Simple enucleation versus standard partial nephrectomy for clinical T1 renal masses: perioperative outcomes based on a matched-pair comparison of 396 patients (RECORd project).

Autor: Longo N; Policlinico Federico II, Università di Napoli, Italy., Minervini A; Clinica Urologica I, AOUC, Università di Firenze, Italy., Antonelli A; Unità Operativa di Urologia Dipartimento di NefroUrologia, Azienda AO Spedali Civili di Brescia, Italy., Bianchi G; Policlinico di Modena, Clinica Urologica, Università di Modena, Italy., Bocciardi AM; Dipartimento Chirurgico Polispecialistico, Urologia, Azienda Ospedaliera Ospedale Riguarda Ca' Granda, Milano, Italy., Cunico SC; Unità Operativa di Urologia Dipartimento di NefroUrologia, Azienda AO Spedali Civili di Brescia, Italy., Fiori C; Divisione di Urologia, Università di Torino, Ospedale San Luigi Gonzaga, Orbassano, Torino, Italy., Fusco F; Policlinico Federico II, Università di Napoli, Italy. Electronic address: ferdinando-fusco@libero.it., Giancane S; Clinica Urologica I, AOUC, Università di Firenze, Italy., Mari A; Clinica Urologica I, AOUC, Università di Firenze, Italy., Martorana G; Dipartimento di Urologia, Università di Bologna, Ospedale S. Orsola-Malpighi, Bologna, Italy., Mirone V; Policlinico Federico II, Università di Napoli, Italy., Morgia G; LUNA Foundation, Italy., Novara G; Clinica Urologica, Università di Padova, Padova, Italy., Porpiglia F; Divisione di Urologia, Università di Torino, Ospedale San Luigi Gonzaga, Orbassano, Torino, Italy., Raspollini MR; Department of Pathology, University of Florence, Careggi Hospital, Florence, Italy., Rocco F; Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Università di Milano, Italy., Rovereto B; I.R.C.C.S. Policlinico San Matteo - Struttura Di Urologia, Italy., Schiavina R; Dipartimento di Urologia, Università di Bologna, Ospedale S. Orsola-Malpighi, Bologna, Italy., Serni S; Clinica Urologica I, AOUC, Università di Firenze, Italy., Simeone C; Unità Operativa di Urologia Dipartimento di NefroUrologia, Azienda AO Spedali Civili di Brescia, Italy., Verze P; Policlinico Federico II, Università di Napoli, Italy., Volpe A; Dipartimento di Urologia, Azienda Ospedaliera Maggiore della Carità, Novara, Italy., Ficarra V; Clinica Urologica, Università di Padova, Padova, Italy., Carini M; Clinica Urologica I, AOUC, Università di Firenze, Italy.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2014 Jun; Vol. 40 (6), pp. 762-8. Date of Electronic Publication: 2014 Feb 01.
DOI: 10.1016/j.ejso.2014.01.007
Abstrakt: Objectives: To compare simple enucleation (SE) and standard partial nephrectomy (SPN) in terms of surgical results in a multicenter dataset (RECORd Project).
Materials and Methods: patients treated with nephron sparing surgery (NSS) for clinical T1 renal tumors between January 2009 and January 2011 were evaluated. Overall, 198 patients who underwent SE were retrospectively matched to 198 patients who underwent SPN. The SPN and SE groups were compared regarding intraoperative, early post-operative and pathologic outcome variables. Multivariable analysis was applied to analyze predictors of positive surgical margin (PSM) status.
Results: SE was associated with similar WIT (18 vs 17.8 min), lower intraoperative blood loss (177 vs 221 cc, p = 0.02) and shorter operative time (121 vs 147 min; p < 0.0001). Surgical approach (laparoscopic vs. open), tumor size and type of indication (elective/relative vs absolute) were associated with WIT >20 min. The incidence of PSM was significantly lower in patients treated with SE (1.4% vs 6.9%; p = 0.02). At multivariable analysis, PSM was related to the surgical technique, with a 4.7-fold increased risk of PSM for SPN compared to SE. The incidence of overall, medical and surgical complications was similar between SE and SPN.
Conclusions: Type of NSS technique (SE vs SPN) adopted has a negligible impact on WIT and postoperative morbidity but SE seems protective against PSM occurrence.
(Copyright © 2014 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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