A Generation of Laparoscopic Nephrectomy: Stage-Specific Surgical and Oncologic Outcomes for Laparoscopic Nephrectomy in a Single Center

作者：Laird Alexander^*; Stewart Grant D; Zhong Jim; Ang W J Jensen; Cutress Mark L; Riddick Antony C P; McNeill S Alan; Tolley David A

来源：Journal of Endourology, 2013, 27(8): 1008-1014.

DOI：10.1089/end.2012.0562

Purpose: To determine the stage-specific operative, postoperative and oncologic outcomes, for patients undergoing a laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) in a single center and assess changes over a generation of practice.
Patients and Methods: From December 1992 to July 2011, data were collected prospectively for 854 consecutive simple laparoscopic necphrectomies (LNs) and LRNs, 397 of which were LRNs for RCC. The first LRN was performed in December 1997. Stage-specific surgical and oncologic outcomes were assessed across the study period. Patients were then grouped into three equal consecutive cohorts. Case mix and surgical outcomes were compared to assess changes with departmental experience.
Results: There were 206, 71, 118, and 2 patients across stages pT(1), pT(2), pT(3), and pT(4), respectively. Median operative time was significantly shorter for pT(1) tumors (125, 150 and 150 min for pT(1-3), P<0.021), while median estimated blood loss (EBL) was greater for pT(3) tumors (50, 50, 100 mL, for pT(1-3), P<0.001). Median follow-up time was 31, 30, and 18 months, respectively, across pT(1)-pT(3). There was a significant difference in 5-year overall survival (82.4%, 68.4%, 58.9%), cancer-specific survival (99.5%, 83.6%, 66.5%) and progression free survival (86.5%, 66.3%, 47.5%) across these stage-specific subgroups. Over the three cohorts, there was an increase in LRN performed for locally advanced disease and cytoreduction. With greater surgical experience, there was improvement in median operative time and median EBL in localized disease over the three periods, but no significant changes for locally advanced disease.
Conclusion: This is the largest reported series of LRN in the United Kingdom. Departmental experience has resulted in improved surgical outcomes for localized RCC, with expansion of practice in more complex advanced disease. Laparoscopic nephrectomy is both operatively and oncologically safe in T-1 and T-2 disease, and although technically more demanding, it is also safe in selected T-3 disease.

• 出版日期2013-8