The Cleveland Clinic Group has shown that with experience they have been able to effectively offer laparoscopic partial nephrectomy (LPN) to more patients with centrally located lesions.
They found that these tumors were significantly larger than those in patients undergoing LPN for peripheral tumors, and required repair of the pelvicaliceal system and sutured hemostatic renal parenchyma re-approximation.
However when compared to patients with peripheral tumors, the central tumor LPN group had similar blood loss, equivalent positive margin rate (1 per group), similar median postoperative serum creatinine, and comparable intraoperative and late postoperative complications.
While the central tumors required significantly longer warm ischemia time (33.5 vs. 30 minutes), operative time (3.5 vs. 3 hours), and longer hospital stays (67 vs. 60 hours), compared to the peripheral group, these were not clinically significant.
However, the early positive complications, notably bleeding and urine leakage, occurred more often in the central tumor group (6% vs. 2% p = 0.05).
Therefore in view of the previous LPN paper and these clinical results, it may be reasonable for the experienced laparoscopist to expand laparoscopic partial nephrectomy to central lesions > 4 cm in size.
By Elspeth M. McDougall, MD
Reference:
Journal Urology 175; 849-852, March 2006
http://www.ncbi.nlm.nih.gov/entrez/