Retroperitoneal laparoscopic surgery and oncological risk

Objective: To retrospectively evaluate the development of metastasis at tro car sires, local recurrence and distance metastases associated with retrope ritoneal laparoscopic surgery performed in the context of malignant tumour. Methods: From 1994 to 1999, 228 retroperitoneal laparoscopic surgical opera tions were performed in our centre. Fifty sir operations (24.6%) were perfo rmed for malignant tumours and comprised 41 radical nephrectomies and 8 par tial nephrectomies for renal tumour and 7 nephro-ureterectomies for upper u rinary tract rumours. The pathological stage and surgical margins were corr elated with TNM 1997 stage, Postoperative data were obtained by physical an d radiological examination performed one month and three months after the o peration and then every six months. Metastases at the trocar sire, local re currences and distant metastases were investigated. The specific progressio n-free survival was calculated according to the Kaplan-Meier method. Results. The mean follow-up was 24.9 +/- 13.85 months. AII patients had tum our-free surgical margins. No trocar site metastasis was observed. For retroperitoneal laparoscopic radical nephrectomies: one patient develop ed a local recurrence with liver metastases 9 months after the operation (p T3G2) and died 19.7 months after the operation. One patient with a pT3G3Mrenal tumour at the time of diagnosis riled 23.1 months after radical nephr ectomy with no signs of local recurrence. For laparoscopic retroperitoneal nephro-ureterectomies: one patient with a pT3G3 lesion developed a local recurrence at 12.1 months and died 26.6 mont hs after surgery. One patient with a pT1G2 tumour developed bone metastases at 9 months and died 29 months after the operation. The recurrence-free su rvival 54 months was 91% for radical nephrectomies. 71% at 30 months for ne phro-ureterectomies and 100% at 49 months for partial nephrectomies. Conclusion: Malignant tumours of the upper urinary tract can be managed by retroperitoneal laparoscopy. The short-term results suggest that this surgi cal technique is not associated with an increased risk of trocar site metas taes or local recurrence and that recurrence-free survival rates comparable to those reported in series of conventional surgery.