IS LAPAROSCOPIC RADICAL NEPHRECTOMY WITH SPECIMEN MORCELLATION ACCEPTABLE CANCER-SURGERY

Laparoscopic radical nephrectomy (LRN) for renal-cell carcinoma (RCC) with removal of the specimen by morcellation and suction remains contr oversial because precise pathologic tumor staging is lost, and there i s a risk of tumor seeding. We assessed the theoretical impact of surre ndering precise pathologic staging an the management of patients with low-stage RCC (T3a or less). In 22 patients who underwent open radical nephrectomy for RCC, the preoperative CT-based clinical stage was cor related with pathologic tumor staging. Possible clinical inclusion cri teria for LRN were then correlated with pathologic tumor staging. When comparing clinical and pathologic staging, one patient was understage d and seven were overstaged by preoperative CT. However, if clinical s tage T3a or lower was used as the inclusion criterion for LRN, 19 pati ents (86%) would have been so treated, none would have been underassig ned, and future management would not have been compromised according t o pathologic staging. Management of patients with low-stage RCC relyin g on clinical staging only is oncologically adequate. This would make LRN an acceptable option for this subset of patients.