Results
Demographic features and tumor characteristics of the patients are shown in Table 1. A total of the 103 patients, 31(30.09%) underwent LPN, 72 (69.90%) RPN. The overall mean (±SD) age, tumor diameter, RENAL score, PADUA score, and preoperative eGFR were 58.85 ±12.01 years, 3.76 ± 1.56 cm, 6.86 ± 1.48, 8.37±1.53 and 77.89 ± 17.87 mL/min/1.73 m2, respectively. There was no statistical difference between the groups for these variables (p=0.479, p=0.199, p=0.120, p=0.073, p= 0.561, respectively). Overall, tumors were on the right side in 48.5% of the patients and on the left side in 51.5% of the patients. The tumor side was more on the right in LPN, while RPN was more on the left side (p=0.03).
The overall mean (±SD) WIT, OT, and LOS values ​​were 26.22 ± 6.34, 151.89 ± 41.74 and 3.44 ± 0.95, respectively. In these variables, there was no statistical difference between the groups (p=0.119, p=0.216, p=0.580, respectively). Only EBL was higher in LPN (121.11 ± 72.17 vs 158.23± 72.24, LPN and RPN, respectively, p=0.019). There was no statistical difference between the two groups in terms of blood transfusion requirement (p= 0.694). No significant differences were observed in PSM rates between the groups (6.5% vs 4.2%, RPN and LPN, respectively, p=0.636).
The conversion to open was seen in 2 patients (6.45%) in the LPN group, while in RPN was not observed (p=0.89). There was no conversion to RN in either group. The patients were generally discharged the next day after the loge drain was removed. The overall mean removal of log drain time and LOS were 2.4 (p=0.351) and 3.4 (p=0.580) days, respectively. Perioperative outcomes of the groups are shown in Table 2.
Intraoperative bowel injury was observed in 1 patient in the RPN group, the primary repair was performed, and no additional problems were observed for this patient in the follow-up period. In the LPN group, 2 patients had intraoperative complications, 1 was renal vein injury and the other was ureter injury. In the ureter injury, a 4.8 f JJ stent was placed and removed at the 3rd postoperative week. In renal vein injury, the primary repair was performed and PN was completed laparoscopically.
The mean 1-year eGFR decrease was -5.91 ml/min/1.73m² (7.59%) in the overall cohort, while it was -5.06 ml/min/1.73m² (6.63%) vs -6.28 ml/min/1.73m² (7.93%) for LPN and RPN, respectively. No statistical difference was observed between the groups in eGFR change (p= 0.503). The overall preoperative stage 3 or stage 4 CKD (eGFR< 60 ml/min/1.73m²) rate was 12.6%, and the new onset stage 3 or stage 4 CKD rate was 4.9% in 1 year postoperatively. There was no statistical difference between the groups in the preoperative stage 3 or stage 4 CKD and postoperative new-onset stage 3 or stage 4 CKD rates (p=0.750, p=0.614, respectively) (Table 3). Complications were observed in 9.7% of LPN patients and 11.1% of RLN in the postoperative early period (0-30 days). All of the complications were minor (Clavien 1-2) complications. Late period (31-90 days) complications were not observed in either group.
The mean follow-up time was 36.07 ± 13.56 months (42.81± 17.55 for LPN and 33.17 ± 10.28 for RPN, p=0.007). During the follow-up period, cancer-related death was not observed in either group, while non-cancer specific survival was 93.5% in the LPN group and 94.4% in the RPN group. Postoperative pathological, complication and survival outcomes are presented in Table 4.