Study on Laparoscopic Partial Nephrectomy: An Approach Towards Surgical Technique, Postoperative Survival, and Tumor Characterization According to VEGF Immunostaining

Abstract

Laparoscopic partial nephrectomy (LPN) was described for the first time in two reports in 1993. Although the surgical technique was innovative concerning the approach, it tried to reproduce the oncological and reconstructive principles of open surgery. In our series, we present the oncological results and establish postoperative survival at 5 years. Furthermore, we quantify the presence of the “Vascular Endothelial Growth Factor” (VEGF), due to the important role of angiogenesis in the pathogenesis of renal carcinomas. During the years 2005 to 2013, we performed 67 LPN for localized kidney tumors, at the Decentralized General Acute Zonal Hospital "Evita Pueblo" in Berazategui. The surgical technique used was transperitoneal laparoscopic partial nephrectomy. After surgery, the patients were included in a follow-up plan. The observed results show that our surgical technique has allowed us to reach an average time of 107 minutes and an ischemia time of 19 minutes. The most frequent complication was hemorrhage in 7.6% of the cases. Although conversion to open surgery was necessary in 2 patients due to bleeding and bile duct injury, conversion to radical surgery was not required in any of the cases. The overall survival determined at 5 years in clinical stages T1a / T1b was 96.7%. We can conclude that our LPN technique has oncological results similar to other open or robotic surgical techniques, also providing the advantages of a minimally invasive surgery at a low cost. Postoperative survival is related not so much to the surgical technique used but to the degree of cell differentiation, which was evidenced in the present study by immunostaining with VEGF, where we show that tumors with higher marking intensity are correlated directly with lower postoperative survival (p <0.002).