Mini-Flank Supra-12th Rib Incision for Open Partial Nephrectomy for Renal Tumor With RENAL Nephrometry Score ≥10

The skill of supra-12th rib mini-flank approach for open partial nephrectomy (MI-OPN) provides an advanced operative method for renal tumor. Compared with laparoscopic and robotic surgery, it may be a feasible selection for the complex renal tumors. We describe our techniques and results of MI-OPN in complex renal tumors with high RENAL nephrometry score (RENAL nephrometry score 10). Fifty-five patients diagnosed with renal tumors between January 2009 and July 2013 were included in this study. Eligibility criteria comprised of patients with complex renal tumor (RENAL score 10) being candidates for partial nephrectomy (PN). All patients received MI-OPN and all surgeries were performed by a single urologist. The preoperative workup comprised of medical history, physical examination, and routine laboratory tests. Serum creatinine was recorded preoperatively and 2 to 3 months after operation. Operative time, ischemia time, blood loss, operative and postoperative complications, renal function, and pathology parameters were recorded. MI-OPN was successfully performed in all cases. Mean tumor size was 4.7 cm (range: 2.5–8.1). Mean warm ischemia time was 28.1 minutes (range: 21–39), mean operative time was 105minutes (range: 70–150) and mean estimated blood loss was 68 mL (range: 10–400). Mean postoperative hospital stay was 6.5 days (range: 5–12). Postoperative complications were found in 3 patients (5.5%). The mean preand postoperative serum creatinine levels were 76.2mmol/L (range: 47– 132) and 87.1mmol/L (range: 61–189) with significant difference (P1⁄4 0.004). The mean preand postoperative estimated glomerular filtration rate (eGFR) were 91.5 (range: 34–133) and 82.5 (range: 22– 126.5), respectively with significant difference (P1⁄4 0.024). In an average follow-up of 19.9 months (range: 8–50), no local recurrence or systemic progression occurred. In conclusion, MI-OPN can combine the benefits of both minimal invasive and traditional open partial nephrectomy (OPN) techniques ang, MD, Zhuoyi X Zhou, MD, nd Guomin Wang, MD (Medicine 94(13):e692) Abbreviations: BMI = body mass index, CT = computed tomography, eGFR = estimated glomerular filtration rate, LPN = laparoscopic partial nephrectomy, MDRD = modification of diet in renal disease, MI-OPN = mini-flank approach for open partial nephrectomy, OPN = open partial nephrectomy, PN = partial