Retroperitoneal laparoscopic versus open radical nephrectomy

Purpose: We analyze the retroperitoneal approach to laparoscopic radical ne phrectomy in regard to feasibility, safety, morbidity and cancer control, a nd compare results and outcomes in patients who underwent retroperitoneal l aparoscopic or open radical nephrectomy from 1995 to 1998. Materials and Methods: The records of 58 consecutive patients with renal ca ncer who underwent radical nephrectomy from 1995 through 1998 were reviewed . Of the patients 29 underwent open radical nephrectomy (group 1) and 29 un derwent retroperitoneal laparoscopic radical nephrectomy (group 2). Various parameters were compared and statistical analyses were performed. Results: The 2 groups were similar in regard to age, gender and side of the tumor. Operative time was slightly shorter in group 1 (mean 121.4 versus 1 45 minutes in group 2, p = 0.047). mean tumor size plus or minus standard d eviation was larger in group 1 (5.71 +/- 2.01 versus 4.02 +/- 1.87 cm. in g roup 2). Group 2 patients had significantly less operative blood loss (mean 100.0 versus 284.5 ml. in group 1, p < 0.005) and used significantly less parenteral pain medication (p < 0.05). Postoperative hospital stay was sign ificantly longer in group 1 (9.7 +/- 3.6 versus 4.8 +/- 2.0 days in group 2 , p < 0.001), and the complication rate was higher (24 versus 8%, respectiv ely). One group 1 patient died of renal cancer (pT2G2) after 14 months and local recurrence with hepatic metastasis occurred after 9 months in a group 2 patient with a pT3G2 tumor. Conclusions: Retroperitoneal laparoscopic nephrectomy for kidney cancer req uires further assessment. It seems to have several advantages over open rad ical nephrectomy, and to be effective and safe for less than 50 cm. renal t umors but a risk of spillage cannot be ruled out for larger tumors.