Tumor enucleation vs sharp excision in minimally invasive partial nephrectomy: technical benefit without impact on functional or oncologic outcomes. Urology 2014 Jun;83(6):1294-9
Date
04/10/2014Pubmed ID
24713137DOI
10.1016/j.urology.2014.02.007Scopus ID
2-s2.0-84901627644 (requires institutional sign-in at Scopus site) 47 CitationsAbstract
OBJECTIVE: To present the benefits and utility of tumor enucleation as an alternative technique to sharp excision during minimally invasive partial nephrectomy (MIPN).
METHODS: We retrospectively compared enucleation and sharp excision during MIPN, with the aim of determining benefits and limitations of enucleation in this setting.
RESULTS: Among 602 patients undergoing MIPN at our institution, 86 and 516 underwent enucleation and sharp excision, respectively, as determined by the surgeon. The nephrometry score was greater in the enucleation vs sharp excision group (mean, 6.7 vs 6.3), but all other preoperative parameters were similar. The mean ischemia and operative times were 4 and 32 minutes shorter in the enucleation group, respectively, likely owing to less frequent entry into renal sinus (21% vs 41%) and need for tumor bed suturing (41% vs 62%), compared with those in the sharp excision group. There was no association with blood loss, positive margins, urine leak, blood transfusion, major complications, renal function, recurrence, or survival.
CONCLUSION: Enucleation appears to provide the benefits of reduced surgical entry into the renal sinus, less need for tumor bed suturing, and shorter operative time, without any impact on functional or oncologic outcomes. Given favorable preoperative radiography and intraoperative findings, enucleation is a useful technique for patients undergoing MIPN.
Author List
Mukkamala A, Allam CL, Ellison JS, Hafez KS, Miller DC, Montgomery JS, Weizer AZ, Wolf JS JrAuthor
Jonathan Scott Ellison MD Associate Professor in the Urologic Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Blood Loss, Surgical
Carcinoma, Renal Cell
Cohort Studies
Female
Humans
Kidney
Kidney Neoplasms
Laparoscopy
Length of Stay
Male
Middle Aged
Minimally Invasive Surgical Procedures
Multivariate Analysis
Neoplasm Invasiveness
Neoplasm Staging
Nephrectomy
Pain, Postoperative
Postoperative Complications
Prognosis
Retrospective Studies
Risk Assessment
Survival Analysis
Treatment Outcome
