Outcomes and Management Considerations in Patients on Dialysis Undergoing Laparoscopic Radical Nephrectomy for Renal-Cell Carcinoma

Perioperative Outcomes of Laparoscopic Radical Nephrectomy for Renal Mass in Patients on Dialysis or with Renal Transplant in Place Compared to Normal Controls

Background: The risk of renal cell carcinoma (RCC) development in the native kidney of patients on dialysis or with a renal transplant is increased compared to the general population. This study examines perioperative outcomes of laparoscopic radical nephrectomy (LN) in dialysis patients or renal transplant patients compared to normal controls. Methods: Four hundred twelve consecutive LN were evaluated (July 2007 to October 2018). Patients were divided into three groups (control, dialysis, and transplant). Perioperative outcomes, including operating room time (OT), postoperative complications, hospital length of stay, and 90-day readmission rates, were evaluated for the three groups. Results: There were 62 patients in the dialysis group, 20 renal transplants, and 330 normal controls. Dialysis patients were younger (median: 58 years versus 67 years; P = .002) and predominantly male (73% versus 59%, P = .047). Dialysis patients compared to controls had shorter total OT (median: 133 versus 149; P = .022), more papillary RCC (27% versus 10%; P < .001), and fewer high grade tumors (73% [8/11] versus 94% [100/106]; P = .038). Renal transplant patients had a higher rate of 90-day readmission (20% versus 6%; P = .034) and more papillary RCC (30% versus 10%; P = .016) compared to controls. Conclusion: LN on dialysis patients does not alter expected perioperative outcomes compared to a large cohort of control LN. LN on renal transplant patients carries a higher 90-day readmission rate than control LN.

Laparoendoscopic single-site nephrectomy for hemodialysis patients with dialysis-related renal tumors

PURPOSE

The purpose of this study is to assess the efficacy of laparoendoscopic single-site (LESS) nephrectomy in hemodialysis patients, we compared outcomes between LESS nephrectomy and conventional laparoendoscopic nephrectomy in hemodialysis patients with dialysis-related renal tumors.

MATERIAL AND METHODS

A total of 16 hemodialysis patients who underwent LESS nephrectomy (LESS-N; n = 8) or conventional laparoendoscopic nephrectomy (C-N; n = 8) between November 2003 and July 2012 were retrospectively evaluated. Outcomes were compared between the two groups.

RESULTS

Patient and tumor characteristics were similar between the LESS-N and C-N groups. The mean operative duration was longer in the LESS-N than in the C-N group (231.0 ± 26.7 min versus 188.6 ± 36.4 min; p = .025). The mean estimated blood loss was lower in the LESS-N compared with the C-N group (26.4 ± 14.4 ml versus 65.6 ± 45.2 ml; p = .047). Postoperative complications were observed in three cases, comprising one case of retroperitoneal hematoma in the LESS-N group and one case each of peritoneal hematoma and retroperitoneal abscess in the C-N group. Surgical scarring was minimal in the LESS-N group.

CONCLUSIONS

Although there is a little extension of the operating time, LESS nephrectomy in hemodialysis patients is a feasible procedure compared with the conventional method.

Surgical and Oncologic Outcomes of Laparoscopic Radical Nephrectomy for Non-Metastatic Renal Cancer in Long-Term Dialysis Patients

This study aimed to compare the outcomes of laparoscopic radical nephrectomy (LRN) between patients undergoing dialysis for ≤240 and >240 months. Data from all dialysis patients with non-metastatic renal cell carcinoma (RCC) treated with LRN between 2008 and 2015 in our hospital were evaluated retrospectively. Patients were divided into two groups, shorter- and longer-term dialysis patients, according to the preoperative duration of dialysis (≤240 vs. >240 months). Of 174 patients, 58 (33.3%) were on longer-term dialysis. Perioperative minor complications were significantly more frequent in the longer-term dialysis patients (P = 0.03). There was no significant difference between the two groups in other perioperative outcomes. Patients on longer-term dialysis more frequently had pathologically advanced RCC (P = 0.009) with poorer prognosis (P = 0.005). LRN for RCC in longer-term dialysis patients appears to be safe and feasible; however, careful follow-up is needed because these patients tend to have poorer prognosis.