Objective: To discuss the feasibility, safety, and effectiveness of conventional laparoscopic partial nephrectomy for patients with kidney tumors R.E.N.A.L. score 10 and higher.
Materials and methods: Retrospective comparative study. Everyone who has been treated from I 2015 to I 2020 by one surgeon in our department by lap partial nephrectomy was included. Patients were randomized by criteria of R.E.N.A.L. score in two groups: 40 those who had this index 10 or more (“R10+”), and 69 – all the rest (“R≤9”). Perioperative factors and results were studied and compared. Video presentation of the surgical technique is available at: https://youtu.be/1254WSFMxJ0.
Results: No conversions to open surgery or nephrectomy & any complications Clavien >III were detected. Of all patients, benign lesions were identified in 21(19,3%). Up stage from СТ1-2 to РТ3А occurred in 6 (6,82%) cases. Intraop complications: 4,3% vs 2,5% (p=0,6) and the same values of postop Clavien III rate for “R≤9” & “R10+” groups respectively. There were no any significant differences between the two groups except for three parameters: OR time, estimated blood loss & warm ischemia time. In “R10+” cohort these values were 170 [130; 210] min, 250 [162; 337] ml & 20,1±5,7 min. And in “R≤9” - 130 [100; 180] min, 200 [150; 300] ml & 15,9±4,5 min respectively (p<0.05 for all). Oncological results were comparable and nephrometric index had no effect on them.
Conclusion: conventional lap partial nephrectomy is safe and efficient even in cases of complex tumors with R.E.N.A.L. score 10 and higher.