BACKGROUND: Laparoscopic radical nephrectomy (LRN) is commonly performed for T1 and T2 renal masses. Questions remain regarding the feasibility and safety of LRN in advanced renal cell carcinoma (RCC), particularly stage pT3, pT4, and cytoreduction for metastatic disease. We evaluated our experience with LRN in advanced RCC and compared it to a concurrent series of LRN in patients without advanced RCC.
METHODS: All patients undergoing LRN at a single academic institution between August 2006 and September 2008 were included. A retrospective analysis of a prospectively collected database was performed. Patients in group 1 had either pT3 disease or known metastatic RCC presenting for cytoreductive LRN. Group 2 patients had either pT1-2 or benign disease. All patients were placed on a LRN clinical pathway during the postoperative (PO) period. Results: There were 59 LRN performed. Group 1 consists of 22 patients with pT3 (n=18) and/or M1 (n=14). Group 2 consists of 37 patients with pT1-2 (n=29) or benign disease (n=8). Patient demographics and peri-operative data are displayed in table 1.
RESULTS: Significant differences were observed in ASA (p=0.0001), tumor size (p=0.03), operative time (p=0.02), and EBL (p=0.03). Age, length of stay, BMI, number of transfusions, and numbers of complications were not significantly different between groups. There were no intraoperative (IO) complications in group 1. In group 2, there were 2 IO complications (5.4%) including one colon thermal injury (oversewn without sequellae) and a brief period or ST depressions in one patient whose subsequent cardiac work-up was negative. Three PO complications were noted in group 1 (13.6%): new onset atrial fibrillation, corneal abrasion, and abscess at a port site managed with bedside drainage. In group 2, there were 7 PO complications (18.9%). Two patients required emergency room evaluation, one for nausea and one for chest pain secondary to dyspepsia. Additional PO complications in group 2 include: ileus (1), wound infection (1), subcutaneous hematoma at extraction site (2), both conservatively managed, and vertebral osteomyelitis from an epidural placed in a patient with chronic pain (1).
CONCLUSIONS: In experienced hands and in selected cases, LRN in patients with advanced RCC (T3 or M1) is safe.