Outcomes Of Laparoscopic Radical Nephrectomy Research Articles

PATIENT AND PATHOLOGICAL CORRELATES WITH PERI-OPERATIVE AND LONG-TERM OUTCOMES OF LAPAROSCOPIC RADICAL NEPHRECTOMY

You have accessJournal of Urology1 Apr 2009PATIENT AND PATHOLOGICAL CORRELATES WITH PERI-OPERATIVE AND LONG-TERM OUTCOMES OF LAPAROSCOPIC RADICAL NEPHRECTOMY Ahmed H Gabr, Yehoshua Gdor, Seth A Strope, William W Roberts, and J Stuart Wolf Ahmed H GabrAhmed H Gabr More articles by this author , Yehoshua GdorYehoshua Gdor More articles by this author , Seth A StropeSeth A Strope More articles by this author , William W RobertsWilliam W Roberts More articles by this author , and J Stuart WolfJ Stuart Wolf More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)61338-0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "PATIENT AND PATHOLOGICAL CORRELATES WITH PERI-OPERATIVE AND LONG-TERM OUTCOMES OF LAPAROSCOPIC RADICAL NEPHRECTOMY." The Journal of Urology, 181(4S), p. 473 © 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 4SApril 2009Page: 473 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Ahmed H Gabr More articles by this author Yehoshua Gdor More articles by this author Seth A Strope More articles by this author William W Roberts More articles by this author J Stuart Wolf More articles by this author Expand All Advertisement PDF downloadLoading ...

LAPAROSCOPIC RADICAL NEPHRECTOMY FOR LARGE RENAL CELL CARCINOMA: A MULTICENTER STUDY ON 134 PATIENTS WITH TUMORS GREATER THAN 7 CM

INTRODUCTION AND OBJECTIVES: Laparoscopy is replacing open surgery in the management of renal masses, but its role for large primary tumors is not clearly established. Our objective is to evaluate the feasibility and outcome of laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) greater than 7cm. METHODS: The records of patients who underwent laparoscopic (transperitoneal) radical nephrectomy for 7cm or larger RCC from January 2001 to September 2008 at four urologic centers in Northern Italy were reviewed. Demographics, operative, pathologic and follow-up data were evaluated. RESULTS: Overall, 134 patients underwent LRN in the study period. The median tumor size was 8.2cm (range 7-14), operative time 192 minutes (100-310), and blood loss 300ml (range 0-1500). 29 (21%) patients received blood transfusion. 16 (12%) cases in 2 centers were converted to open surgery, due to vascular/hemorrhagic complications (n=6), failure to progress (n=5), oncological concerns regarding the ability to completely resect extensive disease (n=4). Complications included: postoperative renal insufficiency (n=6) or hypertension (n=3), anemization (n=4), abdominal hematoma (n=2), wound diastasis/incisional hernia (n=2), splenectomy (n=1, occurring after open conversion). Pathologic stage was: pT2 in 92, pT3a in 22, pT3b in 18, pT4 in 2; 7 cases were pN+. 113 conventional, 5 chromophobe, 4 papillary, and 12 mixed or sarcomatoid RCC were resected. After a median follow-up time of 27 months (range 3-81), 93 (69%) patients were alive with no evidence of disease, 13 (10%) died of recurrent disease or progression, 22 (16%) are alive with disease. CONCLUSIONS: LRN for large renal tumors is feasible and efficacious without substantial complications and morbidity. However, the conversion rate was significant in our experience. Parasitic vessels and displacement of the surrounding organs by large renal masses can increase the risk of vascular/hemorrhagic complications or inability to completely resect the lesion. LRN for large masses confirms the advantages of laparoscopic surgery, but it remains a technically challenging operation, requiring advanced laparoscopic skills.

UP.15: Short- and Long-Term Surgical Outcomes of Laparoscopic Radical Nephrectomy for Kidney Cancer: A Single Center Experience in Brazil

Laparoscopic radical nephrectomy is the gold standard treatment in renal tumor T1-T2 in USA and Europe. There are no long-term postoperative, functional, and oncological outcomes published in Latin America. Our purpose is to report the long-term surgical efficacy of laparoscopic radical nephrectomy in a reference center in Brazil.

Outcomes of Laparoscopic Radical Nephrectomy in the Setting of Vena Caval and Renal Vein Thrombus: Seven-Year Experience

We present our experience with laparoscopic radical nephrectomy for T(3b) disease focusing on thrombus within the vena cava. A total of 14 patients with T(3b) disease were identified from a retrospective laparoscopic renal cancer database from 2000 to 2007. Patient demographics, clinical stage, preoperative imaging, intraoperative parameters, final pathology, and postoperative course were analyzed. In patients with a large tumor thrombus, the infraumbilical extraction excision was performed early and a gel port was placed. This was used when laparoscopic milking or determination of the distal extent of the tumor thrombus was difficult. Preoperative imaging identified T(3b) disease in all but four patients. Four patients had caval involvement seen on imaging, with one extending well above 2 to 3 cm above the renal vein. Of the 14 patients, procedures in 13 were completed laparoscopically. There was one conversion early in the experience because of a positive frozen section of the renal vein; however, additional vein and caval margins were negative. There was one complication-a pulmonary embolism 5 days postoperatively, managed with anticoagulation, with no disease recurrence 4 years later. In patients with T(3b) disease, laparoscopy is feasible and safe. Using advanced laparoscopic techniques to milk the tumor thrombus into the proximal renal vein with laparoscopic vascular instruments is critical to success in a purely laparoscopic thrombectomy. Placement of a gel port in the extraction incision early in the procedure may aid in hand-milking of the tumor thrombus into the renal vein in cases of extensive inferior vena cava involvement.

Laparoscopic radical nephrectomy: long-term outcomes

Concurrent with the rise of laparoscopic radical nephrectomy as the gold standard for managing renal cell carcinoma, awareness has increased regarding the value of nephron-sparing surgery, even in the presence of a normal contralateral kidney. Therefore, whereas fewer radical nephrectomies will be performed for T1a tumors, there is a move towards handling more advanced pathology laparoscopically; that is, very large tumors, T3b disease, and limited lymph-node involvement. This review will highlight the long-term outcomes and recent developments in laparoscopic radical nephrectomy reported over the past year. There were several papers reiterating the excellent long-term outcomes of laparoscopic radical nephrectomy in the form of retrospective comparisons with cohorts of patients undergoing open radical nephrectomy. None of these studies demonstrated any differences in 5-year cancer-specific or overall survival. Surgeons continue to expand upon the current technique and indications. Long-term studies repeatedly support the superiority of laparoscopic radical nephrectomy over open radical nephrectomy for the majority of renal cell cancers due to equivalent oncologic control, low morbidity and shorter convalescence time. Experienced surgeons are able to manage more advanced pathologies laparoscopically without compromising cancer control or patient safety.

Expanding the indications for laparoscopic radical nephrectomy

Laparoscopic radical nephrectomy is an established treatment for patients with clinical T1 renal cell carcinoma who are unsuitable for nephron-sparing surgery. In this review we summarize the expanding indications for laparoscopic nephrectomy, including large tumors, locally advanced disease, venous thrombi and cytoreductive surgery. Laparoscopic nephrectomy remains the foremost conventional laparoscopic procedure in urologic surgery. Multiple studies have demonstrated the feasibility of laparoscopic radical nephrectomy for stage T2 tumors, showing less morbidity and earlier return to activity compared to the open approach. Confirmation of durable oncologic control requires randomized prospective trials with longer follow-up. With growing experience, laparoscopic surgery has been extended to patients with renal cell carcinoma associated with limited local invasion and lymph node metastases. Experimental studies demonstrate the technical feasibility of laparoscopic radical nephrectomy in the presence of renal vein and inferior vena cava thrombi. In well-selected patients with metastatic renal cell carcinoma, laparoscopic cytoreductive nephrectomy can be performed safely, with less morbidity than open nephrectomy. Minimally invasive surgery results in significantly less postoperative morbidity than does open surgery. The intermediate oncologic outcomes of laparoscopic radical nephrectomy for advanced renal cell carcinoma are comparable to those historically achieved with open radical nephrectomy. Longer follow-up is needed to confirm survival equivalence.

100-MINUTE RETROPERITONEOSCOPIC RADICAL NEPHRECTOMY: A NEW RETROPERITONEAL APPROACH WITH A HAND ASSISTED METHOD

A new approach for retroperitoneoscopic radical nephrectomy is introduced. The point of our surgical method is the application of a combination of hand assistance and pure laparoscopic procedures with appropriate surgical steps via the retroperitoneal approach. In our early series we had good surgical results and we completed radical nephrectomy in about 100 minutes using this procedure. A total of 20 consecutive patients with renal cell carcinoma (cT1-2) who were operated on with this surgical method were analyzed. Surgical procedures occurred in 5 steps. In step 1 the retroperitoneal space was created manually from a pararectal incision at the umbilicus level. In step 2 the lateroconal fascia was incised and the renal hilar area was exposed with hand assistance. In step 3 hilar dissection was performed by pure laparoscopic procedure with another surgical instrument inserted from the hand device. Step 4 involved the application of hand assistance again for the quick mobilization of the kidney and adrenal gland. In step 5 the intact surgical specimen was retrieved from the hand device. Mean operative time and estimated blood loss were 103 +/- 21 minutes (range 70 to 145) and 49 +/- 85 ml (range 5 to 360), respectively. Mean days to oral intake and ambulation were 1.0 and 1.1, respectively. Operative times of the steps of hilar dissection and mobilization of the kidney and adrenal were shorter than in other series performed by standard retroperitoneoscopic radical nephrectomy. Major complications were not experienced. At this point, no metastasis has been experienced. Our surgical method may have the benefits of the retroperitoneal approach and hand assistance. The retroperitoneoscopic hand assisted method may be another important option in the 3 major approaches for laparoscopic radical nephrectomy, although longer-term followup is clearly required.

Laparoscopic Radical Nephrectomy: Long-Term Outcomes

Although more than a decade of experience with laparoscopic radical nephrectomy indicates it is an alternative to open surgery for localized renal-cell carcinoma (RCC), the long-term oncologic effectiveness of this procedure remains to be established. A thorough MEDLINE and PubMed literature research on long-term outcomes of laparoscopic radical nephrectomy was performed, and all pertinent articles were reviewed in detail. This review was formulated on the current cancer indication, the oncologic basis, the oncologic efficacy, and the longterm oncologic effectiveness of the procedure, including laparoscopic cytoreductive nephrectomy, with regard to metastasis, port-site tumor recurrence, and the relation to laparoscopic partial nephrectomy. Furthermore, the authors' previous report on the intermediate-term efficacy of laparoscopic radical nephrectomy was updated. With increasing experience, the indications for laparoscopic radical nephrectomy continue to expand. There were many reports of intermediate-term, two reports of long-term, and our up-to-date outcomes analyzing the management of localized RCC that showed effective cancer control with no statistically significant difference between laparoscopic and open radical nephrectomy in the true 5- and 10-year survival analysis. Long-term data, critical in the evaluation of any treatment for cancer, are currently available with respect to laparoscopic radical nephrectomy for localized RCC.

1780: Long Term Outcome of Laparoscopic Radical Nephrectomy for Renal Cell Cancer

1780: Long Term Outcome of Laparoscopic Radical Nephrectomy for Renal Cell Cancer

505 Long term outcome of laparoscopic radical nephrectomy for renal cell cancer

505 Long term outcome of laparoscopic radical nephrectomy for renal cell cancer

Long-term outcome of laparoscopic radical nephrectomy for pathologic T1 renal cell carcinoma

Objectives To evaluate the oncologic adequacy of laparoscopic radical nephrectomy in patients with pathologic Stage T1 renal cell carcinoma, we analyzed the long-term results in those treated with laparoscopy and those undergoing open surgery. Methods The renal tumor of 263 patients was confirmed to be Stage T1 by pathologic examination of the radical nephrectomy specimen between January 1992 and June 2002. Of the 263 patients, 195 were treated laparoscopically and the remaining 68 by open surgery. The patient follow-up lasted until July 31, 2002. Results The follow-up period of the laparoscopy group was 2 to 121 months (median 40). A total of 183 patients survived, 5 died of renal cancer, 7 died without any recurrent disease, and 7 were lost to follow-up. Seeding of the port sites did not develop in any of the patients. Ten patients had metastatic or recurrent disease within 3 to 110 months, and 5 of these patients died of cancer within 12 to 86 months. The 5-year disease-free and patient survival rate was 91%, and 94%, respectively. The 68 patients who underwent open surgery were followed up for 11 to 126 months (median 65). Of the 68 patients, 56 survived without any recurrent disease, 4 survived with metastasis, 6 died of metastatic disease within 8 to 49 months, and 6 were lost to follow-up. The 5-year disease-free and patient survival rate was 87% and 94%, respectively. Conclusions Laparoscopic radical nephrectomy is an alternative technique with comparable oncologic results to open nephrectomy in patients with localized pathologic Stage T1 renal cell carcinoma.

The long-term outcome of laparoscopic radical nephrectomy for small renal cell carcinoma.

To evaluate the efficacy of laparoscopic radical nephrectomy in patients with small renal cell carcinoma, we analyzed the long-term results in those treated with laparoscopy and those undergoing open surgery. A total of 149 patients with tumors less than 5 cm. in diameter enrolled in a radical nephrectomy program between January 1992 and March 2000. Of these patients 103 were treated laparoscopically and the remaining 46 underwent open surgery. Patient followup was until June 30, 2000. Laparoscopy followup was from 3 to 95 months (median 29). A total of 100 patients survived, 2 died without any recurrent disease in months 34 and 45, respectively, and 1 dropped out in postoperative month 3. Seeding of the port sites did not develop in any of the patients. There were 3 patients who had metastatic disease in months 3, 19 and 61, respectively, and 1 had local recurrence in postoperative month 43. The 5-year disease-free and patient survival rates were 95.1%, and 95.0%, respectively. Except for 2 patients who dropped out in months 10 and 16, respectively, 44 who underwent open surgery were followed from 11 to 101 months (median). Of the 44 patients 41 survived without any recurrent disease, 1 also survived with metastasis and 2 died of metastatic disease in months 7 and 11, respectively. The 5-year disease-free and patient survival rates were 89.7% and 95.6%, respectively. Laparoscopic radical nephrectomy can be an alternative to open nephrectomy in patients with localized small renal cell carcinoma.