Operative Safety and Oncologic Outcome of Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma >7 cm: A Multicenter Study of 222 Patients

• Published in: Urology (Ridgewood, N.J.) Vol. 81; no. 6; pp. 1239 - 1245
• Main Authors: Luciani, Lorenzo G, Porpiglia, Francesco, Cai, Tommaso, D'Elia, Carolina, Vattovani, Valentino, Giusti, Guido, Tiscione, Daniele, Chiodini, Stefano, Peschechera, Roberto, Fiori, Christian, Spina, Rosa, Parma, Paolo, Celia, Antonio, Malossini, Gianni
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2013; Elsevier
• Subjects: Adrenal Glands - injuries; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Blood Loss, Surgical; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - surgery; Disease-Free Survival; Humans; Kaplan-Meier Estimate; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Kidneys; Laparoscopy - adverse effects; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Multivariate Analysis; Neoplasm Staging; Nephrectomy - adverse effects; Nephrectomy - methods; Nephrology. Urinary tract diseases; Operative Time; Postoperative Hemorrhage - etiology; Respiratory Insufficiency - etiology; Retrospective Studies; Spleen - injuries; Surgical Wound Dehiscence - etiology; Tumors; Tumors of the urinary system; Urology; Kidney disease; Human; Endoscopic surgery; Nephrology; Urinary system disease; Carcinoma; Prognosis; Toxicity; Multicenter study; Malignant tumor; Urology; Treatment; Nephrectomy; Kidney cancer; Grawitz tumor; Cancer
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2012.12.065

Objective To evaluate the safety of laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) >7 cm, addressing the issue of modality and risk factors for complications and open conversion, and to assess the oncologic outcome. Methods The data of 222 patients undergoing LRN for RCC >7 cm prospectively enrolled from 2002 to 2010 at 5 urologic centers were reviewed. Transperitoneal LRN was performed by 5 experienced laparoscopic surgeons. The Clavien-Dindo classification was used to assess complications. Multivariable analysis of factors predictive of conversions was performed. Oncologic outcomes for survival were estimated using the Kaplan-Meier method. Results Median tumor size was 8.5 cm, operative time was 180 minutes, and blood loss was 280 mL. Forty-two patients (19%) received a blood transfusion. Six (2.7%) patients had grade III-IV complications: 2 with postoperative bleeding requiring abdominal re-exploration and 1 each with adrenal injury, splenic injury, wound diastasis, and respiratory insufficiency. Twelve patients (5.4%) were converted to open surgery. The diameter was 11.9 in converted groups and 8.5 cm in nonconverted groups ( P  = .001). Multivariable analysis revealed that pathologic stage was the only independent predictor of conversion ( P  = .002). The 5-year overall (OS), cancer-specific (CSS), and progression-free (PFS) survival was 74%, 78%, and 66%, respectively. The 5-year stage-adjusted CSS was 89% in pT2 and 40% in pT3 patients ( P  <.0001). Limitations of this study were its retrospective nature and the relatively short follow-up period for oncologic outcome. Conclusion LRN for large RCC is a safe operation. Stage pT3 is a risk factor for open conversion and is associated to significantly lower cancer-specific survival compared with pT2 stage.