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Safety and feasibility of laparoscopic nephrectomy for big tumors (•10 cm): a retrospective multicentric study

Grégory Verhoest 1, 2, * Jean-Philippe Couapel 1 Emmanuel Oger 3 Nathalie Rioux-Leclercq 3, 2 Géraldine Pignot 4 Jean-Jacques Patard 4 Axel Bex 5 Paul Panayotopoulos 6 Pierre Bigot 6 Viktor Eret 7 Milan Hora 8 Burak Turna 9 Maxime Lefevre 10 Jérôme Rigaud 10 Xavier Tillou 11 Arnaud Doerfler 11 Evanguelos Xylinas 12 Yanish Soorojebally 13 Morgan Rouprêt 13 Samuel Lagabrielle 14 Jean-Christophe Bernhard 14 Jean-Alexandre Long 15, 16 Julien Berger 17 Emmanuel Ravier 18 Philippe Paparel 19 Laurent Salomon 20, 21 Alejandro R. Rodriguez 22 Karim Bensalah 1
* Corresponding author
1 Service d'urologie
2 IGDR - Institut de Génétique et Développement de Rennes
3 Service d'anatomie et cytologie pathologiques [Rennes]
4 Hôpital Bicêtre
5 Division of Molecular Biology
6 Service d'urologie
7 University of West Bohemia [Plzeň ]
8 Charles University Hospital
9 Ege University
10 CHU Nantes - Centre hospitalier universitaire de Nantes
11 Service d'Urologie [CHU Caen]
12 Hôpital Cochin [AP-HP]
13 Service d'urologie et transplantation rénales [CHU Pitié-Salpétrière]
14 Service d'urologie, andrologie et transplantation rénale
15 TIMC-IMAG-GMCAO - Gestes Medico-chirurgicaux Assistés par Ordinateur
TIMC-IMAG - Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525
16 CHU - Centre Hospitalier Universitaire [Grenoble]
17 CHU Limoges
18 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
19 Applications des ultrasons à la thérapie
20 Service d'urologie [Mondor]
21 IMRB - Institut Mondor de Recherche Biomédicale
22 Samaritan Medical Center
Abstract : Objective - Evaluate the feasibility of laparoscopic nephrectomy for big tumors. Material and methods - Data from 116 patients were retrospectively collected from 16 tertiary centres. Clinical and operative parameters, tumor characteristics, pre- and postoperative parameters, and renal function before and after surgery were analyzed. Results - Mean age and body mass index were 61 years and 27.8 kg/m(2), respectively. Males represented 63.8% of patients, and 54.4% presented symptoms at diagnosis. Median tumor size was 11 cm, and 75% of the cases were performed by expert surgeons. Median operative time and blood loss were 180 minutes and 200 mL respectively. Conversion to open surgery was necessary in 20.7% of cases. Intraoperative complications related to massive hemorrhage occurred in 16.4% of patients, resulting in open conversion in 62.5%. Major postoperative complications occurred in only 10 patients (8.6%). In univariate analysis, intraoperative complications, age, and blood loss were predictive factors of conversion to open surgery. Positive surgical margins occurred in 6 patients (5.2%). None of them presented a local recurrence. Predictive factors of recurrence or progression were lymph node invasion, metastases, and Furhman grade. Conclusion - Laparoscopic nephrectomy for tumors > 10 cm can be performed safely. Complication rate and positive surgical margins are similar to open surgery. In experienced hands, the benefit of a mini invasive surgery remains evident.
Keywords : renal cell carcinoma kidney cancer laparoscopy renal failure
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Submitted on : Thursday, February 4, 2016 - 11:11:43 AM
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UNIV-RENNES1 | CNRS | UNIV-ANGERS | IMRB | UPEC-UPEM | BIOSIT | INSERM | LTSI | COMUE-NORMANDIE | UNIV-LYON1 | HCL | CHLS | UNIV-RENNES | UNICAEN | UNAM | TIMC-IMAG-GMCAO | UGA | TIMC-IMAG | UPEC | UDL | IMAG | SORBONNE-UNIVERSITE | SU-TI

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Grégory Verhoest, Jean-Philippe Couapel, Emmanuel Oger, Nathalie Rioux-Leclercq, Géraldine Pignot, et al.. Safety and feasibility of laparoscopic nephrectomy for big tumors (•10 cm): a retrospective multicentric study. Clinical Genitourinary Cancer, Elsevier, 2016, 14 (4), pp.e335-e340. ⟨10.1016/j.clgc.2016.01.007⟩. ⟨hal-01267294⟩

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