PTU - Polskie Towarzystwo Urologiczne
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CODE: 9.3 - Laparoscopic radical nephrectomy - a standard treatment of T1N0 tumours
Article published in Urologia Polska 2006/59/Suplement 1.


Marcin Słojewski, Adam Goł±b, Andrzej Sikorski
Katedra i Klinika Urologii PAM w Szczecinie


Introduction. Surgery (nephrectomy and tumorectomy) is the fundamental method of treatment of kidney cancer in all stages. The best oncological outcomes are achieved in patients with tumours below 7 cm in diameter (T1). For more than a decade in experienced centers, laparoscopic radical nephrectomy (LRN) is an option with proven oncological value comparable to open surgery. The approach (transperitoneal vs extraperitoneal) depends on surgeon's preferences.
Objectives. The objective is to analyse our own experience with LRN.
Materials and methods. Between August 2003 and December 2005, 31 LRN were performed (incl. 3 nephroureterectomies) in 13 women and 18 men aged 45-80 (av. 58). Patients were qualified basing on CT results - T1, no nodal involvement, unfavorable tumour localization if nephron sparing surgery was considered. In five cases transperitoneal, and in the rest extraperitoneal approach was used. Four (in 3 patients) or three trocars were used for completing the operation. Due to training reasons procedures were performed by one of four surgeons, including two residents under experienced laparoscopist's supervision.
Results. Operating time was 60-180 min. (av. 110), blood loss was estimated for 10-1200 ml (av. 260). The mean hospital stay was 4.3 days (range 2 to 8). Specimens were extracted in a plastic bag by enlarging an optical trocar orifice or through additional hypogastric incision. The mean tumour size was 46 mm (ange 25-70). Two intraoperative complications were noted (6.6%): bleeding from renal artery and vein. Both were handled laparoscopically. There was one conversion (3.3%) to open procedure due to neoplastic infiltration of the renal pedicle. One patient had to be reoperated because of bleeding symptoms, and the second one due to mesenteric and ileal perforation done incidentally in the time of specimen extraction. Histopathologic examination revealed renal clear cell carcinomas and its subtypes in 27 cases, tumours of renal pelvis (TCC) in 3 cases, one oncocytoma and one metastatic tumour. One of the specimen was free of tumour. In 3 cases of TCC pathologic stage was Ta (2) and T3 (1). Renal tumours were classified as T1, T2 and T3 in 23, 1 and 3 cases respectively (n=27).
Conclusions. LRN became a standard method of treatment of localized renal tumours. Comparing to open surgery LRN is a minimally-invasive procedure and offers the patients shorter hospital stay and recovery time, better cosmetic effect and low probability of postoperative hernia. With rising center's experience, widening of indication for LRN can be expected.