The comparative study on clinical effects of different nephron-sparing surgical methods for T1 and T2a renal cell carcinoma

Abstract

Objective To compare the clinical effect of three different nephron-sparing surgical methods including peritoneal laparoscopy, retroperitoneal laparoscopy and open surgery for localized renal carcinoma. Methods The clinical data of 139 patients with localized renal carcinoma was retrospectively analyzed from March 2008 to March 2015. According to the methods of operation, they were divided into three groups, peritoneal laparoscopic excision group (35 cases), retroperitoneal laparoscopic excision group (60 cases) and open surgery group (42 cases). The operating time, renal warm ischemia time, blood loss, hospital stay, postoperative recurrence and metastasis were compared among the three groups and were statistically analyzed. Results One case in the abdominal group and the retroperitoneum group were transferred to open surgery because of extensive adhesion around the tumor, except for this study, and 137 cases were eventually included. Operation time of three groups was(145.3±32.4)min, (126.4±33.1)min and(114.0±31.3)min respectively. There was no significant difference in operative time between the abdominal laparoscopy group and the laparoscopic group. The operative time in the two groups was higher than that in the open operation group(P 0.05). The indwelling time of abdominal drainage tube was (7.1±3.2)d, (5.4±2.4)d and (5.3±1.6)d, respectively, and there was no significant difference among the three groups(P>0.05). The hospitalization time of the three groups was (11.6±4.3)d, (10.1±3.6)d and (13.8±3.2)d, respectively. The time of hospitalization in the abdominal laparoscopy group and the retroperitoneoscope group was significantly lower than that in the open operation group, with statistical significance(P 0.05). Follow-up for 2 to 3 years, there was no significant difference in mortality, recurrence and metastasis between the three groups, and there was no significant difference in postoperative complications(P>0.05). Postoperative pathological types suggested clear cell carcinoma in 122 cases, papillary cell carcinoma in 10 cases, chromophobe cell carcinoma in 4 cases, and collecting duct carcinoma in 1 cases. The R. E.N.A.L scoring system was significantly associated with renal ischemia time, operation time, and affected glomerular filtration rate (P 0.05). Conclusions Peritoneal laparoscopic and retroperitoneal laparoscopic nephron-sparing surgery for localized renal carcinoma have the advantages of minimal invasion, quick recovery and equal clinical effect with open surgery, and can substitute for open surgery. Key words: Carcinoma, Renal Cell; Laparoscopy; Urologic Surgical Procedures