30. Laparoscopic nephrectomy for advanced renal cell carcinoma: Clinical case and literature review
Main Article Content
Abstract
With experienced surgeon, laparoscopic radical nephrectomy (LRN) for large and locally advanced kidney tumours (T3a) is becoming more prevalent. Limited studies on surgical results exist for such groups. The purpose of the case report is to present surgical techniques and discuss issues related to laparoscopic surgery in patients with significant renal cell carcinoma. The 43-year-old female patient presented to the doctor for pain and palpation of the mass in her left side abdominal. Computed tomography revealed a T3 (88x102x87 mm) left kidney tumour with renal umbilical nodes. We used 4 trocars (1 trocar-10mm, 1 trocar-12mm, 2 trocar-5mm), Ligasure and laparoscopic hem-o-lok. The specimen was taken out through a skin incision 13 cm long at the lateral white line. The operating time was 170 minutes. The amount of blood lost during surgery was negligible. The patient transitioned to oral feeding one day post surgery and was discharged from the hospital on the 7th day without complication. The literature review shows that nephrectomy due to T2-T3a nephrotomy is feasible and achieves radical results, reduced pain, and minimal blood loss. However, this is a complex technique and must be performed by experienced and specialised surgeons.
Article Details
Keywords
Large renal tumour, laparoscopy, large, safety, oncological outcome
References
2. Elkassem AA, Allen BC, Sharbidre KG, et al. Update on the Role of Imaging in Clinical Staging and Restaging of Renal Cell Carcinoma Based on the AJCC 8th Edition, From the AJR Special Series on Cancer Staging. AJR Am J Roentgenol. 2021;217(3):541-555.
3. Wang L, Li KP, Liu Y, et al. Perioperative and oncologic outcomes of transperitoneal versus retroperitoneal laparoscopic radical nephrectomy for large-volume renal carcinoma (> 7cm): a systematic review and pooled analysis of comparative outcomes. World J Surg Oncol. 2023;21(1):86.
4. Guo X, Wang H, Xiang Y, et al. Safety and oncological outcomes for large (stage ≥ T2b) and locally advanced renal cell carcinoma: comparison between laparoscopic and modified hand-assisted laparoscopic radical nephrectomy. J Int Med Res. 2020; 48(10):300060520961238.
5. Clayman RV, Kavoussi LR, Soper NJ, et al. Laparoscopic nephrectomy: initial case report. J Urol. 1991;146(2):278-282.
6. Kumar A, Kumar N, Kumar G, et al. A prospective evaluation of 3-D laparoscopic transperitoneal radical nephrectomy for large renal tumors (clinical stage T2N0M0): A single-centre, single-surgeon experience. Cent European J Urol. 2017;70(3):320.
7. Liu Z, Tang S, Tian X, et al. Laparoscopic conversion to open surgery in radical nephrectomy and tumor thrombectomy: causal analysis, clinical characteristics, and treatment strategies. BMC Surg. 2020;20(1):185.
8. Deng W, Zhou Z, Zhong J, et al. Retroperitoneal laparoscopic partial versus radical nephrectomy for large (≥ 4cm) and anatomically complex renal tumors: A propensity score matching study. Eur J Surg Oncol. 2020;46(7):1360-1365.
9. Pei X, Hu X, Xu Z, et al. Clinical Effect of Retroperitoneal Laparoscopic Radical Nephrectomy on Renal Cell Carcinoma, the Influence of Renal Function, and the Influencing Factors of Recurrence. Evid Based Complement Alternat Med. 2022;2022:4182853.
10. Bolton EM, Hennessy D, Lonergan PE, et al. Evaluating the perioperative safety of laparoscopic radical nephrectomy for large, non-metastatic renal tumours: a comparative analysis of T1-T2 with T3a tumours. Ir J Med Sci. 2018;187(2):313-318.
11. Kim HY, Lee DS, Yoo JM, et al. Retroperitoneal Laparoscopic Radical Nephrectomy for Large (> 7cm) Solid Renal Tumors: Comparison of Perioperative Outcomes with the Transperitoneal Approach. J Laparoendosc Adv Surg Tech A. 2017;27(4):393-397.
12. Binsaleh S, Alomar M, Madbouly K. Pfannenstiel incision for intact specimen extraction in laparoscopic transperitoneal radical nephrectomy: a longitudinal prospective outcome study. Clinics (Sao Paulo). 2015;70(7):475-480.
13. Peltrini R, Iacone B, Pacella D, et al. Laparoscopic Radical Nephrectomy with Transperitoneal Approach for Large Renal Tumors: Standardized Surgical Technique and Outcomes. J Laparoendosc Adv Surg Tech A. 2023;33(9):879-883.
14. Conley SP, Humphreys MR, Desai PJ, et al. Laparoscopic radical nephrectomy for very large renal tumors (> or = 10cm): is there a size limit? J Endourol. 2009;23(1):57-61.
15. Yadav P, Srivastava D, Arakere S, et al. Utility of anteroposterior diameter ratio of tumor and abdomen for laparoscopic approach for radical nephrectomy in large renal masses. Urologia. 2017:0.
16. Jeon SH, Kwon TG, Rha KH, et al. Comparison of laparoscopic versus open radical nephrectomy for large renal tumors: a retrospective analysis of multi-center results. BJU Int. 2011;107(5):817-821.
17. Szydelko T, Tupikowski K, Dembowski J, et al. Laparoscopic radical nephrectomy for large renal tumor - a case report and technical considerations. Cent European J Urol. 2011; 64(1):39-41.
18. Luciani LG, Porpiglia F, Cai T, et al. Operative safety and oncologic outcome of laparoscopic radical nephrectomy for renal cell carcinoma > 7cm: a multicenter study of 222 patients. Urology. 2013;81(6):1239-1244.
19. Pierorazio PM, Hyams ES, Lin BM, et al. Laparoscopic radical nephrectomy for large renal masses: critical assessment of perioperative and oncologic outcomes of stage T2a and T2b tumors. Urology. 2012;79(3):570-575.
20. Nian X, Ye H, Zhang W, et al. Propensity-matched pair analysis of safety and efficacy between laparoscopic and open radical nephrectomy for the treatment of large renal masses (> 10cm): a retrospective cohort study. Transl Androl Urol. 2022;11(8):1148-1156.
21. Hemal AK, Kumar A, Kumar R, et al. Laparoscopic versus open radical nephrectomy for large renal tumors: a long-term prospective comparison. J Urol. 2007;177(3):862-866.
22. Colombo JR Jr, Haber GP, Jelovsek JE, et al. Seven years after laparoscopic radical nephrectomy: oncologic and renal functional outcomes. Urology. 2008;71(6):1149-1154.