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Analysis Of Laparoscopic Partial Nephrectomy For Multiple Renal Tumors
Kristian R Novakovic*, Manish A. Vira, Brian Keuer, W. Marston Linehan, Peter A Pinto, Jonathan A. Coleman
NCI/NIH, Bethesda, MD
Introduction and Objective: Laparoscopic nephron sparing surgery (LNSS) is increasingly employed to treat renal tumors. A subset of patients with renal tumors demonstrate multiple synchronous lesions. To date, there is little data on the use of laparoscopic partial nephrectomy to treat multiple tumors. We report results of treating multiple renal tumors using LNSS.
Methods: Since August 2002, 10 patients have undergone 12 LNSS for multiple renal tumors at the National Cancer Institute. Pre and postoperative renal functional data as well as operative data were collected for comparison.
Results: The median number of tumors removed was 4 (range, 2-12). The largest tumors varied from 2-7cm(mean, 3.2cm). Mean ischemia time in the relevant cases was 31 minutes (range, 19-67min). Mean pre and postoperative estimated creatinine clearances were 110.3 and 106.7 ml/min respectively. Mean overall change in serum creatinine was 0.04 with average follow up of 10 months (range 3days to 30mos). Operative times varied from 280 to 540min (mean 387min). Mean estimated blood loss was 472cc (range, 100-1500cc). Two patients required peri-operative blood transfusion. There were no conversions to open procedures. One patient was treated for a postoperative urinary leak.
Conclusions: LNSS is a viable option for the treatment of multiple renal tumors. The relatively long operative times, potential for significant blood loss and warm ischemia do not appear to compromise overall renal function. Patients with familial cancer syndromes, who often require resection of multiple tumors, are safely treated with LNSS and can therefore realize the benefits of minimally invasive surgery.
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