A Comparative Study Of Retroperitoneal Laparoscopic And Open Radical Nephrectomy In Patients With Localized Renal Cell Carcinoma

Objective: To evaluate the clinical general efficacy of retroperitoneal laparoscopic radical nephrectomy for localized renal carcinoma as compared with open surgery and to observe the changes of immunological function in patients.Methods: From July 2007 to May 2009, 60 patients were eligible for the study in Baoding First Hospital, the affiliated hospital of Hebei university medical school, were randomly divided into two groups, including 38 male and 22 female, aged from 35 to 65 years old, median age is 47 years old. They were randomly assigned into two groups, retroperitoneal laparoscopic radical surgical group or open surgical group respectively. All of the patients received operation which confirmed the preoperative diagnosis of B-ultrosonography, computerized tomography (CT) and intravenous urography. The renal mass was measured on CT, and tumor size was defined by the largest diameter. No patient had evidence of metastatic disease. All patients had a normal contralateral kidney, no history of other malignancy and coagulopathy. Patients with renal vein or cava cancer embolus, and enlarged inferior vena caval, renal vein, renal pedicle and retroperitoneal lymph nodes, and the tumor size >4.0cm were excluded. The operation time, blood loss, postoperative pain, incidence rate of postoperative complications, the time of recovery of bowel function, postoperative ass row spirit time, the time of oral intake, the time of early ambulation, the dosage of analgesic, the perioperative change of inflammatory factors, relapse-free survival, 3-year survival rate, hospitalization expenses, postoperative hospital day, the concentration of serum albumin and prealbumin, and the lymphocyte count of the two groups were compared. The final data was analyzed by SPSS 13.0 software with statistic t-test andχ2-test.Results: Compare with open surgical group, the operation time of retroperitoneal laparoscopic radical surgical group be extended (102.2±24.6min,p<0.05), the operative blood loss(126.2±50.3ml,p<0.05) the time of recovery of bowel function (27.1±7.7h,p<0.01), the concentration of serum albumin (40.92±3.55g/L , p<0.01) and prealbumin (239.50±22.39g/L,p<0.05), and the blood loss (126.2±50.3ml,p<0.05) were significant better in retroperitoneal laparoscopic radical surgical group than in open surgical group. Retroperitoneal laparoscopic radical surgery had advantages of mild pain, rapid recovery and short hospitalizing time. The release of interleukin-6 and C reactive protein at 4h, 24h, 48h, 72h be significantly reduced and the lymphocyte count maintained in the normal range.Conclusion: In comparison with conventional open radical nephrectomy, retroperitoneal laparoscopic nephrectomy has the advantages of shorter operation time, slight trauma, less intraoperative blood loss, little affection to body immunity; less influence of abdominal viscera, rapid recovery and short hospitalizing time etc. On condition that operator has rich experience, it is a safe and effective method of treatment for patients with T1N0M0 localized renal carcinoma. On the basis of improvement of associate technique and instrument, retroperitoneal laparoscopic nephrectomy can be applied in a large number of patients with early stage localized renal carcinoma...