Dados do Trabalho

Título

INITIAL EXPERIENCE, OUTCOMES AND COMPLICATIONS OF INTEGRATING MINIMALLY INVASIVE PARTIAL NEPHRECTOMY INTO A PUBLIC TEACHING HOSPITAL IN BRAZIL

Resumo

Introduction
In 2012, our centre began performing laparoscopic partial nephrectomy (LPN) and in 2013 robotic assisted partial nephrectomy (RAPN). The aim was to combine the benefits of nephron-sparing surgery with the morbidity benefits of a laparoscopic approach to renal tumours. 12,15. We examined our initial experience, outcomes, and complications of integrating LPN and RAPN into a public teaching hospital in Brazil, and compared them to open partial nephrectomy (OPN).
Materials and Methods
After institutional review board approval, data were recorded in prospective or retrospective kidney cancer registries. The records of all patients undergoing partial nephrectomy (PN) at Hospital de Clínicas de Porto Alegre were reviewed between January 1, 2010 and June 31, 2019.
Results:
308 patients underwent PN during the study period, 160 (51.9 %) of those performed OPN and 148 (48.1%) minimally invasive partial nephrectomy (MIPN) (118 were LPN and 30 RAPN). Mean tumor size in the surgical specimen of OPN was found to be 3.32 (1.23) and 3.03 (1.28) in MIPN. Tumors were significantly larger in the OPN group (p = 0.02). Median R.E.N.A.L. nephrometry score was 7 (4– 10) in the OPN and 6 (4-10) in the MIPN group, significantly higher in the OPN technique (p = 0.03). Other characteristics of patients and tumors were not statistically different. Regarding the perioperative surgical outcomes in the OPN and MIPN groups respectively, the mean operation time was 152.9 (60,68) and 254.8 (72,84) (p <0.01). Mean WIT was 17.65 and 21.47 minutes (p =0.51), mean EBL was noted as 490.09 and 273.36 mL (p <0,01), the median length of stay (LOS) was 5 (2-41) and 4 (2-25) days (p<0.01), perioperative complications was higher than Clavien II in 10 (6.3%) and 10 (6.8%) patients (p = 0.389). Renal function after surgery was similar in both groups. Frequency of free margin and recurrence rate was similar during an average follow-up of 41 months.
Conclusions:
In our study, MIPN group confirmed the well known benefits of minimal invasive procedures with lower EBL and shorter LOS. The present study’s 9.5 year experience with MIPN has demonstrated this is a functionally and oncologically safe alternative to OPN with similar complication rates even during the learning curve. We conclude that MIPN can be safe and effectively offered in a public teaching hospital. Further prospective and randomized controlled studies, including large series of patients, are needed.

Palavras Chave ( separado por ; )

partial nephrectomy; laparoscopic; robotic,