[Radical and partial nephrectomy for RCC: laparoscopy or open surgery].
After initial scepticism laparoscopic radical nephrectomy has rapidly been developed to a standard of care which should be offered to all patients as an alternative to open surgery. This procedure is indicated for all renal tumours clinical stage 1-2 which are not considered for partial nephrectomy. Many studies now show that the oncologic outcome is good and comparable to open surgery. Follow-up, however, is limited to about 10 years. Laparoscopic radical nephrectomy has become a standardized procedure. Removal of the kidney by morcellation, favoured by the majority some time ago, has been abandoned to a great extent. Also the controversy about the advantages and disadvantages of the respective approach has been settled. Several prospective randomized studies proved that both the transperitoneal and retroperitoneal approaches are equally effective. Excluding the bias of the learning curve the complication rate of laparoscopy is not higher than that of open surgery, but morbidity is clearly lower. Since the rate of elective partial nephrectomy is increasing rapidly, laparoscopy may be a good choice for this indication as well. When performed during ischaemia all principles of open surgery--excision of the tumour with clear margins, haemostasis using sutures, closure of the collecting system, suture repair of the renal parenchyma--can be duplicated. The problem of long warm ischaemia time can be managed by the evolution of the surgical technique, but also by induction of hypothermia. Complication rates are comparable to open surgery. Oncologic results, with limited follow-up however, are promising.
Janetschek
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Abteilung für Urologie, Krankenhaus der Elisabethinen, Fadingerstrasse 1, A-4010 Linz. urology@janetschek.net
D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007036:Hypothermia, Induced; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D015996:Survival Rate