Retroperitoneal laparoscopic partial nephrectomy in patients with tumors larger than 4 cm

Abstract

Objective To compare the perioperative outcomes and early postoperative complications of retroperitoneal laparoscopic partial nephrectomy to treat renal cell carcinoma in patients with tumor ＞4.0 cm and those with tumor ≤4.0 cm.Methods Three hundred and fifty-eight patients who had undergone retroperitoneal laparoscopic partial nephrectomy for renal cell carcinoma from June 2005 to June 2012 were retrospectively analyzed.The mean diameter of the renal tumors was 2.8 cm (range 0.7-7.9 cm).The clinical factors (i.e.gender,age,tumor characteristics),perioperative course (i.e.,operative time,warm ischemia time,estimated blood loss,and length of hospitalization),and early postoperative complications were collected and compared between the patients with tumor burdens ＞4.0 cm compared with those with tumor burdens of ≤4.0 cm.Results All the patients' surgical margins were negative.Patients with larger tumors had significantly greater tumor grades (P =0.017),collecting system repairing (72.5％ versus 34.9％,P=0.000),more intraoperative (13.7％ versus 3.9％,P=0.002) and postoperative complications (13.7％ versus 2.0％,P=0.000) and a significantly longer hospitalization (13.1±5.3 d versus 10.7±8.1 d,P=0.008).No other significant differences including warm ischemia time were noted between the 2 groups stratified by tumor size.Conclusion Retroperitoneal laparoscopic partial nephrectomy could be a feasible option for tumor burdens ＞4.0 cm to provide a nephron-sparing option for patients in whom lesions can be resected by individually assessed. Key words: Laparoscopes; Partial nephrectomy; Kidney neoplasms; Retroperitoneal