SURGICAL APPROACH FOR PARTIAL NEPHRECTOMY

Partial nephrectomy (PN) provides comparable outcomes compared to radical nephrectomy and should be considered a priority intervention in patients with renal cell carcinoma (RCC).
Material and methods. During the period of 2010–2022 we performed 173 PN. The mean age of the patients was 60.5±11.4 years. The male/female ratio was 1,14:1, the right-sided/left-sided localization of the tumor ratio was 1,04:1, respectively (р>0,05).
Results. Laparoscopic approach was used in 54.9%, open PN in 45.1% of patients. Regression analysis of groups of patients distributed according to access did not reveal any dependence on gender, age, comorbidity, side of the lesion, or body mass index. A positive correlation was registered for tumor size and resection complexity. The ratio between laparoscopic and open PN for tumors up to 4 cm (T1a) was 70.5% and 28.2%, respectively. In the group of patients having undergone laparoscopic PN, the median nephrometric index on the RENAL scale was 5.3 points, which was significantly less than in the group who underwent open PN, with this indicator equal to 10.4 (p<0.01). The median time of warm ischemia in open PN was significantly lower, amounting to 13.1 minutes, the same indicator in the laparoscopic PN group was 28.2 minutes (p<0.05).
Discussion. A retrospective analysis showed the heterogeneity of patient groups depending on the access used for PN. Open PN was used in patients with larger and more technically complex tumors, which was mainly dictated by oncological expediency and reduced risks of surgical complications.
Conclusion. The T category and the RENAL nephrometric index are decisive for the choice of approach for PN in patients with RCC. Open PN is associated with shorter ischemia time and a higher incidence of segmental (partial) ischemia. 

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