A Comparative Study Of Hand-assisted Laparoscopic And Open Surgical Treatment Of Renal Carcinoma

Objective To evaluate the clinical value of hand-assisted laparoscopic treatment of renal carcinoma as compared with open surgery.Methods The clinical data of 25 cases(group A) receiving hand-assisted laparoscopic radical nephrectomy and 9 cases(group C) receiving hand-assisted laparoscopic nephroureterectomy performed at our hospital were reviewed. We retrospectively compared our results with those of 30 open radical nephrectomies(group B) and 11 open nephroureterectomies (group D)performed during the same period. The patient age, weight,male:female ratio, right:left ratio and ASA classification were similar in hand-assisted laparoscopic and open surgical groups. Operative and postoperative parameters included operative time, estimated blood loss, need for transfusion, tumor diameter, volume of drain, days to oral intake, days to out-of-bed activity,days of postoperative hospitalization,VAS analgesia scores, need for anodyne and follow-up period. Complications and tumor recurrence were recorded.Results Hand-assisted laparoscopy was performed successfully on 34 patients with renal tumors.1 Radical nephrectomyPatients in the A group had significantly less mean blood loss(94ml vs 300ml,p=0.0001), less volume of drain(103.6ml vs 181.2ml,p=0.0001),earlier resumption of oral intake(2.3d vs 2.7d,p=0.024) ,earlier out-of-bed activity(5.6d vs 7.6d,p=0.009) and required fewer anodyne (all P < 0.05).But the operative times(157.6min vs 155.0min,p=0.843) ,days of postoperative hospitalization(10.5d vs 8.9d,p=0.069)and follow-up periods(17m vs 16m,p=0.561) in the A and B groups were similar(P >0.05). In group A, the final pathologic examination revealed renal cell carcinoma in 24 (clear cell carcinoma in 18 , chromophobe carcinoma in 1 ) and angiomyolipoma of kidney in 1 .In group B, the pathologic type was renal cell carcinoma (included 29 cases of clear cell carcinoma , 1 case of chromophobe carcinoma ) .No patient in two groups had a positive surgical margin. Cancer control was similar between both groups.2 NephroureterectomyPatients in the C group had significantly less mean blood loss(120ml vs 248.2ml,p=0.022), less volume of drain(153.9ml vs 246.4ml,p=0.034),earlier resumption of oral intake(2.9d vs 3.6d,p=0.019) ,earlier out-of-bed activity(6.2d vs 9.2d,p=0.0001) and required fewer anodyne (all P < 0.05).But the operative times(150.6min vs 182.7min,p=0.134) ,days of postoperative hospitalization(16.4d vs 11.4d,p=0.341)and follow-up periods(14.1m vs 18.2m,p=0.292) in the C and D groups were similar(P >0.05). In group C, the final pathologic examination revealed upper urinary tract transitional cell carcinoma(TCC) in 9(TCC of renal pelvis in4;TCC with sarcomatoid carcinoma of renal pelvis in 1; multiple TCC of renal pelvis and ureter in 4). In group D, the pathologic type was TCC (TCC of renal pelvis in 5; multiple TCC of renal pelvis and ureter in 6).No patient in two groups had a positive surgical margin. Cancer control was similar between both groups.Conclusions The results showed that hand-assisted laparoscopy is a safe, effective, minimally invasive alternative surgical technique for renal carcinoma and provides less blood loss, faster recovery compared with open surgery.