Comparison Of Transperitoneal And Retroperitoneal Laparoscopic Radical Nephrectomy For Renal Tumor

Objective:To compare the perioperative outcomes between transperitoneal and retroperitoneal laparoscopic radical nephrectomy for renal tumor.Methods:We retrospectively analyzed clinical data from January2006to August2012, Fujian Provincial Hospital,61patients with renal tumors underwent laparoscopic radical nephrectomy including30patients were by transperitoneal laparoscopic radical nephrectomy (TLRN group)31w patients were by retroperitoneal laparoscopic radical nephrectomy (RLRN group). We compare the perioperative outcomes,including operation time, blood loss, flatus time after operation, blood hemoglobin decrease value, volume of postoperatively three-day drainage,days of postoperative peritoneal cavity drainage tube, the hospitalization time after operation,intraoperative and postoperative complications in both two groups.Results:The operations were successfully performed in both groups. No case required open conversion. There were no significant differences in age,gender, BMI, side of renal tumor, tumor size,tumor clinical TNM stage, preoperative blood creatinine, preoperative blood hemoglobin between TLRN group and RLRN group.Compared to the RLRN group, the TLRN group had longer operation time(235.27min/169.77min,p<0.05),however, less blood loss(104.33ml/170.39ml p=0.041) and smaller blood hemoglobin decrease value(22.77g/L/32.61g/L,p=0.001).The transperitoneal and retroperitoneal approaches were similar in terms of postoperative hospital stay,flatus time after operation, volume of postoperatively three-day drainage, drainage tube removal time. TLRN group was divided into three groups according to the diameter of tumor size(Group I diameter≤4cm,Group Ⅱ diameter>4and≤7cm,Group III diameter>7cm). There was no significantly different of operation time, volume of postoperatively three-day drainage, blood hemoglobin decrease value, drainage tube removal time, hospitalization time after operation and flatus time after operation, blood loss among three groups. RLRN group was divided into three groups according to the diameter of tumor size(Group I diameter≤4cm,Group Ⅱ diameter>4and≤7cm,Group Ⅲ diameter>7cm). There was significantly different of blood hemoglobin decrease value and blood loss among three groups.There was no significantly different of operation time, volume of postoperatively three-day drainage, drainage tube removal time, hospitalization time after operation and flatus time after operation among three groups.Conclusion:The transperitoneal and retroperitoneal approaches are similar in terms of postoperative hospital stay, flatus time after operation, volume of postoperatively three-day drainage, drainage tube removal time. Compared to the retroperitoneal approach, transperitoneal laparoscopic radical nephrectomy is associated with less blood loss,and not increasing intestinal complications,but with longer operating time, TLRN take advantages of offering a greater working space and anatomy, clear vision and fitting ergonomical needs.In the transperitoneal laparoscopic radical nephrectomy, tumor size had no significant effect on perioperative parameters. In the retroperitoneal laparoscopic radical nephrectomy, tumor size had obvious significant effect on perioperative parameters including blood loss and blood hemoglobin decrease value. Two approachs are safe and effective, and it tips large volume of renal cell carcinoma be suitable for transperitoneal approache.