Open and Robotic/Laparoscopic Partial Nephrectomy: A Large Single-Institutional Experience with Clinicopathologic Analysis and Follow-Up
Lian Liu, John G Pattaras, Adeboye O Osunkoya. Emory University School of Medicine, Atlanta
Background: Interest in partial nephrectomy, or nephron-sparing surgery, for renal tumors has been stimulated by advances in renal imaging, improved surgical techniques, and increasing numbers of incidentally discovered low-stage renal tumors. There are however, only few large studies with emphasis on clinicopathologic analysis and follow up.
Design: A search was made through the surgical pathology files of our institution for patients who had open or robotic/laparoscopic partial nephrectomy procedures between 2007 and 2010. Clinicopathologic parameters and follow up information was obtained.
Results: 136 patients were identified, who had a total of 142 procedures (6 patients had repeat partial nephrectomies, 5 contralateral and 1 ipsilateral kidney). 2/136 patients (2%) underwent subsequent ipsilateral completion radical nephrectomy, 1 of whom was the only patient with a positive renal parenchymal margin. The mean patient age was 57 years (range, 19-84 years), with a male to female ratio of 2.1:1.Of the 142 partial nephrectomy procedures, 91 (64%) were open, and 51 (36%) were robotic/laparoscopic. The mean greatest tumor size was 3.7 cm (range, 1.2-8.2 cm). The most common diagnosis was renal cell carcinoma (RCC) 130/142 cases (92%) including; clear cell RCC 86/130 cases (66%), papillary RCC 31/130 cases (24%), chromophobe RCC 7/130 cases (5%), multilocular cystic RCC 3/130 cases (2%), mucinous tubular and spindle cell carcinoma 2/130 cases (2%) and RCC unclassified 1/130 cases (1%). The remaining 12/142 cases were; angiomyolipoma 5/142 cases (3%), oncocytoma 5/142 cases (3%), simple renal cyst 1/142 cases (1%), and cystic nephroma 1/142 cases (1%). Among the RCC cases the stages were as follows; pT1a 84/130 cases (65%), pT1b 39/130 cases (30%), pT2a 4/130 cases (3%), and pT3a 3/130 cases (2%). Duration of follow up ranged from 3 to 40 months. During the follow up period, only 2/136 patients (2%) developed metastatic RCC (lung and clavicle).
Conclusions: Although over 90% of patients had malignant renal tumors, the outcome was excellent in the majority of cases. Our study demonstrates that partial nephrectomy, either open or robotic/laparoscopic, is a viable option for a select group of patients with malignant or benign renal tumors who may not need to undergo radical nephrectomy.
Category: Genitourinary (including renal tumors)
Tuesday, March 20, 2012 9:30 AM
Poster Session III # 165, Tuesday Morning