title: Laparoscopic radical nephrectomy for patients with T2 and T3 renal-cell carcinoma: evaluation of perioperative outcomes.
abstract: OBJECTIVE
  Laparoscopic radical nephrectomy (LRN) is considered standard of care for T1 renal tumors not amenable to nephron-sparing surgery. Indications are now expanding to include patients with T2 or T3 tumors. The purpose of this study is to evaluate LRN as a minimally invasive procedure for treatment of advanced stage renal tumors.
  
  
  METHODS
  We performed a retrospective analysis of a cohort of consecutive patients with renal tumors undergoing LRN for clinical stages T1 to T3. Parameters examined included patient demographics, medical comorbidities, tumor characteristics, perioperative outcomes, and complications.
  
  
  RESULTS
  In all, 252 kidneys were removed from 247 consecutive patients undergoing LRN; 246/252 (97.6%) kidneys contained renal-cell carcinoma and 55 (21.8%) patients had pT2/T3 disease. Mean pathologic tumor size in the T1 and T2/T3 groups was 4.1 and 7.8 cm, respectively. Compared with patients with T1 tumor, patients with T2/T3 tumor had higher body mass index (p = 0.010), higher specimen weight (p = 0.002), higher mean Fuhrman grade (p = 0.014), and more postoperative complications (p = 0.035). Mean blood loss for T1 and T2/T3 patients was 133 and 198 cc, respectively; 3/197 patients (1.5%) and 4/55 patients (7.3%) in the T1 and T2/T3 groups received blood transfusion, respectively (p < or = 0.05).
  
  
  CONCLUSIONS
  LRN for the treatment of clinical stage T2 and T3 disease should be considered. LRN can be safely performed with good perioperative outcome. Blood transfusion and complication rates are higher for LRN in pT2/T3 patients. However, the decision to modify surgical technique should be considered when either oncologic efficacy or patient safety is a concern.
authors.affiliation: Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida, USA. vbird@med.miami.edu
authors.forename: Vincent G
authors.initials: VG
authors.lastname: Bird
authors.forename: John M
authors.initials: JM
authors.lastname: Shields
authors.forename: Mohammed
authors.initials: M
authors.lastname: Aziz
authors.forename: Rajnikanth
authors.initials: R
authors.lastname: Ayyathurai
authors.forename: Rosely
authors.initials: R
authors.lastname: De Los Santos
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Roeter
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery*; D003710:Demography; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D019990:Perioperative Care; D016896:Treatment Outcome