A new study demonstrates that retroperitoneoscopic partial nephrectomy (RARPN) is preferable for excising posterior kidney tumors less accessible through traditional minimally invasive surgery (MIS) approaches.
Researchers at the University of California, Los Angeles (UCLA; USA), the Swedish Medical Center (Seattle, WA, USA), and the University of Michigan (Ann Arbor, USA) conducted a retrospective multicenter study of 227 consecutive RARPNs performed between 2006 to 2013. The researchers assessed positive margins and cancer recurrence, examining factors associated with complications, estimated blood loss (EBL), warm ischemia time (WIT), operative time (OT), and length of stay (LOS). Median patient age was 60 and median body mass index (BMI) was 28.2 kg/m2.
The results showed that 28 subjects (12.3%) experienced complications, three (1.3%) had urine leaks, and three (1.3%) had pseudoaneurysms that required reintervention. Intersurgeon variation was associated with complications and WIT, with higher surgeon volume associated with shorter WIT. Higher BMI was associated with longer OT, and longer OT was associated with longer LOS. There was also a trend for intersurgeon variation in OT. The study was published online on May 21, 2014, in European Urology.
“RARPN has acceptable morbidity and oncologic outcomes, despite intersurgeon variation in WIT and complications. These differences in warm ischemia time may be attributable to slight variations in surgical technique,” said lead author Jim Hu, MD, of the UCLA Jonsson Comprehensive Cancer Center. “But we showed center-specific variations in the RARPN approach and we present a video on surgical technique to highlight our approach.”
Small renal masses are a heterogeneous group of tumors, and only 20% are aggressive renal cell carcinoma. In general, nephron-sparing treatments are preferred to avoid chronic kidney disease (CKD), which often occurs after radical nephrectomy. RARPN, thermal ablation, and active surveillance are all valid treatment strategies in select patients who are not optimal surgical candidates or who have limited life expectancy.
WIT refers to the amount of time the renal artery, the main blood supply to the kidney, is blocked off during surgery. Longer WITs are associated with increased complications, such as acute kidney failure and long-term CKD.
University of California, Los Angeles
Swedish Medical Center
University of Michigan