We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Open partial nephrectomy when a non-flank approach is required: indications and outcomes.
- Authors
Caraballo, Elvis R.; Palacios, Diego Aguilar; Suk-Ouichai, Chalairat; Wu, Jitao; Dong, Wen; Tanaka, Hajime; Wang, Yanbo; Lane, Brian R.; Campbell, Steven C.
- Abstract
Purpose: To evaluate indications/outcomes for open partial nephrectomy (OPN) when non-flank approaches are required, with comparison to patients managed with the flank approach. Outcomes with a non-flank approach are presumed less favorable yet there have been no previous reports on this topic.Methods: 2747 OPNs were performed (1999-2015) and 76 (2.8%) required a non-flank approach. We also reviewed all traditional flank OPNs performed during odd years in this timeframe yielding 1467 patients for comparison.Results: Overall, median tumor size was 3.5 cm and 274 patients (18%) had a solitary kidney. Non-flank patients were younger, and tumor size and clinical/pathologic stage were significantly increased for this cohort, but the groups were otherwise comparable. Indications for non-flank OPN included large tumor size/locally advanced disease (n = 21), need for simultaneous surgery (n = 25), previous flank incision or failed thermoablation (n = 13), or congenital/vascular abnormalities (n = 9). The most common non-flank approach was anterior subcostal (n = 39, 51%). Operative times, estimated blood loss, positive margins, and functional decline were all modestly increased for non-flank patients. Intraoperative and genitourinary complications were more common in non-flank patients (p < 0.05), although all were manageable, typically with conservative measures. There were no mortalities among non-flank patients and none required long-term dialysis.Conclusions: Our series, the first to address this topic, suggests that outcomes with non-flank OPN are generally less advantageous likely reflecting increased tumor/operative complexity. However, complications in this challenging patient population are manageable and final dispositions are generally favorable. Our findings should be useful for counseling regarding potential outcomes when a non-flank incision is required.
- Subjects
NEPHRECTOMY; SURGICAL complications; RENAL cancer
- Publication
World Journal of Urology, 2019, Vol 37, Issue 3, p515
- ISSN
0724-4983
- Publication type
Article
- DOI
10.1007/s00345-018-2414-4