Laparoscopic partial nephrectomy for cystic masses.
OBJECTIVE
Although laparoscopic partial nephrectomy (LPN) has emerged as an effective treatment option in select patients with a solid renal tumor, scant data are available on cystic renal tumors. We report our experience with LPN in 50 patients with a cystic renal lesion.


METHODS
Of 284 patients undergoing LPN at our institution since August 1999 preoperative computerized tomography identified a suspicious cystic lesion in 50 (17.6%) (group 1). Data were retrospectively compared with those on 50 matched, consecutive patients undergoing LPN for a solid renal mass (group 2). All patients with Bosniak II/IIF cysts were advised to undergo watchful waiting. Surgery was offered if the cyst changed in character or if that was the patient preference.


RESULTS
Median tumor size was 3 cm in group 1 and 2.6 cm in group 2 (p = 0.07). Groups 1 and 2 were comparable in regard to perioperative parameters. In patients with Bosniak II (9), IIF (4), III (12) and IV (21) cysts final histopathology revealed renal cell carcinoma in 22%, 25%, 50% and 90%, respectively. All 100 patients had a negative surgical margin. No patient in group 1 had intraoperative puncture/spillage of the cystic tumor. In group 1 during a mean followup of 14 months (range 1 month to 3 years) 1 patient had retroperitoneal recurrence at 1 year despite negative surgical margins during initial LPN.


CONCLUSIONS
Surgical outcomes of LPN for suspicious cystic masses are similar to those of LPN for solid tumors. However, extreme caution and refined laparoscopic technique must be exercised to avoid cyst rupture and local spillage.
Spaliviero
Massimiliano
M
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Herts
Brian R
BR
Magi-Galluzzi
Cristina
C
Xu
Meng
M
Desai
Mihir M
MM
Kaouk
Jihad H
JH
Tucker
Kay
K
Steinberg
Andrew P
AP
Gill
Inderbir S
IS
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D006801:Humans; D052177:Kidney Diseases, Cystic / Q000453:epidemiology / Q000601:surgery*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies