Laparoscopic radical nephrectomy for very large renal tumors (> or =10 cm): is there a size limit?
OBJECTIVE
The role of laparoscopic radical nephrectomy (LRN) for very large renal tumors remains to be defined. We review our experience with LRN for very large (> or =10 cm) renal malignancies.


METHODS
A retrospective analysis of 360 consecutive patients who underwent LRN for renal tumors between October 1999 and May 2007 in a tertiary academic center identified 11 patients with malignancies > or =10 cm.


RESULTS
Median age was 67 years (range 48-80 y), operative time was 170 minutes (range 80-240 min), estimated blood loss was 150 mL (range 50-300 mL), and length of stay was 2 days (range 1-6 d). There were two minor postoperative complications (acute renal insufficiency and ileus). Median tumor size was 12 cm (range 10-21 cm). Pathologic stage for patients with renal cell carcinoma was T(2), T(3a), T(3b), and T(4), in five, three, two, and one patient(s), respectively. One patient died after brain metastasis developed. Two patients in whom pulmonary metastases developed were still alive at last follow-up.


CONCLUSIONS
LRN was successfully performed in patients with renal tumors up to 21 cm. Important considerations when performing LRN include the individual clinical picture, surgeon experience, tumor location, and patient well-being. LRN for very large tumors is feasible in properly selected patients and can have significant benefits in the palliative setting.
Conley
Sarah P
SP
Department of Urology, Mayo Clinic, Phoenix, Arizona 85054, USA.
Humphreys
Mitchell R
MR
Desai
Premal J
PJ
Castle
Erik P
EP
Dueck
Amylou C
AC
Ferrigni
Robert G
RG
Andrews
Paul E
PE
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*