LAPAROSCOPIC RADICAL NEPHRECTOMY FOR RENAL TUMOR - THE WASHINGTON-UNIVERSITY EXPERIENCE

Purpose: We report our experience with laparoscopic radical nephrectom y in 17 consecutive patients with renal tumors. Materials and Methods: The clinical data on 17 consecutive patients undergoing laparoscopic radical nephrectomy were reviewed. Of the patients 12 with stage pT1 o r pT2 renal cell carcinoma 7 cm. in diameter or smaller undergoing lap aroscopic radical nephrectomy were compared to 12 undergoing open radi cal nephrectomy for stage pT1 or pT2 renal cell carcinoma 6 cm, in dia meter or smaller. Results: Among the 17 patients undergoing laparoscop ic radical nephrectomy average operative time was 6.9 hours (range 4.5 to 9) and average estimated blood loss was 105 cc (range 50 to 600). Average weight of the surgical specimen was 402 gm. (range 190 to 1,10 0), In 12 of 16 patients in whom laparoscopic radical nephrectomy was completed the specimen was removed intact. The patients required an av erage of 24 mg. morphine sulfate equivalent (range 2 to 220) for posto perative pain. Average hospital stay was 4.5 days (range 3 to 11) and average interval to resume normal activities was 3.5 weeks (range 2 to 4). The 12 patients in the open and laparoscopic radical nephrectomy groups were similar with respect to age, American Society of Anesthesi ologists score and interval of surgery, Laparoscopic radical nephrecto my required significantly more operative time than open radical nephre ctomy (6.9 versus 2.2 hours, respectively). However, the laparoscopic radical nephrectomy group compared to the open radical nephrectomy gro up had significantly less postoperative pain (24 versus 40 mg, morphin e sulfate equivalent required for postoperative analgesia), shorter in terval to resuming oral intake (1 versus 3 days), more rapid discharge from the hospital (4.5 versus 8.4 days) and more rapid return to norm al activities (3.5 versus 5.1 weeks). The laparoscopic nephrectomy gro up also fully recovered more rapidly than the open surgical group (5.8 versus 39 weeks). To date, during a 4-year period there was no retrop eritoneal recurrence or seeding of a port site. Conclusions: Laparosco pic radical nephrectomy is a lengthy and demanding procedure. However, it affords patients with renal cell carcinoma a markedly improved pos toperative course while accomplishing the necessary surgical goals.