Login to Access Video or Poster Abstract: MP49-16
Sources of Funding: none

Introduction

Laparoscopic simple enucleation, which appears to reserve more renal parenchyma without compromising oncologic safety, may be an alternative to standard laparoscopic partial nephrectomy (SLPN). The aim of the present study is to examine the impact of modified laparoscopic simple enucleation (MLSE) with single layer suture technique versus SLPN on our large institutional experience in terms of intraoperative, early postoperative and pathologic outcomes.

Methods

We evaluated 385 consecutive patients who underwent MLSE or SLPN for renal tumors in our institution from January 2013 to December 2015 in terms of perioperative pathologic and oncologic outcome variables. In MLSE, the pseudocapsule of the tumor is bluntly dissected along a natural tissue plane without a visible rim of normal parenchyma.The single layer suture technique was performed for renal reconstruction.

Results

In total, 280 patients underwent MLSE and 105 underwent SLPN. The PADUA score was ? 10 for 62 (22.2%) MLSE patients and 12 (11.4%) SLPN patients (p=0.017). Highly-complex renal tumors (PADUA score ? 10) were mostly enucleated. Mean operative time was 182.1 and 192.8 min, respectively (p=0.078). Warm ischemic time was significantly lower in the MLSE than SLPN group (23.2 vs 25.4 min; p=0.004). The estimated blood loss was similar (p=0.537). Tumor bed suturing was performed in 9.3% and 82.9% of MLSE and SLPN cases (P=0.000). No hilar clamping was needed for 29 MLSE patients (10.4%) and 4 SLPN patients (3.8%) (p=0.041). Grade III complications were reported in 5 (1.8%) MLSE patients and 7 (6.6%) SLPN patients (p=0.034). The incidence of positive surgical margins was comparable between the MLSE and SLPN groups (1.8% and 5.7%, p= 0.086). After a median follow-up of 18 months, recurrence did not differ between the 2 groups: 9 (3.2%) MLSE patients and 4 (3.8%) SLPN patients (p=1.000).

Conclusions

MLSE may confer shorter warm ischemic time, almost no need for tumor bed suturing and less Grade III complications than SLPN, with similar oncologic outcomes. MLSE may be safe and acceptable for patients undergoing Nephron-sparing surgery.

Funding

none