Kidney Injury, Kidney Ischemia, Kidney Neoplasms, Oncology, Oncology Problem, Renal Cancer, Renal Cell Carcinoma, Renal Functional Abnormality, Renal Neoplasm, Surgery, Surgery--Complications, Urologic Cancer, Urologic Neoplasms
Conditions
Keywords
laparoscopic partial nephrectomy, Trifecta, Pentafecta, Outcomes
Brief summary
The aim of the study is to evaluate trifecta and pentafecta outcomes for laparoscopic partial nephrectomy (LNP) in patients with clinical T1N0M0 renal tumor.
Detailed description
From November 2009 to August 2018 a total of 292 patients who underwent LPN by global ischemia were included in the study. The patients were allocated into two groups according to the tumor size; T1a (≤ 40 mm, n=215), T1b (41-70 mm, n=77). Demographics features, clinical tumor characteristics, intraoperative and postoperative outcomes were analyzed. A negative surgical margin, warm ischemia time (WIT) \< 20 min and no postoperative complications (Clavien-Dindo ≥ grade 3) were accepted to achieve the trifecta outcomes. Pentafecta has defined as trifecta criteria plus \>90% preservation of estimated glomerular filtration rate (eGFR) and no stage upgrade of chronic kidney disease 12 months after LPN. Univariable and multivariable analysis were used to identify factors predicting trifecta and pentafecta achievement.
Interventions
None listed
Sponsors
Ondokuz Mayıs University
Samsun Liv Hospital
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 82 Years
Healthy volunteers
No
Inclusion criteria
* Functioning contraleteral kidney * Patients with complete data * Patients with single renal tumor on the effected side * Patients who approved the written consent form
Exclusion criteria
* The patients with bilateral renal tumors (n=8, 16 LPNs) * solitary kidney (n=8) * horseshoe kidney (n=4) * pelvic ectopic kidney (n=2) * graft kidney (n=2) * those with multiple renal tumors in a single kidney (n=3) or with \> 7 cm renal tumor (n=6) * Patients who were operated on for colon cancer (n=4), prostate cancer (n=2), endometrial cancer (n=1) or adrenal mass (n=2) within the first year after LPN
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Operation time | at the end of the surgery | time from onset to complete of surgery |
| Blood loss | at the end of the surgery | amount of bleeding during surgery (mL) |
| warm ischemia time | at the and of the surgery | The clamp time of the renal artery and vein which is required to complete tumor excision and renorrhaphy |
| intraoperative complication | at the end of the surgery | abnormal problmes that may be seen during surgery |
| Postoperative complication | up to 3 months | abnormal problmes that may be seen after surgery and require additional intervention, treatment or follow-up |
| functional outcomes | up to 1 year postoperatively | serum creatinine level and estimated glomerular filtration rate |
| surigcal margin status | up to 1 month postoperatively | presence or absence of tumors at the surgical margin |
| Relative decrease in renal function | up to 1 year postoperatively | Comparison of preoperative and postoperative renal functions according to numerical and percentile values |
| CKD stage upgrading | up to 1 year postoperatively | evaluation of preoperative and postoperative renal functions according to chronic kidney disease stages |
| Oncological outomes | up to the last clinical control (months) | Presence or absence of local and/or distal tumor recurrence |
Countries
Turkey (Türkiye)
Outcome results
None listed