Retroperitoneal laparoscopic partial nephrectomy for renal-cell carcinoma in a solitary kidney: report of 56 cases.

OBJECTIVE

The aim of this study was to evaluate the possibility and clinical efficacy of retroperitoneal laparoscopic partial nephrectomy for T(1)- and T(2)-stage renal-cell carcinoma (RCC) of a solitary kidney.

PATIENTS AND METHODS

A total of 56 patients with RCC in a solitary kidney were selected in this study, including 41 men and 15 women with a mean age of 49 years. B-type ultrasonography and CT revealed T(1)N(0)M(0) tumors in 51 cases and T(2)N(0)M(0) tumors in the remaining 5 cases; 41 cases were RCC in left kidney, and 15 were RCC in right kidney. Of them, 24 cases had RCC located in the upper pole, 24 in the inferior pole, and 8 in the central region of the kidney. The mean tumor diameter was 3.0 +/- 0.8 cm (1.5-5.5 cm). Postoperative pathology report showed 46 cases of T(1)-stage tumor (T(1a): 38; T(1b): 8) and 10 cases of T(2) stage. Retroperitoneal laparoscopic nephron-sparing surgery was performed. Surgical resection was performed along a resection line 0.5 cm from the tumors. Renal function was determined using emission CT before and after operation. Preoperative three-dimensional CT image reconstruction was performed using multislice spiral CT.

RESULTS

All procedures were successfully performed without open conversion and serious complications. The mean warm ischemia time was 24 +/- 4.2 minutes (19-50 minutes). The mean operation time was 95 +/- 14.5 minutes. The mean blood loss volume was 105 +/- 20.4 mL. No postoperative urine leakage occurred. Both serum creatinine and nitrogen levels were normal after operation in all cases. The mean hospital stay was 9 +/- 2 days. There was no requirement for hemodialysis. No recurrence, metastasis, and implantation were observed during the 20 +/- 4 month follow-up periods, with a survival rate of 100%.

CONCLUSIONS

Laparoscopic partial nephrectomy can be performed safely and effectively in selected patients with tumors in a solitary kidney owing to its minimal invasion, clear dissection, less hemorrhage, and rapid recovery.