Advertisement

World Journal of Urology

, Volume 25, Issue 6, pp 619–626 | Cite as

Oncologic outcome of 132 cases of laparoscopic radical nephrectomy with intact specimen removal for T1-2N0M0 renal cell carcinoma

  • Ashok K. Hemal
  • Anup Kumar
  • Narmada P. Gupta
  • Rajeev Kumar
Original Article

Abstract

We present the short and long-term oncologic outcome of 132 patients with pathologically confirmed T1–T2, N0M0 renal cell carcinoma (RCC), who underwent laparoscopic radical nephrectomy with intact specimen removal at our institution. Beginning January 1998, we prospectively collected data of 132 patients undergoing laparoscopic radical nephrectomy, whose final pathologic stage was T1 or T2, N0M0, RCC. The clinical data of three groups categorized as group (pT1a)—36 patients, group (pT1b)—51 patients and group (pT2)—45 patients were analyzed statistically to assess oncological outcome. The specimens were removed intact without morcellation in all patients in a homemade plastic bag. The total median follow-up was 56 months (range 3–80 months) and there were no local or port-site recurrences or hernia. Patients with pT2 tumors had significantly greater operating time, blood loss and analgesic requirements than pT1a/pT1b tumor patients. The distant metastases were found in 1, 4 and 5 patients in group pT1a, pT1b and pT2, respectively. The 5-year cancer-specific survival was 97.2, 86.3 and 82.2%, respectively, in pT1a, pT1b and pT2 tumor patients (significantly lower in pT2 than pT1a, P = 0.008). The 5-year recurrence-free survival was 97.2, 84.3 and 82.2%, respectively, in pT1a, pT1b and pT2 tumor patients (significantly lower in pT2 than pT1a, P = 0.02). Laparoscopic radical nephrectomy (retroperitoneal and transperitoneal route) with intact specimen removal for localized renal cell carcinoma (T1-2N0M0) provides satisfactory short and long-term oncologic efficacy.

Keywords

Kidney Carcinoma Laparoscopy Nephrectomy 

References

  1. 1.
    Chan D, Cadeddu JA, Jarrett TW, Marshall F, Kavoussi LR (2001) Laparoscopic radical nephrectomy: cancer control for renal cell carcinoma. J Urol 166:2095–2100PubMedCrossRefGoogle Scholar
  2. 2.
    Gill IS, Meraney AM, Schweizer DK et al (2001) Laparoscopic radical nephrectomy in 100 patients: a single center experience from the United States. Cancer 92:1843–1855PubMedCrossRefGoogle Scholar
  3. 3.
    Ono Y, Kinukawa T, Hattori R et al (1999) Laparoscopic radical nephrectomy for renal cell carcinoma: a five-year experience. Urology 53:280–286PubMedCrossRefGoogle Scholar
  4. 4.
    Deane LA, Clayman RV (2007) Laparoscopic nephrectomy for renal cell cancer: radical and total. BJU Int 99(5 Pt B):1251–1257PubMedCrossRefGoogle Scholar
  5. 5.
    Mattar K, Finelli A (2007) Expanding the indications for laparoscopic radical nephrectomy. Curr Opin Urol 17(2):88–92PubMedCrossRefGoogle Scholar
  6. 6.
    Steinberg AP, Finelli A, Desai MM, Abreu SC, Ramani AP, Spaliviero M et al (2004) Laparoscopic radical nephrectomy for large (greater than 7 cm, T2) renal tumors. J Urol 172:2172–2176PubMedCrossRefGoogle Scholar
  7. 7.
    Portis AJ, Yan Y, Landman J, Chen C, Barrett PH, Fentie DD et al (2002) Long-term follow-up after laparoscopic radical nephrectomy. J Urol 167:1257–1262PubMedCrossRefGoogle Scholar
  8. 8.
    Gong EM, Lyon MB, Orvieto MA, Lucioni A, Gerber GS, Shalhav AL (2006) Laparoscopic radical nephrectomy: comparison of clinical Stage T1 and T2 renal tumors. Urology 68(6):1183–1187PubMedCrossRefGoogle Scholar
  9. 9.
    Permpongkosol S, Chan DY, Link RE, Sroka M, Allaf M, Varkarakis I et al (2005) Long-term survival analysis after laparoscopic radical nephrectomy. J Urol 174:1222–1225PubMedCrossRefGoogle Scholar
  10. 10.
    Cheung MC, Lee YM, Rindani R, Lau H (2005) Oncological outcome of 100 laparoscopic radical nephrectomies for clinically localized renal cell carcinoma. ANZ J Surg 75:593–596PubMedCrossRefGoogle Scholar
  11. 11.
    Lam JS, Belldegrun AS, Pantuck AJ (2006) Long-term outcomes of the surgical management of renal cell carcinoma. World J Urol 24(3):255–266PubMedCrossRefGoogle Scholar
  12. 12.
    Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD et al (1991) Laparoscopic nephrectomy: initial case report. J Urol 146:278–282PubMedGoogle Scholar
  13. 13.
    Guinan P, Sobin LH, Algaba F, Badellino F, Kameyama S, MacLennan G et al (1997) TNM staging of renal cell carcinoma: Workgroup No. 3. Union International Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC). Cancer 80:992–993PubMedCrossRefGoogle Scholar
  14. 14.
    Hemal AK, Kumar A, Kumar R, Wadhwa P, Seth A, Gupta NP (2007) Laparoscopic versus open radical nephrectomy for large renal tumors: a long-term prospective comparison. J Urol 177(3):862–866PubMedCrossRefGoogle Scholar
  15. 15.
    Steiner T, Knels R, Schubert J (2004) Prognostic significance of tumour size in patients after tumour nephrectomy for localised renal cell carcinoma. Eur Urol 46:327–330PubMedCrossRefGoogle Scholar
  16. 16.
    Hernandez F, Rha KH, Pinto PA, Kim FJ, Klicos N, Chan TY et al (2003) Laparoscopic nephrectomy: assessment of morcellation versus intact specimen extraction on postoperative status. J Urol 170:412–415PubMedCrossRefGoogle Scholar
  17. 17.
    Catalano C, Fraioli F, Laghi A, Napoli A, Pediconi F, Danti M et al (2003) High-resolution multidetector CT in the preoperative evaluation of patients with renal cell carcinoma. Am J Roentgenol 180:1271–1277Google Scholar
  18. 18.
    Cohen DD, Matin SF, Steinberg JR, Zagone R, Wood CG (2005) Evaluation of the intact specimen after laparoscopic radical nephrectomy for clinically localized renal cell carcinoma identifies a subset of patients at increased risk for recurrence. J Urol 173(5):1487–1490PubMedCrossRefGoogle Scholar
  19. 19.
    Varkarakis I, Rha K, Hernandez F, Kavoussi LR, Jarrett TW (2005) Laparoscopic specimen extraction: morcellation. BJU Int 95(Suppl 2):27–31PubMedCrossRefGoogle Scholar
  20. 20.
    Dunn MD, Portis AJ, Shalhav AL, Elbahnasy AM, Heidorn C, McDougall EM, Clayman RV (2000) Laparoscopic versus open radical nephrectomy: a 9 year experience. J Urol 164(4):1153–1159PubMedCrossRefGoogle Scholar
  21. 21.
    Yaycioglu O, Roberts WW, Chan T, Epstein JI, Marshall FF, Kavoussi LR (2001) Prognostic assessment of non-metastatic renal cell carcinoma: a clinically based model. Urol 58(2):141–145PubMedCrossRefGoogle Scholar
  22. 22.
    Phillips CK, Taneja SS (2004) The role of lymphadenectomy in the surgical management of renal cell carcinoma. Urol Oncol 22:214–223PubMedGoogle Scholar
  23. 23.
    Blom JH, van Poppel H, Marechal JM, Jacqmin D, Sylvester R, Schroder FH et al (1999) Radical nephrectomy with and without lymph node dissection: preliminary results of the EORTC randomized phase III protocol 30881. EORTC Genitourinary Group. Eur Urol 36:570–575PubMedCrossRefGoogle Scholar
  24. 24.
    Joslyn SA, Sirintrapun SJ, Konety BR (2005) Impact of lymphadenectomy and nodal burden in renal cell carcinoma: retrospective analysis of the National Surveillance, Epidemiology, and End Results database. Urology 65:675–680PubMedCrossRefGoogle Scholar
  25. 25.
    Rassweiler J, Tsivian A, Kumar AV, Lymberakis C, Schulze M, Seeman O et al (2003) Oncological safety of laparoscopic surgery for urological malignancy: experience with more than 1,000 operations. J Urol 169:2072–2075PubMedCrossRefGoogle Scholar
  26. 26.
    Micali S, Celia A, Bove P, De Stefani S, Sighinolfi MC, Kavoussi LR et al (2004) Tumor seeding in urological laparoscopy: an international survey. J Urol 171:2151–2154PubMedCrossRefGoogle Scholar
  27. 27.
    Saika T, Ono Y, Hattori R et al (2003) Long term outcome laparoscopic radical nephrectomy for pathological T1 renal cell carcinoma. Urology 62:1018–1023PubMedCrossRefGoogle Scholar
  28. 28.
    Ficarra V, Novara G, Galfano A, Novella G, Schiavone D, Artibani W (2004) Application of TNM, 2002 version, in localized renal cell carcinoma: is it able to predict different cancer-specific survival probability? Urology 63:1050–1054PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Ashok K. Hemal
    • 1
  • Anup Kumar
    • 1
  • Narmada P. Gupta
    • 1
  • Rajeev Kumar
    • 1
  1. 1.Department of UrologyAll India Institute of Medical SciencesNew DelhiIndia

Personalised recommendations