The Value Of Partial Nephrectomy For Completely Endophytic Renal Tumors

Objective:To study the safety and efficacy of partial nephrectomy for completely endophytic renal tumors.Methods:The clinical data of 20 cases(12 males and 8 females)of completely endophytic renal tumors admitted from January 2012 to November 2017 and managed by partial nephrectomy were analyzed retrospectively.Mean age was 53.6 +5.2 years.8 tumors were on the left side,and 12 were on the right side.All the renal tumors were considered as completely endophytic according to CT and/or MRI scan.Tumor size was 2.1±0.5 cm in diameter,and one tumor was endophytic hilar tumor.The RENAL nephrometry score was 7.3 ± 0.6 points.Results:12 patients underwent open partial nephrectomy,including 11 cases of partial nephrectomy and 1 case of tumor enucleation due to endophytic hilar tumor.8 patients received laparoscopic partial nephrectomy.The tumors were localized on the basis of the relative position between the tumors and renal anatomical structures shown by the preoperative imaging modalities and were resected completely.The operation time was 93.2±14.7 min,and warm ischemia time was 18.6±2.9 min,and the estimated blood loss was less than 100 ml.The time of drainage was 6.3±0.8 d,and the time of postoperative hospitalization was 9.4±1.3 d.The postoperative serum creatinine levels were in normal range.No positive surgical margins were observed.Severe hematuria occurred in one patient receiving laparoscopic partial nephrectomy on the 9th postoperative day.Arteriovenous fistula was detected through selective renal arteriography,and hematuria disappeared after selective renal arterial embolization.Hematuria recurred due to vomiting after 16 days,and right nephrectomy was performed.No postoperative bleeding and urine leak were observed in other patients.3 cases were oncocytoma,12 were clear cell carcinoma,2 cases were papillary renal cell carcinoma,1 case was multiocular cystic renal cell carcinoma,and the pathological stage was TiN0M0;1 case was renal minimal-fat angiomyolipoma,one was renal cysts with hemorrhage and interstitial inflammation.The median follow-up was 11.5 months(3-54),no tumor recurrence and metastasis were observed.Conclusions:The Partial nephrectomy is safe and effective for patients with endophytic renal tumors,and the localization of the tumors on the basis of the relative position between the tumors and renal anatomical structures shown by the preoperative imaging modalities is critical for a successful operation.