The advisability and safety of transperitoneal laparoscopic nephrectomy for renal parenchymal tumors
Objective: to assess the advisability and safety of transperitoneal laparoscopic nephrectomy for renal parenchymal tumors. Subjects and methods. The investigation enrolled 163 patents with clinically localized renal parenchymal tumors that had been resected through laparoscopic (n = 81 (49.7 %)) and open (n = 82 (50.3 %) accesses). The groups of patients operated on via laparoscopic and laparotomic accesses were matched for demographic characteristics, somatic status, baseline renal function, and nephrometric signs of tumor nodules, except the involved side (7 patients in the laparoscopic group had bilateral renal tumors). Renal resection was carried out in all the patients; a contralateral kidney tumor was also removed in 7 patients with a bilateral lesion (nephrectomy and kidney resection were done in 3 and 4 patients, respectively). Histological examination verified benign tumors in 15 (9.2 %) cases, renal cell carcinoma in 148 (90.8 %), including all bilateral renal tumors [рТ1а (n = 135 (91.2 %) cases; рТ1b (n = 4 (2.7 %); рТ3а (n = 9 (6.1 %)]; according to the pT category, the distribution of patients in the laparoscopic and open resection groups was even (p = 0.586). No additional treatment was performed in any case. The median follow-up was 48.2 ± 11.8 months. Results. The use of the laparoscopic access significantly increased the frequency of intraoperative complications (6.1 and 16.0 %; p = 0.037), but failed to affect that of postoperative complications (13.0 and 18.3 %, respectively; p = 0.291) versus the open access. Laparoscopic versus conventional techniques did not cause any reduction in 5-year overall, specific, and relapse-free survival rates (93.3, 100.0, 80.0 % and 97.1, 100.0, 98.5 %, respectively; р > 0.05 for all). The rate of acute renal dysfunction and its distribution by the RIFLE classes, the rate and level of a decrease in glomerular filtration rate in the late postoperative period did not depend on the surgical access (p > 0.05) for all). Questioning has shown that the laparoscopic versus laparotomic access significantly improves quality of life within one month after renal resection. Conclusion. Transperitoneal laparoscopic nephrectomy is a safe alternative to open surgery, which can improve quality of life in the patients with clinically localized kidney tumors within one month after surgical intervention.