الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 53 |  |  |
| | | from | 53 | | |
Abstract
The present prospective study included 47 patients who underwent PN for cT1b-cT2 renal mass. All procedures were performed by experienced surgeons in two centers one in Egypt and the other in Canada.
Baseline clinical characteristics and demographics were studied in all patients and tumor characteristics in each patient.
Complexity of renal masses were assessed using RENAL nephrometry score. we set up a composed parameter including the combination of positive surgical margins, perioperative complications (blood transfusion) and tumor recurrence in 6 months, 45% of complication rate in high complexity ,14% in moderate complexity, no complications occur in low complexity.
We used different types of hilar control between warm, cold ischemia and off clamp. There was no difference between eGFR preoperative and postoperative. The only difference was that all patients need blood transfusion perioperative were from off clamp group.
Pelvicalyceal system repair was done in 18 patients (38%) and one of them needed ureteral stenting. We experienced one case of urine leak postoperative which resolved conservatively. Most urine leaks resolved with prolonged drainage; other cases required further intervention.
Clinical correlation is recommended before re-excision or completion nephrectomy after a positive surgical margin. We had two cases of positive surgical margin and decision was just follow up for 2 years with no recurrence So, radical nephrectomy or re-resection of the margin is overtreatment in many cases, but a small percentage of patients will harbor residual malignancy.
Comparing eGFR preoperative and post-operative after 6 months in this study, we found no significance difference between both them (p value 0.279)
After 6 months follow up, all patients had CT or MRI showing no evidence for residual disease or recurrence and preservation of good functional residual parenchyma.
The ultimate function after PN primarily correlated with parenchymal volume preservation, whereas ischemia played a secondary role. Thus, maximal parenchymal preservation with a precise PN should be a priority during PN