Retroperitoneal laparoscopic partial versus radical nephrectomy for large (≥ 4 cm) and anatomically complex renal tumors: A propensity score matching study
Menée à partir de données portant sur 254 patients atteints d'une grande tumeur rénale (taille supérieure ou égale à 4 cm) ou d'une tumeur rénale complexe traitée entre 2008 et 2017, cette étude évalue l'intérêt, du point de vue de données périopératoires (durée de l'opération, perte de sang), de la préservation de la fonction rénale et des complications, d'une néphrectomie rétropéritonéale laparoscopique partielle par rapport à une néphrectomie radicale
Introduction : To assess the safety and efficiency of retroperitoneal laparoscopic partial nephrectomy (RLPN) and retroperitoneal laparoscopic radical nephrectomy (RLRN) for large (≥4 cm) renal tumors with a RENAL nephrometry score ≥7. Materials and methods : We retrospectively identified and analyzed the data of 254 patients who underwent RLPN or RLRN for large (≥4 cm) and anatomically complex renal tumors between 2008 and 2017. Propensity score matching (PSM) (1:1) method was conducted to adjust for preoperative clinical characteristics. Preoperative, renal functional, and oncological outcomes were compared. Results : Finally, no significant differences in the baseline characteristics existed between the two groups after PSM. Within the well-balanced matched cohort, longer operating time (OT) and higher estimated blood loss (EBL) were found in RLPN group ( p = 0.015 and p = 0.019, respectively), and RLPN trended to protect renal function better at a higher risk of low-grade complications (−10.9 vs −16.8 ml/min, p = 0.001; 23.0% vs 10.8%, p = 0.048, respectively). The patients in the RLPN group had a better overall survival (OS) than those in RLRN group, but cancer-specific survival and progression-free survival didn't differ significantly between the two groups. Conclusion : For patients with large (≥4 cm) and anatomically complex renal tumors, RLPN by highly experienced hands has an evident tendency to a better protection of renal function and a longer OS without waiving oncological control in comparison with RLRN, but at the expense of longer OT, a higher EBL and a higher risk of low-grade complications.