Radiofrequency ablation assisted laparoscopic partial nephrectomy versus laparoscopic partial nephrectomy: a comparison of perioperative and intermediate-term outcomes
Abstract：Objective:To introduce the clinical experience and effects of laparoscopic partial nephrectomy with radiofrequency ablation (RFA-LPN) and LPN in treatment of patients with T1 renal cell carcinoma. Methods:106 patients with T1 renal cell carcinoma who were treated with LPN or RFA-LPN, from Aug. 2010 to Aug. 2012 were retrospectively analyzed. There were 54 patients included in the LPN group (37 males and 17 females, mean age [52.4±10.1] y, average maximum tumor diameter was [2.90±0.90] cm). There were 52 patients included in the RFA-LPN group (34 males and 18 females, mean age [55.3±10.2] y, average maximum tumor diameter was (3.04±0.97). All patients were followed up with detection of serum creatinine and calculated glomerular filtration rate before and after operation was analyzed. Results:All the 106 cases were operated successfully without conversion to open surgery. The operative time was (131.0±29.6) min in LPN group, and all the patients in this group underwent the hilar clamping with the average hilar clamping time being (23.9±6.3) min. The operative time was (111.0±28.2) min in RFA-LPN group, and 11 patients in this group underwent the hilar clamping with the average hilar clamping time being (20.1±5.7) min. The estimated blood loss was (264.0±85.1) mL in LPN group and (213.8 ±91.8) mL in RFA-LPN group (P<0.05). The postoperative hospital stay was (9±3) days and (8.2±2.6) days in LPN and RFA-LPN groups respectively. In LPN group, complications occurred in 8 cases (14.8%) (Clavien grade Ⅰ: 5 cases; Clavien grade Ⅱ: 2 cases; Clavien grade Ⅲ: 1 case). In the RFA-LPN group, complications occurred in 9 ccases (14.8%) (Clavien grade Ⅰ: 4 cases; Clavien gradeⅡ: 3 cases; Clavien grade Ⅲ: 2 cases). The patients in both LPN and RFA-LPN groups had normal renal function and had no tumor recurrence or metastasis [mean follow-up time: (24.5±9.8) months in LPN group, and (21.3±5.7) months in RFA-LPN group). The SCr and eGFR in LPN group before and after operation were (78.3±8.5) μmol/L and (79.5±7.7) μmol/L (P>0.05), and (82.7±8.5) mL·min-1·1.73 m-2 and (81.1±7.8) mL·min-1·1.73 m-2 (P>0.05) respectively. In RFA-LPN group, the SCr and eGFR before and after operation were (68.9±14.5) μmol/L and (76.1±18.9) μmol/L (P>0.05), and (73.4±9.3) mL·min-1·1.73 m-2 and (78.2±9.4) mL·min-1·1.73 m-2 (P>0.05) respectively. Conclusions: Compared with the LPN, RFA-LPN for renal cell carcinoma T1 is safe and effective, and can retain kidney function. For RFA-LPN selection, the indications for surgery should be strictly followed.
[1]Ljungberg B, Cowan NC, Hanbury DC, et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol, 2010,58(3):398-406. [2]胡建庭,周玉东,马杰锋等.后腹腔镜下肾部分切除术的并发症及预防.微创泌尿外科,2013,2(6):368-370. [3]Chen DY, Uzzo RG. Optimal management of localized renal cell carcinoma: surgery, ablation, or active surveillance. J Natl Compr Canc Netw, 2009,7(6):635-642. [4]庄君龙,连惠波,郭宏骞,等.射频消融在肾癌中的应用.微创泌尿外科杂志,2012,1(1):37-40. [5]Levey AS, Stevens LA, Schmid CH, et al. A New Equation to Estimate Glomerular Filtration Rate. Ann intern Med, 2009,150(9):604-612. [6]Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2):187-196. [7]Becker F, Van Poppel H, Hakenberg OW, et al. Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol, 2009,56(4):625-634. [8]Godoy G, Ramanathan V, Kanofsky JA, et al. Effect of warm ischemia time during laparoscopic partial nephrectomy on early postoperative glomerular filtration rate. J Urol, 2009,181(6):2438-2443. [9]Shao P, Tang L, Li P, et al. Application of a vasculature model and standardization of the renal hilar approach in laparoscopic partial nephrectomy for precise segmental artery clamping. Eur Urol, 2013,63(6):1072-1081. [10]Lane BR, Campbell SC, Gill IS. 10-year oncologic outcomes after laparoscopic and open partial nephrectomy. J Urol, 2013,190(1):44-49. [11]Olweny EO, Park SK, Tan YK, et al. Radiofrequency ablation versus partial nephrectomy in patients with solitary clinical T1a renal cell carcinoma: comparable oncologic outcomes at a minimum of 5 years of follow-up. Eur Uol, 2012,61(6):1156-1161. [12]Remzi M, Marberger M. Renal tumor biopsies for evaluation of small renal tumors: why, in whom, and how? Eur Urol, 2009,55(2):359-367. [13]Montag S, Waingankar N, Sadek MA, et al. Reproducibility and fidelity of the R.E.N.A.L. nephrometry score. J Endourol, 2011,25(12):1925-1928. [14]黄毅,阴雷,黄海,等.R.E.N.A.L评分在后腹腔镜下肾部分切除术中预测肾脏热缺血时间的应用.微创泌尿外科杂志,2013,2(5).324-327. [15]Zeltser IS, Moonat S, Park S, et al. Intermediate-term prospective results of radiofrequency-assisted laparoscopic partial nephrectomy: a non-ischaemic coagulative technique. BJU Int, 2008, 101(1):36-38. [16]Frank I, Colombo JR Jr, Rubinstien M, et al. Laparoscopic partial nephrectomy for centrally located renal tumors. J Urol, 2006,175 (3 Pt 1):849-852. [17]Wu SD, Viprasit DP, Cashy J, et al. Radiofrequency ablation-assisted robotic laparoscopic partial nephrectomy without renal hilar vessel clamping versus laparoscopic partial nephrectomy: a comparison of perioperative outcomes. J Endourol, 2010, 24(3):385-391.
