Comparing Zero Ischemia Laparoscopic Radio Frequency Ablation Assisted Tumor Enucleation and Laparoscopic Partial Nephrectomy for Clinical T1a Renal Tumor: A Randomized Clinical Trial

Currently, the gold standard for treating T1a renal tumors is nephron sparing surgery, with laparoscopic partial nephrectomy (LPN) being widely used as a minimally invasive nephron sparing option. During partial nephrectomies (PN), transient hilar clamping is used to produce a relatively bloodless field, which facilitates precise tumor excision and renal reconstruction. Unfortunately, temporary hilar clamping can result in renal warm ischemia (WI) injury, which could have consequential effects on renal functions. In 2012, Zhao et al performed a technique, (LRATE), which does not use the clamping technique in patients with renal cell carcinoma (RCC), and reported positive oncologic and renal functional results. This study then presents to evaluate the function outcome, safety, and efficacy of zero ischemia LRATE when compared to LPN.

The investigators conducted a prospective randomized controlled trial conducted from April 2013 to March 2015 in patients with cT1a renal tumor, scheduled for laparoscopic nephron sparing surgery. 201 patients were eligible, and overall 89 patients were recruited and randomly assigned into 2 groups for the study: LRATE group or LPN group. The primary outcome of the study was to look at change in glomular filtration rate (GFR) of the affected kidney by renal scintigraphy at 12 months post-operatively, and secondary outcomes included changes in eGFR, EBL, operative time, postoperative complications, pathological outcomes, hospital stay and oncologic outcomes.

The study found that patients in the LRATE group have a smaller decreased in GFR of the affected kidney at 3 months (10.2% vs 20.5%, p=0.001) and at 12 months (7.6% vs 16.2%, p=0.002). Patients in the LRATE group also had shorter operative time (p=0.002), lower estimated blood loss (p<0.001, and a shorter hospital stay (p=0.029).

LRATE is a PN technique that has many advantages in protecting renal function in patients with cT1a renal tumor when compared to conventional LPN. The study found that LRATE enables tumor excision with better renal preservation when compared to LPN, because of less blood loss and shorter operative time. The author acknowledge the limitations of the study, which includes completing it at a single high volume center, relatively small sample size with short follow up period, and excluding patients with renal tumor involving the urinary collecting system. Long-term follow up data is needed to draw further conclusions on LRATE oncologic outcomes, and thus it is recommended that zero ischemia LRATE technique is used in selected renal tumor cases.

Authors: Jiwei Huang, Jin Zhang, Yanqing Wang, Wen Kong, Xei Xue, Dongming Liu, YongHui Chen, and Yiran Huang
Affiliations: Department of Urology, Ren Ji Hosptial, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

Read the Abstract

Reference: Zhao X, Zhang S, Liu G et al: Zero ischemia laparoscopic radio frequency ablation assisted enucleation of renal cell carcinoma: experience with 42 patients. J Urol 2012; 188: 1095.

Login