Incidence and treatment of complications in nephron sparing surgery.
Conservative renal surgery (enucleation or segmentary resection) has become the gold standard treatment for small and peripheral malignant kidney lesions or in cases of reduced renal function or bilateral lesions. The aim of this study is to evaluate the incidence and treatment of complications of this technique in our experience.


METHODS
Between March 1997 and March 2005, 159 patients aged from 23 to 77 years (median 66 years) underwent conservative renal surgery. In 123 patients the indication was elective and in 36 imperative. In 92 patients lesions were located in the upper pole, 41 in the lower pole and 24 were meso-renal . Two patients suffered from von Hippel-Lindau (VHL) disease and therefore presented multicentric lesions. Mean lesion diameter was 3 cm ( range 1 to 9 cm). Retroperitoneal access with flank incision was the approach used in all patients. In 124 patients the technique consisted of enucleation with hypothermia from contact with sterile ice. Time to ischaemia was between 12 - 40 minutes. The collecting system was opened in 23 patients.


RESULTS
Twelve cases of perioperative complications were encountered in this group of patients. Major complications were: two massive hemorrhage, two arteriovenous fistula, one lesion of the ureter, five cases of acute kidney failure. The two massive bleedings occurred within the first eight hours after surgery and necessitated surgical intervention to check a bleeding perinephric vessel. The arteriovenous fistulas, which occurred on the seventh and tenth postoperative day, were treated with selective percutaneous sclero-embolisation. The five acute kidney failures involved patients with functional or anatomical solitary kidney. No patient required dialysis in the post-operative period. Ureter lesion characterised the post-operative course of one solitary kidney patient affected by voluminous angiomyolipoma. Anuria and urine emission from drainage lead to exploratory lumbotomy which evidenced an iatrogenic lesion of the lumbar ureter that was treated with termino-terminal anastomosis. No other major complications were noted, with the exception of delay in intestinal canalization occurring in a 74 year old patient, and a wound infection in a patient with previous renal abscess associated to infundibular lithiasis and caliceal exclusion. There were no postoperative deaths.


CONCLUSIONS
Conservative renal surgery is a valid alternative to radical surgery. In our study, as already reported in literature, surgical complications were slight in incidence and conservatively treatable. Therefore, nephron sparing surgery (NSS) can be performed with safety and maximum preservation of renal function.
Seveso
Mauro
M
Department of Urology, Istituto Clinico Humanitas, Rozzano, Milan, Italy. mauro.seveso@humanitas.it
Maugeri
Orazio
O
Taverna
Gianluigi
G
Giusti
Guido
G
Piccinelli
Alessandro
A
Benetti
Alessio
A
Pasini
Luisa
L
Graziotti
Pierpaolo
P
D000328:Adult; D000368:Aged; D005069:Evaluation Studies as Topic; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D009399:Nephrons / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies