The Study Of Clinical Efficacy In Renal Cell Carcinoma Treatment With Laparoscopic Surgery

Background: Renal cancer patients with Gerota fascial invasion have poor prognosis.However,the patients who were completely remove renal tumors,including Gerota fascia,often have a longer survival time after surgery.Methods: The clinical data of 268 patients who underwent transperitoneal laparoscopic radical nephrectomy(TLRN)and retroperitoneal laparoscopic radical nephrectomy(RLRN)from April 2008 to March 2017 were retrospectively analyzed.The Kolmogorov-Smirnov test is used to test whether the continuous variables conform to the normal distribution.When the data of continuous variables do not obey normal distribution,they are expressed by median and quartile range(IQR),and the Mann-Whitney U test is used for inter-group comparison.When the continuous variables obey the normal distribution,the mean ± standard deviation is used to represent them,and the independent sample t test is used to compare the two groups.Pearson chi-square test or Fisher exact test are used to compare the classified variable data.Mann-Whitney U test was used to compare ordered data results.OS,RSS and PFS were estimated by Kaplan-Meier survival analysis,and compared by log-rank-χ2 test.Cox proportional risk model(forward LR method)was used for multivariate regression analysis,and log-rank-χ2 test was used for comparison.Results: 56 patients in TLRN group and 204 patients in RLRN group successfully completed radical nephrectomy.The median follow-up time in TLRN group and RLRN group was 62.0(IQR: 34.0-78.0)months and 38.0(IQR: 23.0-59.0)months.There was no significant difference between TLRN group and RLRN group in age,sex,BMI,location of tumors(anterior/middle/posterior,upper/ middle/lower),ASA score,symptoms,maximum diameter of tumors,clinical stage and diabetes or hypertension.Operative time,intraoperative blood loss,number of transfusion cases,postoperative ventilation time and hospital stay were similar in TLRN group and RLRN group.Compared with TLRN,RLRN has shorter drainage tube removal time and less volume of drain,and the difference was significant.Survival analysis showed that there was no significant difference in OS,PFS and RSS between the two groups.Cox multivariate regression analysis showed that RLRN operative method and clinical symptoms were independent risk factors affecting the prognosis of RCC.Conclusion: RLRN operative method and having clinical symptoms are independent risk factors for poor oncological prognosis in patients with renal cell carcinoma after laparoscopic radical nephrectomy.Objective: To compare the efficacy of laparoscopic radical nephrectomy(LRN)and laparoscopic nephron sparing surgery(LNSS)in the treatment of stage T1 b renal cell carcinoma.Methods: The clinical data of 220 cases of T1 b renal cell carcinoma treated with laparoscopic surgery in our hospital from September 2008 to February 2017 were retrospectively analyzed.Among them,8 cases were converted into open surgery,and 212 cases were eventually included in the study.There were 156 patients in the LRN group,118 males and 38 females,aged(57.19±10.65)years old,BMI: 24.15(22.5-25.85)kg/m2,ASA score 2(1-2),The maximum diameter of the tumor is 5(4.5-6)cm,93 cases on the left side,63 cases on the right side;the tumor is located in the upper part of the kidney in 61 cases,44 cases in the middle part,51 cases in the lower part;79 cases with clinical symptoms and 77 cases with no clinical symptoms.There were 56 patients in the LNSS group,37 males and 19 females,aged(56.36±11.84)years old,BMI: 24(22.82-25.18)kg/m2,ASA score 1.5(1-2),The maximum diameter of the tumor is 4.5(4-5)cm;33 cases on the left side and 23 cases on the right side;21 cases in the upper part of the kidney,9 cases in the middle,26 cases in the lower part;25 cases with clinical symptoms and 31 cases with no clinical symptoms.The operation time,intraoperative blood loss,postoperative drainage,postoperative hospital stay,intraoperative complication rate,early postoperative complication rate,postoperative ventilation time and follow-up data were compared between the two surgical methods.Result: There was no significant difference between LRN group and LNSS group in median operative time(180(124-180)min vs.150(150-210)min,t=-0.225,P>0.05),volume of intraoperative bleeding(100(50-100)ml vs.100(50-160)ml,t=-1.025,P>0.05),postoperative volume of drain(125(100-220)ml vs.120(100-210)ml,t=-0.611,P>0.05),length of hospital stay after surgery(8(7-10)d vs.8(7-10)d,t=-0.401,P>0.05),the number of intraoperative complications(P > 0.05)and the number of early postoperative complications(P > 0.05);compared with LRN group,the postoperative ventilation time(2(2-3)d vs.2(2-2)d,t=-2.421,P <0.05)in LNSS group was shorter.The follow-up period ranged from 4 to 116 months.The median follow-up time was 36 months(23-57 months).The median follow-up time was 40 months(23.25-59.00 months)in LRN group and 29 months(20.00-42.00 months)in LNSS group.Postoperative recurrence occurred in 5 cases of LNSS group,including 4 deaths,2 deaths due to lung metastasis and 2 deaths due to bone metastasis;In LRN group,there were 32 recurrent cases,of which 23 died,including 8 cases of bone metastasis,1 case of brain metastasis,9 cases of lung metastasis,1 case of cervical lymph node metastasis,1 case of liver metastasis,2 cases of abdominal metastasis and 1 case of cerebral infarction.There was no significant difference in overall survival,RCC specific survival and progression-free survival between the two groups(P = 0.3001;P = 0.3413;P = 0.2951).Conclusion: Both LRN and LNSS are effective surgical procedures for T1 b renal cell carcinoma.Compared with LRN,LNSS has no significant difference in oncological prognosis.