title: Feasibility and outcomes of laparoscopic renal intervention after prior open ipsilateral retroperitoneal surgery.
abstract: OBJECTIVE
  Treating patients with renal-cell carcinoma (RCC) after previous retroperitoneal surgery (renal or adrenal) is technically challenging. We present our initial experience with laparoscopic renal interventions (LRI) after previous open retroperitoneal surgery in patients needing ipsilateral renal intervention. We report on feasibility, functional and oncologic outcomes of LRI after previous open retroperitoneal surgery.
  
  
  METHODS
  We reviewed records of patients undergoing attempted laparoscopic or robot-assisted renal intervention after at least one previous open ipsilateral retroperitoneal surgery. We identified 34 patients who underwent 39 staged attempted LRI after 48 previous open ipsilateral renal or adrenal surgeries. The LRI included 20 minimally invasive partial nephrectomies (MIPN), 11 laparoscopic radiofrequency ablations (LRFA), and 8 laparoscopic nephrectomies (LTN). Demographic, perioperative, renal functional, and oncologic outcome data were collected. Statistical analyses were performed to identify risks for conversion to open surgery.
  
  
  RESULTS
  No attempted nephron-sparing procedure resulted in kidney loss. Overall conversion rate of the cohort was 28% and was highest in the MIPN group (40%). On univariate analysis, only multiple tumors that were treated significantly increased chances of open conversion (P<0.01). Subset analysis demonstrated similar rates of blood loss, operative times, and conversion rates in patients undergoing partial nephrectomy having previous open partial nephrectomy compared with previous open adrenal surgery only. There was no significant difference in preservation of renal function between MIPN and LRFA, with more than 85% of preoperative renal function preserved. Mean follow-up of 11.9 months (range 1-97.5 mos) metastasis-free survival and overall survival was 94.1% and 97%, respectively.
  
  
  CONCLUSIONS
  LRI after previous open ipsilateral retroperitoneal surgery is feasible. Repeated partial nephrectomy has the highest conversion risks among the laparoscopic renal interventions and appears to be independent of previous renal or adrenal procedure. Attempting repeated LRI for multiple tumors is a significant risk factor for open conversion. Renal functional and oncologic outcomes are encouraging at early follow-up.
authors.affiliation: National Institutes of Health, National Cancer Institute, Urologic Oncology Branch, Bethesda, Maryand, USA.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Boris
authors.forename: Gopal N
authors.initials: GN
authors.lastname: Gupta
authors.forename: Jonas S
authors.initials: JS
authors.lastname: Benson
authors.forename: W Marston
authors.initials: WM
authors.lastname: Linehan
authors.forename: Peter A
authors.initials: PA
authors.lastname: Pinto
authors.forename: Gennady
authors.initials: G
authors.lastname: Bratslavsky
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology / Q000601:surgery*; D007677:Kidney Function Tests; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D019990:Perioperative Care; D012187:Retroperitoneal Space / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome