Volume 24, Issue 105, September - October, 2020

Partial nephrectomy in surgical management of renal neoplasms - National Cancer Institute experience

Amr Mounir Selim^1♦, Waleed Mohamed Fadlalla²

¹MSc, Assistant Lecturer of Surgical Oncology, Surgical Oncology department, National Cancer Institute-Cairo University, Cairo, Egypt, Email: dr.amrmounirnci@gmail.com
²MD, Lecturer of Surgical Oncology, Surgical Oncology department, National Cancer Institute-Cairo University, Egypt, Email: waleed.fadlalla@nci.cu.edu.eg

^♦Corresponding author
Assistant Lecturer of Surgical Oncology, Surgical Oncology department, National Cancer Institute-Cairo University, Cairo, Egypt, Email: dr.amrmounirnci@gmail.com

ABSTRACT

Background: Nephron sparing surgery (NSS) is currently considered the best alternative in treatment of renal tumors <4 cm and its indication is expanding to selected cases of lesions up to 7 cm in size (whether open, laparoscopic or robotic) compared to radical nephrectomy, and the benefit of preserving renal function. Several studies have demonstrated the surgical and oncological safety of NSS in terms of local recurrence, long-term cancer-specific survival and the overall survival, which is comparable to radical nephrectomy. Patients and Methods: This is a retrospective descriptive cohort study including 40 patients with renal masses treated with partial nephrectomy (PN) whether open or minimally invasive (laparoscopic or robotic). These cases were treated by surgical intervention between March 2015 and July 2018. The study was performed at National Cancer Institute (NCI) - Cairo University (CU). Tumor size, site and relation to renal pelvis and vascular pedicle were assessed by contrast enhanced computed tomography (CT) abdomen and pelvis. Warm ischemia time (WIT), estimated blood loss (EBL), operative time, postoperative pain, postoperative complications, and hospital stay were recorded. Results: Mean operative time was 187 minutes. Mean blood loss was 413 ml. Mean warm ischemia time was 22.3 min. Open partial nephrectomy (OPN) was converted to radical in 1 case. 1 laparoscopic partial nephrectomy (LPN) case was converted to open radical and 2 LPN cases were converted to open partial. 3 patients had positive margin after resection and 2 patients had close margin (0.1 cm). 18 patients experienced mild postoperative pain, while 13 had moderate pain and 3 had severe pain.6 cases had no pain postoperative. Mean hospital stay was 3.2 days. Conclusion: NSS is an accepted safe procedure that can be done open, laparoscopic and robotic which resulted in short hospital stay and preserved renal function but moderate blood loss and long operative time which can be reduced by improving learning curve of operating surgeons. We recommend adoption of NSS in any case with renal neoplasm indicated for partial nephrectomy.

Keywords: laparoscopic partial nephrectomy; robotic; operative time; warm ischemia time.

Medical Science, 2020, 24(105), 3690-3695

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