A Comparative Study Of Laparoscopic And Open Nephron Sparing Surgery For Small Renal Cell Carcinoma

Backgroud:Renal tumor is one of the most common diseases of Urology. The morbidity of renal tumor is around2%among all the tumors. In recent years, with the development of medical imaging techniques, increasing number of people are diagnosed with small renal cell carcinoma, without clinical symptoms. Long-term evidence-based data showed that, nephron-sparing surgery can achieve a significant oncologic therapeutic effect in dealing with these incidental small renal cell carcinoma. Winfield and his colleagues completed the first laparoscopic nephron-sparing surgery (LNSS) in1993, which has the advantages of less invasive, fewer complications, and faster recovery, etc. With the development of laparoscopic techniques and the accumulation of experience, LNSS becomes more and more popular with urological surgeons. According to our clinical experience, LNSS can completely remove the tumor, effectively control the bleeding and protect the renal function. It has a significant clinical effect. We investigated the clinical effects of LNSS in small renal cell carcinoma (SRCC) patients in our hospital.Objective:To evaluate the safety and effectiveness of laparoscopic nephron-sparing surgery.Methods:51patients who underwent NSS for small renal cell carcinoma from June2009to June2011in the affiliated provincial hospital of Shandong university were entered this retrospective analysis. LNSS were performed in27patients, and open nephron-sparing surgery were performed in the other24patients. We collected clinical data to estimate the clinical effect of LNSS, including the tumor size, operation time, ischamia time, intraoperative blood loss, blood transfusion, postoperative drainage, the drainage tube indwelling time, postoperative hospital stay, complications, length of incision, preoperative and postoperative GFR of the operative side kidney, etc.Results.-All the51cases were performed with NSS successfully. Between the LNSS and the ONSS group, there are not significant differences in age, gender, tumor size, tumor side, drainage tube indwelling time, preoperative and postoperative renal function. But the LNSS group has obviously less operation time, less intraoperative blood loss, less postoperative drainage, less length of the incision, fewer complications, fewer postoperative hospital stay and more ischemia time. No local recurrence or distant metastasis were found in patients in both of the groups.Conclusion:We can completely remove the tumor, effectively control the bleeding and protect the renal function by LNSS. Compared to ONSS, LNSS has the advantages of less invasive, less operation time, fewer complications, and faster recovery, etc. It is a very effective operation method for SRCC.