title: Laparoscopic radical nephrectomy with hilar lymph node dissection in patients with advanced renal cell carcinoma.
abstract: OBJECTIVE
  Lymph node dissection (LND) may improve accuracy of staging, decrease recurrence rates, and improve survival in patients with advanced renal cell carcinoma (RCC). Here we assess the feasibility and safety of laparoscopic LND.
  
  
  METHODS
  Data were analyzed for patients who underwent combined laparoscopic radical nephrectomy (LRN) with LND between July 1997 and September 2006. Demographics, operative data, pathologic data, outcomes, and complications were assessed.
  
  
  RESULTS
  In a cohort of 700 patients who underwent LRN, 14 (13 male, 1 female) underwent LND. Transperitoneal LRN was conducted in 12 patients (86%). Retroperitoneal LRN and laparoscopic partial nephrectomy were conducted in 1 patient each (7%). Lymph node dissection yielded an average of 2.7 lymph nodes. Median tumor size was 9.5 cm (range, 1.5 to 13 cm), and median node size was 2.3 cm (range, 0.8 to 11 cm). Tumor stage was T2 or higher in 9 cases (64%), and distant metastasis was present in 7 patients (50%). One elective hand-assist and one open conversion were performed. Median estimated blood loss was 250 mL (range, 100 to 2100 mL). Median length of hospital stay was 2.5 days (range, 2 to 5 days). Median operative time was 199 minutes (range, 152 to 260 minutes). There was a single grade 1 complication (7%).
  
  
  CONCLUSIONS
  Patients with advanced or metastatic RCC may require cytoreductive nephrectomy for staging and tumor debulking before secondary therapy. Laparoscopic LND is both feasible and safe in select patients. Decreased morbidity associated with the laparoscopic approach is beneficial to patients with advanced disease.
authors.affiliation: Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Matthew N
authors.initials: MN
authors.lastname: Simmons
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.forename: Amr
authors.initials: A
authors.lastname: Fergany
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*