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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
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.
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Submitted on : Thursday, February 4, 2016 - 11:11:43 AM
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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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