Contemporary experience with laparoscopic radical nephrectomy.

INTRODUCTION: We present our single-center contemporary experience with laparoscopic radical nephrectomy (LRN). LRN is an established minimally invasive approach comparable to open radical nephrectomy for the treatment of renal cortical neoplasms. Technical advancements and surgical experience with LRN mandate a re-evaluation of contemporary outcomes. METHODS: Between June 2005 and July 2009, 74 patients underwent LRN for an enhancing renal mass. Six of these patients underwent a cytoreductive nephrectomy for metastatic renal cell carcinoma. Patient demographics, perioperative data, tumor characteristics, complication rates, and outcomes were retrospectively collected and analyzed from our prospectively established renal database. RESULTS: The mean follow-up for patients undergoing nephrectomy without metastasis was 17.4 months (1-52 months). The mean estimated blood loss was 93 mL (0-600 mL) and the overall complication rate was 5.9%. Two patients developed metastatic disease after surgery, both of whom had high-stage (pT3a) tumors. No death was caused by renal cell carcinoma. In the cytoreductive cohort, the mean estimated blood loss was 592 mL (200-1200 mL). Four were high stage (pT3a/pT3b). The mean follow-up was 4.7 months (1-15 months), with an overall survival of 50%. CONCLUSIONS: With contemporary technology and increased laparoscopic surgical experience, LRN and, in selected cases, cytoreductive LRN can be performed safely and effectively for the majority of renal tumors. Experience has resulted in a reduction in operative time and blood loss complication rates. LRN remains the approach of choice for the management of renal cortical neoplasms not amenable to nephron-sparing surgery.

Duke Scholars

Author Michael B Rothberg Urology