Oncologic Outcomes After Partial Nephrectomy without hilar clamping
INTRODUCTION AND OBJECTIVES: The aim of the study is to report intermediate and long-term oncologic outcomes of zero ischemia partial nephrectomy, to make specific conclusions about the oncologic efficacy of the procedure.
METHODS: We performed a chart review of 790 patients who had undergone ZIPN since January 2001; patients with a minimum of 2 yr of follow-up were included in this study. Length of follow-up was calculated from the date of surgery to the date of last clinical follow-up. The intervention adopted was open, laparoscopic and robot-assisted partial nephrectomy without hilar clamping. The Kaplan-Meier method was used to calculate overall survival, cancer specific survival and disease-free survival.
RESULTS: Of 790 renal masses, 583 were malignant tumours. In this cohort, all the patients had a minimum follow up of 2 yr with 139 who had a minimum of 5 yr. The mean age was 60.2(±13.4) yr, body mass index was 26.4(±2.9) kg/m(2), and Charlson comorbidity index score was 3.9±1.8. The mean tumor size on computed tomography scan was 4.0(±2.1) cm, RENAL score was 8.1±1.3, estimated blood loss (EBL) was 191±119 ml, operative time was 60±19 min. No intraoperative complications were detected while 17 high-grade Clavien postoperative complications (2.9%) occurred. Patients stayed on average for 4.5±1.6 days in the hospital, and the median follow-up was 4 yr. OS was 98.2% at 5yr; DFS for the malignant cohort was 91.6% at 3 yr and 90.7% at 5 yr; CCS was 98.5% at 5 yr as projected by the Kaplan-Meier method. Renal recurrence was observed in 16 patients (2.7%). The mean preoperative GFR was 81.9±22.1ml/min per 1.73m²; the latest postoperative GFR was 71.1±17.4 ml/min per 1.73m². No patient required to start dialysis.
CONCLUSIONS: This study affirms that ZIMIPN is effective in oncologic control at an intermediate and long-term followup