Original Study| Volume 14, ISSUE 4, e291-e297, August 2016

Impact of Accidental Tumor Incision During Laparoscopic Partial Nephrectomy on the Oncologic and Clinical Outcomes

Published:November 25, 2015DOI:



      To investigate the impact of accidental tumor incision (ATI) during laparoscopic partial nephrectomy (LPN) on the treatment outcome of LPN and to determine the predictive factors for ATI.

      Patients and Methods

      Consecutive 156 patients with renal tumors suspicious of renal cell carcinoma cT1N0M0 undergoing laparoscopic partial nephrectomy at Yokohama City University between May 2003 and November 2014 were retrospectively evaluated. The analyzed clinical factors included maximum tumor diameter, the R.E.N.A.L. Nephrometry Score, occurrence of ATI during surgery, and the postoperative pathological findings including the presence of a pseudocapsule. Port site metastasis, tumor seeding, and local recurrence were investigated by routine follow-up computed tomography during the postoperative period.


      Among enrolled 156 procedures, 12 (7.7%) showed ATI during surgery. Positive surgical margin and local tumor recurrence were observed in 5 and 1 cases in the non-ATI group, respectively, as compared with in no cases in the ATI group. Port site metastasis or tumor seeding was not observed in either group. Multivariate analysis indicated that pseudocapsule formation significantly correlated with ATI (P = .022) and that maximum tumor diameter was a possible predictor of ATI (P = .054).


      To our knowledge, there are no previous studies to evaluate the impact of ATI, and we here, for the first time, report that the risk of ATI is influenced by the presence of a pseudocapsule, and, to some degree, by the tumor size. Moreover, we also show that ATI during laparoscopic partial nephrectomy is not necessarily associated with poor outcomes such as local tumor recurrence.

      Key words

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        • Van Poppel H.
        • Da Pozzo L.
        • Albrecht W.
        • et al.
        A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma.
        Eur Urol. 2011; 59: 543-552
        • Tan H.J.
        • Norton E.C.
        • Ye Z.
        • et al.
        Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer.
        JAMA. 2012; 307: 1629-1635
        • Weight C.J.
        • Larson B.T.
        • Fergany A.F.
        • et al.
        Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses.
        J Urol. 2010; 183: 1317-1323
        • Ljungberg B.
        • Bensalah K.
        • Canfield S.
        • et al.
        EAU guidelines on renal cell carcinoma: 2014 update.
        Eur Urol. 2015; 67: 913-924
        • Marszalek M.
        • Meixl H.
        • Polajnar M.
        • et al.
        Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients.
        Eur Urol. 2009; 55: 1171-1178
        • Campbell S.C.
        • Novick A.C.
        • Belldegrun A.
        • et al.
        Guideline for management of the clinical T1 renal mass.
        J Urol. 2009; 182: 1271-1279
        • Curet M.J.
        Port site metastases.
        Am J Surg. 2004; 187: 705-712
        • Castillo O.A.
        • Vitagliano G.
        Port site metastasis and tumor seeding in oncologic laparoscopic urology.
        Urology. 2008; 71: 372-378
        • Tsivian A.
        • Sidi A.A.
        Port site metastases in urological laparoscopic surgery.
        J Urol. 2003; 169: 1213-1218
        • Lee S.W.
        • Whelan R.L.
        • Southall J.C.
        • et al.
        Abdominal wound tumor recurrence after open and laparoscopic-assisted splenectomy in a murine model.
        Dis Colon Rectum. 1998; 41: 824-831
        • Yossepowitch O.
        • Thompson R.H.
        • Leibovich B.C.
        • et al.
        Positive surgical margins at partial nephrectomy: predictors and oncological outcomes.
        J Urol. 2008; 179: 2158-2163
        • Bensalah K.
        • Pantuck A.J.
        • Rioux-Leclercq N.
        • et al.
        Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery.
        Eur Urol. 2010; 57: 466-471
        • Raz O.
        • Mendlovic S.
        • Shilo Y.
        • et al.
        Positive surgical margins with renal cell carcinoma have a limited influence on long-term oncological outcomes of nephron sparing surgery.
        Urology. 2010; 75: 277-280
        • Borghesi M.
        • Brunocilla E.
        • Schiavina R.
        • et al.
        Positive surgical margins after nephron-sparing surgery for renal cell carcinoma: incidence, clinical impact, and management.
        Clin Genitourin Cancer. 2013; 11: 5-9
        • Makiyama K.
        • Nakaigawa N.
        • Miyoshi Y.
        • et al.
        Improvement on parenchymal suturing technique in laparoscopic partial nephrectomy.
        Int J Urol. 2008; 15: 854-855
        • Kutikov A.
        • Uzzo R.G.
        The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth.
        J Urol. 2009; 182: 844-853
        • Patard J.J.
        • Pantuck A.J.
        • Crepel M.
        • et al.
        Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication.
        Eur Urol. 2007; 52: 148-154
        • Rassweiler J.
        • Tsivian A.
        • Kumar A.V.
        • et al.
        Oncological safety of laparoscopic surgery for urological malignancy: experience with more than 1,000 operations.
        J Urol. 2003; 169: 2072-2075
        • Micali S.
        • Celia A.
        • Bove P.
        • et al.
        Tumor seeding in urological laparoscopy: an international survey.
        J Urol. 2004; 171: 2151-2154
        • Tanaka K.
        • Hara I.
        • Takenaka A.
        • et al.
        Incidence of local and port site recurrence of urologic cancer after laparoscopic surgery.
        Urology. 2008; 71: 728-734
        • Elbahnasy A.M.
        • Hoenig D.M.
        • Shalhav A.
        • et al.
        Laparoscopic staging of bladder tumor: concerns about port site metastases.
        J Endourol. 1998; 12: 55-59
        • Azhar R.A.
        • de Castro Abreu A.L.
        • Broxham E.
        • et al.
        Histological analysis of the kidney tumor-parenchyma interface.
        J Urol. 2015; 193: 415-422
        • Rosenthal C.L.
        • Kraft R.
        • Zingg E.J.
        Organ-preserving surgery in renal cell carcinoma: tumor enucleation versus partial kidney resection.
        Eur Urol. 1984; 10: 222-228
        • Marszalek M.
        • Carini M.
        • Chlosta P.
        • et al.
        Positive surgical margins after nephron-sparing surgery.
        Eur Urol. 2012; 61: 757-763
        • Minervini A.
        • di Cristofano C.
        • Lapini A.
        • et al.
        Histopathologic analysis of peritumoral pseudocapsule and surgical margin status after tumor enucleation for renal cell carcinoma.
        Eur Urol. 2009; 55: 1410-1418
        • Campbell S.C.
        • Novick A.C.
        • Streem S.B.
        • et al.
        Complications of nephron sparing surgery for renal tumors.
        J Urol. 1994; 151: 1177-1180
        • Crispen P.L.
        • Boorjian S.A.
        • Lohse C.M.
        • et al.
        Outcomes following partial nephrectomy by tumor size.
        J Urol. 2008; 180: 1912-1917
        • Porpiglia F.
        • Fiori C.
        • Bertolo R.
        • et al.
        Does tumour size really affect the safety of laparoscopic partial nephrectomy?.
        BJU Int. 2011; 108: 268-273
        • Frank I.
        • Colombo Jr., J.R.
        • Rubinstein M.
        • et al.
        Laparoscopic partial nephrectomy for centrally located renal tumors.
        J Urol. 2006; 175: 849-852
        • Venkatesh R.
        • Weld K.
        • Ames C.D.
        • et al.
        Laparoscopic partial nephrectomy for renal masses: effect of tumor location.
        Urology. 2006; 67 (discussion: 1174): 1169-1174
        • Bruner B.
        • Breau R.H.
        • Lohse C.M.
        • et al.
        Renal nephrometry score is associated with urine leak after partial nephrectomy.
        BJU Int. 2011; 108: 67-72
        • Ng C.S.
        • Gill I.S.
        • Ramani A.P.
        • et al.
        Transperitoneal versus retroperitoneal laparoscopic partial nephrectomy: patient selection and perioperative outcomes.
        J Urol. 2005; 174: 846-849