title: [Clinical efficacy of transperitoneal verus retroperitoneal laparoscopic partial nephrectomy for renal tumors with R. E. N. A. L score over 7].
abstract: OBJECTIVE
  To compare the safety, feasibility and efficacy of transperitoneal and retroperitoneal laparoscopic partial nephrectomy (LPN) in the treatment of renal tumors with R. E. N. A. L score more than 7.
  
  
  METHODS
  The clinical data were collected from 62 patients undergoing transperitoneal LPN (32 cases) and retroperitoneal LPN (30 cases) for a complex renal mass (R.E.N.A.L. score≥7) between January 2012 and March 2014. The surgical and early postoperative outcomes and complications were analyzed to evaluate the efficacy of the treatments. The mean operative time, estimated blood loss, warm ischemia time, surgical complications, blood transfusion rate, tolerating regular diet time, postoperative hospital stay and surgical margin were compared between the two groups.
  
  
  RESULTS
  The operations were completed successfully in all cases except for 1 case in transperitoneal group and 3 in retroperitoneal group that required conversion to open surgery. No significant differences were found in age, body mass index, ASA score, Charlson comorbidity index, tumor size or R.E.N.A.L. nephrometry score (P>0.05), nor in estimated blood loss, warm ischemia time, intraoperative complication, blood transfusion rate or surgical margin between the two groups (P>0.05, respectively). The transperitoneal LPN group had a shorter mean operative time than retroperitoneal LPN group (210.4∓59.2 vs 252∓58.3 min, P<0.05) but showed longer tolerating regular diet time (47∓10 h vs 23∓6 h, P<0.05) and postoperative hospital stay time (8.4∓1.9 days vs 6.5∓1.6 days, P<0.05).
  
  
  CONCLUSIONS
  Both transperitoneal LPN and retroperitoneal LPN are safe, feasible and effective for surgical management of complex localized tumors, but the transperitoneal procedure offers larger operative space with better exposure; the retroperitoneal procedure better promotes postoperative recovery of the patients.
authors.affiliation: Reproductive Sciences Center, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, China.E-mail: pxyurol@163.com.
authors.forename: Xiaoyong
authors.initials: X
authors.lastname: Pu
authors.forename: Zhanping
authors.initials: Z
authors.lastname: Xu
authors.forename: Jiuming
authors.initials: J
authors.lastname: Liu
authors.forename: Xiangguang
authors.initials: X
authors.lastname: Zheng
authors.forename: Dong
authors.initials: D
authors.lastname: Li
authors.forename: Yaoxiong
authors.initials: Y
authors.lastname: Luo
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Xian
mesh_terms: D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D009392:Nephrectomy; D061646:Operative Time; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D016896:Treatment Outcome