Laparoscopic and Partial Nephrectomy

Abstract

Radical nephrectomy is the gold standard curative operation for patients with localized renal cell carcinoma (RCC). Since its introduction in 1990, laparoscopic radical nephrectomy is being increasingly done at numerous institutions worldwide. In the hands of experienced laparoscopic urological surgeons and with adherence to established principles of open radical nephrectomy, laparoscopic radical nephrectomy is now a standard of care for patients with T 1-3a N 0 M 0 RCC. Intermediate-term outcome data indicate equivalent cancer-free survival to open radical nephrectomy in such cases. Nephron-sparing surgery (NSS) is now an established approach for patients with localized RCC when there is a clinically relevant need to preserve renal function. NSS is also indicated in patients with a single, small, unilateral, localized RCC when the opposite kidney is completely normal. The technical success rate with NSS for RCC is excellent, and long-term patient survival free of cancer is comparable with that obtained after radical nephrectomy. We recently reviewed the results of NSS in 107 patients with localized sporadic RCC treated at the Cleveland Clinic before 1988 who were followed up for a minimum of 10 years. Long-term preservation of renal function was achieved in 93% of patients, and the 10-year cancer specific survival rate was 73%. Although open surgical partial nephrectomy remains the gold standard for nephron-sparing treatment of RCC, laparoscopic partial nephrectomy is now available in selected cases. The optimal indications for laparoscopic NSS are in patients with a relatively small and peripheral renal tumor. In such cases, laparoscopic NSS is proving to be an effective, minimally invasive therapeutic approach with respect to renal functional outcome, with additional advantages of reduced postoperative narcotic use, earlier hospital discharge, and a faster convalescence. The laparoscopic approach is associated with longer warm renal ischemia time, more major intraoperative complications, and more postoperative urological complications. Continued efforts are required to develop laparoscopic renal hypothermia techniques and to facilitate intrarenal suturing while minimizing the warm ischemia time.

Diffusion of surgical innovation among patients with kidney cancer

“…[2][3][4][5][6] Easier convalescence [7][8][9][10] and equivalent cancer control 10 have established laparoscopy as an alternative standard of care for most patients who undergo radical nephrectomy. 1,2,4,11,12 In synchronicity with the gradual dissemination of laparoscopic radical nephrectomy, 2,4 multiple investigators reported that, for selected patients with smaller renal tumors, partial nephrectomy yields oncologic outcomes that are indistinguishable from the outcomes achieved by radical excision. [13][14][15] Partial nephrectomy also preserves long-term renal function 16,17 while reducing over-treatment of patients with benign 18 or clinically indolent 19 tumors.…”

Management of kidney cancer: Canadian Kidney Cancer Forum Consensus Statement

“…Partial nephrectomy provides recurrence-free and longterm survival rates similar to radical nephrectomy for tumours < 4 cm in diameter. [8][9][10] Further, partial nephrectomy is associated with a lower risk of longterm renal dysfunction. 11 There is preliminary experience with HIFU (high intensity focussed ultrasound), but probe ablation by RFA and cryotherapy has been extensively reported with promising early results in terms of efficacy and side effects.…”

IVC Thrombectomy in Renal Cell Carcinoma—Analysis of Out Come Data of 100 Patients and Review of Literature

“…Some have questioned its benefits [28][29][30][31] while others have used laparoscopy for IVC tumor thrombi using open incisions for tumor thrombectomy after laparoscopic mobilization and dissection [32][33][34] or pure laparoscopy with hand assistance for the thrombectomy only [35]. Single case reports have also been described using hand-assisted or pure laparoscopy for short thrombi [36,37], recently few case reports and one case series of robotic IVC thrombectomy has been reported in the literature [38].We await results of larger series since robotic and laparoscopic IVC tumor thrombectomy remain a challenging procedure and should not be embarked on lightly and hence open surgery remains the predominant method for addressing RCC involving the IVC.…”