title: Laparoscopic partial nephrectomy for endophytic hilar tumors: feasibility and outcomes.
abstract: OBJECTIVE
  To analyze feasibility and outcomes of laparoscopic partial nephrectomy (LPN) for endophytic hilar tumors in low-intermediate (ASA I-II) risk patients.
  
  
  METHODS
  This is a single centre retrospective study. From May 2009 to September 2011, 208 LPNs were performed at our institution. Overall 11 (5.2%) elective LPNs were for hilar tumors not visible on kidney surface. Hilar tumor was defined as a mass located in the renal hilum and in contact with a major renal vessel on preoperative imaging. Procedures were carried out by a single experienced surgeon (G.G.) via retroperitoneal approach by clamping the only main renal artery.
  
  
  RESULTS
  Mean (range) age of patients was 45.3 years (38.2-64.1), tumor size 1.6 cm (1.2-2.0), warm ischemia time 24 min (19-32), operative time 140 min (110-200) and estimated blood loss 270 ml (100-750). Two collecting system injuries were observed and repaired intraoperatively. No conversion to open surgery was required. Final pathological examination revealed 10 renal cell carcinomas and 1 oncocytoma. A negative surgical margin was obtained in 10/11 (91%) patients. Renal function and serum hemoglobin were nearly unaltered pre and post-surgery. No tumor recurrence was observed at mean (range) follow-up of 34 months (15-43).
  
  
  CONCLUSIONS
  In experienced hands, LPN represents a feasible, safe and effective treatment for selected patients diagnosed with endophytic hilar masses. A larger number of patients and longer follow-up are required to draw definitive conclusions.
authors.affiliation: Department of Scienze Ginecologico-Ostetriche e Scienze Urologiche, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy. Electronic address: gb.dipierro@libero.it.
authors.forename: G B
authors.initials: GB
authors.lastname: Di Pierro
authors.affiliation: Department of Scienze Ginecologico-Ostetriche e Scienze Urologiche, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Tartaglia
authors.affiliation: Casa di Cura Privata Dott. Pederzoli, Divisione di Urologia, Peschiera del Garda, VR, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Aresu
authors.affiliation: Casa di Cura Privata Dott. Pederzoli, Divisione di Urologia, Peschiera del Garda, VR, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Polara
authors.affiliation: Casa di Cura Privata Dott. Pederzoli, Divisione di Urologia, Peschiera del Garda, VR, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Cielo
authors.affiliation: Department of Scienze Ginecologico-Ostetriche e Scienze Urologiche, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Cristini
authors.affiliation: Department of Scienze Ginecologico-Ostetriche e Scienze Urologiche, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Grande
authors.affiliation: Department of Scienze Ginecologico-Ostetriche e Scienze Urologiche, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Gentile
authors.affiliation: Casa di Cura Privata Dott. Pederzoli, Divisione di Urologia, Peschiera del Garda, VR, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Grosso
mesh_terms: D000328:Adult; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Complications; Endophytic hilar tumors; Laparoscopic partial nephrectomy; Renal function; Tumor recurrence