Laparoscopic Partial Nephrectomy For Cystic Masses

Scant data are available as regards laparoscopic nephron-sparing surgery for cystic lesions. Many centers employ laparoscopic techniques for the management of symptomatic renal cysts. However, the risk of potential seeding of cells due to inadvertent tumor spillage during laparoscopic cyst manipulation remains a concern in laparo-scopic partial nephrectomy for indeterminate renal cysts. Thirty-five patients with a complex renal cyst were evaluated laparoscopically by Santiago et al. (121). No local or distant recurrence was noted in all five patients (14%) with cystic renal cancer case after a mean follow-up of 20.2 months. The authors recently updated this experience and presented long-term follow-up results in 57 patients with indeterminate Bosniak II and III cystic lesions. None of the 11 patients (19%) found to have cystic renal cancer case had evidence of laparoscopic port site, renal fossa, local or distant recurrence at a mean follow-up of 40 months (122).

Spaliviero et al. (123) recently reported their experience with laparoscopic partial nephrectomy in 50 patients with a cystic renal lesion. Of 284 patients undergoing laparoscopic partial nephrectomy at the Cleveland Clinic since August 1999, 50 (19%) patients presented with a suspicious Bosniak > II cystic lesion on preoperative computed tomograpgy scan (group I). Outcome data were retrospectively compared with 50 consecutive patients undergoing laparoscopic partial nephrectomy for a solid renal mass (group II). Mean tumor size was 3 cm in group I and 2.6 cm in group II (p = 0.07). Perioperative parameters were comparable in groups I and II. Final histopathology revealed renal cancer case in 20%, 25%, 46%, and 90% of patients with Bosniak II (n = 10), II (n = 4), III (n = 13), and IV (n = 20) cysts, respectively. All patients had negative surgical margin. Inadvertent intraoperative puncture/spillage of the cystic tumor did not occur in any instance in patients in group I. Mean follow-up was 14 months (range, 1 month to three years). The solitary recurrence in the entire series of 284 laparoscopic partial nephrectomy cases occurred in group I at one year in a patient who, despite negative surgical margins during initial laparoscopic partial nephrectomy, developed retroperitoneal recurrent disease that was resected open surgically at one year. The authors concluded that although laparoscopic partial nephrectomy nephrectomy for a suspicious cystic mass was feasible and efficacious, extreme caution and refined laparo-scopic technique had to be exercised to prevent cyst rupture and local spillage.

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