title: Perioperative outcomes for laparoscopic radical nephrectomies performed on ≥ 10 cm tumors.
abstract: BACKGROUND
  The role of laparoscopic radical nephrectomy (LRN) in the management of very large renal masses has yet to be determined. Moreover, no studies have considered the total size of the specimen removed. We report our experience managing renal masses ≥ 10 cm with transperitoneal LRN.
  
  
  METHODS
  We retrospectively reviewed cases of LRN performed in the context of renal masses from 2006 to 2012 at our institution. LRNs were divided into two groups; tumors 10 cm or larger (n = 24) and tumors smaller than 10 cm (n = 124). Patient demographics, tumor characteristics, operative and perioperative outcomes were compared. Complication rate was assessed in relation to tumor and specimen size.
  
  
  RESULTS
  Mean pathologic tumor size was 11.8 cm (range 10.0 cm-17.0 cm) and 5.8 cm (range 2.1 cm-9.5 cm) for tumors ≥ 10 cm and < 10 cm, respectively. No difference was found in demographic characteristics, operative and perioperative outcomes (estimated blood loss, rate of conversion to open radical nephrectomy, length of postoperative stay and complication rate), between both groups, except higher surgical time in the ≥ 10 cm group (171 min versus 143 min, respectively, p = 0.005). There was no difference in tumor and total specimen size between patients with and without complications. Due to its retrospective nature, the major limitation of this study is missing data regarding specimen size.
  
  
  CONCLUSIONS
  LRN can be performed safely with acceptable operative and perioperative outcomes by experienced laparoscopists for very large renal masses (≥ 10 cm). Complication rates were unrelated to tumor and total specimen size.
authors.affiliation: Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Ouellet
authors.forename: Michel
authors.initials: M
authors.lastname: Carmel
authors.forename: Arold
authors.initials: A
authors.lastname: Martel
authors.forename: Robert
authors.initials: R
authors.lastname: Sabbagh
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery*; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; D061646:Operative Time; D012189:Retrospective Studies; D047368:Tumor Burden