Analysis of oncological outcomes and renal function after laparoendoscopic single-site (LESS) partial nephrectomy: a multi-institutional outcome analysis

作者：Springer Christopher; Greco Francesco^*; Autorino Riccardo; Rha Koon H; Derweesh Ithaar; Cindolo Luca; Richstone Lee; Herrmann Thomas R W; Liatsikos Evangelos; Sun Yinghao; Fanizza Caterina; Nagele Udo; Stolzenburg Jens Uwe; Rais Bahrami Soroush; Liss Michael A; Schips Luigi; Kassab Ahmad; Wang Linhui; Kallidonis Panagiotis; Wu Zhenjie; Young Shin Tae; Altieri Vincenzo M; Haber Georges Pascal; Fornara Paolo; Kaouk Jihad H

来源：BJU International, 2014, 113(2): 266-274.

DOI：10.1111/bju.12376

• laparoendoscopic single-site surgery
• LESS
• partial nephrectomy
• warm ischaemia time
• complications

Objective %26lt;br%26gt;To report on a large multi-institutional series of laparoendoscopic single-site (LESS) partial nephrectomy (PN) and analyse renal function and short-term oncological outcomes. %26lt;br%26gt;Material and Methods %26lt;br%26gt;We conducted a retrospective analysis of consecutive cases of LESS-PN performed between November 2007 and March 2012 at 11 participating institutions. %26lt;br%26gt;Demographic data and data on the main peri-operative outcomes and complications were gathered and analysed. %26lt;br%26gt;Kidney function was evaluated by measuring serum creatinine concentration and estimated glomerular filtration rate (eGFR). %26lt;br%26gt;Chronic kidney disease was defined in stages for each patient according to the National Kidney Foundation, Kidney Disease Outcomes Quality Initiative. %26lt;br%26gt;Results %26lt;br%26gt;A total of 190 cases were included in this analysis. The mean renal tumour size was 2.6cm, and the mean PADUA score was 7.2. %26lt;br%26gt;The median operating time was 170min with a median estimated blood loss of 150mL. A clampless technique was used in 70 cases (36.8%) and the median warm ischaemia time (WIT) was 16.5min. %26lt;br%26gt;PADUA score independently predicted the length of WIT (low vs high score: odds ratio 5.11, CI 1.50-17.41, P = 0.009; intermediate vs high score: odds ratio 5.13, CI 1.56-16.88, P = 0.007). %26lt;br%26gt;The overall postoperative complication rate was 14.7%. Where a clamping technique was used, a significant increase in serum creatinine concentration and a significant decrease in eGFR were observed postoperatively and at 6 months. On multivariate analysis PADUA score was the only predicting factor. %26lt;br%26gt;Overall survival rates were 99, 97 and 88% at 12-, 24- and 36-month follow-up, respectively, while disease-free survival rates were 98% at 12-month and 97% at 24- and 36-month follow-up. %26lt;br%26gt;Conclusion %26lt;br%26gt;The study showed that LESS-PN is effective in terms of renal function preservation and oncological control at short- and intermediate-term follow-up.

• 出版日期2014-2