Abstract：Objective: To compare the efficacy of laparoscopic surgery vs. open surgery in the treatment of T2 and above renal cell carcinoma (>7 cm). Methods: From Jan. 2012 to Jan. 2015, the clinical data of 57 patients undergoing nephrectomy in our hospital were analyzed retrospectively. There were 34 males and 23 females, with age ranging from 44 to 72 (mean 58.2±7.0) years old. The size of tumor was between 7.0-12.2 cm (mean 8.8±1.2 cm). Left renal tumor was found in 30 patients and right renal tumor in 27 patients. Clinical stages of tumors were T2 to T3. All patients were subjected to the nephrectomy via the retroperitoneal approach in 26 cases (observation group) and open approach in 31 cases (control group). The exclusive criteria included inferior vena cava tumor thrombus, lymphatic or distant metastasis, mutiple tumors. There were no significant differences in the age, gender, tumor size and location between two groups (P>0.05). The perioperative indexes and oncological outcomes, such as operation time, blood loss, incidence of blood transfusion, postoperative hospital stay, complications and follow-up results, were collected and compared between two groups. Results: Conversion occurred in one case from observation group. Operative time in observation group was significantly shorter than that in control group (115.0±23.1 min vs. 132.2±28.4 min, P<0.05). Bowel function recovered more rapidly in observation group than in control group (1.7±0.6 d vs. 2.3±0.6 d,P<0.05). However, the estimated blood loss, the incidence of blood transfusion, the postoperative hospital stay and perioperative complications showed no significant difference between two groups (P>0.05). The histopathological examination confirmed renal clear cell carcinoma in all cases. In observation group there were 21 cases of T2 stage and 5 cases of T3a stage, and in control group there were 25 cases of T2 stage and 6 cases of T3a stage. The follow-up duration ranged from 4 to 40 months (mean 19 months). Mean overall survival was 17.5 months in observation group and 18.2 months in control group. Progression free survival time was 15.5 months in observation group and 16.9 months in control group. Cox survival analysis showed that only pre-operative stage of the tumor was independent risk factor for the survival time (P=0.018) and progression free survival time (P=0.020), while the operative approach was not the independent risk factor (P=0.312, 0.331). Conclusions: For large renal tumor(>7 cm) retroperitoneal laparoscopic radical nephrectomy was safe and feasible. Compared to the open approach, retroperitoneal approach costs less operative time and obtains rapid recovery. But the operation approach is not an independent risk factor for the survival time and progression free survival time.
侯毅,陈晓亮,霍威,孔祥波,王志新. 后腹腔镜手术与开放手术治疗T2期及以上肾癌的对照研究[J]. 微创泌尿外科杂志, 2015, 4(6): 321-324.
Hou Yi , Chen Xiaoliang , Huo Wei , Kong Xiangbo , Wang Zhixin. Comparison between laparoscopic and open surgical treatment for T2 renal cell carcinoma. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2015, 4(6): 321-324.
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