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Inicio Actas Urológicas Españolas (English Edition) Off-clamp laparoscopic partial nephrectomy in a hybrid room after tumor emboliza...
Journal Information
Vol. 46. Issue 9.
Pages 577-583 (November 2022)
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Vol. 46. Issue 9.
Pages 577-583 (November 2022)
Original article
Off-clamp laparoscopic partial nephrectomy in a hybrid room after tumor embolization versus conventional partial nephrectomy: A propensity score matched pair analysis
Nefrectomía parcial laparoscópica off-clamp tras la embolización del tumor en sala híbrida frente a nefrectomía parcial convencional: un análisis de pares emparejados por puntuación de propensión
I. Ouzaida,
Corresponding author
idir.ouzaid@free.fr

Corresponding author.
, P. Capogrossob, R. Bertoloc, A. Bouvierd, E. Xylinasa, U. Capitaniob, P. Bigote
a Department of Urology, Hôpital Bichat Claude Bernard, Paris Diderot University, Paris, France
b Department of Urology, San Raffaele Scientific Institute, Milan, Division of Experimental Oncology/Unit of Urology; URI; IRCCS San Raffaele Hospital, Milan, Italy
c Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
d Department of Radiology, CHU d'Angers, Angers, France
e Department of Urology, CHU d'Angers, Angers, France
Article information
Abstract
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Abstract
Objective

Off-clamp laparoscopic partial nephrectomy in a hybrid operating room after superselective arterial embolization (hLPN) is a promising minimally invasive approach. In this study, we compared the perioperative surgical outcomes of this innovative technique with the conventional standard of care laparoscopic partial nephrectomy (cLPN) technique.

Patients and methods

Overall, 86 and 127 patients treated with hLPN and cLPN, respectively, were included. These two techniques were compared in terms of surgical complications, estimated blood loss (EBL), operative time, length of stay (LOS), surgical margins, and Trifecta achievement rate (defined as warm ischemia duration <25 min, negative surgical margins and absence of complications). A propensity score based on age, gender, BMI, preoperative eGFR and tumor size was used for a 1:1 matching of patients of each group. After matching, 2 groups of 67 patients with similar characteristics were obtained.

Results

Conversion rate to open surgery, complications and EBL were similar in both groups. Conversely, operative time, LOS and Trifecta rates favored hLPN. The multivariate analysis showed that hLPN had a 70% higher chance of Trifecta achievement than cLPN in all age groups and for all tumor size across the study population.

Conclusion

Compared to a conventional approach, off-clamp laparoscopic partial nephrectomy in a hybrid room after superselective arterial embolization showed satisfying immediate surgical outcomes and reached a higher rate of Trifecta achievement. Mid and long-term functional and oncological results are needed to establish this minimally invasive surgical alternative.

Keywords:
Renal cell carcinoma
Partial nephrectomy
Minimally invasive
Hybrid operating room
Super-selective renal embolization
Abbreviations:
RCC
PN
LPN
hLPN
cLPN
RAPN
LOS
EBL
BMI
eGFR
MDRD
SM
Resumen
Objetivo

La nefrectomía parcial laparoscópica off-clamp tras la embolización arterial superselectiva (NPLh) en un quirófano híbrido es un abordaje mínimamente invasivo prometedor. En este estudio, comparamos los resultados quirúrgicos perioperatorios de esta técnica innovadora con los de la técnica estándar de nefrectomía parcial laparoscópica convencional (NPLc).

Pacientes y métodos

En total, se incluyeron 86 y 127 pacientes tratados con NPLh y NPLc, respectivamente. Las dos técnicas se compararon en términos de complicaciones quirúrgicas, pérdida de sangre estimada (PSE), tiempo quirúrgico, duración de la estancia hospitalaria (DEH), márgenes quirúrgicos y tasa de consecución de la Trifecta (definida como duración de isquemia caliente <25 min, márgenes quirúrgicos negativos y ausencia de complicaciones). Se utilizó una puntuación de propensión basada en la edad, el sexo, el IMC, la TFGe preoperatoria y el tamaño tumoral para un emparejamiento 1:1 de los pacientes de cada grupo. Tras el emparejamiento, se obtuvieron 2 grupos de 67 pacientes con características similares.

Resultados

La tasa de conversión a cirugía abierta, las complicaciones y la PSE fueron similares entre ambos grupos. Por el contrario, el tiempo quirúrgico, la DEH y las tasas de Trifecta favorecieron la NPLh. El análisis multivariante demostró que la NPLh tenía un 70% más de probabilidades de lograr la Trifecta que la NPLc en todos los grupos de edad y para cualquier tamaño tumoral en toda la población del estudio.

Conclusión

En comparación con el abordaje convencional, la nefrectomía parcial laparoscópica sin clampado después de la embolización arterial superselectiva en una sala híbrida mostró resultados quirúrgicos satisfactorios inmediatos y alcanzó una mayor tasa de consecución de la Trifecta. Se necesitan resultados funcionales y oncológicos a medio y largo plazo para establecer esta alternativa quirúrgica mínimamente invasiva.

Palabras clave:
Carcinoma de células renales
Nefrectomía parcial
Mínimamente invasiva
Quirófano híbrido
Embolizaciónrenalsuperselectiva

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