Study On The Efficacy And Safety Of Three Different Nephron-sparing Surgical Procedures For Localized Renal Cancer

Objective The efficacy and safety of three different nephron-sparing procedures for localized renal cancer were observedMethods A data details of 117 patients with localized renal carcinoma who underwent renal unit preserving surgery in the Department of Urology,Qilu Hospital,Shandong University between October 2019 and October 2020 were collected,including open nephron sparing surgery(ONSS)41 patients,laparoscopic nephron-sparing surgery(LNSS)38 patients,and retroperitoneal laparoscopic nephron sparing surgery(RLNSS)38 patients.General clinical data,tumor characteristics,perioperative related indicators,prevalence of postoperative adverse events,indicators of inflammatory factors and changes in renal function parameters were investigated retrospectively in the three groups.Multivariate linear regression analysis was used to determine the independent factors affecting postoperative renal function and length of postoperative hospital stay.Results Differences in age,sex,mean diameter of the tumor,and body weight between the three groups were not significant(P>0.05);R.E.N.A.L scores of ONSS group were higher than those in the LNSS and RLNSS groups(P<0.05);Surgical duration and renal blocking time in the RLNSS group were lower than those in the LNSS group and higher than those in the ONSS group(P<0.05);Compared with LNSS group,the operation time and renal block time in RLNSS group were obviously lower,but significantly higher than those in ONSS group(P<0.05);Postoperative hospitalization length was higher in the ONSS group than in the RLNSS and LNSS groups(P<0.05);The incidence of incision infection,incision bleeding,and urine leakage and pleural injury in RLNSS group were significantly lower than those in patients with ONSS and LNSS groups(P<0.05);There were no significant differences in preoperative serum creatinine(SCR)and glomerular filtration rate(GFR)and blood urea nitrogen(BUN)in the three groups;Postoperative SCR was increased in all three groups compared with preoperative surgery,with the most significant postoperative SCR increase in the LNSS group,(P<0.05);Postoperative GFR was decreased in all three groups,which was the most significant in the LNSS surgery group,and the difference was statistically significant(P<0.05);Postoperative BUN was elevated in all three groups compared with preoperative patients,BUN was most significantly elevated in the ONSS group(P<0.05);There were no significant differences in preoperative Tumor Necrosis Factor-α(TNF-α)and C-reactive protein(CRP)and Interleukin-6(IL-6)and White Blood Cell(WBC)in the three groups,all were increased after surgery,the lowest elevation was lowest in the RLNSS group,(P<0.05);Multiple linear regression analysis showed that the age(P=0.002),GFR(P=0.000),and the length of intraoperative renal thermal ischemia(P=0.027)had a statistically significant effect on postoperative renal function.The effect of postoperative drainage tube removal time(P=0.000)and renal artery block time on postoperative hospital stay length was statistically significant.Conclusion In the treatment of patients with limited renal cell carcinoma,retroperitoneal laparoscopic nephron sparing surgery can shorten the operation time,reduce the amount of bleeding and renal blocking time,shorten the length of hospital stay,improve the postoperative recovery,inhibition of the postoperative inflammatory response,reduce the incidence of postoperative adverse events,and have good safety.There is no significant difference in renal function indexes among the three groups.As mentioned above,there are many methods to treat localized renal cell carcinoma,but retroperitoneal laparoscopic nephron sparing surgery is safer and the postoperative recovery rate is better.