Nephron sparing laparoscopic surgery in renals tumors. Preliminary outcome

Abstract

Introduction: The development of diagnosis through imaging has allowed the detection of small kidney tumors when the disease is in its early stages. Although Radical Nephrectomy (RN) is still the most common treatment, nephron sparing surgery (NSS) is displacing it with similar oncological results and a favorable effect in overall kidney function. Laparoscopic nephron sparing surgery (L-NSS) is a complex technique that requires great specialization and experience. Objective: To show the preliminary results of L-NSS in a series of patients. Methods: A descriptive study is carried out with 14 patients who underwent L-NSS at the National Center of Minimal Invasive Surgery (NCMIS). Tumors were evaluated by imaging studies and the R.E.N.A.L. score was used. L-NSS was performed by transperitoneal approach and hand-assistance or by lumboscopic approach. The technique was considered feasible, when conversion to open surgery was not required. Complications were classified according to Clavien-Dindo. Results: The average age was 51.5 %; female patients and incidental diagnosis prevailed. L-NSS was feasible in 85.7 %. The average operative time was 171 minutes and bleeding was 272.8 ml. Postoperative hospital stay was 3.1 days. There were four complications (28.4%), only one grade V. 78.5% were stage T1a. Renal carcinoma prevailed. Surgical margin (PSM) was positive in one case and there was one tumor recurrence. Neither metastasis nor cancer-related diseases occurred. Conclusions: L-NSS has shown satisfactory preliminary results at the NCMIS which makes it a safe and feasible alternative for the treatment of T1 kidney tumors.

Key words: renal tumors, laparoscopic surgery, conservative surgery.