Volume 113, Issue 2 p. 266-274
Robotics and Laparoscopy

Analysis of oncological outcomes and renal function after laparoendoscopic single-site (LESS) partial nephrectomy: a multi-institutional outcome analysis

Christopher Springer

Christopher Springer

Department of Urology and Renal Transplantation, Martin-Luther-University, Halle/Saale, Germany

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Francesco Greco

Corresponding Author

Francesco Greco

Department of Urology and Renal Transplantation, Martin-Luther-University, Halle/Saale, Germany

Correspondence: Dr Francesco Greco, Department of Urology and Kidney Transplantation, Martin-Luther-University, Ernst-Grube-Strasse 40, 06120 Halle/Saale, Germany.

e-mail: [email protected]

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Riccardo Autorino

Riccardo Autorino

Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

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Koon H. Rha

Koon H. Rha

Department of Urology, Yonsei University College of Medicine, Seoul, South Korea

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Ithaar Derweesh

Ithaar Derweesh

Division of Urology, University of California San Diego, La Jolla, CA, USA

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Luca Cindolo

Luca Cindolo

Urology Unit, S. Pio da Pietrelcina Hospital, Vasto, Italy

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Lee Richstone

Lee Richstone

The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, USA

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Thomas R.W. Herrmann

Thomas R.W. Herrmann

Depatment of Urology and Urological Oncology, Division of Endourology and Laparoscopy, Hannover Medical School, Hannover, Germany

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Evangelos Liatsikos

Evangelos Liatsikos

Department of Urology, University of Patras, School of Medicine, Patras, Greece

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Yinghao Sun

Yinghao Sun

Department of Urology, Changhai Hospital, Shanghai, China

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Caterina Fanizza

Caterina Fanizza

Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy

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Udo Nagele

Udo Nagele

Department of Urology, LKH, Hall i. Tirol, Austria

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Jens-Uwe Stolzenburg

Jens-Uwe Stolzenburg

Department of Urology, University of Leipzig, Leipzig, Germany

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Soroush Rais-Bahrami

Soroush Rais-Bahrami

The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, USA

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Michael A. Liss

Michael A. Liss

Division of Urology, University of California San Diego, La Jolla, CA, USA

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Luigi Schips

Luigi Schips

Urology Unit, S. Pio da Pietrelcina Hospital, Vasto, Italy

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Ahmad Kassab

Ahmad Kassab

Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

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Linhui Wang

Linhui Wang

Department of Urology, Changhai Hospital, Shanghai, China

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Panagiotis Kallidonis

Panagiotis Kallidonis

Department of Urology, University of Patras, School of Medicine, Patras, Greece

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Zhenjie Wu

Zhenjie Wu

Department of Urology, Changhai Hospital, Shanghai, China

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Shin Tae Young

Shin Tae Young

Department of Urology, Yonsei University College of Medicine, Seoul, South Korea

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Vincenzo M. Altieri

Vincenzo M. Altieri

Department of Urology and Renal Transplantation, Martin-Luther-University, Halle/Saale, Germany

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Georges-Pascal Haber

Georges-Pascal Haber

Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

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Paolo Fornara

Paolo Fornara

Department of Urology and Renal Transplantation, Martin-Luther-University, Halle/Saale, Germany

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Jihad H. Kaouk

Jihad H. Kaouk

Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

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First published: 22 July 2013
Citations: 23

Abstract

Objective

  • To report on a large multi-institutional series of laparoendoscopic single-site (LESS) partial nephrectomy (PN) and analyse renal function and short-term oncological outcomes.

Material and Methods

  • We conducted a retrospective analysis of consecutive cases of LESS-PN performed between November 2007 and March 2012 at 11 participating institutions.
  • Demographic data and data on the main peri-operative outcomes and complications were gathered and analysed.
  • Kidney function was evaluated by measuring serum creatinine concentration and estimated glomerular filtration rate (eGFR).
  • Chronic kidney disease was defined in stages for each patient according to the National Kidney Foundation, Kidney Disease Outcomes Quality Initiative.

Results

  • A total of 190 cases were included in this analysis. The mean renal tumour size was 2.6 cm, and the mean PADUA score was 7.2.
  • The median operating time was 170 min with a median estimated blood loss of 150 mL. A clampless technique was used in 70 cases (36.8%) and the median warm ischaemia time (WIT) was 16.5 min.
  • PADUA score independently predicted the length of WIT (low vs high score: odds ratio 5.11, CI 1.50–17.41, P = 0.009; intermediate vs high score: odds ratio 5.13, CI 1.56–16.88, P = 0.007).
  • The overall postoperative complication rate was 14.7%. Where a clamping technique was used, a significant increase in serum creatinine concentration and a significant decrease in eGFR were observed postoperatively and at 6 months. On multivariate analysis PADUA score was the only predicting factor.
  • Overall survival rates were 99, 97 and 88% at 12-, 24- and 36-month follow-up, respectively, while disease-free survival rates were 98% at 12-month and 97% at 24- and 36-month follow-up.

Conclusion

  • The study showed that LESS-PN is effective in terms of renal function preservation and oncological control at short- and intermediate-term follow-up.