Laparoscopic radical nephrectomy for large renal-cell carcinomas.
OBJECTIVE
We retrospectively reviewed the clinical outcome and long-term cancer control of patients with localized large renal-cell carcinomas (RCCs) who underwent laparoscopic radical nephrectomy in comparison to open procedure.


METHODS
One hundred and thirty-one patients with RCCs greater than 7 cm who underwent radical nephrectomy between 1996 and 2008 were studied: 52 patients in the laparoscopy group and 79 in the open group. In this analysis patients who had metastasis or pT4 disease or tumor thrombus in the inferior vena cava were excluded. The median follow-up period was 41 months in the laparoscopy group and 51 months in the open group.


RESULTS
Patients in the laparoscopy group had tumors similar in size to those in the open group (88 and 89 mm, respectively), lesser blood loss (245 and 663 mL p < 0.01), but more intraoperative complications (15% and 2.5%). One laparoscopy patient was converted to open surgery because of an injury to the inferior vena cava (IVC). The 5- and 10-year disease-free rates and patient-survival rates were comparable in both groups.


CONCLUSIONS
Laparoscopic nephrectomy is feasible for localized large RCC, although intraoperative complications were more frequent. No statistically significant differences were found in either disease-free or cause-specific patient survival rates between the laparoscopy and the open groups. Laparoscopic nephrectomy can be an alternative to the open procedure for localized large RCC. However, a longer follow-up period is necessary to confirm the oncological efficacy of this procedure.
Hattori
Ryohei
R
Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan. rhattori@med.nagoya-u.ac.jp
Osamu
Kamihira
K
Yoshino
Yasushi
Y
Tsuchiya
Futoshi
F
Fujita
Takashi
T
Yamada
Shin
S
Funahashi
Yasuhito
Y
Ono
Yoshinari
Y
Gotoh
Momokazu
M
D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence