Title : Clinical outcome analysis of laparoscopic transperitoneal radical nephrectomy for large renal tumors
Abstract:
Background and Aims:
Laparoscopic nephrectomy is now accepted for the treatment of large renal tumors given that it is less invasive and can significantly improve patient prognosis. The surgical approaches of laparoscopic radical nephrectomy include transperitoneal approach and retroperitoneal approach, but the efficacy of these two surgical approaches is controversial. The aim of this study was to evaluate the safety and efficacy of transperitoneal laparoscopic radical nephrectomy for large renal tumors.
Methods:
This study retrospectively analyzed the clinical information of patients with large renal cancer (>7 cm) who underwent laparoscopic radical nephrectomy for renal cancer from January 2014 to December 2020 in our hospital. A total of 168 patients were included in this study, including 73 cases of transperitoneal approach (transperitoneal group, T group) and 95 cases of retroperitoneal approach (retroperitoneal group, R group). In this study, we compared the clinical and pathologic information of the patients and also performed a propensity score matching between the two groups based on the baseline information. We analyzed the perioperative recovery and postoperative C-reactive protein (CRP) and interleukin-1β (IL-1β) levels, and followed up the patients.
Results:
Compared with the R group, the T group had a higher proportion of patients aged >60 years (P=0.013), a higher proportion of males (P=0.023), and a higher proportion of patients with comorbidities (P=0.034). We performed propensity score matching, and 61 pairs of patients reached the matching of basic information. There was no significant difference between the matched two groups (PR Group and PT Group) of patients in terms of operative time, time to intestinal function recovery, and intraoperative blood loss. However, the postoperative time to discharge was longer for patients in the PT Group than for patients in the PR Group. Postoperative CRP and IL-1β levels were elevated in both groups compared with preoperative levels, with no significant difference between the groups. The follow-up results showed that the mean overall survival and progression-free survival were 19.3 months and 17.0 months in the PT group and 18.1 months and 16.8 months in the PR group, respectively, with no significant difference between the two groups.
Conclusion:
Transperitoneal radical resection is efficacious in the treatment of large renal tumors, with no significant difference in safety and efficacy from retroperitoneal laparoscopic radical resection, and is more suitable for elderly patients or patients with complications.
Keywords:laparoscopic, transperitoneal, radical nephrectomy ,large renal tumors
