Seven Years After Laparoscopic Radical Nephrectomy: Oncologic and Renal Functional Outcomes
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. Urology
(Impact Factor: 2.19).
07/2008; 71(6):1149-54. DOI: 10.1016/j.urology.2007.11.081
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.
Available from: Shih-Chieh Jeff Chueh
- "Laparoscopic nephrectomy has been shown effective in removing diseased kidneys with tumors, even tumors larger than 7-cm in diameter. (Berger et al., 2008; Steinberg et al., 2004) Long-term oncologic outcomes (overall, cancer-specific, and recurrence-free survivals) of laparoscopic radical nephrectomy, either with pure laparoscopic or HAD technique, or with trans-peritoneal or trans-retroperitoneal approach, for renal cell carcinoma (RCC) are comparable to those of its open counterpart, with the obvious benefits of less pain, less blood loss and earlier recuperation (Colombo et al., 2008; Chung et al., 2007; Venkatesh et al., 2007; Desai et al., 2005; Nambirajan et al., 2004). "
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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.
Available from: Kenneth W Gow
- "It is possible that this loss of tactile feedback could hinder identification of metastatic disease in certain patients. Finally, there has been limited study of the effects of laparoscopic insufflation on the biology of malignant cells; adult data, however, show equivalent outcomes in early stage renal cell carcinoma with open and laparoscopic approaches to radical nephrectomy . "
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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.
Available from: Yann Neuzillet
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