Perioperative and renal functional outcomes of laparoscopic partial nephrectomy (LPN) for renal tumours of high surgical complexity: a single-institute comparison between clampless and clamped procedures

Abstract

Purpose: In recent times there has been a trend in mininvasive renal tumour surgery. Very limited evidence can be found in literature of the outcomes of laparoscopic partial nephrectomy (LPN) for highly complex renal tumours. The aim of the present study was to assess the feasibility and safety of LPN for renal tumours of high surgical complexity in our single-institutional experience, comparing perioperative and functional data between clampless and clamped procedures.

Materials and methods: We enrolled 68 patient who underwent a clampless LPN (Group A) and 41 patients who underwent a clamped LPN (Group B) for a renal tumour with a R.E.N.A.L. NS ≥ 10. Intraoperative and post-operative complications have been classified and reported according to international criteria. Kidney function was evaluated by measuring serum creatinine concentration and eGFR.

Results: Group A was found to be similar to Group B in all variables measured except for WIT (P = 0) and blood loss (P = 0.0188). In group A the mean creatinine levels were not significantly increased at the third post-operative (P = 0.0555) day and at the 6-month follow-up (P = 0.3047). Otherwise, in the group B the creatinine levels were significantly increased after surgery (P = 0.0263), but decreased over time, showing no significant differences at 6 month follow-up (P = 0.7985) compared to preoperative values. The same trend was seen for eGFR. Optimal Trifecta outcomes were achieved in both groups.

Conclusions: Clampless LPN represents a feasible and safe procedure, even for tumours with high surgical complexity, in highly experienced laparoscopic centers. When compared to clamped LPN, it results in better preservation of immediate post-operative renal function.

Keywords: Carcinoma; Clampless; Laparoscopic partial nephrectomy; Nephron-sparing surgery; Outcomes; R.E.N.A.L. N.S..