Laparoscopic nephron-sparing surgery for complex renal cystic lesions: a single-center experience

TL;DR

This paper shows that laparoscopic surgery to remove complex kidney cysts is safe and effective, especially for those at higher risk of being cancerous.

Contribution

Demonstrates the safety and effectiveness of laparoscopic nephron-sparing surgery for complex renal cystic lesions classified as Bosniak IIF or higher.

Findings

Laparoscopic partial nephrectomy was successful in all 83 patients with complex renal cystic lesions.

Postoperative creatinine levels remained stable, indicating preserved kidney function.

Most lesions were found to be renal clear cell carcinoma, confirming the need for surgical intervention in high-risk cysts.

Abstract

This study aimed to explore the feasibility and safety of laparoscopic nephron-sparing surgery (LNSS) for complex renal cystic lesions.

A retrospective study was conducted on 83 cases of complex renal cystic lesions treated with LNSS in our hospital. There were 32 men and 51 women, ranging in age from 24 to 73 years (average, 47.22 ± 9.03 years). The diameter of the cysts was 1.5–5.9 cm (average, 3.44 ± 0.86cm). According to the Bosniak classification, there were 15 cases of type II, 23 cases of type IIF, 29 cases of type III, and 16 cases of type IV complex renal cystic lesions. According to clinical classification based on the difficulty of laparoscopic partial nephrectomy and the depth of the lesion, the 83 complex renal cystic lesions were divided into 48 cases of the extra-renal type, 15 cases of the centrally located type, seven cases of the renal sinus type, and 13 cases of the renal hilum type.

Laparoscopic partial nephrectomy was successful in all 83 patients. The surgical time was 35–102 min (average, 52.13 ± 14.38 min), the intraoperative bleeding volume was 10–200 ml (average, 27.25 ± 12.26 ml), and the renal artery occlusion time was 12–28 min (average, 12.46 ± 4.45 min). There was no significant change in creatinine before and after surgery. The postoperative pathological results showed 71 cases of renal clear cell carcinoma, five cases of low malignant potential multilocular cystic renal tumors, and seven cases of pure renal cysts with all margins negative.

There is potential for the malignant transformation of complex renal cysts into renal cell carcinoma. For complex renal cysts classified as Bosniak IIF or higher, surgical intervention is recommended, and LNSS is safe and effective. The complexity of the surgical procedure varies depending on the location classification of the complex renal cysts.

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