Is. Gill et al., Laparoscopic radical nephrectomy in 100 patients - A single center experience from the United States, CANCER, 92(7), 2001, pp. 1843-1855
BACKGROUND. The objective of the current study was to report a single-surge
on, single-center experience with 100 consecutive laparoscopic radical neph
rectomies with intact specimen extraction, with the aim of evaluating the o
ncologic adequacy of the laparoscopic dissection from a technical standpoin
t and various parameters including the learning curve.
METHODS. Of the 140 laparoscopic radical nephrectomies performed at the stu
dy institution since August 1997, the initial 100 are evaluated herein. To
evaluate the technical oncologic adequacy, comparison was made with 40 cont
emporary open radical nephrectomy specimens with regard to detailed radiolo
gic (computed tomography scan) and pathologic data.
RESULTS. In the 100 patients studied (with a mean tumor size of 5.1 cm), th
e mean surgical time was 2.8 hours, the blood loss was 212 mL, the specimen
weight was 554.3 g, and the hospital stay was 1.6 days. Complications occu
rred in 14 patients (14%) and were major in 3 (3%) and minor in 11 (11%). T
wo patients (2%) were converted to open surgery. There was no perioperative
mortality. Over a mean follow-up of 16.1 months, there was no local or por
t site recurrence reported; 2 patients developed metastatic disease with 1
death occurring at 11 months. When evaluating the learning curve in the ini
tial 50 versus the second 50 patients, a shorter surgical time (P = 0.02) a
ppeared to be the only significant variable. On multivariate analyses, the
only variables found to impact on surgical time were specimen weight (P < 0
.001) and chronologic time period of surgery (P = 0.05). All laparoscopic s
pecimens were extracted intact; surgical margins were negative for tumor in
all 100 patients. All detailed radiologic and histopathologic parameters e
valuated were nearly identical between the laparoscopic and open surgery gr
oups.
CONCLUSIONS. Laparoscopic radical nephrectomy with intact specimen extracti
on currently is a routine, effective, and efficacious treatment option for
patients with T1-T3aN0M0 renal tumors. Although no long-term data were avai
lable as of last follow-up, the negative surgical margins achieved routinel
y in the current series provide encouraging surrogate evidence of the techn
ical efficacy of laparoscopy from an oncologic standpoint. As such, at the
study institution, laparoscopic radical nephrectomy with intact specimen ex
traction currently is the standard-of-care for patients with T1-3aN0M0 rena
l tumors measuring less than or equal to 10-12 cm in size. (C) 2001 America
n Cancer Society.