IS PARTIAL NEPHRECTOMY SAFE? A LITERATURE REVIEW: ACCESS EFFICACE, SURGICAL MARGINS, ISCHEMIA TIME, ACUTE AND CHRONIC RENAL FUNCTION IMPACT.
Introduction: Renal tumor accounts for 2-3% of all cancer in east. Main treatment consists in surgical exeresis with negative margins. There are two ways to excise the tumours: radical nephrectomy or partial nephrectomy, also known as nephron sparing surgery. The advantages of nephron sparing surgery is unquestionable specially in patients with only one kidney and limitrofe renal function.
Objectives: The aim of this study was comparing outcomes of partial nephrectomy among open, laparoscopic and robotic approaches.
Methods: Literature review in pubmed databases using key words: partial nephrectomy, small renal mass, renal tumor.
Results: Partial nephrectomy offers good cancer control and cancer specific survival (93% in 3 years). Oncological outcomes were similar independently of the approach used (minimally invasive vs. open). The standardization of suture techniques and hilar clamping, including selective clamping, allows a great control of bleeding in partial nephrectomies with little (non clinical significance) advantage for minimally invasive techniques and in general, fewer patients required blood transfusion. The most common causes of conversion from minimally invasive approach to open laparotomy was hilar involvement by the tumor (25%), followed by possibilities of positive surgical margins and complexity of masses (higher R.E.N.A.L scores). Surgical time was higher in minimally invasive techniques vs. open, but return to laboral activities was earlier in laparoscopic and robotic access.
Conclusion: The main current urological guidelines indicate that minimally invasive nephron sparing techniques is the gold standard for T1 tumors (TNM), with evidence of a similar survival rate compared to open radical nephrectomy and the advantage of a lower rate of progression to end-stage renal disease when compared to radical nephrectomy.
partial nephrectomy; small renal mass; renal tumor; renal cancer; laparoscopic; robotic; open nephrectomy.
Pontifícia Universidade Católica de São Paulo - SP - Sorocaba - Sao Paulo - Brasil
Eduardo Miolo Carvalho, Raphael Souza Sanches, Diogo Vicentainer Silva, Matheus Zeraik Lima Del Debbio Zaroni, Thais Marcondes Jacomini, Lucas Tafner Zahed, Felipe Silveira Dini, Brunno Cezar Framil Sanches