Nierenteilresektion bei cT1 Nierentumoren: Vergleich der konventionellen laparoskopischen Nierenteilresektion mit der LESS Nierenteilresektion in SITUS-Technik

Zusammenfassung

Hintergrund: Die Nierenteilresektion ist Therapie der Wahl bei Nierentumoren im klinischen Stadium 1 (cT1). Als Standardtherapie gilt die offene Operation, der Anteil minimalinvasiver Verfahren, wie der laparoskopischen, der robotisch assistierten oder der laparoendoskopischen single site (LESS) partiellen Nephrektomie, hat in den letzten Jahren zugenommen.

Patienten/Material und Methoden: In dieser retrospektiven Studie wurden alle Patienten erfasst, bei denen aufgrund des Verdachts auf einen malignen Nierentumor zwischen Dezember 2008 und November 2013 eine laparoskopische Nierenteilresektion durchgeführt wurde. Die Operationen erfolgten entweder als konventionelle transperitoneale Nierenteilresektionen (cLPN) oder als LESS partielle Nephrektomien (LESS-PN) in SITUS-Technik (single incision trancumbilical surgery). Ziel unserer Studie ist ein Vergleich beider Patientengruppen bezüglich perioperativer Outcomeparameter wie Operationsdauer, Ischämiezeit, Komplikationen, Transfusionsbedarf, Konversionsraten, Veränderungen der Nierenfunktion sowie der Krankenhausverweildauer.

Ergebnisse: Im Zeitraum der Studie wurden 85 laparoskopische Nierenteilresektionen durchgeführt (72 cLPN, 13 LESS-PN). Die durchschnittliche Tumorgröße betrug 2,68±1,47 cm (cLPN) vs. 2,46±1,11 (LESS-PN). Die Operationsdauer lag im Mittel bei 175,17±50,026 min (cLPN) und 185,77±35,991 min (LESS-PN). 45 (62,5%) Operationen (cLPN) vs. 10 (76,9%) (LESS-PN) erfolgten ohne Ischämie. Bezüglich perioperativer Outcomeparameter konnten keine signifikanten Unterschiede zwischen beiden Gruppen festgestellt werden. Die Rate postoperativer Komplikationen (Clavien-Dindo≥3) lag bei 11,1% (cLPN) vs. 7,7% (LESS-PN).

Schlussfolgerung: Die LESS-Nierenteilresektion in SITUS-Technik ist eine attraktive Alternative zur konventionellen laparoskopischen Nierenteilresektion und zur offenen partiellen Nephrektomie.

Abstract

Background: Partial nephrectomy is the treatment of choice for clinical stage 1 renal tumours. Open partial nephrectomy is the standard operative technique. The use of minimally-invasive strategies such as laparoscopic, robot-assisted partial nephrectomy or laparoendoscopic single site (LESS) partial nephrectomy has increased in recent years.

Patients/Material and Methods: In this retrospective study, patients undergoing laparoscopic partial nephrectomy between December 2008 and November 2013 were evaluated. All patients presented with renal lesions suspicious for malignancy. Operations were performed as conventional laparoscopic transperitoneal partial nephrectomies (cLPN) or LESS partial nephrectomies (LESS-PN) in SITUS technique (single incision transumbilical surgery). The aim of the study was to compare perioperative outcome parameters such as duration of surgery, time of ischaemia, complications, need for transfusion, conversion rates, changes in renal function and duration of hospital stay in both groups.

Results: A total of 85 laparoscopic partial nephrectomies were performed in this study (72 cLPN and 13 LESS-PN). The average tumour size was 2.68±1.47 cm (cLPN) vs. 2.46±1.11 cm (LESS-PN). The mean duration of surgery was 175.17±50.026 min (cLPN) and 185.77±35.991 min (LESS-PN). 45 (62.5%) operations (cLPN) vs. 10 (76.9%) (LESS-PN) were performed in zero-ischaemia technique. There were no significant differences in perioperative outcome parameters between both groups. Postoperative complication rates (Clavien-Dindo≥3) were 11.1% (cLPN) vs. 7.7% (LESS-PN).

Conclusions: LESS partial nephrectomy in SITUS technique is an attractive alternative to conventional laparoscopic and open partial nephrectomy.

Schlüsselwörter

Laparoskopie - Nierenteilresektion - laparoendoscopic single site surgery (LESS) - nephron sparing surgery (NSS) - single incision transumbilical surgery (SITUS)

Key words

laparoscopy - partial nephrectomy - laparoendoscopic single site surgery (LESS) - single incision transumbilical surgery (SITUS)

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