| Objectives: To retrospectively compare the application and perioperative outcomes of laparoscopic partial nephrectomy(LPN) and open partial nephrectomy(OPN) for complex tumors(R.E.N.A.L nephrometry score ≧7).Methods and Materials: A retrospective analysis was performed for 170 patients(R.E.N.A.L nephrometry score ≧7) who underwent either LPN(n=118) or OPN(n=52) between January 2012 and October 2014 in the Department of Urology of First Affiliated Hospital of Fujian Medical University. Perioperative outcomes like operative time, estimated blood loss, warm ischemic time, hospital stay, postoperative complications, serum creatinine and GFR changes were compared.Results: There were no significant differences between the two groups with respect to age, gender, laterality, BMI or R.E.N.A.L nephrometry score. The difference of tumor size between patients undergoing LPN and OPN was not statistically significant(3.8±1.4cm VS. 4.2±1.5cm, P=0.103, respectively). Operative time was longer in the LPN group than in the OPN group(128.3±23.0min VS. 116.2±30.6min, P=0. 013, respectively). But the estimated blood loss in the LPN group was shorter(153.3±88.5ml VS. 192.9±117.4ml,P=0. 016). The hospital stay of the two groups were 10.0±2.8 VS. 11.4±2.7, respectively,P=0.002. There were 4 positive surgical margins in two groups. And there were no significant differences in the serum creatinine and GFR change between the LPN and OPN groups(P=0.990, 0.752, respectively). On multivariate analysis, there was a increased odds of undergoing OPN for each increase in tumor size(P=0.004).Conclusions: Among the complex renal tumors(R.E.N.A.L nephrometry score≧7), the operative time was longer in the LPN group than in the OPN group for complex renal tumors. But the estimated blood loss and hospital stay were shorterin the LPN group. The post-operative renal function change among the groups were comparable. R.E.N.A.L nephrometry score was associate with type of surgical approach. |
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