Long-term Results And Follow-up Of Laparoscopic Nephron Sparing Surgery For Renal Cell Carcinoma

Purpose: Because of the widespread use of ultrasound and CT scan, there is increasing number of asymptomatic, incidentally diagnosed mass lesions in the kidney. Laparoscopic nephron sparing surgery(LNSS) is a technique that is emerging as an attractive option for the treatment of renal tumors <4 cm. We investigate the clinical effects of nephron-paring surgery in renal cell carcinoma(RCC)patients in our hospitalMaterials and methods: 26 patients of renal cell carcinoma (RCC)were selected from the Urology department of second affiliated hospital of Zhejiang University College of medicine from January 2005 to August 2008. There were 15 male patients and 11 female with an average age of 47. The tumor diameter ranged from 1.3 to3.9 cm with a mean of 2.7cm. All the 26 cases were classified to have T₁ stage tumor. Pathological examination showed that 24 cases had clear cell carcinoma,and 2 had papillary renal cell carcinoma,and all the 26 with negative margin. All the 26 cases were examined by CTA before operation. 24 cases via retroperitoneal approach,and 2 via transperitoneal.19 cases with temporary hilar control and 7 cases without hilar clamping. Mean surgical time was 105min(85-130).Mean hospital stay after operation was 5.5d(3-7).All the cases were under interferon therapy after operation. After operation all the patients underwent abdominal CT,ultrasound,urine test and renal function examination regularly. Results: The operation was performed successfully in all the 26 patients. The mean follow-up was 20 months(6-50).All patients were underwent CTU or IVU examination,and the results showed that all the renal function were normal. Follow-up showed that all the 26 patients lived without tumor recurrence.Conclusions: Laparoscopic nephron sparing surgery is an effective and safe procedure for RCC patients under specific circumstances. It is selective for RCC patients with localized(<4.0 cm in diameter)unilateral tumor and a normal Contralateral kidney; however, it is imperative if the Contralateral kidney is functionally compromised or RCC exists in a solitary kidney.