Abstract
Objective
Evaluate the feasibility of laparoscopic nephrectomy for big tumors.
Material and Methods
Data from 116 patients were retrospectively collected from 16 tertiary centres. Clinical
and operative parameters, tumor characteristics, pre- and postoperative parameters,
and renal function before and after surgery were analyzed.
Results
Mean age and body mass index were 61 years and 27.8 kg/m2, respectively. Males represented 63.8% of patients, and 54.4% presented symptoms
at diagnosis. Median tumor size was 11 cm, and 75% of the cases were performed by
expert surgeons. Median operative time and blood loss were 180 minutes and 200 mL
respectively. Conversion to open surgery was necessary in 20.7% of cases. Intraoperative
complications related to massive hemorrhage occurred in 16.4% of patients, resulting
in open conversion in 62.5%. Major postoperative complications occurred in only 10
patients (8.6%). In univariate analysis, intraoperative complications, age, and blood
loss were predictive factors of conversion to open surgery. Positive surgical margins
occurred in 6 patients (5.2%). None of them presented a local recurrence. Predictive
factors of recurrence or progression were lymph node invasion, metastases, and Furhman
grade.
Conclusion
Laparoscopic nephrectomy for tumors > 10 cm can be performed safely. Complication
rate and positive surgical margins are similar to open surgery. In experienced hands,
the benefit of a mini invasive surgery remains evident.
Keywords
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Article info
Publication history
Published online: January 27, 2016
Accepted:
January 16,
2016
Received in revised form:
December 23,
2015
Received:
September 25,
2015
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
