Retroperitoneal laparoscopic and open radical nephrectomy for T1 renal cell carcinoma.

OBJECTIVE: To evaluate the clinical therapeutic effects of retroperitoneal laparoscopic radical nephrectomy for T1 renal cell carcinoma (RCC).

METHODS: A total of 352 patients with T1 RCC underwent radical nephrectomy in our study, and they were randomly divided into two groups, including 185 cases of retroperitoneal laparoscopic radical nephrectomy and 167 cases of open radical nephrectomy through an extraperitoneal 11th rib flank incision. All operations were performed by the same platoon doctors. There were no statistically significant differences in age, sex ratio, tumor stage, and serum creatinine between the two groups. The operation time, blood loss during operation, hospital stay, and postoperative complications were analyzed and compared. All cases were followed up for 25 +/- 4 months (6-42 months) and the survival rates, wound healing, and carcinoma metastasis were recorded.

RESULTS: The operation time in retroperitoneal laparoscopic radical nephrectomy group versus open radical nephrectomy was 75.6 +/- 11.2 min (55-130 min) versus 68 +/- 10.6 min (50-140 min), without statistically significant difference (p > 0.05). The blood loss was 110.6 +/- 32.3 mL (50-1200 mL) versus 160.8 +/- 38.1 mL (50-1500 mL), with statistically significant difference (p < 0.05); narcotic was required in 8 cases versus 132 cases between the two groups (p < 0.05); the fasting period was 1.3 +/- 0.5 days (1-2 days) versus 2.9 +/- 1.2 days (2-5 days), and hospital stay was 4.6 +/- 1.2 days (3-7 days) versus 8.9 +/- 1.6 days (7-14 days), with statistically significant differences (p < 0.05).

CONCLUSIONS: Compared with open radical nephrectomy, retroperitoneal laparoscopic radical nephrectomy is associated with less blood loss, narcotic requirement, and complications; shorter hospital stay; and earlier resumption of routine activities. Therefore, retroperitoneal laparoscopic radical nephrectomy is a better therapy for T1 RCC.