Open Nephron-Sparing Surgery Remains Gold Standard -- MEDICA - World Forum for Medicine

“By comparing the first decade of elective open surgeries with more contemporary ones, we found that patient outcomes have greatly improved,” says Michael Blute, M.D., Mayo Clinic urologist and lead investigator of the study. “This leads us to the understanding that while there are some new treatment options out there, what was once the only option is still quite often the best option.”

Blute and his co-investigators reviewed all open NSS procedures performed at Mayo Clinic between 1985 and 1995, and compared them to those performed between 1996 and 2001: Hospital stay declined from a median of seven days to five days, blood loss and transfused units of blood significantly decreased, early complications declined considerably, and urine leak occurrence was demonstrated in only 0.6 percent (compared to previous reports as high as 17 percent).

When studying the more recent surgeries, researchers also found that open NSS showed some benefits compared with laparoscopic NSS. While laparoscopic NSS can often offer patients reduced postoperative pain, shorter hospital stays and smaller scars, it carries some risks that open NSS actually lessens.

Mayo Clinic surgeons needed to clamp the renal artery, stopping blood flow to the kidney, in only 50 percent of open NSS surgeries. For the majority of similarly complex laparoscopic NSS, this artery is clamped for durations typically much longer than those required for open NSS. The importance of limiting artery clamp times was indicated by fewer early surgical complications seen in patients with 20 minutes or less of stopped blood flow.

“While there is a definite benefit for many patients with tumours on the kidney’s surface to have laparoscopy,” says primary author R. Houston Thompson, M.D., “we find that NSS via an open approach remains the best option for patients with complex kidney tumours.”; Source: Mayo Clinic