Evaluation Of Partial Nephrectomy For Renal Tumors

[Objective]To evaluate the the results and feasibility of partial nephrectomy for renal tumors.[Methods]A retrospective analysis was performed for 50 patients who were affected by renal tumors and treated with partial nephrectomy in Peking Union Medical College Hospital between December 2008 and December 2009. Among these patients,34 cases with blocked-renal pedicle,16 cases were not blocked. The amount of blood lost during operation and operation time, the time of hospital stay in postoperation, complications rate and serum creatinine level in postoperation were compared between the two groups to evaluate the effect of blocking treatment of renal vascular pedicle on patients. Otherwise, we divide the blocked-renal pedicle group into two groups as:clamping time≤20min group (22 cases) and clamping time> 20min group (12 cases), and compared postoperative serum creatinine changes to evaluate the effect of ischemic time on renal function. The data were analyzed by the independent-sample T test,chi-square test and repeated measurement analysis of variance, P value less than 0.05 was regarded as statistically significance. Data were analyzed by SPSS 18.0 software.[Results]Nephron-sparing sugery was done for relative indication in 16 patients, and for elective indication in 34 patients. All was treated with partial nephrectomy. The renal vessel was clamped in 34 cases intraoperative, the mean interrupted time was 21+10 mins(range 10 to 60). The mean tumor size was 3.4+1.4 cm(range 1.Oto 7.0cm),42 cases staged in TlaNOMO, while 8 cases staged in TlbNOMO. The size of surgical margin was range 0.5cm to 1.0cm and surgical margin were negative in all cases. The histological subtype was clear cell carcinoma in 28 cases, papillary renal cell carcinoma in 2cases, chromophobe in 2 cases, unclassified carcinoma in 2 cases, oncocytoma in 1case, renal juxtaglomerular cells tumor in 1case, angiomyolipoma in 12cases, renal cysts in 2 cases. Two patients had postoperative complications and no perioperative acute renal failure occurred. After a median follow-up of 10 months (range 4 to 16), no patient had developed local recurrence. There was no significant difference in age, gender, tumor size and location, operative time, postoperative complication rate, postoperative hospital stay, postoperative changes in serum creatinine between the renal pedicle occlusion group and the non-blocking group (P>0.05). The amount of blood loss in renal pedicle occlusion group was significantly lower than that in the non-blocking group (P= 0.003).The change of postoperative serum creatinine in renal pedicle clamping time≤20 min group was significantly different from that in the clamping time>20 min group (P= 0.028).【Conclusion】The NSS is a safe and effective procedure for patients with localized renal tumors, and should be used widely in clinic. Clamping the renal vessel can decrease blood losing intra-operation effectively, and if clamping time was controled within a reasonable time, influence on renal function was slight. We recommend that it is better to control warm ischemia time within 20 minutes, efforts should be made to start immediately with cold ischemia if the ischemia time is expected to exceed this limit.