Introduction and Objectives
Laparoscopic radical nephrectomy (LRN) is considered a standard of care in the treatment of T1–2 (≤ 8 cm) renal tumours. The objective of this paper is to summarize our results and our own experience in the treatment of advanced renal tumours (cT2 >8 cm, cT3a−b, cN+).
Material and Methods
From January 2003 to June 2009, we have accomplished 281 LRN at our institution. Transperitoneal approach was prefered in 259 (92%) patients. We preoperatively indicated CT or MR angiography of kidneys. Tumor thrombus was present in renal vein not extending into IVC. In our cohort, we identified patients with cT1–2 (≤ 8 cm) tumours – group 1 – and statistically compared their perioperative data with clinically advanced renal tumours (14× cT2 > 8 cm, 51× cT3a, 5× cT3b, 1× cT3acN2) – group 2.
Results
There were 195 (73.7%) patients in group 1 and 70 (26.3%) patients in group 2. We found statistically significant differences (p-value <0.05) between these two groups in terms of tumour size (51.6±13.0mm in group 1 vs. 70.0±19.4mm in group 2) and weight of specimen (550.8±199.1 g in group 1 vs. 691.6±233.4 g in group 2). Remaining perioperative data (group 1 vs. group 2) were statistically comparable (mean age was 61.9±11.7 yrs vs. 63.5±10.0 yrs, operating time was 128.9±45.9 min vs. 118.8±31.1 min, blood loss was 82.8±128.0 ml vs. 108.9±141.5 ml, hospitalization time was 6.4±2.2 vs. 5.3±1.3 days, complication rate was 6.2% vs. 8.6% and conversion rate was 5.8% vs. 5.4%). Mean follow-up was 34.2±20.1 months in group 1 vs. 25.8±17.8 months in group 2.
Conclusions
Minimally invasive surgery in the treatment of advanced renal tumours (cT2 > 8 cm, cT3a−b, cN+) is feasible in selected patients and demands experienced laparoscopic surgeon. Surgical outcomes are then comparable with T1–2 (≤8 cm) group. These procedures should be centralized and performed in high volume centres
These procedures should be centralizedThe work was supported by Czech government research project MSM 0021620819.
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Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
