[Retroperitoneal laparoscopic surgery and carcinogenic risk].
OBJECTIVE
To retrospectively evaluate the development of metastasis at trocar sites, local recurrence and distance metastases associated with retroperitoneal laparoscopic surgery performed in the context of a malignant tumour.


METHODS
From 1994 to 1999, 228 retroperitoneal laparoscopic surgical operations were performed in our centre. Fifty six operations (24.6%) were performed for malignant tumours and comprised 41 radical nephrectomies and 8 partial nephrectomies for renal tumour and 7 nephro-ureterectomies for upper urinary tract tumours. The pathological stage and surgical margins were correlated with TNM 1997 stage. Postoperative data were obtained by physical and radiological examination performed one month and three months after the operation and then every six months. Metastases at the trocar site, local recurrences and distant metastases were investigated. The specific progression-free survival was calculated according to the Kaplan-Meier method.


RESULTS
The mean follow-up was 24.9 +/- 13.85 months. All patients had tumour-free surgical margins. No trocar site metastasis was observed. For retroperitoneal laparoscopic radical nephrectomies: one patient developed a local recurrence with liver metastases 9 months after the operation (pT3G2) and died 19.7 months after the operation. One patient with a pT3G3M+ renal tumour at the time of diagnosis died 23.1 months after radical nephrectomy with no signs of local recurrence. For laparoscopic retroperitoneal nephro-ureterectomies: one patient with a pT3G3 lesion developed a local recurrence at 12.1 months and died 26.6 months after surgery. One patient with a pT1G2 tumour developed bone metastases at 9 months and died 29 months after the operation. The recurrence-free survival at 54 months was 91% for radical nephrectomies, 71% at 30 months for nephro-ureterectomies and 100% at 49 months for partial nephrectomies.


CONCLUSIONS
Malignant tumours of the upper urinary tract can be managed by retroperitoneal laparoscopy. The short-term results suggest that this surgical technique is not associated with an increased risk of trocar site metastases or local recurrence and that recurrence-free survival rates comparable to those reported in series of conventional surgery.
Cicco
A
A
Service d'Urologie, Hôpital Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil. a.cicco@oreka.com
Salomon
L
L
Saint
F
F
Hoznek
A
A
Chopin
D
D
Abbou
C C
CC
D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D009366:Neoplasm Seeding; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D012307:Risk Factors; D014523:Urethral Neoplasms / Q000473:pathology* / Q000601:surgery*