Seven years after laparoscopic radical nephrectomy: Oncologic and renal functional outcomes
ABSTRACT To compare the long-term oncologic and renal function outcomes in patients undergoing laparoscopic (LRN) versus open radical nephrectomy (ORN).
The medical records of 116 patients undergoing radical nephrectomy for pathologically confirmed renal cell carcinoma before January 2000 were reviewed. Of these 116 patients, 63 underwent LRN and 53 ORN. The oncologic and renal functional data were obtained from the patient charts, radiographic reports, and direct telephone calls to the patients or their families.
The median follow-up was 65 months (range 19 to 92) in the LRN group and 76 months (range 8 to 105) in the ORN group. LRN was successfully completed in all patients without open conversion. The mean tumor size was 5.4 cm in the LRN group and 6.4 cm in the ORN group (P = 0.007). The 5-year overall survival (78% versus 84%, respectively; P = 0.24), cancer-specific survival (91% versus 93%, respectively; P = 0.75), and recurrence-free survival (91% versus 93%, respectively; P = 0.75) rates were similar between the LRN and ORN groups. At 7 years, the overall survival (72% versus 84%; P = 0.24), cancer-specific survival (91% versus 93%; P = 0.75), and recurrence-free survival (91% versus 93%; P = 0.75) rates were also comparable. No port site recurrence was noted in the laparoscopic group. The long-term renal function outcomes were similar in the LRN and ORN groups, with serum creatinine increasing by 33% and 25%, and the estimated creatinine clearance decreasing by 31% and 23% from baseline, respectively. Chronic renal insufficiency developed in 4% of patients in each group.
The results of our study have shown that LRN and ORN have comparable long-term oncologic and renal functional outcomes.
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ABSTRACT: Implantation of a kidney graft into the extraperotineal iliac fossa has not changed much surgically since its inception from 1950s; whereas the other renal transplant-related surgical approaches have dramatically been updated for the past ten more years, especially with the commencement of urological laparoscopic surgery. The most important mile-stone advancement is the laparoscopic live donor nephrectomy. Since its original report in 1995, in spite of the initial concerns regarding the quality of the graft function and the safety issue for the live donor, laparoscopic live donor nephrectomy has been recently well recognized academically and practically as the surgery of choice for harvesting live donor kidney; which in fact was driven both by the donors’ preference and by the surgeons’ competence in performing this surgery. It can be performed either via a pure laparoscopic approach, in which a wound is extended at the end of the procedure to harvest the kidney; or it can also be performed via a hand-assisted approach, in which the graft is harvested from the hand-assisted incision. More recently a newer variant of the laparoscopic surgery—laparoendoscopic single site (LESS) surgery has been evolved to the field of live donor nephrectomy in certain elite transplant centers. This technique creates a smaller and single incision to accomplish the procedure under the same surgical principles with a much steeper learning curve, and some special equipments are necessary to facilitate such operation. The ultimate value of LESS live donor nephrectomy still warrants further proof with prospective randomized data even though it is surgically feasible. Besides the donor nephrectomy, laparoscopic surgery has also been applied to a variety of procedures related to the renal transplant recipients. Recurrent lymphoceles resistant to repeated aspiration and drainage can be managed with laparoscopic marsupilization (internal drainage into the peritoneal cavity). Incidence of renal cell carcinomas (RCC) in the native kidneys has been shown higher in the transplant recipients than that of the general population. If the RCC is still localized at diagnosis, it can be treated with laparoscopic radical nephrectomy. In certain areas around the world the incidence of urothelial carcinoma in the native upper urinary tract (ureters, renal pelvis and calyses) has also been reported much higher in the transplant recipients. With proper equipment laparoscopic bilateral nephroureterectomy with bladder cuff resection can be performed in one session through several small incisions without changing the patient’s position. Very rarely, tumor in the transplant kidneys might be found during follow-up. If the graft is still functioning, and the tumor is localized, partial nephrectomy of the transplant kidney can be used to excise the tumor while preserve the graft function. The surgical procedures of each mentioned above have been detailed in this chapter.Understanding the Complexities of Kidney Transplantation, 09/2011: chapter 23: pages 487-508; InTech., ISBN: 978-953-307-819-9
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ABSTRACT: Wilms' tumor is the most common malignant renal tumor of childhood. Surgical resection is an important aspect of therapy and is traditionally performed through an open transabdominal approach. The advent of advanced laparoscopic techniques for benign renal lesions has led to interest in applying a minimally invasive approach to Wilms' tumors in children. We describe a 2-year-old girl who presented with a right renal mass measuring 18 × 13 cm with peritoneal seeding and pulmonary metastatic disease. Wilms' tumor was confirmed on open biopsy. After neoadjuvant chemotherapy, a laparoscopic resection of the tumor with right radical nephroureterectomy, retroperitoneal lymph node dissection, and resection of peritoneal metastases was achieved using one 12-mm and four 5-mm ports. The specimens were removed in an endoscopic retrieval bag through a small Pfannenstiel incision by extending the 12-mm port site. The patient had an uncomplicated recovery and was discharged on the fifth post-operative day. She remains disease free at 19 months postoperatively. Minimally invasive techniques may be considered for resection of Wilms' tumor provided oncologic principles are carefully followed.Journal of Pediatric Surgery 05/2011; 46(5):978-82. DOI:10.1016/j.jpedsurg.2011.01.014 · 1.31 Impact Factor
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