Operative safety and oncologic outcome of laparoscopic radical nephrectomy for renal cell carcinoma >7 cm: A multicenter study of 222 patients

Lorenzo G. Luciani, Francesco Porpiglia, Tommaso Cai, Carolina D'Elia, Valentino Vattovani, Guido Giusti, Daniele Tiscione, Stefano Chiodini, Roberto Peschechera, Christian Fiori, Rosa Spina, Paolo Parma, Antonio Celia, Gianni Malossini

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To evaluate the safety of laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) >7 cm, addressing the issue of modality and risk factors for complications and open conversion, and to assess the oncologic outcome. Methods: The data of 222 patients undergoing LRN for RCC >7 cm prospectively enrolled from 2002 to 2010 at 5 urologic centers were reviewed. Transperitoneal LRN was performed by 5 experienced laparoscopic surgeons. The Clavien-Dindo classification was used to assess complications. Multivariable analysis of factors predictive of conversions was performed. Oncologic outcomes for survival were estimated using the Kaplan-Meier method. Results: Median tumor size was 8.5 cm, operative time was 180 minutes, and blood loss was 280 mL. Forty-two patients (19%) received a blood transfusion. Six (2.7%) patients had grade III-IV complications: 2 with postoperative bleeding requiring abdominal re-exploration and 1 each with adrenal injury, splenic injury, wound diastasis, and respiratory insufficiency. Twelve patients (5.4%) were converted to open surgery. The diameter was 11.9 in converted groups and 8.5 cm in nonconverted groups (P =.001). Multivariable analysis revealed that pathologic stage was the only independent predictor of conversion (P =.002). The 5-year overall (OS), cancer-specific (CSS), and progression-free (PFS) survival was 74%, 78%, and 66%, respectively. The 5-year stage-adjusted CSS was 89% in pT2 and 40% in pT3 patients (P

Original languageEnglish
Pages (from-to)1239-1244
Number of pages6
JournalUrology
Volume81
Issue number6
DOIs
Publication statusPublished - Jun 2013

ASJC Scopus subject areas

  • Urology

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