Presentation Authors: WEN DONG*, TIANXIN LIN, DEHUA OU, WEIBIN XIE, JIAN HUANG, Guangzhou, China, People's Republic of
Introduction: TumorÂ enucleationÂ (TE) optimizes parenchymal preservation with a promising short-term oncologic outcome than standard partial nephrectomyÂ (SPN), however, long-term oncologic outcomes for TE after minimally invasive surgery are scarce in the literature. We aim to provide long-term oncologic outcomes after laparoscopic and roboticÂ tumorÂ enucleationÂ for renal cell carcinoma (RCC) in a tertiary medical center in this study.
Methods: We retrospectively analyzed 146 consecutive patients who underwent TEÂ with either laparoscopic or robotic approach for localized RCC between 2009 and 2017. Local recurrence, cancer-specific survival(CSS) and overall survival(OS) were the main outcomes of this study. Survival curves were generated using a Kaplan-Meier method. Perioperative outcomes and pathological outcomes were also analyzed.
Results: Overall, 106 male and 40 female patients were eligible for the study. Laparoscopic TE was applied to 108 patients and robotic TE was used for 38 patients. The medianÂ tumorÂ size was 3.4cm with a median RENAL score of 7. Warm ischemia was used in all patients and median ischemia time was 20 minutes. Two patients (1.4%) had major complications(Clavien IIIa). The median global GFR preserved at 1 year after surgery was 93%. Peritumoral pseudocapsule was present in 142 (97.2%) tumors with a median thickness of 0.36mm. Pseudocapsule invasion was reported in 50 tumors (34%). Positive surgical margins were reported in 3/146 (2.1%) tumors. At a median follow-up of 62 months, local recurrence happened in 1 patient (0.7%). The 5-year actuarial cancer-specific survival and overall survival were 95.9% and 92.5%, respectively.Â
Conclusions: This study indicates that tumorÂ enucleationÂ with laparoscopic or robotic approach in experienced hands for the treatment of RCC appears oncologically safe at a median follow-up of more than 5 years. TE can achieve negative surgical margins and thus prevent local recurrence due to the existence of pseudocapsule in the vast majority of patients. Prospective studies with longer follow-up will be required to further evaluate oncologic safety after TE.