Laparoscopic partial nephrectomy for multiple tumours: Feasibility and analysis of peri-operative outcomes

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Laparoscopic nephron-sparing procedures have been increasingly utilized. However, in the presence of multiple tumours the procedure choice is usually shifted to radical nephrectomy. In view of favourable perioperative outcomes, the benefits of minimally-invasive, nephron-sparing surgery in experienced hands could be safely extended to patients presenting with multiple ipsilateral renal masses. OBJECTIVE To describe our experience with laparoscopic partial nephrectomy (LPN) for multiple kidney tumours and compare the outcomes with LPN performed for single masses. PATIENTS AND METHODS Retrospective analysis of medical records of patients undergoing LPN at our institution between 2005 and 2009 was performed. The cohort was divided in two groups based on tumour focality: group 1, LPN for a single tumour (n= 99) and group 2, LPN for multiple ipsilateral tumours (n= 12). The groups were compared with regards to demographic and peri-operative variables. RESULTS Demographic variables were not different between the groups. Median dominant tumour size was 3.1 cm (interquartile range [IQR] 2.4-4.0) and 4.0 cm (2.3-5.9) in groups 1 and 2, respectively. Median secondary tumour size in group 2 was 1.0 cm (1.0-1.8). Operative times were longer in group 2 compared with group 1 (220 vs 160 min, P= 0.009). Warm ischaemia times (WIT) (23 vs 22 min) and estimated blood loss (EBL) (100 vs 85 mL) were similar. CONCLUSIONS LPN is a viable option for the treatment of multiple ipsilateral renal tumours. Peri-operative outcomes are similar to standard LPN with the exception of longer operative time. In experienced hands, the advantages of minimally invasive surgery may be extended to select patients with ipsilateral multifocal renal tumours.