**3.2.3 Impact of tumour size**

#### **3.2.3.1 Impact of tumour size on peri-operative and post-operative complications**

Porpiglia (Porpiglia et al., 2010) reviewed 100 consecutive laparoscopic partial nephrectomies. A third of these procedures concerned tumours larger than 4 cm. Intraoperatively, the latter required more often a transperitoneal approach and pelvicalyceal repair. Also, warm ischemia time was longer and they were associated with greater blood loss, however no significant bleeding or conversion occurred. Complication rates were similar in the small versus large tumour groups respectively: fever (6% vs. 3%), acute hemorrhage (4.5% vs. 15.1%, p=0.06), retroperitoneal hematoma (1.5% vs. 6%). One case of pneumonia was seen in the small tumour group and one urinary fistula in large tumours group.

The Role of Nephron-Sparing Surgery (NSS) for Renal Tumours >4 cm 343

The complication rate in a series of 183 Robot-assisted Partial Nephrectomy (RAPN) was

Patel (Patel et al., 2010) described 71 transperitoneal robotic partial nephrectomies. On

Peri-operatively, warm ischemia time was significantly longer in larger tumours. (p=0.011). He noted no intra-operative complications. The other peri-operative parameters: operative time, need to repair the collecting system, estimated blood loss, elective conversions were not significantly different between the smaller and the larger tumour groups. Postoperative complication rate was similar. There were also no differences in post-operative variables: length of stay and change of haemoglobine. Tumour size between 4 and 7.9 cm was not a risk factor for increased peri- and post-operative complications in patients

Benway (Benway et al., 2010) compared 118 LPN and 129 RAPN: the PSM rates were 0.8% and 3.9%, respectively. The PSM rate was higher in RAPN, however this was not significant (p=0.11). Wang (Wang & Bhayani, 2010) reviewed 100 LPN versus 100 RAPN and also noted no significant differences in PSM rate. Benway (Benway et al., 2010), in a review of 183 RAPN, described 3.8% PSM. Gill (Gill et al., 2007) reported a PSM rate of 2.85% in LPN versus 1.26% in open procedures. Kural (Kural et al., 2009) reported no PSM but his study contained only 10 RAPN. On his 71 RAPN, Patel (Patel et al., 2010) had no PSM in 15 tumours larger than 4 cm and 3 PSM on 56 smaller tumours. To our knowledge, no study

Having a tumour larger than 4 cm was not significantly predictive of an increased risk of kidney function loss at the first post- operative day or at 1-3 month follow-up. However, only 9 tumours larger than 4 cm and 28 smaller tumours were included (Patel et al., 2010)

Robot-assisted partial nephrectomy is still a young technique. Follow up is yet too limited to

Our latest study showed excellent surgical feasibility and cancer-specific survival for NSS in T1b RCC (Joniau et al., 2008). Local cancer control was achieved in the large majority of patients, with preservation of renal function in those with elective indications. NSS is at present the gold standard treatment for renal tumours less than 4 cm. Other studies

showed an increased PSM rate in tumours measuring between 4 and 7 cm.

evaluate recurrence-free survival and cancer-specific survival rates.

**3.3.2 Complications in Robot assisted laparoscopic partial nephrectomy** 

9.8%: 8.2% were major complications and 1.6% minor (Benway et al., 2010).

**3.3.3 Impact of tumour size** 

preoperative imaging, 15 were larger than 4 cm.

undergoing robotic partial nephrectomy.

**3.3.4 PSM** 

**3.3.5 Renal function** 

**3.3.6 Oncologic outcomes** 

**4. Conclusion** 

The sole significant risk factor for overall complications was the cortico-medullar location of the tumour (Porpiglia et al., 2010).
