension - complications ; Kidney - pathology ; Kidney - physiopathology ; Kidney Neoplasms - pathology ; Kidney Neoplasms - surgery ; Laparoscopy - adverse effects ; Laparoscopy - methods ; Length of Stay - statistics &amp; numerical data ; Male ; Medicine ; Medicine &amp; Public Health ; Middle Aged ; Neoplasm Staging ; Nephrectomy - adverse effects ; Nephrectomy - methods ; Nephrology ; Oncology ; Original Article ; Retroperitoneal Space - surgery ; Retrospective Studies ; Treatment Outcome ; Urology</subject><ispartof>World journal of urology, 2015-03, Vol.33 (3), p.427-432</ispartof><rights>Springer-Verlag Berlin Heidelberg 2014</rights><rights>Springer-Verlag Berlin Heidelberg 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-3ceb4322ba398470fe4143e9fd9845c46c13c541f0921c06c00f2bf3ba7e09e83</citedby><cites>FETCH-LOGICAL-c442t-3ceb4322ba398470fe4143e9fd9845c46c13c541f0921c06c00f2bf3ba7e09e83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00345-014-1325-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00345-014-1325-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24903348$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pansadoro, Alberto</creatorcontrib><creatorcontrib>Cochetti, Giovanni</creatorcontrib><creatorcontrib>D’amico, Francesco</creatorcontrib><creatorcontrib>Barillaro, Francesco</creatorcontrib><creatorcontrib>Del Zingaro, Michele</creatorcontrib><creatorcontrib>Mearini, Ettore</creatorcontrib><title>Retroperitoneal laparoscopic renal tumour enucleation with local hypotension on demand</title><title>World journal of urology</title><addtitle>World J Urol</addtitle><addtitle>World J Urol</addtitle><description>Purpose Laparoscopic partial nephrectomy is the standard treatment for peripheric cT1 renal tumours and is usually performed under warm ischaemia. However, it is important to reduce ischaemia time as much as possible to avoid renal damage. The aim of our study was to investigate the feasibility and safety of our technique and to evaluate short-term functional and oncological results. Materials and methods From June 2010 to December 2012, 54 consecutive patients with T1a–T1b renal tumour were enrolled in a high-volume tertiary institution. All patients underwent laparoscopic enucleation with controlled selective hypotension on demand. Karnofsky performance status scale, R.E.N.A.L. Nephrometry Score and Clavien–Dindo Classification were used to assess patients’ status, to stratify patients according to kidney disease and to evaluate complications, respectively. Renal function was evaluated with serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) preoperative and 3, 5, 7 and 90 days postoperatively. Results All the procedures were completed laparoscopically. Renal hypotension was necessary in 3/54 cases. Mean intraoperatively blood loss was 210 ± 98 ml. Renal carcinoma was found in 87 % patients. Margins revealed to be positive in 5.5 % cases. Mean hospital stay was 7.2 days. Grade IIIa and IIIb postoperative complications were 5.5 and 11 %, respectively. At 3 months, increase for sCr was 0.04 mg/dL; eGFR reduction was 1.2 ml/min. At a median follow-up of 20 months, there was one local recurrence that happened in a positive margin case. 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However, it is important to reduce ischaemia time as much as possible to avoid renal damage. The aim of our study was to investigate the feasibility and safety of our technique and to evaluate short-term functional and oncological results. Materials and methods From June 2010 to December 2012, 54 consecutive patients with T1a–T1b renal tumour were enrolled in a high-volume tertiary institution. All patients underwent laparoscopic enucleation with controlled selective hypotension on demand. Karnofsky performance status scale, R.E.N.A.L. Nephrometry Score and Clavien–Dindo Classification were used to assess patients’ status, to stratify patients according to kidney disease and to evaluate complications, respectively. Renal function was evaluated with serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) preoperative and 3, 5, 7 and 90 days postoperatively. Results All the procedures were completed laparoscopically. Renal hypotension was necessary in 3/54 cases. Mean intraoperatively blood loss was 210 ± 98 ml. Renal carcinoma was found in 87 % patients. Margins revealed to be positive in 5.5 % cases. Mean hospital stay was 7.2 days. Grade IIIa and IIIb postoperative complications were 5.5 and 11 %, respectively. At 3 months, increase for sCr was 0.04 mg/dL; eGFR reduction was 1.2 ml/min. At a median follow-up of 20 months, there was one local recurrence that happened in a positive margin case. Conclusions Our preliminary results proved laparoscopic enucleation with controlled selective local hypotension on demand to be a feasible, safe and effective technique for T1 renal tumours.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>24903348</pmid><doi>10.1007/s00345-014-1325-2</doi><tpages>6</tpages></addata></record>
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subjects Adult
Aged
Aged, 80 and over
Blood Loss, Surgical - statistics & numerical data
Carcinoma, Renal Cell - pathology
Carcinoma, Renal Cell - surgery
Feasibility Studies
Female
Follow-Up Studies
Glomerular Filtration Rate - physiology
Humans
Hypotension - complications
Kidney - pathology
Kidney - physiopathology
Kidney Neoplasms - pathology
Kidney Neoplasms - surgery
Laparoscopy - adverse effects
Laparoscopy - methods
Length of Stay - statistics & numerical data
Male
Medicine
Medicine & Public Health
Middle Aged
Neoplasm Staging
Nephrectomy - adverse effects
Nephrectomy - methods
Nephrology
Oncology
Original Article
Retroperitoneal Space - surgery
Retrospective Studies
Treatment Outcome
Urology
title Retroperitoneal laparoscopic renal tumour enucleation with local hypotension on demand
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