title: Modified laparoscopic simple enucleation with single-layer suture technique versus standard laparoscopic partial nephrectomy for treating localized renal cell carcinoma.
abstract: OBJECTIVE
  To compare modified laparoscopic simple enucleation (MLSE) and standard laparoscopic partial nephrectomy (SLPN) for treating localized renal cell carcinoma in our large institutional experience.
  
  
  METHODS
  We evaluated 385 consecutive patients who underwent MLSE or SLPN for renal tumors in our institution from January 2013 to December 2015 in terms of perioperative pathological and oncologic outcome variables. During MLSE, the single-layer suture technique was performed for renal reconstruction.
  
  
  RESULTS
  In total, 280 patients underwent MLSE and 105 underwent SLPN. Mean operative time was 182.1 and 192.8 min, respectively (p = 0.078). Warm ischemic time was significantly lower in the MLSE than SLPN group (23.2 vs 25.4 min; p = 0.004). The estimated blood loss was similar (p = 0.537). Tumor bed suturing was performed in 9.3 and 82.9% of MLSE and SLPN cases (p = 0.000). No hilar clamping was needed for 29 MLSE patients (10.4%) and 4 SLPN patients (3.8%) (p = 0.041). Grade III complications were reported in 5 (1.8%) MLSE patients and 7 (6.6%) SLPN patients (p = 0.034). The incidence of positive surgical margins was comparable between the MLSE and SLPN groups (1.8 and 5.7%, p = 0.086). After a median follow-up of 18 months, recurrence did not differ between the 2 groups: 9 (3.2%) MLSE patients and 4 (3.8%) SLPN patients (p = 1.000).
  
  
  CONCLUSIONS
  MLSE may confer shorter warm ischemic time, almost no need for tumor bed suturing and less grade III complications than SLPN, with similar oncologic outcomes. MLSE may be safe and acceptable for patients undergoing partial nephrectomy.
authors.affiliation: Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
authors.forename: Qun
authors.initials: Q
authors.lastname: Lu
authors.affiliation: Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
authors.forename: Xiaozhi
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
authors.forename: Changwei
authors.initials: C
authors.lastname: Ji
authors.affiliation: School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Suhan
authors.initials: S
authors.lastname: Guo
authors.affiliation: Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
authors.forename: Guangxiang
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
authors.forename: Shiwei
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
authors.forename: Xiaogong
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
authors.forename: Weidong
authors.initials: W
authors.lastname: Gan
authors.affiliation: Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China. dr.guohongqian@gmail.com.
authors.forename: Hongqian
authors.initials: H
authors.lastname: Guo
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery; D002681:China; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000601:surgery; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; D061646:Operative Time; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D013536:Suture Techniques; D052096:Warm Ischemia / Q000706:statistics & numerical data
keywords: Laparoscopic partial nephrectomy; Partial nephrectomy; Renal cell carcinoma; Renal reconstruction; Simple enucleation