title: Laparoscopic nephrectomy for renal cell cancer: evaluation of efficacy and safety: a multicenter experience.
abstract: OBJECTIVE
  Although laparoscopic radical nephrectomy is a safe and minimally invasive alternative to open surgery, the long-term disease-free outcome of this procedure has not been reported. We evaluated our experience with the laparoscopic management of renal cell carcinoma to assess the clinical efficacy of this surgical modality.
  
  
  METHODS
  Between February 1991 and June 1997, 157 patients at five institutions were retrospectively identified who had clinically localized, pathologically confirmed, renal cell carcinoma and had undergone laparoscopic radical nephrectomy. Operative and clinical records were reviewed to determine morbidity, disease-free status, and cancer-specific survival. Of the patients followed up for at least 12 months (n = 101), 75% had an abdominal computed tomography scan at their last visit.
  
  
  RESULTS
  The mean age at surgery was 61 years (range 27 to 92) and all patients were clinical Stage T1-2,NO,MO. Fifteen patients (9.6%) had perioperative complications. During a mean follow-up of 19.2 months (range 1 to 72; 51 patients with 2 years or more of follow-up), no patient developed a laparoscopic port site or renal fossa tumor recurrence. Four patients developed metastatic disease, and 1 patient developed a local recurrence. The 5-year actuarial disease-free rate was 91%+/-4.8 (SE). At last follow-up, there were no cancer-specific mortalities.
  
  
  CONCLUSIONS
  The laparoscopic surgical management of localized renal cell carcinoma is feasible. Short-term results indicate that laparoscopic radical nephrectomy is not associated with an increased risk of port site or retroperitoneal recurrence. Longer follow-up is necessary to compare long-term survival and disease-free rates with those of open surgery.
authors.affiliation: James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Cadeddu
authors.forename: Y
authors.initials: Y
authors.lastname: Ono
authors.forename: R V
authors.initials: RV
authors.lastname: Clayman
authors.forename: P H
authors.initials: PH
authors.lastname: Barrett
authors.forename: G
authors.initials: G
authors.lastname: Janetschek
authors.forename: D D
authors.initials: DD
authors.lastname: Fentie
authors.forename: E M
authors.initials: EM
authors.lastname: McDougall
authors.forename: R G
authors.initials: RG
authors.lastname: Moore
authors.forename: T
authors.initials: T
authors.lastname: Kinukawa
authors.forename: A M
authors.initials: AM
authors.lastname: Elbahnasy
authors.forename: J B
authors.initials: JB
authors.lastname: Nelson
authors.forename: L R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000601:surgery*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies