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Partial Nephrectomies: A 5 year retrospective review

Partial Nephrectomies: A 5 year retrospective review. Mr Fady Youssef Mr Neil Oakley Mr Patrick Cutinha Mr David Smith. Introduction. Nephron sparing surgery Indications Solid renal tumour in pt with solitary kidney or compromised contralateral kidney Bilat renal tumours

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Partial Nephrectomies: A 5 year retrospective review

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  1. Partial Nephrectomies: A 5 year retrospective review Mr FadyYoussef Mr Neil Oakley Mr Patrick Cutinha Mr David Smith

  2. Introduction • Nephron sparing surgery • Indications • Solid renal tumour in pt with solitary kidney or compromised contralateral kidney • Bilat renal tumours • Small localised tumours • Laparoscopic / Open

  3. Aims & Objectives • Difference in morbidity and hospital stay between Lap Vs Open? • Difference in blood transfusion rates and post-op Hb drop between Lap Vs Open? • Difference between DGH Vs TRC?

  4. Patients & Methods • All pts undergoing Partial Nephrectomy from 01/01/05  31/12/09 • Grade & T-stage • +ve / -ve surgical margins • Tumour recurrence • Blood loss (g/dl) & BTx rate • Length of stay • Post-op complications / Adverse events

  5. Results • Total 92 Partial Nephrectomies performed • 68 @ RHH • 54 (79%) Open • 14 (21%) Lap (2 conv to open) • 24@ BDGH • 24 Open

  6. Results • 63 (68%) Malignant • 29 (32%) Benign

  7. Surgical Margins • All malignancies, oncocytomas and AMLs • Fisher’s exact test, 2 tailed P value = 0.679 • No significant difference btwn Lap Vs Open

  8. Recurrences / Metastases • 1 Local Recurrence •  Radiofrequency ablation • Clear Surgical Margin (Open) • 2 Metastases • 1  Brain (Involved surgical margin - Open) • 1  Bone (Clear surgical margin – Lap)

  9. Blood Loss • Unpaired T-test, P-value = 0.88 • No significant difference • Unpaired T-test, P-value = 0.59 • No significant difference

  10. BTx • 13 (14%) received BTx • Fisher’s exact test, 2 tailed P value = 0.683 • No significant difference btwn Lap Vs Open

  11. Length of Stay • Unpaired T-test, P-value = 0.05 • Significant difference btwn Open Vs Lap • Unpaired T-test, P-value = 0.25 • No significant difference

  12. Adverse Events / Complications • 1  Pseudoaneurysm  Embolisation • Open @ RHH • 1  Perirenal Haematoma  Cons Mx • Open @ BDGH • Transferred to RHH for observation

  13. Discussion • No difference btwn TRC Vs DGH • Able to provide a high standard of care for Nephron Sparing Surgery in BDGH • Lap Vs Open • No diff in +ve margin rates • No diff in blood loss • No diff in BTx rates • Sig difference on length of stay

  14. Conclusions • Demonstrated reduced length of stay in Lap Vs Open in Nephron Sparing Surgery • Demonstrated no difference in standard of care in DGH in Nephron Sparing Surgery

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