Application of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma with intermediate complexity R.E.N.A.L. score

Objective:To study the application of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma with intermediate complexity R.E.N.A.L.score. Method:From April 2005 to June 2011,82 cases(51 males and 31 females)of intermediate complexity R.E.N.A.L.score(range from 7 to 9 score)renal cell carcinoma were retrospectively analyzed.Mean age was(53.2±9.8)years,mean tumor size was(3.0±0.9)cm in diameter,with 36 cases on the left side and 46 cases on the right side.Tumor located anteriorly in 34 cases,and 48 cases were located posteriorly.11 cases of tumor were near the renal hilum.All 82 patients received retroperitoneal laparoscopic partial nephrectomy. Result:Eighty-two cases were operated successfully without conversion to open surgery,no severe perioperative complications.The mean operation time was(102.0±23.1)min,and mean warm ischemia time(WIT)was(17.3±4.6)min,and mean blood loss was(26.8±7.9)ml,;mean postoperative hospital stay was(5.0±1.2)days.Postoperative urinary leakage in three cases,symptoms disappeared one week after indwelling catheterization and ureteral catheter.Serum creatinine transient increased in 8 cases after surgery,and fell to normal range within 6 weeks.In a mean follow up for(33.5±11.6)months,estimated glomerular filtration rate(eGFR)6 months after operation was no statistical significance compared with preoperation in 80 cases,another 2 patients' eGFR decreased by 30% and 35%.Postoperative renal function remained in CKD3 period and CKD2 period were in 2 cases and 3 cases,none of these cases were treated with hemodialysis,and the remaining patients with normal renal function after surgery,no tumor recurrence and metastasis during follow-up in all cases. Conclusion: Treatment of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma with intermediate complexity R.E.N.A.L.score is safe and effective,but its long-term effects still need to study by large samples with long-term follow-up.