Article

Nephron sparing surgery: A single institution experience.

Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, (UP), India.
Indian Journal of Urology 02/2007; 23(1):23-7. DOI: 10.4103/0970-1591.30260
Source: PubMed

ABSTRACT To report our experience in managing various benign and malignant renal tumors with nephron-sparing surgery.
Records of patients who underwent nephron-sparing surgery (NSS) either through open or laparoscopic approach between May 1997 and June 2006 at our institution were reviewed. Patient and tumor-related characteristics, treatment modality and complications were noted.
There were 26 patients (29 renal units), including three with bilateral lesions who underwent nephron-sparing surgery. Mean age at surgery was 47.0 years (range 16-67 years). Mean tumor size was 4.7 cm (range 2-7.5 cm). Mean warm ischemia time was 41 min and 32.5 min, operative time 158 min and 186 min and blood loss 200ml and 85 ml in open (n=24) and laparoscopic approach (n=2) respectively. Complications were seen in five (19.2%) patients of whom two had postoperative bleeding requiring nephrectomy in one and angioembolization in another. One patient with persistent urinary leak required intervention. Local wound infection in one patient and incisional hernia in another were surgically managed. Histopathological profile revealed 13 (44.8%) benign lesions which included angiomyolipoma (eight), simple cyst (two), cortical adenoma (one), metanephric adenoma (one) and myelolipoma (one). The remaining 16 (55.2%) malignant lesions included renal cell carcinoma (15) and metastatic adenocarcinoma (one). At a mean follow-up of 38.6 months (range 1-91) no patient had local recurrence or distant metastasis. Cancer-specific survival was 100% and overall survival was 92.3%.
Nephron-sparing surgery is a safe and effective alternative to nephrectomy in both benign and malignant lesions of the kidney.

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  • Indian Journal of Urology 02/2007; 23(1):27-8.
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    ABSTRACT: ObjectiveThe aim of the study was to report the experience of National Cancer Institute (NCI), Cairo University, Egypt, in managing various benign and malignant renal tumors with nephron sparing surgery (NSS), and to assess its safety and feasibility. MethodsReviewing the literature for NSS, and records of patients who underwent NSS in the period from January 2000 to December 2009 at National Cancer Institute, Cairo University regarding the patient and tumor related characteristics, the indication for NSS, operative technique, postoperative complications, full histopathological data, and follow up results. ResultsThe total number of patients was 17. Mean age at surgery was 30.7 years (range 1.5–65 years). Five patients had bilateral tumors during surgery. The mean tumor size was 4.5 cm (range 1–9 cm). All patients had normal preoperative kidney functions. Seven patients had an absolute indication for NSS, 6 patients had a relative indication, and 4 patients had an elective indication. All the 5 patients with bilateral tumors underwent bilateral simultaneous surgery. Cold ischemia was used in 8 patients, 1 patient was exposed to warm ischemia, manual compression was used in 2 patients, and no vascular control was applied in 6 patients. Complications were encountered in 2 patients, one of them had urinary leakage which needed reoperation, and the other had subcutaneous hematoma which was treated conservatively. Histopathological analysis revealed Wilm’s tumor (8 patients), angiomyolipoma (4 patients), renal cell carcinoma (4 patients), and hydatid cyst (1 patient). All patients had negative surgical margin. For patients with Wilm’s tumor, the mean follow up was 21.4 months (range 0–94 months), 2 patients had local recurrence, and 1 patient had distant metastasis. For patients with RCC, the mean follow up was 15.3 months (5–33 months), no patients had local recurrence or distant metastasis. All patients had normal kidney functions during postoperative and follow up periods. ConclusionNSS is a feasible safe procedure that can be done with acceptable complications rate and it provides a good solution for patients with bilateral tumors, early localized renal cell carcinoma, and benign tumors. Key wordsnephron sparing surgery (NSS)–renal tumors–evaluation
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