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Title: Open partial nephrectomy when a non-flank approach is required: indications and outcomes
Authors: Elvis R. Caraballo
Diego Aguilar Palacios
Chalairat Suk-Ouichai
Jitao Wu
Wen Dong
Hajime Tanaka
Yanbo Wang
Brian R. Lane
Steven C. Campbell
The First Bethune Hospital of Jilin University
Yantai Yuhuangding Hospital
Michigan State University
Cleveland Clinic Foundation
Faculty of Medicine, Siriraj Hospital, Mahidol University
Tokyo Medical and Dental University
Sun Yat-sen University
Keywords: Medicine
Issue Date: 12-Mar-2019
Citation: World Journal of Urology. Vol.37, No.3 (2019), 515-522
Abstract: © 2018, Springer-Verlag GmbH Germany, part of Springer Nature. 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.
ISSN: 14338726
Appears in Collections:Scopus 2019

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