Laparoscopic radical nephrectomy: comparison of clinical Stage T1 and T2 renal tumors.

OBJECTIVES: To compare the outcomes after laparoscopic radical nephrectomy (LRN) at our institution to treat Stage T1 and T2 renal tumors. LRN for Stage T1 renal tumors (less than 7 cm) has become the standard of care at many institutions. The feasibility of performing more complex LRNs on higher stage tumors is continually evolving.

METHODS: A retrospective review was performed of a prospective database of patients undergoing LRN at the University of Chicago from October 2002 to January 2006. The data on 141 unilateral LRNs, 98 for clinical Stage T1 tumors and 43 for clinical Stage T2 tumors, were analyzed. The demographic, operative, and postoperative data were compared between the two groups.

RESULTS: The demographic data between the two groups was comparable. Operatively, patients with larger tumors had significantly greater blood loss, a longer operative time, and a longer surgical incision. Open conversions (1% versus 12%, P = 0.013) and intraoperative complications (5% versus 19%, P = 0.006) were more likely in patients with clinical Stage T2 tumors. Most intraoperative complications were hemorrhage requiring transfusion. However, the postoperative complication rates (25% versus 21%, P = 0.646) and hospital stay (2.0 versus 2.4 days, P = 0.134) were similar between the two groups.

CONCLUSIONS: In experienced centers, clinical Stage T2 renal tumors can be managed efficiently with laparoscopy. LRN for larger tumors demonstrated equivalent perioperative safety compared with LRN for smaller tumors.