Laparoscopic radical nephrectomy: a journey from T1 to very large T2 tumors.

OBJECTIVES: To evaluate the feasibility, efficacy and safety of laparoscopic radical nephrectomy (LRN) in T1 and T2 renal tumors.

PATIENTS AND METHODS: From December 1999 to March 2007, a retrospective analysis of 102 patients was done. A thorough preoperative workup was done in all patients. Postoperatively the patients were followed up every 3 months for the first year, 6-monthly for the next 2 years and yearly thereafter.

RESULTS: Transperitoneal radical nephrectomy was done in 85 patients, whereas 7 patients had a retroperitoneal surgery. A combined approach of retroperitoneal renal artery clipping followed by transperitoneal nephrectomy was done in 10 patients. 72 patients had clinically T1 tumors and 30 patients were T2 tumors. Mean tumor size was 6.97 cm, mean operative time was 174 min, mean blood loss was 230 ml, mean hospital stay was 4.6 days, and mean incision length was 8 cm. 19 patients had conversion to open surgery. Mean follow-up was 22.6 (range 4-56) months. Overall recurrence-free survival was 88.1%.

CONCLUSIONS: LRN is a safe and effective treatment for renal tumors with a steep learning curve. Large right-sided T2 tumors can be safely treated with the combined approach. Disease control rates with LRN are satisfactory.