Zero ischemia laparoscopic microwave ablation assisted enucleation vs. laparoscopic partial nephrectomy in clinical T1a renal tumor: a randomized clinical trial

Xiaorong Wu, Wei Chen, Jiwei Huang, Jin Zhang, Dongming Liu, Yiran Huang, Yonghui Chen, Wei Xue, Xiaorong Wu, Wei Chen, Jiwei Huang, Jin Zhang, Dongming Liu, Yiran Huang, Yonghui Chen, Wei Xue

Abstract

Background: The study aims to evaluate efficiency, safety and the functional outcomes of zero ischemia laparoscopic microwave ablation assisted tumor enucleation (LMWATE) in comparison with laparoscopic partial nephrectomy (LPN) for cT1a renal tumors.

Methods: A prospective randomized controlled trial on cT1a renal tumor patients treated by laparoscopic nephron sparing surgeries between October 2014 to September 2017 was conducted. Tumor enucleation was performed in the LMWATE group after microwave ablation (MWA) without hilar clamping. The endpoint was the affected kidney's change of GFR measured by renal scintigraphy at the 3rd month and 12th month postoperatively. All the patients were followed up for at least 12 months. The Student t-test, Wilcoxon rank sum tests and Pearson Chi-square or Fisher exact were applied to analyse data.

Results: The number of patients enrolled in the LMWATE group and LPN group were 90 and 93 respectively. Patients in the LPN group showed much more decline of effect kidney glomerular filtration rate at 3 months (10.3 vs. 17.4, P<0.001) and 12 months postoperatively (8.8 vs. 10.2, P=0.023) when compared to the LMWATE group. Additionally, in the LMWATE group, considerably shorter median operation duration (91 vs. 112 minutes, P<0.001), lower median estimated blood loss (82.5 vs. 117.5 mL, P<0.001) and shorter hospital stay (5.5 vs. 6 days, P=0.013) were observed but with similar postoperative complications in both groups. There was no positive margin or local recurrence in both groups.

Conclusions: Zero ischemia LMWATE may provide better preservation of renal function, decrease operative time and blood loss compared to LPN with similar complication rates.

Keywords: Ablation techniques; kidney neoplasms; minimally invasive surgical procedures; organ sparing treatments.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tcr.2019.12.73). The authors have no conflicts of interest to declare.

2020 Translational Cancer Research. All rights reserved.

Figures

Figure 1
Figure 1
Consolidated standards of reporting trials flow diagram.
Figure S1
Figure S1
The conventional LPN procedures. (A,B) After the tumor was completely exposed, the parenchyma was then incised, and the tumor was excised along its capsule with a margin of 1 to 2-mm normal parenchyma by blunt dissection, the dissection was kept at the relatively avascular intrarenal plane. On reaching the target vessels of the tumor, operation was done with Hem-o-lok clips. (C) Hemostasis was achieved with point-specific suturing and incised calyces were repaired. (D) the defected parenchyma was closed via continuous suturing with Hem-o-lok clips. LPN, laparoscopic partial nephrectomy.
Figure S2
Figure S2
The details of microwave ablation assisted tumor enucleation. (A,B) Microwave ablation was performed at a range of 1 to 3 min per tumor according to size and depth of the tumor for 1 to 3 cycles. (C) The tumor was enucleated without hilar clamping via blunt and sharp dissection. (D) The unipolar or bipolar coagulation or ablation were used to control tumor bed bleeding.

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