Efficacy of trans-lumbar-and-peritoneally joint approach for renal neoplasms by laparoscopic surgery: a clinically prospective study

Abstract

Objective To explore the safety and efficacy of a new trans-lumbar-and-peritoneally joint (TLPJ) approach for treating renal cell carcinoma by laparoscopic operation. Methods From January, 2007 to December, 2013, one hundred patients with renal tumor were divided into 4 groups according to the size of tumors and operative approaches. And the clinic information was compared retrospectively. Group A (TLPJ laparoscopic partial nephrectomy) included 17 male and 13 female with average age (49.7±14.5) years old and average weight (65.2±14.1) kg. The location of tumor included 16 in left kidney and 14 in right kidney. The mean size of tumor was (4.2±0.9) cm. Group B (trans-peritoneal laparoscopic partial nephrectomy) included 16 male and 14 female with average age (48.5±13.9) years old and average weight (63.9±15.0) kg. The location of tumor included 17 in left kidney and 13 in right kidney. The mean size of tumor was (4.3±1.0) cm. Forty patients with tumor size over than 7cm were divided into group C and group D. Group C (TLPJ laparoscopic radical nephrectomy) included 11 male and 9 female patients, with average age (52.3±13.1) years old and average weight (64.4±13.5) kg. The mean tumor size was (8.5±0.9) cm. 12 tumors were located in the left kidney and 8 in right kidney. average tumor size. Group D (trans-peritoneal laparoscopic radical nephrectomy) included 12 male and 8 female patients with average age (53.5±12.8) years old and average weight (65.0±13.6) kg. 10 tumors were located in the left kidney and 10 in right kidney. The average tumor size was (8.7±0.9) cm. General anesthesia was applied in all groups. The body position and the surgical approach in group A and C were similar to the retroperitoneal approach. However, the entire side peritoneum was opened to connect the retroperitoneal space with the abdominal space, which largely extended the operative space and was particularly appropriate for the manipulation of the tumors with large size or in special location. Results All patients experienced successful operation without the open approach conversion. For patients in group A and B, the operative duration were (109.5±22.5) and (110.7±23.6) mins. The time of warm ischemia were (24.0±2.5) and (24.8±2.4) min. The estimated blood loss (EBL) were (61.0±17.0) and (70.0±15.5) ml with one patient and two patients needed blood transfusion, respectively. The time for gastrointestinal function restoration were (41.3±6.4) and (53.7±5.2) h. There were no significant differences between the two groups in comparing those parameters mentioned above (P>0.05). For patients in group C and D, the operative duration were (100.8±21.4) and (106.4±20.5) min. The EBL were (40.0±9.5) and (48.5±9.0) ml without any case needed blood transfusion. The time for gastrointestinal function restoration were (39.7±6.2) and (52.3±5.8) h. There were no significant differences between the two groups in comparing those parameters mentioned above (P>0.05). All patients gained a satisfactory recovery after a hospital stay of 3.5 to 6.3 days, without any severe postoperative complications, such as intra-abdominal organ injury and intestinal obstruction. During a follow up from 3 to 84 months, one patient was found recurrence in group A and a new occurrence of renal tumor appeared in one patient in group B. Both of them presented survivals of non-neoplasm after an immediately radical nephrectomy. In group C, no recurrence was reported.2 cases were diagnosed as pulmonary metastases, in which one died due to this disease. The other one survived with tumor after 6 months therapy of targeted drugs. Two cases died due to the pulmonary metastases in group D. Conclusions Partially or radically laparoscopic nephrectomy could be completed safely and efficiently with TLPJ approach. This approach is especially suitable for large renal neoplasms or the neoplasms nearby peritoneum. Key words: Laparoscope; Renal neoplasm; Trans-lumbar-and-peritoneally joint approach; Operation