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Impact of Curative Effect of Laparoscopic and Open Partial Nephrectomy for Complex Renal Tumours on Renal Function.

OBJECTIVE
To explore the effect and safety of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) in the treatment of complex renal tumours and to compare renal function in the perioperative period.


STUDY DESIGN
Comparative study.


PLACE AND DURATION OF STUDY
Departments of Urology and Cardiovascular Medicine, Affiliated Hospital of Hebei University, from July 2016 to June 2018.


METHODOLOGY
A total of 168 complex renal tumour patients with renal tumour scoring system scores (R.E.N.A.L) <7 and tumour stages of T1aN0M0~TlbN0M0 (diameter of tumour <7 cm without metastasis) were chosen. The patients were classified into the retroperitoneal laparoscopic partial nephrectomy (RLPN) group and open partial nephrectomy (OPN) group, comprising 84 patients in each group. Intraoperative and postoperative characteristics of both groups were compared. Statistical analysis of the occurrence rate of postoperative complications was conducted. Renal function indicators, including serum urea (UREA), creatinine (Cr), uric acid (UA) and glomerular filtration rate (GFR), were evaluated one day before the operation and one week after the operation.


RESULTS
The differences between the two groups in intraoperative renal warm ischaemia time (WIT) and postoperative drainage time were not statistically significant. Compared with OPN group, RLPN group had shorter recovery time of gastrointestinal function, less use of analgesics and longer hospital stay. The difference in the recent occurrence rate of complications was not statistically significant. The differences between the two groups in UREA, Cr, UA and GFR one day before the operation and one week after the operation were not statistically significant (p>0.05). The Cr and UA levels of both groups improved significantly after the operation, and the GFR level declined significantly. The differences were statistically significant compared with preoperation levels (p<0.05).


CONCLUSION
The effect and safety of RLPN in the treatment of complex renal tumours are equal to those of open operations. Laparoscopic surgery involves a small operative wound and contributes to renal function recovery, allowing patients to recover quickly; however, laparoscopic surgery has high technical requirements for its operators.