TY - JOUR
T1 - Operative safety and oncologic outcome of laparoscopic radical nephrectomy for renal cell carcinoma >7 cm
T2 - A multicenter study of 222 patients
AU - Luciani, Lorenzo G.
AU - Porpiglia, Francesco
AU - Cai, Tommaso
AU - D'Elia, Carolina
AU - Vattovani, Valentino
AU - Giusti, Guido
AU - Tiscione, Daniele
AU - Chiodini, Stefano
AU - Peschechera, Roberto
AU - Fiori, Christian
AU - Spina, Rosa
AU - Parma, Paolo
AU - Celia, Antonio
AU - Malossini, Gianni
PY - 2013/6
Y1 - 2013/6
N2 - 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
AB - 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
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U2 - 10.1016/j.urology.2012.12.065
DO - 10.1016/j.urology.2012.12.065
M3 - Article
C2 - 23608667
AN - SCOPUS:84878574868
VL - 81
SP - 1239
EP - 1244
JO - Urology
JF - Urology
SN - 0090-4295
IS - 6
ER -