138 - Comparison of results of laparoscopic partial nephrectomy renal in lesions minor an... Page 1 of 1
e138 Comparison of results of laparoscopic partial nephrectomy renal in lesions minor and major 4cm Bollini S., Figueiredo A., Nunes P., Parada B., Moreira P., Antunes P., Rolo F., Mota A. University Hospitals of Coimbra, Dept. of Urology and Renal Transplantation, Coimbra, Portugal INTRODUCTION & OBJECTIVES: Surgical treatment of renal lesions has evolved substantially in recent years with the attempt to preserve renal function, maintenance of oncological outcomes and decreased morbidity in relation to radical nephrectomy. When technically feasible laparoscopic partial nephrectomy (LPN) is an increasingly used option. The authors present a study comparing this surgery in lesions smaller than 4 cm with ≥ 4cm. MATERIAL & METHODS: We reviewed the medical records and imaging of 109 patients underwent LPN between November 2005 and February 2011. We assessed the main data for the patient, tumor, surgery and evolution. Of the 109 patients, 66 (60.6%) were men and 43 (39.4%) were women. The mean age was 61.21 years (21-88 years). The lesions ≥ 4 cm, representing 26 cases (23.9%), while <4 cm in 83 cases (76.1%). RESULTS: Malignant lesions were found in 76 cases (69,7%) and benign in 33 cases (30,2%). Mean follow-up was 27,6 months (1-67 months). Mean surgical time in lesions ≥ 4 cm, was 125, 6 min (40-180 min) and 98,8 min (40-150 min) in lesions Average bleeding was 252,0 ml (50-800 ml) in lesions ≥ 4 cm and 191,7 ml (0-1000 ml) in lesions <4cm (p 0.002). Average number of ports used in lesions ≥ 4 cm was 3,32 ports (3-5 ports) and at < 4cm 3,15 ports (14 ports) (p 0.23). The excretory was opened in 10 cases (38,5%) in lesions ≥ 4 cm and 12 cases (14,4%) of lesions <4 cm (p 0.01). Vascular pedicle clamping was performed in 22 cases (84,6%) in lesions ≥ 4 cm and in 62cases (75,6%) in lesions < 4 cm (p 0.25). In the case of clamping the average ischaemia time was 24, 5 min (17-30) in lesions ≥ 4 cm and 19,8 min (11-29 min) in lesions < 4cm (p 0.0001). Complications (urinary fistula, arteriovenous fistula, conversion, haemoperitoneum, ATN and pneumoperitoneum) occurred in 7 cases (26,9%) in lesions ≥ 4 cm in 5 cases (6,0%) in lesions < 4 cm (p 0.007). The difference between pre and post operative creatinine was 0,1 mg/dL in lesions ≥ 4 cm and 0,02 mg/dL in lesions < 4cm (p 0.01). The average hospital stay was 4,19 days (2-13 days) in lesions ≥ 4 cm and 3,12 days (1-9 days) in lesions <4cm (p0.007). No cases of local recurrence or systemic metastasis were found to date. CONCLUSIONS: LPN in lesions ≥ 4 cm, has similar cancer control to lesions <4cm, but has a higher morbidity, higher incidence of complications and days of hospitalization. Surgery is more demanding with more bleeding, greater surgical time, higher duration of vascular clamping and higher number of ports.