S. Stavridis, O. Stankov.
Medical Faculty Skopje, University Clinic of Urology Skopje, Macedonia
Aims: To evaluate and compare laparoscopic radical nephrectomy (LRN) with open radical nephrectomy (ORN) in patients with T1-T3 renal tumors.
Materials and Methods: The study consisted of 43 patients who underwent LRN between January 2011 and January 2012. The patients were compared with selected 43 patients who had undergone ORN between January 2010 and January 2011. The two groups were comparable in terms of age, body mass index (BMI) and tumor size. We compared operative room time, blood loss, complications, analgesic requirement, hospital stay and initiation of oral intake. The oncologic outcome was also evaluated. We also performed a computerized MEDLINE search followed by a manual bibliographic review of cross-references. The reports were analyzed and the important findings summarized.
Results: The laparoscopy group had a significantly shorter hospital stay, analgesia requirement and hemoglobin decline. All of the pathology specimens showed renal cell carcinoma with majority of T1 stage in both groups. The cancer-free survival rate at 12 months for ORN and LRN in T1, T2 and T3 lesions was 97.1%/97.1%, 100% and 97.1% and 100% and 94.1%, respectively. The patient survival rate was 100% in both groups. There were neither port sites nor distant metastasis in the LRN group. In the ORN group we found local metastasis in one patient and distant metastasis in two patients.
Laparoscopic radical nephrectomy has advantages in terms of shorter hospitalization and a lower analgesia requirement. It is feasible and produces effective cancer control in T1 and T2 lesions. The T3 lesions could be also manageable but it is mostly dependent on the tumors size and the surgeon’s experience.
Keywords: renal cell carcinoma, laparoscopy, nephrectomy