| Objective: Renal cell carcinoma(RCC),also known as renal carcinoma,is responsible for 2%-3% of all new adult malignancies.In general,during the last two decades there has an annual increase of nearly 2% in incidence both worldwide.Surgical treatment is still the main treatment option for RCC.With development of surgical techniques,the damage of surgery to the patients has been decreased.Since 1991,laparoscopic radical nephrectomy(LRN)was first finished by Clayman et al,LRN was considered as a standard surgical treatment option for early RCC,reducing the damage to the patients and providing the same survival benefits as open surgery.Gasless laparoscopic radical nephrectomy for the treatment of RCC succeeded by Suzuki et al in 1995.However,there are few studies aiming of the comparisons between gasless laparoscopic radical nephrectomy and retroperitoneal LRN currently.We designed a study to explore the intraoperative and postoperative data presented by both techniques used for the treatment of RCC.There were 37 cases treated by gasless laparoscopic radical nephrectomy and 37 cases performed by retroperitoneal LRN between January 2004 and July 2017 in the First Hospital of China Medical University which were recruited for this study.Methods: Reviewed the clinical data of 74 RCC cases performed by gasless laparoscopic radical nephrectomy or retroperitoneal LRN from January 2004 to July 2017.I group(gasless laparoscopic group)included 37 cases treated by gasless laparoscopic radical nephrectomy between January 2004 and December 2010,and 37 cases of radical nephrectomy according to 1:1 pairing principle,were performed by retroperitoneal laparoscopic radical nephrectomy as group II.The advantages and disadvantages between gasless laparoscopic radical nephrectomy and retroperitoneal laparoscopic radical nephrectomy were evaluated by comparing the clinical data of age,gender,the location of tumor,the diameter of tumor,the operation time,the incision for removing the specimens,postoperative fasting time,drainage time,the amount of drainage,hospital stay,complication,and hospitalization costs.Results: There were 74 patients undergoing radical nephrectomy,including 37 patients with gasless laparoscopic radical nephrectomy and 37 patients with retroperitoneallaparoscopic radical nephrectomy.And there was no statistical difference in age and tumor size between two groups(P>0.05).The operation time of the gasless laparoscopic group and retroperitoneal laparoscopic group were 97.3±25.6min and 102.9±32.2 min;the incision for removing the specimens were 6.4 ± 1.6 cm and 6.9 ± 1.7 cm;the postoperative fasting time were 3.4 ± 0.8 d and 3.1 ± 1.0 d;drainage time were 5.2 ± 1.6d and 5.6 ± 1.9 d;the amount of drainage were 164.3 ± 83.7ml and 152.2 ± 92.3 ml respectively;the hospitalization expenses were 31958.37 ±7167.82 yuan and 34733.74±5861.33 yuan;the cost of operation were 5043.49 + 860.10 yuan and 13225.17 +1932.18 yuan;the cost of trocar were 2341.22±637.67 yuan and the cost of Hem-o-lok were 4461.42±1728.75 yuan.The operation time,the incision for removing the specimens,postoperative fasting time,drainage time and the amount of drainage showed no significant differences between the two groups(P>0.05).From the postoperative data,the hospital stay of retroperitoneal LRN group(7.3 ± 2.0 d)was shorter than the gasless laparoscopic group(9.6±4.2 d)(P<0.05).There was no complications such as bleeding,pulmonary embolism and deep venous thrombosis of the lower extremities occurred and no perioperative deaths between two groups.But pneumoperitoneum complications occurred in 3 patients with retroperitoneal laparoscopic,including 2 cases of subcutaneous emphysema and 1 case of suspected transient hypercapnia.Conclusions: Gasless laparoscopic radical nephrectomy gets the following advantages:fewer incisions,less length of incision,reduced technical demands,more safe of operation and cost-effectiveness,which are not associated with retroperitoneal LRN.In general,there is a good prospect of clinical application for Gasless laparoscopic radical nephrectomy. |
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