Laparoscopic radical nephrectomy: a journey from T1 to very large T2 tumors.
OBJECTIVE
To evaluate the feasibility, efficacy and safety of laparoscopic radical nephrectomy (LRN) in T1 and T2 renal tumors.


METHODS
From December 1999 to March 2007, a retrospective analysis of 102 patients was done. A thorough preoperative workup was done in all patients. Postoperatively the patients were followed up every 3 months for the first year, 6-monthly for the next 2 years and yearly thereafter.


RESULTS
Transperitoneal radical nephrectomy was done in 85 patients, whereas 7 patients had a retroperitoneal surgery. A combined approach of retroperitoneal renal artery clipping followed by transperitoneal nephrectomy was done in 10 patients. 72 patients had clinically T1 tumors and 30 patients were T2 tumors. Mean tumor size was 6.97 cm, mean operative time was 174 min, mean blood loss was 230 ml, mean hospital stay was 4.6 days, and mean incision length was 8 cm. 19 patients had conversion to open surgery. Mean follow-up was 22.6 (range 4-56) months. Overall recurrence-free survival was 88.1%.


CONCLUSIONS
LRN is a safe and effective treatment for renal tumors with a steep learning curve. Large right-sided T2 tumors can be safely treated with the combined approach. Disease control rates with LRN are satisfactory.
Department of Urology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. anees@sgpgi.ac.in
Aneesh
A
Srivastava
Manu
M
Gupta
Pratipal
P
Singh
Deepak
D
Dubey
Anil
A
Mandhani
Rakesh
R
Kapoor
Anant
A
Kumar
D000293:Adolescent; D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult