Comparative Study Of Clinical Curative Effect Between Retroperitoneal Laparoscopic Radical Nephrectomy And Open Surgery For CT1-T2 Renal Carcinoma

Objective:Make a study to compare the security and clinical curative effect between retroperitoneal laparoscopic radical nephrectomy and open surgery for renal carcinoma with clinical stage T1-T2.Methods:The clinical data were reviewed and analyzed between 99 patients who underwent retroperitoneal laparoscopic radical nephrectomy (LRN) and 266 patients who underwent open radical nephrectomy (ORN) between Oct,2007 and Oct,2010 in the first affiliated hospital of Zhejiang university with cTl-T2 renal carcinoma. To compare age, gender, body mass index (BMI), operation time, blood loss, tumor size, pathologic types, pathologic TNM staging, recovery time of intestinal, residence time of drainage tube, hospitalization stay after operation, perioperative complications, recurrence rate and survival rate between the two groups.Results:The age, gender(55.3±12.8y vs 57.4±13.5y,P>0.05), body mass index (24.15±3.29kg/m2 vs 23.74±3.31 kg/m2,P>0.05), operation time(105.1±41.7min vs 102.3±50.6min,P>0.05), tumor size(4.77±2.29cm vs 5.05±2.43cm,P>0.05), pathologic types, residence time of drainage tube(3.35±1.26d vs 3.89±1.45d,P>0.05), perioperative complications, recurrence rate in LRN group(99 patients) equivalent to those of the ORN group(266 patients). And there are statistically significant differences in blood loss(145.7±160.9 vs 294.3±234.8,P<0.05), pathologic TNM staging, recovery time of intestinal(1.91±0.75d vs 2.92±1.08d,P<0.05), hospitalization stay after operation(8.22±3.77d vs 10.72±4.64d,P<0.05) between LRN group and ORN group. One patient in LRN group converted to open surgery for bleeding. Others were all successfully performed. Postoperative follow-up times are both 4months to 3 years. The mean follow-up time in LRN group is 20.4±11.5 months. For patients with pT1-T2 staging in LRN group,2 died of distant metastasis,1 survived with tumor recurrence, ldied of nontumorous factors. For patients with pT3 staging,1 died of distant metastasis. The mean follow-up time in ORN group is 21.4±10.2 months. For patients with pT1-T2 staging in ORN group,5 died of distant metastasis,3 survived with tumor recurrence,5 died of nontumorous factors. For patients with pT3 staging,3 died of distant metastasis,1 died of nontumorous factors. No statistically significant differences were found in the 3-year survival rate between the two groups(95.4% vs 96.1%, p>0.05) with pT1-T2 staging.3-year survival rate in pT1-T2 staging is significant higher than pT3-T4 staging.Conclusion:Retroperitoneal laparoscopic radical nephrectomy is characterized by less-bleeding, minimally invasive, quick recovery and short hospitalization stay after operation than open surgery for cT1-T2 renal carcinoma. It has the same clinical curative effect,3-year survival rate to open surgery. Retroperitoneal laparoscopic radical nephrectomy is a minimally invasive, safe and effective surgery.