TY - JOUR
T1 - Analysis of oncological outcomes and renal function after laparoendoscopic single-site (LESS) partial nephrectomy
T2 - A multi-institutional outcome analysis
AU - Springer, Christopher
AU - Greco, Francesco
AU - Autorino, Riccardo
AU - Rha, Koon H.
AU - Derweesh, Ithaar
AU - Cindolo, Luca
AU - Richstone, Lee
AU - Herrmann, Thomas R.W.
AU - Liatsikos, Evangelos
AU - Sun, Yinghao
AU - Fanizza, Caterina
AU - Nagele, Udo
AU - Stolzenburg, Jens Uwe
AU - Rais-Bahrami, Soroush
AU - Liss, Michael A.
AU - Schips, Luigi
AU - Kassab, Ahmad
AU - Wang, Linhui
AU - Kallidonis, Panagiotis
AU - Wu, Zhenjie
AU - Young, Shin Tae
AU - Altieri, Vincenzo M.
AU - Haber, Georges Pascal
AU - Fornara, Paolo
AU - Kaouk, Jihad H.
PY - 2014/2
Y1 - 2014/2
N2 - Objective To report on a large multi-institutional series of laparoendoscopic single-site (LESS) partial nephrectomy (PN) and analyse renal function and short-term oncological outcomes. Material and Methods We conducted a retrospective analysis of consecutive cases of LESS-PN performed between November 2007 and March 2012 at 11 participating institutions. Demographic data and data on the main peri-operative outcomes and complications were gathered and analysed. Kidney function was evaluated by measuring serum creatinine concentration and estimated glomerular filtration rate (eGFR). Chronic kidney disease was defined in stages for each patient according to the National Kidney Foundation, Kidney Disease Outcomes Quality Initiative. Results A total of 190 cases were included in this analysis. The mean renal tumour size was 2.6 cm, and the mean PADUA score was 7.2. The median operating time was 170 min with a median estimated blood loss of 150 mL. A clampless technique was used in 70 cases (36.8%) and the median warm ischaemia time (WIT) was 16.5 min. PADUA score independently predicted the length of WIT (low vs high score: odds ratio 5.11, CI 1.50-17.41, P = 0.009; intermediate vs high score: odds ratio 5.13, CI 1.56-16.88, P = 0.007). The overall postoperative complication rate was 14.7%. Where a clamping technique was used, a significant increase in serum creatinine concentration and a significant decrease in eGFR were observed postoperatively and at 6 months. On multivariate analysis PADUA score was the only predicting factor. Overall survival rates were 99, 97 and 88% at 12-, 24- and 36-month follow-up, respectively, while disease-free survival rates were 98% at 12-month and 97% at 24- and 36-month follow-up. Conclusion The study showed that LESS-PN is effective in terms of renal function preservation and oncological control at short- and intermediate-term follow-up.
AB - Objective To report on a large multi-institutional series of laparoendoscopic single-site (LESS) partial nephrectomy (PN) and analyse renal function and short-term oncological outcomes. Material and Methods We conducted a retrospective analysis of consecutive cases of LESS-PN performed between November 2007 and March 2012 at 11 participating institutions. Demographic data and data on the main peri-operative outcomes and complications were gathered and analysed. Kidney function was evaluated by measuring serum creatinine concentration and estimated glomerular filtration rate (eGFR). Chronic kidney disease was defined in stages for each patient according to the National Kidney Foundation, Kidney Disease Outcomes Quality Initiative. Results A total of 190 cases were included in this analysis. The mean renal tumour size was 2.6 cm, and the mean PADUA score was 7.2. The median operating time was 170 min with a median estimated blood loss of 150 mL. A clampless technique was used in 70 cases (36.8%) and the median warm ischaemia time (WIT) was 16.5 min. PADUA score independently predicted the length of WIT (low vs high score: odds ratio 5.11, CI 1.50-17.41, P = 0.009; intermediate vs high score: odds ratio 5.13, CI 1.56-16.88, P = 0.007). The overall postoperative complication rate was 14.7%. Where a clamping technique was used, a significant increase in serum creatinine concentration and a significant decrease in eGFR were observed postoperatively and at 6 months. On multivariate analysis PADUA score was the only predicting factor. Overall survival rates were 99, 97 and 88% at 12-, 24- and 36-month follow-up, respectively, while disease-free survival rates were 98% at 12-month and 97% at 24- and 36-month follow-up. Conclusion The study showed that LESS-PN is effective in terms of renal function preservation and oncological control at short- and intermediate-term follow-up.
KW - LESS
KW - complications
KW - laparoendoscopic single-site surgery
KW - partial nephrectomy
KW - warm ischaemia time
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U2 - 10.1111/bju.12376
DO - 10.1111/bju.12376
M3 - Article
C2 - 24053124
AN - SCOPUS:84892498770
SN - 1464-4096
VL - 113
SP - 266
EP - 274
JO - British Journal of Urology
JF - British Journal of Urology
IS - 2
ER -