Laparoscopic Radical Nephrectomy for T2 Renal Cell Carcinoma

Abstract

Background: Large volume centres from the USA suggest laparoscopic radical nephrectomy (LRN) for T2 (>7 cm) renal cell carcinoma (RCC) is safe and associated with few complications. Similar data for low and intermediate volume centres in Europe is lacking. Objective: To determine whether LRN for T2 RCC in two intermediate volume UK hospitals compares favourably with larger volume centres. To determine whether LRN for T2 RCC is associated with favourable outcomes when compared to LRN for T1 RCC. Patients and methods: Data from 118 consecutive LRN performed in Oxford, UK (tertiary academic centre, catchment population 2,000,000) and Reading, UK (large district general hospital, catchment population 500,000). All patients undergoing LRN from 2004 to 2008 were included; outcome data were collected prospectively. All patients underwent a standard 4-port trans-peritoneal LRN with intact specimen removal. Patients were divided into two groups—Group 1 (clinical T1 tumours) and Group 2 (clinical T2 tumours). Demographic data and operative outcome data were collected for every patient including age, weight, operative duration, estimated blood loss, transfusion rates, complications, hospital stay and histology. Data were compared using Chi-square test and the Student t-test. Results: Mean patient age was 62.5 years; 57% of tumours were right sided. Mean tumour dimension in Group 1 was 4.3cm and 9.3cm in Group 2. Demographics were similar between the two groups. Operative duration, estimated blood loss and transfusion rates were significantly greater in Group 2. Despite this, complication rates, conversion rates and hospital stay were similar. 12% of tumours were benign and nearly half of all clinical T2 tumours were ultimately staged T3 on final histology. Conclusions: LRN for T2 RCC can be performed safely in intermediate volume centres. The procedure is more challenging but operative outcomes are similar to LRN for smaller tumours. Many >7 cm RCC are T3 on final histology.