Surgical and oncologic outcomes of laparoscopic partial nephrectomy

A Japanese multi-institutional study of 1375 patients

Hideo Saito, Tadashi Matsuda, Kazunari Tanabe, Akihiro Kawauchi, Toshiro Terachi, Ken Nakagawa, Masatsugu Iwamura, Masanobu Shigeta, Katsunori Tatsugami, Akihiro Ito, Jiro MacHida, Mutsushi Kawakita, Hidefumi Kinoshita, Nobuo Shinohara, Naomasa Ioritani, Toshimori Seki, Yoichi Arai

Research output: Contribution to journalArticle

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Abstract

Background and Purpose: Despite clear trends toward minimally invasive surgery, information about laparoscopic partial nephrectomy (LPN) in Japan is sparse. We conducted a retrospective survey to clarify time trends for LPN and analyze surgical and oncologic outcomes. Patients and Methods: A nationwide survey was performed. Between 1998 and 2008, 1375 patients underwent LPN at 54 institutions. Complications, patterns of tumor recurrence, and recurrence-free survival were analyzed. Results: Renal pedicle clamping was used in 1031 (75%) cases, and renal cooling was performed in 64%. Median warm/cold ischemic time was 37/53 minutes. Median tumor size was 2.26 cm (interquartile range 1.6 to 2.7). Multivariate analysis identified total operative time, operative blood loss, and surgical margin status as independently associated with high grade (grade 3-5) urologic and nonurologic complications. Despite increases in central tumor, a trend was seen toward shorter warm/cold ischemic time in recent cases, and the overall complication rate did not change throughout the study period. With a median follow-up of 26 months for 1193 malignancies, recurrence occurred in 22 (1.7%) patients, including local recurrence in 7 (0.5%), lung in 8 (0.7%), lymph nodes in 2 (0.1%), and bone in 4 (0.3%). Of the 26 cases with positive surgical margins, local tumor recurrence occurred in only one. Conclusions: This is the first nationwide survey of LPN in Japan to be reported. LPN could be performed with acceptable positive margins and complication rates. Most tumor recurrences occur as metastases, and surgical margin status appears to have little impact on oncologic outcomes.

Original languageEnglish
Pages (from-to)652-659
Number of pages8
JournalJournal of Endourology
Volume26
Issue number6
DOIs
Publication statusPublished - Jun 1 2012

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Nephrectomy
Recurrence
Cold Ischemia
Warm Ischemia
Neoplasms
Japan
Kidney
Minimally Invasive Surgical Procedures
Operative Time
Constriction
Multivariate Analysis
Lymph Nodes
Neoplasm Metastasis
Bone and Bones
Lung
Survival
Surveys and Questionnaires
Margins of Excision

All Science Journal Classification (ASJC) codes

  • Urology

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Surgical and oncologic outcomes of laparoscopic partial nephrectomy : A Japanese multi-institutional study of 1375 patients. / Saito, Hideo; Matsuda, Tadashi; Tanabe, Kazunari; Kawauchi, Akihiro; Terachi, Toshiro; Nakagawa, Ken; Iwamura, Masatsugu; Shigeta, Masanobu; Tatsugami, Katsunori; Ito, Akihiro; MacHida, Jiro; Kawakita, Mutsushi; Kinoshita, Hidefumi; Shinohara, Nobuo; Ioritani, Naomasa; Seki, Toshimori; Arai, Yoichi.

In: Journal of Endourology, Vol. 26, No. 6, 01.06.2012, p. 652-659.

Research output: Contribution to journalArticle

Saito, H, Matsuda, T, Tanabe, K, Kawauchi, A, Terachi, T, Nakagawa, K, Iwamura, M, Shigeta, M, Tatsugami, K, Ito, A, MacHida, J, Kawakita, M, Kinoshita, H, Shinohara, N, Ioritani, N, Seki, T & Arai, Y 2012, 'Surgical and oncologic outcomes of laparoscopic partial nephrectomy: A Japanese multi-institutional study of 1375 patients', Journal of Endourology, vol. 26, no. 6, pp. 652-659. https://doi.org/10.1089/end.2011.0505
Saito, Hideo ; Matsuda, Tadashi ; Tanabe, Kazunari ; Kawauchi, Akihiro ; Terachi, Toshiro ; Nakagawa, Ken ; Iwamura, Masatsugu ; Shigeta, Masanobu ; Tatsugami, Katsunori ; Ito, Akihiro ; MacHida, Jiro ; Kawakita, Mutsushi ; Kinoshita, Hidefumi ; Shinohara, Nobuo ; Ioritani, Naomasa ; Seki, Toshimori ; Arai, Yoichi. / Surgical and oncologic outcomes of laparoscopic partial nephrectomy : A Japanese multi-institutional study of 1375 patients. In: Journal of Endourology. 2012 ; Vol. 26, No. 6. pp. 652-659.
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T1 - Surgical and oncologic outcomes of laparoscopic partial nephrectomy

T2 - A Japanese multi-institutional study of 1375 patients

AU - Saito, Hideo

AU - Matsuda, Tadashi

AU - Tanabe, Kazunari

AU - Kawauchi, Akihiro

AU - Terachi, Toshiro

AU - Nakagawa, Ken

AU - Iwamura, Masatsugu

AU - Shigeta, Masanobu

AU - Tatsugami, Katsunori

AU - Ito, Akihiro

AU - MacHida, Jiro

AU - Kawakita, Mutsushi

AU - Kinoshita, Hidefumi

AU - Shinohara, Nobuo

AU - Ioritani, Naomasa

AU - Seki, Toshimori

AU - Arai, Yoichi

PY - 2012/6/1

Y1 - 2012/6/1

N2 - Background and Purpose: Despite clear trends toward minimally invasive surgery, information about laparoscopic partial nephrectomy (LPN) in Japan is sparse. We conducted a retrospective survey to clarify time trends for LPN and analyze surgical and oncologic outcomes. Patients and Methods: A nationwide survey was performed. Between 1998 and 2008, 1375 patients underwent LPN at 54 institutions. Complications, patterns of tumor recurrence, and recurrence-free survival were analyzed. Results: Renal pedicle clamping was used in 1031 (75%) cases, and renal cooling was performed in 64%. Median warm/cold ischemic time was 37/53 minutes. Median tumor size was 2.26 cm (interquartile range 1.6 to 2.7). Multivariate analysis identified total operative time, operative blood loss, and surgical margin status as independently associated with high grade (grade 3-5) urologic and nonurologic complications. Despite increases in central tumor, a trend was seen toward shorter warm/cold ischemic time in recent cases, and the overall complication rate did not change throughout the study period. With a median follow-up of 26 months for 1193 malignancies, recurrence occurred in 22 (1.7%) patients, including local recurrence in 7 (0.5%), lung in 8 (0.7%), lymph nodes in 2 (0.1%), and bone in 4 (0.3%). Of the 26 cases with positive surgical margins, local tumor recurrence occurred in only one. Conclusions: This is the first nationwide survey of LPN in Japan to be reported. LPN could be performed with acceptable positive margins and complication rates. Most tumor recurrences occur as metastases, and surgical margin status appears to have little impact on oncologic outcomes.

AB - Background and Purpose: Despite clear trends toward minimally invasive surgery, information about laparoscopic partial nephrectomy (LPN) in Japan is sparse. We conducted a retrospective survey to clarify time trends for LPN and analyze surgical and oncologic outcomes. Patients and Methods: A nationwide survey was performed. Between 1998 and 2008, 1375 patients underwent LPN at 54 institutions. Complications, patterns of tumor recurrence, and recurrence-free survival were analyzed. Results: Renal pedicle clamping was used in 1031 (75%) cases, and renal cooling was performed in 64%. Median warm/cold ischemic time was 37/53 minutes. Median tumor size was 2.26 cm (interquartile range 1.6 to 2.7). Multivariate analysis identified total operative time, operative blood loss, and surgical margin status as independently associated with high grade (grade 3-5) urologic and nonurologic complications. Despite increases in central tumor, a trend was seen toward shorter warm/cold ischemic time in recent cases, and the overall complication rate did not change throughout the study period. With a median follow-up of 26 months for 1193 malignancies, recurrence occurred in 22 (1.7%) patients, including local recurrence in 7 (0.5%), lung in 8 (0.7%), lymph nodes in 2 (0.1%), and bone in 4 (0.3%). Of the 26 cases with positive surgical margins, local tumor recurrence occurred in only one. Conclusions: This is the first nationwide survey of LPN in Japan to be reported. LPN could be performed with acceptable positive margins and complication rates. Most tumor recurrences occur as metastases, and surgical margin status appears to have little impact on oncologic outcomes.

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