800 Laparoscopic Partial Nephrectomies: A Single Surgeon Series

Purpose

We hypothesized that from 1999 to 2008 patient and tumor selection criteria, perioperative outcomes, complications and renal function outcomes may have evolved significantly in 800 laparoscopic partial nephrectomies.

Materials and Methods

We retrospectively divided 800 patients who underwent laparoscopic partial nephrectomy for tumor, as done by 1 surgeon, into 3 chronologic eras, including era 1—276 from September 1999 to December 2003, era 2—289 from January 2004 to December 2006 and era 3—235 from January 2007 through November 2008. We evaluated prospectively collected data on tumor characteristics, perioperative outcomes and renal function outcomes.

Results

When comparing eras 1 to 3, tumors in the most recent era were larger, more commonly 4 cm or greater, and central, and less often peripheral and less than 4 cm (each p value significant). Despite increasing tumor complexity warm ischemia time was shorter (31.9, 31.6 and 14.4 minutes, respectively, p <0.0001), and the overall rates of postoperative and urological complications were significantly lower in the most recent era. The rate of parenchymal margins positive for cancer was 1%, 1% and 0.6%, respectively. Renal function outcomes were superior in era 3, as reflected by a lesser decrease in the estimated glomerular filtration rate (18%, 20% and 11%, respectively). In the 744 patients with pathologically confirmed malignancy 5-year overall, cancer specific and recurrence-free survival was 90%, 99% and 97%, respectively.

Conclusions

During our 9-year experience with 800 consecutive laparoscopic partial nephrectomies tumor characteristics and surgical outcomes evolved. Despite increasing tumor complexity in contemporary practice 3 key outcomes of laparoscopic partial nephrectomy improved significantly, including ischemia time, complications and renal function. We now routinely offer laparoscopic partial nephrectomy for most tumors hitherto reserved for open nephron sparing surgery.

Key Words: kidney, carcinoma, renal cell, nephrectomy, laparoscopy, outcome assessment (health care)

Abbreviations and Acronyms: CT, computerized tomography, eGFR, estimated glomerular filtration rate, LPN, laparoscopic partial nephrectomy, LRN, laparoscopic radical nephrectomy, MDRD, modification of diet in renal disease, RCC, renal cell carcinoma, WIT, warm ischemia time