Transperitoneal Laparoscopic Nephrectomy And Open Nephrectomy For Radical Treatment Of Renal Cell Carcinoma: A Comparison Of Clinical Outcomes

Background:Renal cell carcinoma(RCC) is one of China's most common oncological diseases of urology.According to the incidence of renal cell carcinoma in china,in recent years its incidence rate is still rising.The national academic study of how to improve the treatment of renal cell carcinoma effectively has attract the world's attention.Open radical nephrectomy(ORN) for renal tumors was first described in 1969 by Robson et al.Surgical results for ORN were better than the results for simple nephrectomy in previously published studies of renal tumors:ORN had a 52%5-year survival for all pathological stages,and a 66%5-year survival in patients with nonmetastatic renal cell carcinoma(RCC) which are confined to the kidney parenchyma,while simple nephrectomy had overall 5-year survival rates of 39-48%.Since the introduction of the laparoscopic radical nephrectomy(LRN) procedure by Clayman et al in 1991,the role of laparoscopy in the field of urology has continued to evolve over the last decade.Reductions in postoperative pain,length of hospitalization and convalescence had been well documented.Early reports also demonstrated oncologic control equivalent with the open technique.Minimally invasive radical nephrectomy had gained widespread acceptance in the urological community.Both the Transperitoneal laparoscopic and Retroperitoneal laparoscopic approach have been established and advocated for radical surgery.In China,the time of starting using laparoscopic techniques is later than the overseas.There are not many reports concerned about laparoscopic radical nephrectomy in China,and most of Chinese urologists prefer Retroperitoneal laparoscopic radical nephrectomy.There are much less reports about Transperitoneal laparoscopic radical nephrectomy.Methods:1.Cases and exclusion criteria included:(1) included standardsRenal cell carcinoma(RCC) definition:All RCC are diagnosed pathologically,including clear cell type,papillary,Chromophobe type et al. Clinical Stage is T₁-T₂N₀M₀(2) The exclusion criteriaDuring surgery at the same time,rule out these such as cholecystectomy surgery, gynecology surgery cases,in order to avoid the interference of the statistical data.2.Case collectionCollected from January 2004 to December 2008,a total of 152 cases for Clinical Stage T₁-T₂N₀M₀ done by radical nephrectomy in Sir Run Run Shaw Hospital.Chose 71 cases at random from the total cases and made detailed record of the name,gender,age,diagnosis,the merger disease,computer tomography,operative methods,date of surgery,operation time,blood loss,postoperative complications,days of postoperative peritoneal cavity drainage tube,days of returning to oral feeding,the hospitalization time after operation,and the patient follow-up. Results:46 transperitoneal LRN and 25 ORN were successfully performed.In one case of LRN group,postoperative haemorrhage required open revision,in this case,the patient was 55year-old man with fight clear cell renal cancer of 7 cm.There was no obvious difference in gender,the side of renal tumor,TNM stage and history of past abdominal opration between the two groups byχ2 test,There was no obvious difference in age,tumor size,blood urea nitrogen(BUN),blood creatinine(CR),blood haemoglobin(HB) and the hospitalization time before operation between the two groups by T test.In the LRN group:operation time was 141.9±42.2min(range 85-240min),blood loss was 164.4±148.0ml(range 50-500ml),no intraoperative blood transfusion;days of postoperative peritoneal cavity drainage tube were 3.1±1.6days(range 1-9days); days of returning to oral intake were 2.2±1.0days(range 1-3days);the hospitalization time after operation was 8.2±2.3days(range 3-15days).Two cases had severe complications.In the ORN group:operation time was 115.8±52.8min(range 50-250min),blood loss was 234.0±178.4ml(range 100-1000ml);days of postoperative peritoneal cavity drainage tube were 4.0±2.4days(range 0-10days);days of returning to oral intake were 3.1±1.4 days(range 2-8days);the hospitalization time after operation was 9.6±2.3days(range 6-14days).One case had severe complications The LRN group had lesser blood loss(p=0.041),shorter days of postoperative peritoneal cavity drainage tube(p=0.040),days of returning to oral intake(p=0.001) and the hospitalization time after operation(p=0.01).But the ORN had shorter operation time(p=0.013).The LRN group was devided into two groups:LRN groupâ… (tumor size≤4cm) and LRN groupâ…¡(tumor size＞4cm&≤7cm).There was no obvious difference in gender, the side of renal tumor and TNM stage between the two groups byχ2 test,There was no obvious difference in age,blood urea nitrogen(BUN),blood creatinine(CR),blood haemoglobin(HB),operation time,blood loss,days of postoperative peritoneal cavity drainage tube and the hospitalization time between the two groups by T test.29.9(range 5-50)months' follow-up has been taken in LRN group.One case had metastasis and die of that 15 months later.23.0(range 5-60)months' follow-up has been taken in ORN group.One case had dorsal vertebra metastasis 1 month later and die of that 15 months later.Another case had lung metastasis 18 months later and take oral sorafenib from than on,now the patient is healthy and has no metastasis.There was no obvious difference between these two groups.Conclusion:The transperitoneal LRN patients had a significantly shorter convalescence with quicker return to normal activities and work,less blood loss,shorter oral intake and hospital stay than the ORN group.The LRN has comparable curative effect.It's also safe for the the LRN groupâ…¡(tumor size＞4cm&≤7cm ).