Laparoscopic radical nephropathy effective for advanced renal masses

By Sally Robertson, B.Sc.Apr 29 2013

Laparoscopic radical nephrectomy is an effective treatment approach for individuals with renal cell carcinoma who have larger or more advanced renal masses, report researchers.

Among 222 patients with pathologic stage 2 to 3 disease (stage pT2-3) who underwent the procedure for masses larger than 7 cm in diameter, there was a low rate of conversion to open surgery and a low frequency of intraoperative and postoperative grade III-IV complications, say Carolina D'Elia (Santa Chiara hospital, Trento, Italy) and colleagues.

However, locally advanced stage pT3 disease was a risk factor for conversion to open surgery and for poorer survival outcome, compared with organ-confined pT2 disease, says the team.

In addition, although tumor size was not significantly associated with risk for conversion, those who did have open surgery also had larger tumors, compared with the rest of the patients. These patients should be warned about the higher likelihood for conversion to open surgery, say D'Elia et al.

In the large multicenter study, the median tumor size among the patients was 8.5 cm, the median operative time was 180 minutes, and the median blood loss was 280 mL.

As reported in Urology, grade II complications, which included postoperative anemia requiring blood transfusion, occurred in 42 (19.0%) patients.

Grade III and IV complications occurred in 6 (2.7%) patients and included postoperative bleeding requiring abdominal reexploration, splenic injury with subsequent splenectomy, adrenal injury, wound diastasis necessitating suturing, and respiratory insufficiency requiring intensive care monitoring.

Twelve (5.4%) patients were converted to open surgery, and these patients had a mean tumor size of 11.9 cm, compared with 8.5 cm among the nonconverted individuals.

"Patients with tumors >10cm should be informed about a higher likelihood of experiencing open conversion," says the team.

Multivariate analysis revealed that pathological stage was the only significant predictor for conversion to open surgery, with individuals who had stage pT3 disease at more than a 4-fold increased risk for conversion than those with stage pT2 disease.

"Interestingly, the conversion rate exceeded the major (grade III-IV) complication rate (5.4% vs 2.7%)," says the team. "In other words, open conversion might be the price to pay to maintain the complication rate acceptably low."

Five-year follow up of the patients showed that overall survival, cancer-specific survival (CSS), and progression-free survival were 74%, 78%, and 66% respectively. And the 5-year stage adjusted CSS was 89% in pT2 patients compared with 40% in pT3 patients.

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