Partial nephrectomy for large renal masses: Lessons we learned
Mohamed Sharafeldeen1, Wael Sameh1, Amer Alaref2, Radu Rozenberg2, Asmaa Ismail3, Hazem Elmansy3, Walid Shahrour3, Ahmed S. Zakaria Ahmed3, Osama Elmeslemany1, Nishigandha Burute2, Anatoly Shuster2, Owen Prowse3, Ahmed Kotb3.
1Department of Urology, Alexandria University, Alexandria, Egypt; 2Department of Radiology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada; 3Department of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
Introduction: The aim of our study was to show our experience in managing large renal masses (cT1b/ T2) through partial nephrectomy (PN) over the last three years.
Methods: We collected retrospective data for all patients managed by PN for masses larger than 4 cm over the last three years, including surgical, biochemical, radiological, and pathological data.
Results: We identified 47 patients managed by PN for >4 cm renal masses. The mean age of the patients was 55.7±13.4, including 29 males and 18 females. The tumor was located on the right and left sides in 30 and 17 patients, respectively. Forty-four and three patients had solid mass and Bosniak 3/4 renal cysts, respectively. Masses were T1b and T2 in 40 and seven patients, respectively. The mean tumor size was 6.2±1.5 cm (4.5–10.5). Using renal nephrometry score, eight (17%), 28 (60%), and 11 (23%) had low, moderate, and high complexity, respectively. All cases were managed by open surgery. The median warm and cold ischemic times were 10 minutes (10–29). Hospital stay was 48–72 hours. One patient (2%) developed grade 3 complications, presenting one week post-surgery with hypotension and low hemoglobin. Computed tomography angiogram confirmed a bleeding pseudoaneurysm and was successfully embolized. RCC was identified in 42 patients, while five patients had oncocytoma and angiomyolipoma. Two patients (4%) had positive surgical margins. Five patients out of 42 cancerous cases (12%) had pathological T3 RCC. The mean preoperative and postoperative estimated glomerular filtration rates were 89.09±12.41 and 88.50±10.50, respectively (p=0.2). The median followup was 14 months and no patient had evidence of cancer recurrence. Figures 1–4 demonstrate some of our successfully managed cases.
Conclusions: Partial nephrectomy for large renal masses is safe in experienced hands and should be attempted on a higher percentage of patients, regardless of the tumor complexity. No cancer recurrence or significant deterioration of renal function was observed within our short-term followup.
