Laparoscopic surgery for stage T1 renal cell carcinoma: Radical nephrectomy and wedge resection

Objectives: Renal cell carcinoma (RCC) is likely to become one of the most important indications for laparoscopic surgery. We herein report our experi ence. Methods: From April 1994 until April 1999, 98 patients presenting with RCC were treated laparoscopically by either radical nephrectomy (RN; n = 73) or wedge resection (WR; n = 25). The mean age was 62.3 years. The mean tumour diameters were 3.8 cm (RN) and 1.9 cm (WR). All tumours were clinical stag e T1 lesions. The transperitoneal approach was used for RN in all patients. For WR either the transperitoneal or the retroperitoneal approach was used . In 15 patients, the adrenal gland was removed simultaneously. The specime n was entrapped in an organ bag and removed intact through a small muscle-s plitting incision in the lower abdominal wall. Results: RN: The mean operating time was 142 (range 86-230) min, the mean b lood loss was 170 (range 0-1,500) mi, and the mean postoperative hospital s tay was 7.4 (range 3-32) days. Minor complications occurred in 4.0% of the patients, while major complications were seen in 8.0% of them. WR: The mean operating time was 163.5 (range 90-300) min, the mean blood loss was 287 ( range 20-800) mi, and the postoperative hospital stay was 8.0 (range 3-8) d ays. Minor complications: 4%, major complications: 8%. Histology revealed R CC stage T1 in 77 patients, stage T3a in 7, and stage T3b in 3 patients, on cocytoma in 2 patients, angiomyolipoma in 2, renal adenoma in 1, renal meta stasis in 1, multilocular cysts in 4, and renal abscess in 1 patient. Over mean follow-up periods of 13.3 and 22.2 months for RN and WR, respectively, neither local recurrences nor metastases have been observed among patients with histologically confirmed RCC. Conclusions: Laparoscopic surgery for clinical stage T1 RCC is safe and eff icient. Excellent tumour control can be achieved. However, longer follow-up periods will be necessary to confirm these results. Copyright (C) 2000 S. Karger AG. Basel.