Safety Of Laparoscopic Radical Nephrectomy Research Articles

Propensity-matched pair analysis of safety and efficacy between laparoscopic and open radical nephrectomy for the treatment of large renal masses (>10 cm): a retrospective cohort study.

BackgroundOpen radical nephrectomy (ORN) is a practical procedure for treating patients with large renal carcinomas >10 cm in size, and few studies have focused on feasibility and safety of laparoscopic radical nephrectomy (LRN). The current study was to assess the safety and effectiveness of LRN and ORN in large renal carcinoma patients by propensity matched pair analysis.MethodsIn this cohort study, a retrospective review of radical nephrectomy data from October 2010 to October 2018 at Changhai Hospital was conducted. Patients with renal carcinomas >10 cm in size by pre-operative images were included. Patients’ demographics including age, gender, body mass index (BMI), tumor size, operation time, hospitalization days, etc. were collected. Renal tumor patients undergoing LRN or ORN were match-paired by gender, BMI, age, and tumor size. Peri-operative outcomes including estimated blood loss and complications were compared. The follow-up contents included survival time, disease progression, and cause of death, and cancer-specific and progression-free survival were estimated via Kaplan-Meier curve analysis.ResultsAmong 92 patients with clinical T2b renal masses, 37 pairs were matched. The average tumor sizes of the LRN and ORN groups were 11.37±0.30 and 11.67±0.33 cm (P=0.375), respectively. The average operating time for LRN was slightly longer (204.32±11.17 vs. 192.78±8.50 min, P=0.414). Estimated blood loss (EBL) (336.49±63.58 mL for LRN vs. 545.95±74.52 mL for ORN, P=0.036), the length of postoperative stay [6.0 (5.0–9.0) for LRN vs. 9.0 (6.0–11.5) days for ORN, P=0.015], and removal time of the drainage tube [4.0 (3.0–5.0) days for LRN vs. 5.0 (4.0–6.0) for ORN, P<0.001] were less than in the LRN group. The pathological subtype and Fuhrman grade were comparable. Both groups were followed up for a similar period, and no difference was observed in 5-year survival rates.ConclusionsConsidering the conversion rates and overall complication rates, it seems that LRN for large renal carcinomas demonstrated equivalent peri-operative safety and effectiveness compared with ORN, with no adverse effects on midterm oncological outcomes.

Laparoscopic radical nephrectomy with inferior vena cava level I–III thrombectomy: experience of one center and literature review

Objective. Radical nephrectomy with thrombectomy of the inferior vena cava is the preferred treatment for renal cell carcinoma with an tumor thrombosis. We describe our experience and presentreview of the literature evaluating the feasibility and safety of laparoscopic nephrectomy with inferior vena cava thrombectomy.Materials and methods. The study included 37 patients who underwent laparoscopic radical nephrectomy with level I–III thrombectomy for renal cell carcinoma in our institution from 2018 to 2021. We analyzed the clinical, radiographic, intraoperative, pathological and postoperative parameters of the patients. The literature was reviewed by the Medline search engine, PubMed, with a review of publications on laparoscopic radical nephrectomy with inferior vena cava levelI–IIIthrombectomy.Results. The mean operation time was 275 ± 60.1 min, the median blood loss was 450 ± 81.6 ml (≥50 % of the circulating blood volume – 32.4 %). Intraoperative complications were observed during 10 (27.0 %) operations. Postoperative complications developed in 29.7 % of patients and reached gradesIII–IV according to the Clavien–Dindo scale on 13.0 % ill. All patients are activated according to the fast track rehabilitation program. The average hospital stay was 5 days. A literature review identified clinical cases and small series demonstrating the technical feasibility and safety of laparoscopic radical nephrectomy with thrombectomy in selected patients.Conclusion. Laparoscopic radical nephrectomy with thrombectomy is a technically feasible approach in carefully selected patients with level I–III tumor thrombosis. Optimal patient selection, extensive experience in laparoscopy and specialized centers are essential for the safe use of thistechnique.

Laparoscopic management renal cell carcinoma in left kidney with tumor caval thrombus

Background. Treatment of level II-III inferior vena cava (IVC) tumor thrombus for left renal cell carcinoma is among the most challenging open urologic oncologic surgeries with 38 % complications and 4—10 % mortality rate. There are increasing numbers of centers using a right side laparoscopic radical nephrectomy with thrombectomy at last years but only few reports about laparoscopic management of IVC thrombus from left kidney. The study objective is to demonstrate reproducibility and relative safety of laparoscopic radical nephrectomy with thrombectomy of IVC tumor thrombus originating from the left kidney. Materials and methods . We describe the method and present the initial series of full laparoscopic level II-III IVC thrombectomy in three patients with tumor in left kidney. One patient had been diagnosed distant metastases before operation, the another — pancreas involvement in the tumor process. The follow up time consist 4—26 months after surgery. Results . All procedures completed without conversion to open surgery. Tumor sizes were 5—16 cm, length of thrombus in IVC — 2.4—7.0 cm. Volume of blood loss ranged from 300 to 2500 ml. One patient received blood transfusion after surgery. One patient have died because of distant metastases 5 months after surgery. Two others were alive at 4 and 26 months follow-up without signs of progression. Conclusion. Laparoscopic IVC tumor thrombectomy for level II-III thrombi in cases of left kidney cancer is feasible, safe. This kind of pro­cedure doesn’t lead to serious perioperative complications and can gain a quicker recovery after surgery. It needs more operations and longer follow-up for evaluation oncological efficiency.

Evaluating the perioperative safety of laparoscopic radical nephrectomy for large, non-metastatic renal tumours: a comparative analysis of T1-T2 with T3a tumours.

With increasing surgeon experience, the use of laparoscopic radical nephrectomy (LRN) in large and locally advanced renal tumours (T3a) is gaining favour in urological practice. There are limited studies reporting surgical outcomes in such groups. The aim of this study was to review our experience with LRN in these patients. Data was retrospectively collected on 201 consecutive patients who underwent LRN for renal cancer by a single surgeon. Perioperative parameters assessed were age, gender, American Society of Anaesthesiologists score (ASA), waist circumference, tumour size, specimen size, histological subtypes, anaesthetic duration, operative approach and technique, surgery duration, blood loss, pre and postoperative renal function, complication rate and duration of hospital stay. Of 201 patients undergoing LRN, 43 (21%) patients had T3a tumours (group 2). The remaining 158 (79%) patients had T1 tumours (group1). Mean tumour size in group 2 was 12.2cm. Renal cell carcinoma (RCC) was more common in males than females (131/201; 65%). Patients with T3a disease were more likely to have an ASA score of 2 (37/201; 18%). In the majority of patients across both groups, LRN was completed using a 3-port approach (173/201; 86%). There were no significant differences between groups in terms of mean anaesthetic duration, average surgical time, average estimated blood loss, complication rate and mean hospital stay. Our study shows that LRN has equivalent perioperative outcomes and safety in larger and locally advanced renal tumours.

Feasibility and safety of laparoscopic nephrectomy in uremic patients with end-stage renal disease.

The purpose of this study was to analyse the feasibility and safety of laparoscopic radical nephrectomy (LRN) vs. open radical nephrectomy (ORN), in terms of perioperative and postoperative outcomes, in uremic patients. Between September 2007 and December 2013, 19 patients with end-stage renal disease (ESRD), who underwent LRN or ORN for chronic pyelonephritis, renal calculi, hydronephrosis, renal tumors, complicated cyst, or associated polycystic kidney, were retrospectively analysed. All patients with complete preoperative clinical and intraoperative parameters, including age at surgery, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) score, surgical technique, operation time, complications, were available for further analyses. The 30-day complication rate in both groups was retrospectively review and graded according to the modified Clavien System in five grades. Overall, nine (47.3%) vs. 10 (52.7%) patients underwent LRN vs. ORN, respectively. The mean ASA score (2.7 ± 0.8 vs. 2.9 ± 0.7) did not show statistically significant differences in both groups (p = 0.632). None of the patients in G1 was converted to open surgery for intraoperative complications or CO2 retention. The estimated blood loss was 223 ± 155 mL in G1 and 455 ± 134 mL in G2 (p&lt;0.005). Both groups were comparable with regard to mean operation time. The mean hospital stay was 5.95 ± 1.85 days in G1 and 8.10 ± 1.67 days in G2 (p&lt;0.001). The present study revealed that laparoscopic surgery in uremic patients might be performed safely under the expertise of an experienced laparoscopic team. This surgical technique is a minimally invasive treatment, reduces blood loss, shortens postoperative hospital stay, minimizes wound pain, and encourages an earlier return to normal activity.

Editorial Comment

Surgical innovations for the management of renal cell carcinoma (RCC) have resulted from the ingenuity of numerous urologists. In addition, tremendous technologic advancements have facilitated the successful application of minimally invasive options to an increasing number of patients with suspected RCC. Today, most kidney surgeons consider laparoscopic radical nephrectomy (LRN) the standard of care for many patients with renal tumors who are neither candidates for nephron preservation nor for observation. However, in the contemporary era, is a LRN an acceptable surgical approach for patients with larger or more advanced renal masses? Operative Safety and Oncologic Outcome of Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma >7 cm: A Multicenter Study of 222 PatientsUrologyVol. 81Issue 6PreviewTo evaluate the safety of laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) >7 cm, addressing the issue of modality and risk factors for complications and open conversion, and to assess the oncologic outcome. Full-Text PDF ReplyUrologyVol. 81Issue 6PreviewWe thank Dr. Sexton and the Editorial Board for their attention to our article and appreciate his comments. As mentioned, the issue of minimally invasive surgery in renal cancer is of particular interest. Innovations and progress in surgical techniques occur mostly outside of randomized trials. Only 5% to 7% of studies published in the surgical literature are randomized controlled trials; more than half of surgical research studies are retrospective record reviews.1,2 The evidence supporting laparoscopic radical nephrectomy (LRN) is no exception. Full-Text PDF

Operative Safety and Oncologic Outcome of Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma >7 cm: A Multicenter Study of 222 Patients

To evaluate the safety of laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) >7 cm, addressing the issue of modality and risk factors for complications and open conversion, and to assess the oncologic outcome. The data of 222 patients undergoing LRN for RCC >7 cm prospectively enrolled from 2002 to 2010 at 5 urologic centers were reviewed. Transperitoneal LRN was performed by 5 experienced laparoscopic surgeons. The Clavien-Dindo classification was used to assess complications. Multivariable analysis of factors predictive of conversions was performed. Oncologic outcomes for survival were estimated using the Kaplan-Meier method. Median tumor size was 8.5 cm, operative time was 180 minutes, and blood loss was 280 mL. Forty-two patients (19%) received a blood transfusion. Six (2.7%) patients had grade III-IV complications: 2 with postoperative bleeding requiring abdominal re-exploration and 1 each with adrenal injury, splenic injury, wound diastasis, and respiratory insufficiency. Twelve patients(5.4%) were converted to open surgery. The diameter was 11.9 in converted groups and 8.5 cm in nonconverted groups (P= .001). Multivariable analysis revealed that pathologic stage was the only independent predictor of conversion (P= .002). The 5-year overall (OS), cancer-specific (CSS), and progression-free (PFS) survival was 74%, 78%, and 66%, respectively. The 5-year stage-adjusted CSS was 89% in pT2 and 40% in pT3 patients (P<.0001). Limitations of this study were its retrospective nature and the relatively short follow-up period for oncologic outcome. LRN for large RCC is a safe operation. Stage pT3 is a risk factor for open conversion and is associated to significantly lower cancer-specific survival compared with pT2 stage.

Laparoscopic Nephrectomy Treatment of Renal Tumors over 7 cm: Our Experience

Radical nephrectomy by open surgery is the gold standard treatment for localized renal cancers. Several studies can demonstrate the efficacy and safety of laparoscopic radical nephrectomy for tumors in stage T1. From June 2004 to June 2011 we studied 132 patients undergoing videolaparoscopic radical nephrectomy, and analyzed the following parameters: cancer site, cancer dimension, eventual lymphadenectomy and surrenectomy, approach used (transperitoneal or retroperitoneal), surgery time, pre- and post-surgery (24h) hemoglobin and creatinine. Patients were then divided in 2 groups: Group A (78 patients): T1 cancer (dimension less than 7 cm); Group B (54 patients): T2-T3 cancer (dimension equal or larger than 7 cm) (T2 = 62%; T3 = 38%). There were no significant statistic differences between the 2 groups about number of patients, decrease of hemoglobin and increase of creatinine. On the other side, significant differences were found about surgery time: 127 min for Group A against 170 min for Group B. Laparoscopic radical nephrectomy shows a lower morbidity compared to open surgery, although this is confirmed by a few studies; cancer controls seem equivalent between the T1 and T2 tumors. Radical nephrectomy by laparoscopy was and is still recommended for T1 and T2 cancers, but there is no enough evidence that it can be useful in the same way for T3 cases. Our study supports the thesis that laparoscopic radical nephrectomy is a safe and effective approach for tumors at and above 7 cm and not just those smaller, with an equal number of complications compared to an increase in the average surgery time.

Safety of Laparoscopic Radical Nephrectomy in the Elderly Patients

Results: The mean age was 77.7±2.5 years for the elderly group and 55.9±10.5 years for the young group. No significant differences existed between the groups in terms of mean operative time, intraoperative blood loss, complications, and hospital stay. However, American Society of Anesthesiologists (ASA) score, co-morbidities (p<0.05), and rate of transfusion (p<0.05) were significantly higher in the elderly group. In overall analyses, we conclude that in elderly patients undergoing laparoscopic radical nephrectomy, close monitoring of hemoglobin level as well as intraoperative transfusion for maintenance of hemoglobin level at 10 mg/L or higher is necessary in elderly patients to achieve adequate circulation. Conclusion: Laparoscopic radical nephrectomy can be considered a safe and effective procedure for most elderly patients.

Laparoscopic Radical Nephrectomy: A Journey from T1 to Very Large T2 Tumors

Objectives: To evaluate the feasibility, efficacy and safety of laparoscopic radical nephrectomy (LRN) in T1 and T2 renal tumors. Patients and Methods: From December 1999 to March 2007, a retrospective analysis of 102 patients was done. A thorough preoperative workup was done in all patients. Postoperatively the patients were followed up every 3 months for the first year, 6-monthly for the next 2 years and yearly thereafter. Results: Transperitoneal radical nephrectomy was done in 85 patients, whereas 7 patients had a retroperitoneal surgery. A combined approach of retroperitoneal renal artery clipping followed by transperitoneal nephrectomy was done in 10 patients. 72 patients had clinically T1 tumors and 30 patients were T2 tumors. Mean tumor size was 6.97 cm, mean operative time was 174 min, mean blood loss was 230 ml, mean hospital stay was 4.6 days, and mean incision length was 8 cm. 19 patients had conversion to open surgery. Mean follow-up was 22.6 (range 4–56) months. Overall recurrence-free survival was 88.1%. Conclusions: LRN is a safe and effective treatment for renal tumors with a steep learning curve. Large right-sided T2 tumors can be safely treated with the combined approach. Disease control rates with LRN are satisfactory.

Laparoscopic Radical Nephrectomy: The New Gold Standard Surgical Treatment for Localized Renal Cell Carcinoma

We will try to demonstrate that laparoscopic radical nephrectomy could be the new gold standard treatment for renal cell carcinoma with the aid of the current reports exploring the advantages and disadvantages of laparoscopic radical nephrectom overopen surgery.Reported perioperative outcomes like operating time, blood loss, postoperative analgesia requirement, and length of hospital stay and duration of convalescence had been found to be in favor of laparoscopic radical nephrectomy. Some technical issues like approach of laparoscopic technique (Transperitoneal versus retroperitoneal laparoscopic nephrectomy), removal of dissected specimen and need for lymph node dissection had been also discussed in detail in this review. Besides, oncological safety of laparoscopic radical nephrectomy had been explored. The overall five-year disease free survival rates of laparoscopic radical nephrectomy in recent series were found to be over 90%. All of the series including the present one at least confirmed the oncological efficacy of LRN as compared with open surgical approach. The contemporary review of the literature documents clearly demonstrated the perioperative benefits of laparoscopy compared to the open approach. Nevertheless, the development, however, more safe and reliable technique in laparoscopy is necessary for tumor extraction. Recent studies confirmed the long-term similar cancer control results of laparoscopic radical nephrectomy with open surgery. Despite some technical modifications by the different groups, it can be stated that laparoscopic radical nephrectomy is the new gold standard treatment modality for patients with localized renal cell carcinoma.

Laparoscopic Transperitoneal Radical Nephrectomy for Treating of Renal Cell Carcinoma

Purpose: Laparoscopic radical nephrectomy has emerged as a feasible treatment option for patients with clinically localized renal cell carcinoma. We evaluated the clinical efficacy and oncologic safety of laparoscopic radical nephrectomy. Materials and Methods: Between April 2004 and October 2005, 31 laparoscopic radical nephrectomies were performed for clinically localized, stages cT1/2 NXMX, pathologically confirmed renal cell carcinoma. The clinical parameters including the operative time and the learning curve, the estimated blood loss, the postoperative hospital stay and the recurrence rate were evaluated. Results: All procedures were completed laparoscopically via transperitoneal approach. There were no complications. The mean operative time was 140.6 minutes (range: 80-270) and the mean blood loss was 230.4ml (range: 30-800). The mean postoperative hospital stay was 4.9 days (range: 3-9) and all patients had satisfactory outcomes with objective cure on the follow up imaging studies. No patient had laparoscopic port site, wound or renal fossa tumor recurrence during the follow up periods (mean: 13 months). Conclusions: Laparoscopic transperitoneal radical nephrectomy can be a safe and effective treatment. It could be considered as a primary procedure for treating localized renal cell carcinoma. (Korean J Urol 2006;47:968-973) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ