Renal cancer. Contemporary management. Editor John A. Libertino. Springer New York 2013.
Laparoscopic partial nephrectomy in solitary kidneys
Tumor in a functional or anatomic solitary kidney poses a unique clinical challenge. While oncologic control remains the most important goal, preservation of renal function and avoidance of long-term hemodialysis are also crucial. To accomplish these goals, nephron-sparing surgery, if technically possible, is imperative.
In the largest published series to date, Haber et al. report their experience with 78 patients with a solitary kidney undergoing LPN. There were four intraoperative complications, all requiring open conversion. The postoperative complication rate was 22.9%, which is consistent with the range of postoperative complications after MIPN published in other series. Lane et al. compared OPN (n = 169) to LPN (n = 30) in patients with solitary kidneys. LPN had longer warm ischemia time by an average of 9 min. Patients in the LPN were 2.54-fold more likely to have a postoperative complication. Three patients undergoing LPN required renal replacement therapy acutely, and two required permanent hemodialysis within 1 year. The small sample size and retrospective nature of these studies are inherent limitations. Nonetheless, MIPN in this subset of patients is feasible although with the potential for renal functional morbidity.