Central Vs Peripheral Tumor

Centrally located tumors typically require precise intracorporeal suturing and complex reconstruction. As such, in the past they have not been approached laparoscopically due to the added time constraints imposed by renal ischemia. Only a limited experience in eight patients with central tumors using a hand-assisted technique has been reported (115). Open partial nephrectomy remains the gold standard for the treatment of centrally located tumors (116,117). Frank et al. (118) specifically addressed the outcomes of pure laparoscopic partial nephrectomy for central tumors and compared with peripherally located tumors. In 363 patients undergoing laparoscopic partial nephrectomy, tumors were located centrally in 154 patients, and peripherally in 209. Central tumors were defined as tumors touching, abutting, or directly invading the collecting system on the preoperative three-dimensional computed tomography. Lesions with no contact with the pelvicalyceal system were classified as peripheral. Preoperative, intraoperative, postoperative, and pathologic data were compared. Central tumors were larger in size on preoperative imaging (median 3.0 vs. 2.4 cm, p < 0.001) and had larger specimens at surgery (median 43 vs. 22 g, p < 0.001) than peripheral tumors. Although blood loss was similar (150 cm3), central tumors required longer operative times (3.5 vs. 3 hours, p = 0.008), warm ischemia times (33.5 vs. 30.0 minutes, p < 0.001), and hospital stay (67 vs. 60 hours, p < 0.001). The incidence of margin positivity was 0.8% versus 1.7% (p = 0.502) for the central and peripheral groups. The median postoperative creatinine was 1.2 and 1.1 mg/dL for central and peripheral lesions, respectively. Intraoperative and late postoperative complications were comparable. However, there were more early postoperative complications in the central group (6% vs. 2%, p = 0.05).

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