Comparison of the results of large and small renal masses under transperitoneal laparoscopic radical nephrectomy

Öz

OBJECTIVES We want to represent perioperative results of RCC with 8 cm or greater tumor size underwent laparoscopic nephrectomy (LRN) METHODS In our institution, 35 patients who underwent LRN by a single surgeon in the period between 2018 and 2020, were reviewed. After institutional review board approval, patients were divided into 2 groups, according to tumor size of pathology report, as small renal cancer with small size (tumor size <8 cm) and renal cancer with large size (tumor size ≥8 cm). Included patients were assessed in terms of demographic characteristics, preoperative diagnosis, duration of surgery and hospitalization, complications before and after surgery, and postoperative requirement for open surgery. RESULTS Small renal masses (group 1) and large renal masses (group 2) consisted of 19 and 16 patients, respectively. The 2 groups were compared in terms of age, body mass index and mean tumor size (5,9±1,4; 9,73±2,17, respectively). There was no significant difference with respect to age and tumor size between patients. Group 1 patients experienced significantly less blood loss (respectively, 80,7±56,57; 126,87±66,3; p=0,002), shorter operation time (respectively, 87,36±15,21; 103,12±11,38 minutes, p=0,001). CONCLUSIONS Our data showed that larger tumors can safely be resected with transperitoneal laparoscopic nephrectomy. Urologists with laparoscopic experience should consider expanding their indication for LRN.

Anahtar Kelimeler

• laparoscopy
• radical nephrectomy
• renal cancer

Transperitoneal laparoskopik radikal nefrektomi uygulanan büyük ve küçük renal kitlelerin sonuçlarının karşılaştırılması

Öz

AMAÇLAR Laparoskopik nefrektomi (LRN) uygulanan 8 cm veya daha büyük tümörlü RCC'nin perioperatif sonuçlarını sunmak istiyoruz. GEREÇ VE YÖNTEM Hastanemizde 2018-2020 yılları arasında tek bir cerrah tarafından LRN uygulanan 35 hasta gözden geçirildi. Kurumsal inceleme kurulu onayından sonra, patoloji raporunun tümör büyüklüğüne göre, hastalar küçük boyutlu kitleler (tümör boyutu <8 cm) ve büyük boyutlu kitleler (tümör boyutu ≥8 cm) olarak hastalar 2 gruba ayrıldı. Çalışmaya dahil edilen hastalar demografik özellikler, preoperatif tanı, cerrahi ve yatış süresi, cerrahi öncesi ve sonrası komplikasyonlar ve postoperatif açık cerrahi gereksinimi açısından değerlendirildi. BULGULAR Küçük böbrek kanseri grubu (grup 1) ve büyük böbrek kanseri grubu (grup 2) sırasıyla 19 ve 16 hastadan oluşmaktaydı. İki grup yaş, vücut kitle indeksi ve ortalama tümör büyüklüğü açısından karşılaştırıldı (sırasıyla 5,9 ± 1,4; 9,73 ± 2,17). Hastalar arasında yaş ve tümör boyutu açısından anlamlı farklılık yoktu. Grup 1 hastalarında anlamlı olarak daha az kan kaybı (sırasıyla, 80,7 ± 56,57; 126,87 ± 66,3; p = 0,002) ve daha kısa ameliyat süresi (sırasıyla 87,36 ± 15,21; 103,12 ± 11,38 dakika, p = 0,001) izlendi. SONUÇLAR Verilerimiz transperitoneal laparoskopik nefrektomi ile daha büyük tümörlerin güvenle rezeke edilebildiğini göstermiştir. Laparoskopik deneyime sahip ürologlar LRN endikasyonlarını genişletmeyi düşünmelidir.

Anahtar Kelimeler

• laparoskopi
• radikal nefrektomi
• böbrek kanseri

Kaynakça

1. Referans1- Clayman RV, Kavoussi LR, Soper NJ, et al: Laparoscopic nephrectomy: initial case report. J Urol 1991;146: 278-282.
2. Referans2- Chan DY, Cadeddu JA, Jarrett TW, et al: Laparoscopic radical nephrectomy: cancer control for renal cell carcinoma. J Urol 2001;166:2095-2099.
3. Referans3- Ono Y, Kinukawa T, Hattori R, et al: The long-term outcome of laparoscopic radical nephrectomy for small renal cell carcinoma. J Urol 2001;165:1867-1870.
4. Referans4- Gill IS, Meraney AM, Schweizer DK, et al: Laparoscopic radical nephrectomy in 100 patients: a single center experience from the United States. Cancer 2001;92:1843-1855.
5. Referans5- Gill IS, Schweizer D, Hobart MG, et al: Retroperitoneal laparoscopic radical nephrectomy: the Cleveland Clinic experience. J Urol 2000;163:1665-1670.
6. Referans6- Portis AJ, Yan Y, Landman J, et al: Long-term followup after laparoscopic radical nephrectomy. J Urol 2002;167:1257-1262.
7. Referans7- Dunn MD, Portis AJ, Shalhav AL, et al: Laparoscopic versus open radical nephrectomy: a 9 year experience. J Urol 2000;164:1153-1159.
8. Referans8- Shuford MD, McDougall EM, Chang SS, et al: Complications of contemporary radical nephrectomy: comparison of open vs. laparoscopic approach. Urol Oncol 2004;22:121-126.

9. Referans9- Swanson DA, and Borges PM: Complications of transabdominal radical nephrectomy for renal cell carcinoma. J Urol 1983;129:704-707.
10. Referans10- Walther MM, Lyne JC, Libutti SK, et al: Laparoscopic cytoreductive nephrectomy as preparation for administration of systemic interleukin-2 in the treatment of metastatic renal cell carcinoma: a pilot study. Urology 1999;53:496-501.
11. Referans11- Matin SF, Madsen LT, and Wood CG: Laparoscopic cytoreductive nephrectomy: the M.D. Anderson Cancer Center experience. Urology 2006;68:528-532.
12. Referans12- Rabets JC, Kaouk J, Fergany A, et al: Laparoscopic versus open cytoreductive nephrectomy for metastatic renal cell carcinoma. Urology 2004;64:930-934.
13. Referans13- Steinberg AP, Finelli A, Desai MM, et al: Laparoscopic radical nephrectomy for large (greater than 7 cm, T2) renal tumors. J Urol 2004;172:2172-2176.
14. Referans14- Gong EM, Lyon MB, Orvieto MA, et al: Laparoscopic radical nephrectomy: comparison of clinical stage T1 and T2 renal tumors. Urology 2006;68:1183-1187.
15. Referans15- Stifelman MD, Handler T, Nieder AM, et al: Hand-assisted laparoscopy for large renal specimens: a multi-institutional study. Urology 2003;61:78-82.
16. Referans16- Malaeb BS, Sherwood JB, Taylor GD, et al: Hand-assisted laparoscopic nephrectomy for renal masses 9.5 cm: series comparison with open radical nephrectomy. Urol Oncol Semin 2005;23:323-327.
17. Referans17- Dillenburg W, Poulakis V, Skriapas K, et al: Retroperitoneoscopic versus open surgical radical nephrectomy for large renal cell carcinoma in clinical stage cT2 or cT3a: quality of life, pain, and reconvalescence. Eur Urol 2006;49:314-322.