Publication: Open partial nephrectomy when a non-flank approach is required: indications and outcomes
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Issued Date
2019-03-12
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ISSN
14338726
07244983
07244983
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2-s2.0-85050606161
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Mahidol University
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SCOPUS
Bibliographic Citation
World Journal of Urology. Vol.37, No.3 (2019), 515-522
Suggested Citation
Elvis R. Caraballo, Diego Aguilar Palacios, Chalairat Suk-Ouichai, Jitao Wu, Wen Dong, Hajime Tanaka, Yanbo Wang, Brian R. Lane, Steven C. Campbell Open partial nephrectomy when a non-flank approach is required: indications and outcomes. World Journal of Urology. Vol.37, No.3 (2019), 515-522. doi:10.1007/s00345-018-2414-4 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/51791
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Title
Open partial nephrectomy when a non-flank approach is required: indications and outcomes
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.