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)

1 Service d'urologie [Rennes] = Urology [Rennes]
2 IGDR - Institut de Génétique et Développement de Rennes
3 Service d'anatomie et cytologie pathologiques [Rennes] = Anatomy and Cytopathology [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 [CHU Pitié-Salpêtrière]
14 Service d'urologie, andrologie et transplantation rénale
15 TIMC-IMAG-GMCAO - Gestes Medico-chirurgicaux Assistés par Ordinateur
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

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; renal failure; kidney cancer; laparoscopy

Domains: Life Sciences [q-bio]; Life Sciences [q-bio]; Cancer

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, 2016, 14 (4), pp.e335-e340. ⟨10.1016/j.clgc.2016.01.007⟩. ⟨hal-01267294⟩