Comparison Of The Clinical Outcomes Between Transperitoneal Laparoscopic Partial Nephrectomy And Retroperitoneal Laparoscopic Partial Nephrectomy

Objective: To analyze the different clinical characteristics between Transperitoneal laparoscopic partial nephrectomy(TLPN)and Retroperitoneal laparoscopic partial nephrectomy(RLPN),and to explore the laparoscopic approach of surgical treatment of patients with T1N0M0 stage renal cell carcinoma.Methods: We retrospectively compared the results of TLPN with that of RLPN in 45 patients with T1N0M0 stage renal cell carcinoma from January 2015 to March 2017 underwent laparoscopic nephrectomy.There were 22 cases in the group of TLPN,10 cases of T1 a stage,12 cases of T1 b stage.There were 23 cases in the group of RLPN,12 cases of T1 a stage and 11 cases of T1 b stage.All of the patients were routinely accecpted preoperative examinations,include blood routine examination,renal function examination,chest X-ray,kidney enhanced computed tomography,renal artery CTA,renal Emission Computed Tomography.Abdominal drainage tube was indwelled postoperatively.Data regarding ages,BMI,tumor size,operating time,Warm ischemic time of kindey,intraoperative blood loss,hemoglobin changes,volume of drainage,drainage time,time to oral take,Pain index,and duration of hospital stay were analyzed retrospectively.Data are expressed as mean ± standard error of the mean(SEM).Results: All operations were completed successfully by the same surgical team,and no procedure converted open surgery,no complications occurred during surgery.For the group of T1 a stage renal cell carcinoma,there were no statistical significant difference in ages,BMI,tumor size,intraoperative blood loss,volume of drainage,drainage time,Pain index between TPLA group and RPLA group(P>0.05),Whereas the operating time and the Warm ischemic time were significantly shorter in the TPLA group(P<0.05).Besides,the duration of hospital stay and the time to oral take were significantly longer in the TPLA group(P<0.05).For the group of T1 b stage renal cell carcinoma,there were no statistical significant difference in ages,BMI,tumor size,intraoperative blood loss,volume of drainage,drainage time,time to oral take,Pain index,duration of hospital stay between TPLA group and RPLA group(P>0.05),the operating time and the Warm ischemic time were significantly shorter in the TPLA group(P<0.05).Conclusions: For patients with T1 a stage renal cell carcinoma,the operating time and the Warm ischemic time were significantly shorter in the TPLA group.This is a positive significance for the protection of renal function.But because of intraoperative intestinal interference,the duration of hospital stay and the time to oral take were significantly longer in the TPLA group.For patients with T1 b stage renal cell carcinoma,the operating time and the Warm ischemic time were also significantly shorter in the TPLA group.In conclusion,for patients with stage T1N0M0 stage renal cell carcinoma,TPLN and RPLN each have their own advantages.In the actual clinical work,the choice of the laparoscopic approach of surgical treatment should be combined with the tumor size and the experience of the surgeon.