Application of retroperitoneal laparoscopic partial nephrectomy for renal cell carcinoma of the early stage.

Abstract

To evaluate the feasibility and clinical efficacy of retroperitoneal laparoscopic nephronsparing surgery for renal cell carcinoma of the early stage. Between June 2003 and June 2008, 53 patients (31 males and 22 females) with renal mass were selected to undergo wedge resection of the tumor through retroperitoneal laparoscopy. Spiral computerized tomography (CT) and color Doppler ultrasound were used to provide information for nephron-sparing surgery (NSS). Patients with small (≤ 3 cm), peripheral, shallow and exophytic tumors, at a distance which exceeded approximately 10 mm between the tumor and renal collecting system, were enrolled into our studies. Surgical resection was performed along a resection line about 0.5 cm from the tumors. All procedures were technically successful. Mean operating time was 96 min (ranging from 75 to 110 min). Mean warm ischemia time was 15 min (ranging from 10 to 21 min). Mean estimated blood loss was 70 mL (ranging from 40 to 120 mL). Mean hospital stay after the surgery was 4.2 days (ranging from 3 to 6 days). No intraoperative or postoperative complications occurred. Of 53 patients, 52 had negative surgical margins and a 63-year male patient had a positive surgical margin. Neither local recurrence nor trocar-site metastasis was observed in the 53 patients during follow ups averaging 39 months (ranging from 11 to 83 months). Under the modified techniques of the surgery and conservative criteria for patient selection, laparoscopic partial nephrectomy can be safely and effectively performed and satisfactory outcomes are achievable.