Journal List > Korean J Urol > v.49(3) > 1005065

Lee, Seo, and Rim: Surgical Results of Laparoscopic Radical Nephrectomy according to Tumor Size in Renal Cell Carcinomas

Abstract

Purpose

Laparoscopic surgery has been generalized for the treatment of localized renal cell carcinoma (RCC). Recently, laparoscopic radical nephrectomy for an RCC over the pT2 stage has gained rapid momentum as an effective surgery for treatment. We evaluated the possibility of the use of laparoscopic surgery for a large RCC, using the surgical results according to tumor size.

Materials and Methods

Between June 2003 and June 2007, a total of 46 patients that under underwent a laparoscopic radical nephrectomy for RCC were divided into three groups according to tumor size: group 1 (n=16, tumor size ≤4cm), group 2 (n=15, tumor size 4cm<n≤7cm), and group 3 (n=15, tumor size >7cm). The surgical outcomes and perioperative morbidities were evaluated retrospectively, and were compared for each group.

Results

The transfusion rate for group 3 patients was higher than for the other groups (group 1: 0%, group 2: 13.3%, group 3: 26,7%). However, the mean operative time (group 1: 154.3 minutes, group 2: 158.4 minutes, group 3: 197.9 minutes), postoperative initiative time to ambulate (group 1: 1.88 days, group 2: 2.00 days, group 3: 1.87 days) postoperative initiative time to diet (group 1: 1.38 days, group 2: 1.53 days, group 3: 1.53 days), total hospital stay (group 1: 7.94 days, group 2: 8.47 days, group 3: 8.20 days) and complication rate (group 1: 12.5%, group 2: 13.3%, group 3: 13.3%) were similar for patients in the three groups. Pathological results indicated that all cases showed a renal cell carcinoma with a negative surgical margin.

Conclusions

There were no differences in the operative and postoperative results of the performance of laparoscopic radical nephrectomy according to tumor size, except for the transfusion rate. If the use of the technique and experience accumulate, laparoscopic radical nephrectomy will be feasible for all localized RCC regardless of tumor size.

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Table 1.
Clinical characteristics
Group 1 Group 2 Group 3 p-value
No. of patients 16 15 15
Male to female ratio 2.2:1 4:1 6.5:1
Mean age (years) 61.3 61.5 59.3 0.780
Mean body mass index (kg/m2) 24.2 23.3 23.6 0.625
History of abdominal surgery 4 (2: hermia op., 1: appendectomy 1: panperitonitis) 0 1 (1: ureterolithotomy)
Medical history
   Diabetes mellitus 3 2 2
   Hypertension 6 7 4
   Liver disease 3 3 0

SPSS (ver. 13.0) Kruskall Wallis test

Table 2.
Operative results
Group 1 Group 2 Group 3 p-value
Mean operation time (min.) 154.3 158.4 197.9 0.057
Open conversion 0 0 0
Mean postoperative initiative day of diet 1.38 1.53 1.53 0.660
Mean postoperative initiative day of ambulation 1.88 2.00 1.87 0.769
Analgesics use (diclofenac mg.) 118.8 108.7 102.0 0.363
Hospital stay (days) 7.94 8.47 8.2 0.780
Complication rate (%) 12.5 (2 pts.: pleural injuries) 13.3 (2 pts.: pleural injury, incisional hernia) 13.3 (2 pts.: pneumothorax, wound dehiscence) 0.945
Transfusion rate (%) 0 14.3 26.6 0.029

SPSS (ver. 13.0), Kruskall Wallis test, Transfusion rate, Complication rate: SPSS (ver. 13.0), Pearson's chi-square test

Table 3.
Operative results (statistical results)
Group 1 Group 2 Group 3 p-value
Mean operation time (min.) 154.3±54.73 158.4±50.45 197.9±59.14 0.057
Open conversion
Mean postoperative initiative day of diet 1.37±0.50 1.53±0.92 1.53±0.52 0.660
Mean postoperative initiative day of ambulation 1.88±0.62 2.00±0.53 1.87±0.64 0.769
Analgesics use (diclofenac, mg) 118.8±72.0 108.7±61.7 102.0±112.1 0.363
Hospital stay (days) 7.94±1.99 8.47±2.47 8.20±2.45 0.780
Complication rate (%) 12.5±33.3 13.3±33.3 13.3±33.3 0.945
Transfusion rate (%) 0.00±0.0 13.3±33.3 26.7±66.7 0.029

SPSS (ver. 13.0), Kruskall Wallis test, Transfusion rate, Complication rate: SPSS (ver. 13.0), Pearson's chi-square test

Table 4.
Pathological results
Group 1 Group 2 Group 3
Mean diameter (cm) 3.0 4.8 8.6
Mean weight (g) 309.6 366.4 500.7
Cell type
   Clear cell 9 9 10
   Conventional 5 5 4
   Chromophobe 2 1 1
Positive surgical margin
Lymph node metastasis
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