Evaluation Of Feasibility And Surgical Expreience Of Laparoscopic Partial Nephrectomy In Treatment Of Complex Renal Tumors

Objective: To evaluate the feasibility and surgical experience of the laparoscopic partial nephrectomy in the treatment of Complex Renal Tumors,by comparison with laparo scopic partial nephrectomy and open partial nephrectomy.Methods: A retrospective review of the clinical data of 90 patients(para-hilus kidney neoplasms 2 cases,centrally located or hilar tumors 4 cases and other complex tumors R.E.N.A.L nephrometry score ?7))at the Department of Urological Surgery,Second Affiliated Hospital of Dalian Medical University from January 2010 to february 2016.All the operations were taken by the same urologist Laparoscopic Partial Nephre ctomy group 52 cases(LNP group,n=52),Open Partial Nephrectomy group 38 cases(OPN group,n=38).Variables compared included(1)demographics characteristics: age,gender,body mass index(BMI),chronic obstructive pulmonary disease(COPD),diabetes,hypertension,coronary artery disease,ASA(American Society of Anesthe siologists)score;(2)the preoperative characteristics:CT tumour size,tumour location,laterality,CT depth of invasion,estimated glomerular filtration rate(GFR);(3)intraoperative characteristics: operative time,warm ischaemia time,estimated blood loss;(4)postoperative outcomes character--istics:tumor size,pathology,surgical margin status,GFR,perioperative complications,length of beginning taking food and stay after surgery.The result of type-B ultrasonic and CT for check review.Results:(1)There was no statistically significant difference in the demographics of the two groups.(including demographics characteristics: age,gender,body mass index(BMI),chronic obstructive pulmonary disease(COPD),diabetes,hypertension,coronary artery disease,ASA(American Society of Anesthesiologists)score)).(2)There was no statistically significant difference in the demographics of the two groups(including the preoperative characteristics:CT tumour size,tumour location,laterality,CT depth of invasion,estimated glomerular filtration rate(GFR)).(3)Intraoperative characteristics: The difference of Operative time between patients under going LPN and OPN was not tatistically significant(135.6±49.8 min VS.123.5±34.2 min,p>0.05,respectively);The difference of renal pedicle clamp time was tatistically significant(29.3±5.2 min VS.20.3±4.1 min,P<0.05);Estimated blood loss(160.7±84.5 ml VS.232.8±125.4 ml,P<0.01);(4)Postoperative outcomes character--istics:The difference of tumor size was not tatistically significant(3.1.±1.5cm VS.3.4±1.3 cm,P>0.05).There were 0 positive surgical margins in two groups,so no tatistically significant.There were no significant differences in the serum creatinine and GFR change;Surgical complications for two groups was not tatistically significant;The peristaltic sound time,practical eating time and recovery eating time were much earlier in the LPN group than those in the open group(52.8±23.2 h vs 78.8±25.6 h,P<0.001);Hospital stay of the two groups(5.4±2.4 d vs 12.3±5.8 d,P<0.001).There were not local recurrence,metastasisand and enal insufficiency was observed during a mean follow-up from 6-36 months by laboratory examination,type-B ultrasonic and CT.Conclusion: LPN is treating complex renal tumor as a safe and effective operation.the operation has a small trauma,less intraoperative bleeding,short postoperative hospital stay and bowel faster recovery.Though the warm ischemia time of LPN is longer than OPN,but two groups of patients with postoperative serum creatinine and GFR rate no statistical difference.therefore,laparoscopic partial nephrectomy is safe and effective surgery for the treatment of complex renal tumors.