Laparoscopic nephrectomy treatment of renal tumors over 7 cm: our experience

INTRODUCTION: Radical nephrectomy by open surgery is the gold standard treatment for localized renal cancers. Several studies can demonstrate the efficacy and safety of laparoscopic radical nephrectomy for tumors in stage T1. MATERIALS AND METHODS: From June 2004 to June 2011 we studied 132 patients undergoing videolaparoscopic radical nephrectomy, and analyzed the following parameters: cancer site, cancer dimension, eventual lymphadenectomy and surrenectomy, approach used (transperitoneal or retroperitoneal), surgery time, pre-and post-surgery (24h) hemoglobin and creatinine. Patients were then divided in 2 groups: Group A (78 patients): T1 cancer (dimension less than 7 cm); Group B (54 patients): T2-T3 cancer (dimension equal or larger than 7 cm) (T2 = 62%; T3 = 38%). RESULTS: There were no significant statistic differences between the 2 groups about number of patients, decrease of hemoglobin and increase of creatinine. On the other side, significant differences were found about surgery time: 127 min for Group A against 170 min for Group B. CONCLUSIONS: Laparoscopic radical nephrectomy shows a lower morbidity compared to open surgery, although this is confirmed by a few studies; cancer controls seem equivalent between the T1 and T2 tumors. Radical nephrectomy by laparoscopy was and is still recommended for T1 and T2 cancers, but there is no enough evidence that it can be useful in the same way for T3 cases. Our study supports the thesis that laparoscopic radical nephrectomy is a safe and effective approach for tumors at and above 7 cm and not just those smaller, with an equal number of complications compared to an increase in the average surgery time.