Results of retroperitoneal laparoscopic radical nephrectomy

Purpose: To analyze the retroperitoneal approach to laparoscopic radical ne phrectomy in terms of feasibility, safety, morbibity, and cancer control. Patients and Methods: We reviewed the records of 50 consecutive patients wi th renal cancer underwent radical nephrectomy via the retroperitoneal lapar oscopic approach from 1995 through 1999. Results: The mean operative time was 139 minutes (range 60-330 minutes) wit h a mean of 149.78-mL operative blood loss (0-1500 mL). The mean renal size was 100 mm (70-150 mm) with a mean tumor size of 38.6 mm (20-90 mm), The p ostoperative hospital was 6 days (2-13 days). Three open conversions were n ecessary: one for laparoscopically uncontrolled bleeding and two because ob esity interfered with surgery. We noted two major complication and two mino r complications. Two disease progression have been noted to date. One patie nt with a pT(3) grade 2 renal-cell carcinoma had a local recurrence with fi ver metastasis 9 months after the procedure and died 19.7 months after radi cal nephrectomy. Another patient with a pT(3a)N(+)M(+) cancer died 23.1 mon ths after the procedure. Conclusion: Retroperitoneal laparoscopic nephrectomy for kidney cancer requ ires further assessment. It seems to have several advantages over open radi cal nephrectomy and to be effective and safe for small (< 50-mm) renal tumo rs.