Indications and contraindications for the use of laparoscopic surgery for renal cell carcinoma.

Surgery remains the only treatment with a chance of cure for renal cell carcinoma. Laparoscopic radical nephrectomy (LRN) has developed to be a standard treatment for the management of suspected renal malignancy in many centers worldwide, with oncologic efficacy equal to that of open radical nephrectomy. LRN has considerable advantages over open surgery, such as decreased postoperative morbidity, decreased analgesic requirements, and shorter hospital stay and convalescence. Current indications for LRN include all patients with localized stage T1-2 renal tumors. LRN for stage T3 renal tumors may be technically feasible in individual situations, but cannot be considered standard treatment. Open radical nephrectomy is reserved for advanced renal tumors, according to the surgeon's judgment. Partial nephrectomy is well established and considered to be the standard management for all organ-confined tumors of <or=4 cm in diameter. The scope of partial nephrectomy, however, is expanding, and now includes patients with organ-confined renal tumors of <or=7 cm. Laparoscopic partial nephrectomy is a continuously evolving technique. Continuing developments allow the experienced laparoscopist to use laparoscopic surgery for virtually all patients who are eligible for elective partial nephrectomy. This review evaluates the current indications and contraindications for laparoscopic radical and partial nephrectomy.