후복막강경 근치적 신적출술: 개복 근치적 신적출술과의 비교

Abstract

Purpose: Although kidney is located in the retroperitoneal space laparoscopic radical nephrectomy is usually performed by the transperitoneal approach. At our institution the retroperitoneal approach is preferred. We evaluated the surgical outcomes, safety, oncologic outcomes, and compared with the results those of open radical nephrectomy in a contemporary cohort. Materials and Methods: Between January 2000 and December 2005 we performed retroperitoneal laparoscopic radical nephrectomy for renal cell carcinoma in 37 patients with clinical stage cT1 and cT2. Data from the these patients were retrospectively compaired with 30 contemporary cases treated with open radical nephrectomy. The clinical parameters including perioperative outcomes, complications, pathologic data, learning curve and recurrence were evaluated. Results: For the 37 retroperitoneal radical nephrectomies mean tumor size was 4.6cm (range 2.3 to 8.0), surgical time was 203.6min (range 110-410) and blood loss was 241.8cc. Mean specimen size was 10.4cm (8.7-14.4). Mean analgesic used day was 1.3 (0-4) and mean postoperative hospital stay was 4.2 days. minor complications occur in 16 cases and no major complications occurred. Surgical margins were negative for tumor in all patients. Variable parameters were comparable between patients undergoing laparoscopic and open radical nephrectomy. However, laparoscopy resulted in decreased blood loss, surgical times, analgesia use, time to oral intake, time to drain removal and postoperative hospital stay. No different complication rate is between two groups Conclusions: Retroperitoneal laparoscopic radical nephrectomy can be a safe and effective treatment in renal cell carcinoma. Although no long-term follow-up is available, our follow up to mean 31 months confirm the effectiveness of retroperitoneal laparoscopic radical nephrectomy in terms of surgical principles and oncological effectiveness.