Zero ischemia partial nephrectomy: is it oncologically safe?
OBJECTIVE: evaluate oncologic outcomes of zero ischemia partial nephrectomy (ZIPN) regardless the approach performed (open, laparoscopic and robot-assisted).
DESIGN, SETTING, PARTECIPANTS: we retrospectively analyzed data of 790 consecutive patients with diagnosis of renal tumors and treated with open, laparoscopic and robot-assisted ZIPN between 2001 and 2013. Survival curves were extimated with Kaplan Meier method and compared with Log Rank test.
RESULTS: pathologic evaluation revealed: 378 Clear cells RCC (64.8%), 106 Papillary type I RCC (18.2%), 45 Papillary type II RCC (7.7%), 42 Chromophobe RCC (7.2%), 12 others histology (2.1%). 34 patients with Clear cell RCC were G1 (9.1%), 235 G2 (63%) 96 G3 (25.7%) and 8 G4 (2.1%). The mean pathologic tumor size was 3.7 cm (±2.0). 363 tumors were pT1a (65.6%), 144 pT1b (25.5%), 26 pT2 (4.3%), 27 pT3a (4.7%). Positive surgical margins were detected in 9 patients (1.7%). Disease recurrence occurred in 40 patients but we have not encountered any case of disease-related death. The median follow-up was 24 months.
For Clear Cell RCC 5 yrs DFS was 88% for pT1a, 81% for pT1b and 72% for pT2 and over [p=0.02]; 81% for G1-2 and 72% for G3-4 [p=0.001].
When adjusted for pT stage no significance difference was found among groups while when adjusting for Fuhrman grade a significance difference was obtained.
CONCLUSIONS: Avoiding hilar clamping is oncologically safe. Further data are necessary to confirm our findings.