Open AccessMini-Flank Supra-12th Rib Incision for Open Partial Nephrectomy for Renal Tumor With RENAL Nephrometry Score ≥10
Author(s) -
Hang Wang,
Lili Sun,
Yiwei Wang,
Zhuoyi Xiang,
Lin Zhou,
Jianming Guo,
Guomin Wang
Publication year - 2015
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000000692
Subject(s) - medicine , nephrectomy , flank , renal tumor , surgery , urology , kidney , anatomy
The skill of supra-12th rib mini-flank approach for open partial nephrectomy (MI-OPN) provides an advanced operative method for renal tumor. Compared with laparoscopic and robotic surgery, it may be a feasible selection for the complex renal tumors. We describe our techniques and results of MI-OPN in complex renal tumors with high RENAL nephrometry score (RENAL nephrometry score ≥ 10). Fifty-five patients diagnosed with renal tumors between January 2009 and July 2013 were included in this study. Eligibility criteria comprised of patients with complex renal tumor (RENAL score ≥ 10) being candidates for partial nephrectomy (PN). All patients received MI-OPN and all surgeries were performed by a single urologist. The preoperative workup comprised of medical history, physical examination, and routine laboratory tests. Serum creatinine was recorded preoperatively and 2 to 3 months after operation. Operative time, ischemia time, blood loss, operative and postoperative complications, renal function, and pathology parameters were recorded. MI-OPN was successfully performed in all cases. Mean tumor size was 4.7 cm (range: 2.5–8.1). Mean warm ischemia time was 28.1 minutes (range: 21–39), mean operative time was 105minutes (range: 70–150) and mean estimated blood loss was 68 mL (range: 10–400). Mean postoperative hospital stay was 6.5 days (range: 5–12). Postoperative complications were found in 3 patients (5.5%). The mean pre- and postoperative serum creatinine levels were 76.2 μmol/L (range: 47–132) and 87.1 μmol/L (range: 61–189) with significant difference ( P = 0.004). The mean pre- and postoperative estimated glomerular filtration rate (eGFR) were 91.5 (range: 34–133) and 82.5 (range: 22–126.5), respectively with significant difference ( P = 0.024). In an average follow-up of 19.9 months (range: 8–50), no local recurrence or systemic progression occurred. In conclusion, MI-OPN can combine the benefits of both minimal invasive and traditional open partial nephrectomy (OPN) techniques with a smaller incision. It is an innovation of traditional OPN and suitable for the complex renal tumors with high RENAL nephrometry score safely and effectively.