Clinical Comparative Study Of Retroperitoneal Laparoscopic Partial Nephrectomy For Central And Peripheral Renal Tumors

ObjectivesThe laparoscopic partial nephrectomy for peripheral renal tumors has been carried out widely in clinical,but the laparoscopic partial nephrectomy for central renal tumors is still challenging because they are deep and close to the renal pedicle vessels or collection system.Retroperitoneal laparoscopic partial nephrectomy can shorten the operation time,reduce the blood loss and complications.The objection of this study is to evaluate the safety and feasibility of the retroperitoneal laparoscopic partial nephrectomy for central renal tumors.Material and methodsRetrospective review of clinical data of 61 cases who underwent retroperitoneal laparoscopic partial nephrectomy due to renal tumors in the Department of Urology in Qilu Hospital between December,2014 and June,2016 was conducted.They included 10 cases of central renal tumors and 51 cases of peripheral renal tumors.By collecting and sorting relative data,we have contrasted and analyzed gender,age,body mass index,ASA scores,warm ischemia time,operation time,intraoperative blood loss,tumor location,tumor diameter,pathological type,Fuhrman stage,perioperative complications,preoperative serum creatinine,postoperative serum creatinine,glomerular filtration rate reduction,together with the workload,operating difficulty,performance,temporal demand for the operators and the cooperation workload for the nurses.Data analysis was performed by using SPSS 22.0 statistical software.Kolmogorov-Smirnov was used to test the normality of measurement data.The comparisons of measurement data were analyzed using independent sample t test.Unordered categorical data or measurement data that do not conform to the normal distribution was analyzed using the Mann-Whitney U rank test.Ordered categorical data was verified by the chi square test or Fisher exact test.P value of<0.05 was considered statistically significant.ResultsThe preoperative data was not significantly different between central renal tumors and peripheral renal tumors groups.The 61 patients experienced successfully operations under general anesthesia and there was no switch of surgery methods during the operation.The average operation time was 139.7±30.6min,warm ischemia time 19.1±3.9min,blood loss 91.6±66.1ml,glomerular filtration rate reduction was 5.9±11.2%,9 postoperative complications of Clavien I and 2 of Clavien Ⅱoccurred in the peripheral renal tumors group.All surgical margins were negative.No local recurrence or distant metastasis was found in two groups.The difference of operation time and warm ischemia time between the two groups was statistically significant.Both the operation time and the warm ischemia time of the central renal tumors group were significantly longer than those of the peripheral renal tumors group.There were no statistical differences in the intraoperative blood loss,tumor diameter,pathological type,Fuhrman stage,perioperative complications,glomerular filtration rate reduction between two groups.The central renal tumors group possessed significantly higher workload(3.10±0.74 vs.2.12±0.79)and operating difficulty(3.10±0.57 vs.2.37±0.75)for the operators,but no significantly different performance and temporal demand.Besides,there were no significant differences on the workload for nurses.ConclusionsRetroperitoneal laparoscopic partial nephrectomy for central renal tumors is safe and effective,and is worthy of clinical application.