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Objectives: Partial nephrectomy is the newly treatment of choice for management of small renal mass. The warm ischemic time (WIT) is the most important factor that affects postoperative renal function. In this study, we explored the anatomical factors of the renal mass that influence warm ischemic time and perioperative outcomes during laparoscopic partial nephrectomy (LPN).
Materials and Methods: We performed a single institutional, retrospective analysis in the patients who underwent LPN at Ramathibodi Hospital from 2007 to 2013. The anatomy of the renal mass was evaluated preoperatively by computed tomography or magnetic resonance imaging according to R.E.N.A.L. nephrometry scoring system (radius, exophytic/endophytic, growth pattern, nearness of the collecting system, anterior/posterior and location). Statistical analysis was performed to evaluate the associations between the anatomy of renal mass and WIT, operative time (OT), estimated blood loss (EBL) and postoperative complications.
Results: A total of 28 patients underwent LPN from 2007 to 2013. The average tumor size was 3.75 cm (range 0.8-8.5 cm), 62.3% of these masses were < 4 cm in diameters, 21.4% were 4-7 cm and 16.3% were > 7 cm. For growth pattern of the renal mass: 25% were exophytic 50% and 75% were exophytic < 50%. The location of the tumors: 67.9% were in anterior part of the kidney, 24.9% were in posterior part and 14.3% were located between the anterior and posterior part of the kidney. In addition, 35.7% were upper pole tumors, 28.6% were in the lower pole, and 35.7% were in interpolar location. According to R.E.N.A.L. scoring system, the nearness of the collecting system was the only factor that was found to be significantly correlated with EBL (P = 0.036). From our results, anatomical factors of renal mass could not predict OT and WIT.
Conclusions: The nearness of collecting system of renal mass is a useful parameter for the prediction of EBL during LPN.
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