Partial nephrectomy: a 14-year case series

1. No. 068 Partial nephrectomy: a 14-year case series Yang Sun, Nigel Dunglison, David Hussey, Anthony James, Robert Gardiner, Troy Gianduzzo Royal Brisbane and Women’s Hospital, Herston, Queensland Introduction The mainstay of curative treatment for renal cell carcinoma is surgical excision. It is now accepted that radical nephrectomy is an independent risk factor for chronic renal impairment. In recent years a greater emphasis has been placed on preserving functional renal parenchyma in the surgical treatment of renal tumours. Partial nephrectomy (PN), once reserved for patients with absolute indications, has become the new ideal for all patients with suitable tumours. Results A total of 56 cases were identified in 54 patients. 4 cases were excluded due to conversion to total nephrectomy. There were 15 cases whose medical records were not available during period of data collection. In total, 37 cases of PN in 36 patients were analysed. All cases were performed open; surgical approach was extraperitoneal in 36 cases and transperitoneal in 1 case. Aim We aimed to evaluate the outcomes of patients who underwent PN for suspected renal malignancy at our centre. Specific objectives were to confirm preservation of renal function and examine histological diagnosis of resected lesions. Secondary objectives were to analyse trends in utility of PN during the study period and examine complication rates. Methods We retrospectively reviewed the cases of consecutive patients at our centre who underwent partial nephrectomy during the period January 1997 to December 2010. Cases were identified by searching computerised operating records. The main search criterion was: all patients who underwent PN. Both laparoscopic and open PN modalities were included. Patients were subsequently excluded if: 1) they were identified as undergoing PN for a known benign pathology (such as non-functioning duplex moiety) or 2) if the operation was converted to total nephrectomy. Patient demographics and comorbidities, pre-operative renal function, post operative renal function within 30 days and subsequently at 3 to 6 monthly intervals, operative details, tumour pathology and tumour recurrence were recorded. A separate audit of complications was also recorded. Data were analysed using commercially available software (Microsoft Excel). Distributions were reported as median and range. Malignant (29, 78%) Clear cell 15 Papillary 8 Chromophobe 2 Mixed 4 Benign (8, 22%) Oncocytoma 5 AML 2 Interstitial fibrosis 1 Median tumour size 22 mm (range 12-85mm) Follow up Follow up duration ranged from 1.5-72 months (median 27 months). Renal function was better or unchanged in 22 of 37 cases. In the remaining 15 cases, the median reduction in eGFR was 17.8% with an a mean of 15.9%. No case of disease recurrence was observed. Conclusions Partial nephrectomy is an established approach for localised tumours where preservation of renal function is desired. At our institution partial nephrectomy is now being increasingly used with half of the cases being performed in the last 3 years of the 14 year assessment period. Our results demonstrate good preservation of renal function with minimal complications following this procedure. References Gill IS, Aron M, Gervais DA, Jewett MA. Clinical practice. Small renal mass. N Engl J Med 2010;362(7):624-34. Ljungberg B et al. Guidelines on Renal Cell Carcinoma. EuropeanAssociationof Urology 2010 Novick AC et al. Guidelinefor Management oftheClinicalStage 1 RenalMass. AmericanUrologicalAssociation 2009. Pettus JA, Sharp DS, Yossepowitch O, Schacter LR, Ferrandino MN, Snyder ME, Bach AM, Russo P. Tumor location does not affect long-term renal function after partial nephrectomy. Urology. 2007;69(6):1059-63. Volpe A, Cadeddu JA, Cestari A, Gill IS, Jewett MA, Joniau S, Kirkali Z, Marberger M, Patard JJ, Staehler M, Uzzo RG. Contemporary Management of Small Renal Masses. EurUrol 2011;60(3):501-15. Yip SKH, Cheng WS, Tan BS, Li MK, Foo KT. Partial nephrectomy for renal tumours: the Singapore General Hospital experience. J R CollSurgEdinb1999;44:156-60 Acknowledgements The author would like to thank the medical records and operating records staff at RBWH for assistance during data collection. Poster presentation sponsor