title: Operative safety and oncologic outcome of laparoscopic radical nephrectomy for renal cell carcinoma >7 cm: a multicenter study of 222 patients.
abstract: OBJECTIVE
  To evaluate the safety of laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) >7 cm, addressing the issue of modality and risk factors for complications and open conversion, and to assess the oncologic outcome.
  
  
  METHODS
  The data of 222 patients undergoing LRN for RCC >7 cm prospectively enrolled from 2002 to 2010 at 5 urologic centers were reviewed. Transperitoneal LRN was performed by 5 experienced laparoscopic surgeons. The Clavien-Dindo classification was used to assess complications. Multivariable analysis of factors predictive of conversions was performed. Oncologic outcomes for survival were estimated using the Kaplan-Meier method.
  
  
  RESULTS
  Median tumor size was 8.5 cm, operative time was 180 minutes, and blood loss was 280 mL. Forty-two patients (19%) received a blood transfusion. Six (2.7%) patients had grade III-IV complications: 2 with postoperative bleeding requiring abdominal re-exploration and 1 each with adrenal injury, splenic injury, wound diastasis, and respiratory insufficiency. Twelve patients (5.4%) were converted to open surgery. The diameter was 11.9 in converted groups and 8.5 cm in nonconverted groups (P = .001). Multivariable analysis revealed that pathologic stage was the only independent predictor of conversion (P = .002). The 5-year overall (OS), cancer-specific (CSS), and progression-free (PFS) survival was 74%, 78%, and 66%, respectively. The 5-year stage-adjusted CSS was 89% in pT2 and 40% in pT3 patients (P <.0001). Limitations of this study were its retrospective nature and the relatively short follow-up period for oncologic outcome.
  
  
  CONCLUSIONS
  LRN for large RCC is a safe operation. Stage pT3 is a risk factor for open conversion and is associated to significantly lower cancer-specific survival compared with pT2 stage.
authors.affiliation: Department of Urology, Santa Chiara Hospital, Trento, Italy. lorenzo_luciani@hotmail.com
authors.forename: Lorenzo G
authors.initials: LG
authors.lastname: Luciani
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.forename: Tommaso
authors.initials: T
authors.lastname: Cai
authors.forename: Carolina
authors.initials: C
authors.lastname: D'Elia
authors.forename: Valentino
authors.initials: V
authors.lastname: Vattovani
authors.forename: Guido
authors.initials: G
authors.lastname: Giusti
authors.forename: Daniele
authors.initials: D
authors.lastname: Tiscione
authors.forename: Stefano
authors.initials: S
authors.lastname: Chiodini
authors.forename: Roberto
authors.initials: R
authors.lastname: Peschechera
authors.forename: Christian
authors.initials: C
authors.lastname: Fiori
authors.forename: Rosa
authors.initials: R
authors.lastname: Spina
authors.forename: Paolo
authors.initials: P
authors.lastname: Parma
authors.forename: Antonio
authors.initials: A
authors.lastname: Celia
authors.forename: Gianni
authors.initials: G
authors.lastname: Malossini
mesh_terms: D000311:Adrenal Glands / Q000293:injuries; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D061646:Operative Time; D019106:Postoperative Hemorrhage / Q000209:etiology; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries; D013529:Surgical Wound Dehiscence / Q000209:etiology