title: Safety and Feasibility of Laparoscopic Nephrectomy for Big Tumors (≥ 10 cm): A Retrospective Multicentric Study.
abstract: Evaluate the feasibility of laparoscopic nephrectomy for big tumors.
  
  
  
  Data from 116 patients were retrospectively collected from 16 tertiary centres. Clinical and operative parameters, tumor characteristics, pre- and postoperative parameters, and renal function before and after surgery were analyzed.
  
  
  
  Mean age and body mass index were 61 years and 27.8 kg/m(2), respectively. Males represented 63.8% of patients, and 54.4% presented symptoms at diagnosis. Median tumor size was 11 cm, and 75% of the cases were performed by expert surgeons. Median operative time and blood loss were 180 minutes and 200 mL respectively. Conversion to open surgery was necessary in 20.7% of cases. Intraoperative complications related to massive hemorrhage occurred in 16.4% of patients, resulting in open conversion in 62.5%. Major postoperative complications occurred in only 10 patients (8.6%). In univariate analysis, intraoperative complications, age, and blood loss were predictive factors of conversion to open surgery. Positive surgical margins occurred in 6 patients (5.2%). None of them presented a local recurrence. Predictive factors of recurrence or progression were lymph node invasion, metastases, and Furhman grade.
  
  
  
  Laparoscopic nephrectomy for tumors > 10 cm can be performed safely. Complication rate and positive surgical margins are similar to open surgery. In experienced hands, the benefit of a mini invasive surgery remains evident.
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Rennes, Rennes, France. Electronic address: gregory.verhoest@chu-rennes.fr.
authors.forename: Grégory
authors.initials: G
authors.lastname: Verhoest
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Rennes, Rennes, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Couapel
authors.affiliation: Department of Clinical Pharmacology, Centre Hospitalier Universitaire Rennes, Rennes, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Oger
authors.affiliation: Department of Pathology, Centre Hospitalier Universitaire Rennes, Rennes, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rioux-Leclercq
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Kremlin-Bicêtre, Paris, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Pignot
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Kremlin-Bicêtre, Paris, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.affiliation: Department of Urology, The Netherlands Cancer Institute, Amsterdam, Netherlands.
authors.forename: Axel
authors.initials: A
authors.lastname: Bex
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Angers, Angers, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Panayotopoulos
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Angers, Angers, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bigot
authors.affiliation: Department of Urology, Pilsen University, Pilsen, Czech Republic.
authors.forename: Viktor
authors.initials: V
authors.lastname: Eret
authors.affiliation: Department of Urology, Pilsen University, Pilsen, Czech Republic.
authors.forename: Milan
authors.initials: M
authors.lastname: Hora
authors.affiliation: Department of Urology, Ege University, Ege, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Turna
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Nantes, Nantes, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Lefevre
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Nantes, Nantes, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Rigaud
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Caen, Caen, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Tillou
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Caen, Caen, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Doerfler
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Cochin, Paris, France.
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire La Pitié-salpétrière, Paris, France.
authors.forename: Yanish
authors.initials: Y
authors.lastname: Soorojebally
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire La Pitié-salpétrière, Paris, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France.
authors.forename: Samuel
authors.initials: S
authors.lastname: Lagabrielle
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Bernhard
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Grenoble, Grenoble, France.
authors.forename: Jean-Alexandre
authors.initials: JA
authors.lastname: Long
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Limoges, Limoges, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Berger
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Lyon Sud, Lyon, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Ravier
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Lyon Sud, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Paparel
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Henri Mondor, Créteil, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.affiliation: Department of Urology, Samaritan Medical Center, Watertown, NY.
authors.forename: Alejandro R
authors.initials: AR
authors.lastname: Rodriguez
authors.affiliation: Department of Urology, Centre Hospitalier Universitaire Rennes, Rennes, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
mesh_terms: D000368:Aged; D015992:Body Mass Index; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000145:classification / Q000453:epidemiology*; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Kidney cancer; Laparoscopy; Nephrectomy; Renal cell carcinoma; Renal failure