Morbidity of tumour enucleation for renal cell carcinoma (RCC): results of a single-centre prospective study

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Study Type – Therapy (case series) Level of Evidence 4What's known on the subject? and What does the study add?Nephron sparing surgery is the standard treatment for RCC up to a diameter of 7 cm, but it's intra and postoperative morbidity is not negligable. Tumour enucleation is a nephron sparing technique with a demonstrated oncological efficacy while no prospective study evaluated its surgical results and postoperative morbidity to date.Our study adds a prospective evaluation of tumour enucleation morbidity. Our results showed that this technique has a low incidence of postoperative complications, especially of urinary fistula. Major tumour dimension and endorenal tumour growth resulted predictors of postoperative complications.OBJECTIVETo evaluate the incidence and risk factors of adverse events (AEs) after tumour enucleation (TE).PATIENTS AND METHODSBetween 2006 and 2009, clinical, surgical and functional data were prospectively gathered from 200 consecutive patients who had open TE.TE was done by blunt dissection using the natural cleavage plane between the tumour capsule and normal parenchyma.All the AEs were stratified for severity according to the National Cancer Institute Common Toxicity Criteria version 2.0 grading system.Risk factors for AEs were determined by univariate analysis.RESULTSThe mean (range) tumour size was 3.2 (0.8–10.0) cm, and mean (range) warm ischaemia time (WIT) was 16.5 (5–31) min.Overall, 32 AEs (six grade I, 20 grade II, and six grade III) occurred after TE in 30 patients and of those 27 were surgical (13.5%) and five were medical AEs (2.5%).On univariate analysis, imperative/relative surgical indication was the only predictive factor for the development of medical AEs. Statistically significant predictors of overall surgical AEs and urinary fistula were clinical tumour dimension, completely endorenal tumour growth and a positive tumour relationship with the urinary collecting system (UCS).A completely endorenal tumour growth and a positive tumour relationship with the UCS also correlated with bleeding requiring transfusions. Completely endorenal tumour growth was significantly associated with major (grade III) AEs.CONCLUSIONSThe TE technique was associated with a 16% AE rate and of those only 3% required re-intervention (grade III).Urinary fistula occurred in six patients (3%) and ureteric stenting was required in 0.5% of cases.

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