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.