Comparison Of Laparoscopic And Open Partial Nephrectomy In Local Renal Tumors

Background and Purpose:Renal cell carcinoma is one of the most common malignant tumors of urinary system.As the development of abdominal imaging,the incidence of asymptomatic detected small renal masses has increased in the past 20 years.The morbidity of renal cell carcinoma currently covering about 2%-3%of all the tumor disease.In 2008,an estimated 54,390 new renal cancers were diagnosis in USA and there were approximately 13,010 deaths.The morbidity and the mortality rate increased year by year.According to the incidence of renal cell carcinoma in China,the number of the new patients is between 20,000 and 47,000 every year.In recent years its incidence rate is still arising.The national academic study of how to improve the treatment of renal cell carcinoma effectively has attract the world's attention.Radical nephrectomy had been established as a golden standard of renal cell carcinoma.However,more studies reavealed that nephron-sparing surgery allows for maximal preservation of functioning nephrons with comparable oncologic outcomes.Laparoscopic partial nephrctomy emerged as a minimally invasive nephron-sparing surgical option for treating the appropriately selected renal mass.As we all know,laparoscopic partial nephrctomy has long learning curve and more operating times compared with open partial nephrectomy,so we have reason to compared the clinical effects with LPN and OPN,which contributes to study the feasibility of LPN,and how to control the bleeding of the surgical field,and how to decrease the time for renal vessel clamping. Methods1.Cases and exclusion criteria included:(1) included standardsThe selective cases only include in renal tumors with Clinical stage T1NOM0.All these cases have received LPN or OPN.(2) The exclusion criteria①During surgery at the same time,rule out these who under the surgery that co-operate with other clinic departments in order to avoid the interference of the statistical data.②Considering the complicated surgical manipulations,we ruled out those nephrons -paring surgical cases with deformation or anatomy variation,such as renal duplication and horse shoe kidney.③Ruled out these patients who suffered with other disease that may impair the renal function.2.Case collectionBetween July 2003 to December 2008,clinical data were respectively obtained on our 29 consecutive cases of LPN and 24 OPN.We gathered the detailed clinic data with these patients,including a detailed record of the name,gender,age,home address, telephone number,main complaint,tumor size,diagnosis,operative methods,date of surgery,amount of bleeding,the time of block of renal blood flow at usual temperature,postoperative complications,the serum creatinine levels within three days after opertation,the hospitalization time after operation,B-ultrasound and CT urography or MRI results,etc.3.Data analysis:We evaluated the role of the LPN in contrast to OPN by analyzing the data of the gender,age,tumor size,amount of bleeding,the time of block of renal blood flow at usual temperature,postoperative complications,the serum creatinine level within three days after opertation,the hospitalization time after operation etc.All the data were analyzed by SPSS 16.0 for Windows.We choseχ~2-test and independent t-test statistical methods depended on the different data information. ResultsThe patient populations were demographically similar and the serum creatinine levels within three days post-opertation of all the cases were normal.From the tablel,we can conclude that the mean tumor size in the laparoscopic cohort was 2.9cm, the mean estimated blood loss was 319ml in the laparoscopic cohort,while in the OPN cohort the mean estimated blood loss 509m1(319 vs 509cm,P＜0.01).However,the OPN cohort demonstrated shorter operative(113 vs 177min,P＜0.05) and ischemia times(24 vs 13.5 min).The complication in laparoscopic group was more than the open surgery group.In the laparoscopic cohort,1 case turn to nephrectomy,because operative hemorrhage.and pseudoaneurysm rupturing occurred in 1 case,then sufferred nephrectomy in emergency.Postoperative urine leakage developed in two LPN patients:one was controlled with double J stent drainage,and One patient with urinary leakage in the LPN cohort was treated conservatively with close clinical observation.One patient also developed urinary leakage in the OPN cohort and was treated with double J stent drainage.All the patients were cured and discharged,the mean hospitalization time in the LPN cohort lasts 8 days,less than in the OPN cohort.There no significant difference between LPN and OPN in gender,the age,and the serum creatinine level within three days post-opertation.Pathological result confirmed all the patient: 21cases clear cell carcinoma,25 cases angioleiomyolipoma,3 cases chromophobe adenoma 2 cases papillary renal cell carcinoma and 2 case multiple cyst renal cell carcinoma.Conclusion:Though with long learning curve and more post-operation complications,LPN is more challenging than OPN.LPN for the treatment of localized renal tumor has the advantages of minimal invasion and efficiency,and may be a goden standard for the small localized renal tumor.Further efforts need to be made to make this procedure less technically challenging and provide patient se-lection criteria to minimize surgical risk.