Evolving Approach in Nephron-Sparing Surgery: Has Anything Changed From Open Surgery To Laparoscopy

Abstract

Objective: This study aimed to provide valuable insights into the comparative efficacy of different surgical approaches fornephron-sparing surgery (NSS) and contribute to the existing literature in this field. Materials and Methods: This study included patients who underwent NSS for small renal masses between January 2016 andMarch 2024. A total of 97 patients (41 in the open approach group, 56 in the laparoscopic approach group) with demographic,radiological, intraoperative, renal functional, and oncological follow-up data were included. Three different anatomical scoringsystems (R.E.N.A.L. nephrometry score, PADUA score and C-index) were utilised to assess tumour location and estimate prox-imity to the hilum and collecting system. Results: In the open nephron-sparing surgery (ONSS) and laparoscopic nephron-sparing surgery (LNSS) groups, the mean kid-ney tumour diameters (SD) were 5.20 +/- 2.30 and 4.90 +/- 2.10, which were similar in both surgical method groups (p= 0.061).However, tumours treated with ONSS had significantly more adverse morphometric features (p<0.05). For ONSS and LNSSgroups, the mean R.E.N.A.L. nephrometry scores (SD) were 6.15 +/- 2.04 and 5.2 +/- 1.4 (p= 0.032), respectively; The mean PADUAscores (SD) were 7.46 +/- 1.14 and 6.8 +/- 1.0 (p= 0.049), respectively; And the mean C-index (SD) scores were 1.39 +/- 0.4 and 1.37 +/- 0.5 (p= 0.062), respectively. No significant differences were found in the mean tumour diameter (cm) (Inter Quantile Range(IQR)) distribution of both groups (p= 0.058). Despite the slight increase in transfusion rate in the LNSS group, estimated bloodloss (EBL), transfusion rates, and length of hospital stay were similar in both groups. Conclusions: Although LNSS does not appear superior in terms of intraoperative blood loss, length of hospital stay and transfu-sion rate, it provides comparable long-term outcomes to ONSS. Our study suggests that when matched with nephrometry scores,LNSS can achieve similar outcomes to ONSS