OBJECTIVES: To compare simple enucleation (SE) and standard partial nephrectomy (SPN) in terms of surgical results in a multicenter dataset (RECORd Project).
MATERIALS AND METHODS: Patients treated with nephron sparing surgery (NSS) for clinical T1 renal tumors between January 2009 and January 2011 were evaluated. Overall, 198 patients who underwent SE were retrospectively matched to 198 patients who underwent SPN. The SPN and SE groups were compared regarding intraoperative, early post-operative and pathologic outcome variables. Multivariable analysis was applied to analyze predictors of positive surgical margin (PSM) status.
RESULTS: SE was associated with similar WIT (18 vs 17.8 min), lower intraoperative blood loss (177 vs 221 cc, p = 0.02) and shorter operative time (121 vs 147 min; p < 0.0001). Surgical approach (laparoscopic vs. open), tumor size and type of indication (elective/relative vs absolute) were associated with WIT >20 min. The incidence of PSM was significantly lower in patients treated with SE (1.4% vs 6.9%; p = 0.02). At multivariable analysis, PSM was related to the surgical technique, with a 4.7-fold increased risk of PSM for SPN compared to SE. The incidence of overall, medical and surgical complications was similar between SE and SPN.
CONCLUSIONS: Type of NSS technique (SE vs SPN) adopted has a negligible impact on WIT and postoperative morbidity but SE seems protective against PSM occurrence.
Written by:
Longo N, Minervini A, Antonelli A, Bianchi G, Bocciardi AM, Cunico SC, Fiori C, Fusco F, Giancane S, Mari A, Martorana G, Mirone V, Morgia G, Novara G, Porpiglia F, Raspollini MR, Rocco F, Rovereto B, Schiavina R, Serni S, Simeone C, Verze P, Volpe A, Ficarra V, Carini M. Are you the author?
Policlinico Federico II, Università di Napoli, Italy; Clinica Urologica I, AOUC, Università di Firenze, Italy; Unità Operativa di Urologia Dipartimento di NefroUrologia, Azienda AO Spedali Civili di Brescia, Italy; Policlinico di Modena, Clinica Urologica, Università di Modena, Italy; Dipartimento Chirurgico Polispecialistico, Urologia, Azienda Ospedaliera Ospedale Riguarda Ca' Granda, Milano, Italy; Divisione di Urologia, Università di Torino, Ospedale San Luigi Gonzaga, Orbassano, Torino, Italy; Dipartimento di Urologia, Università di Bologna, Ospedale S. Orsola-Malpighi, Bologna, Italy; LUNA Foundation, Italy; Clinica Urologica, Università di Padova, Padova, Italy; Department of Pathology, University of Florence, Careggi Hospital, Florence, Italy; Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Università di Milano, Italy; I.R.C.C.S. Policlinico San Matteo - Struttura Di Urologia, Italy; Dipartimento di Urologia, Azienda Ospedaliera Maggiore della Carità, Novara, Italy.
Reference: Eur J Surg Oncol. 2014 Feb 1. pii: S0748-7983(14)00061-4.
doi: 10.1016/j.ejso.2014.01.007
PubMed Abstract
PMID: 24529794
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