Predictors of surgical outcomes of retroperitoneal laparoscopic partial nephrectomy

Objectives: To evaluate surgical outcomes in a series of laparoscopic retroperitoneal partial nephrectomies. Methods: A total of 147 patients who underwent laparoscopic retroperitoneal partial nephrectomy by a single surgeon were evaluated. Pre-operative parameters (body mass index, ASA score, tumour size, cTNM stage, PADUA score risk, surgeon experience) and intraoperative and postoperative outcomes (operative mean time, warm ischemia time, blood loss, transfusion rate, length of hospitalization, and margin-ischaemia-complications [MIC] success rate) were considered. Results: For 134 patients (91.1%) the success of the treatment, defined by a MIC = 3, was obtained. When the statistical significance of each of the independent variables was tested, surgeon's experience added statistical significance to the prediction of operative time (p = 0.000), warm ischemia time (p = 0.000) and blood loss (p = 0.000); tumour size (p = 0.046) to the prediction MIC (p = 0.010), operative time (p = 0.000), warm ischemia time (p = 0.003) and blood loss (p = 0.010); ASA score to the length of hospitalization (p = 0.009). Conclusions: Laparoscopic retroperitoneal partial nephrectomy represents an adequate and safe technique for the treatment of T1 renal cancer. Optimal MIC success rate can be achieved, although intraoperative outcomes tend to be related to the learning curve even in a very experienced laparoscopic surgeon. Length of hospitalization depends on general health condition of patients.