Laparoscopic Radical Nephrectomy for Large Renal Masses: Critical Assessment of Perioperative and Oncologic Outcomes of Stage T2a and T2b Tumors

• DOI: 10.1016/j.urology.2011.10.065
• Publication Date: 2012-03-06T07:26:54Z
• Authors: Phillip M. Pieror...; Elias S. Hyams; Brian M. Lin; Jeffrey K. Mullins; Mohamad E. Allaf
• Keywords: Adult; Aged, 80 and over; Male; Adolescent; Middle Aged; Nephrectomy; Disease-Free Survival; Kidney Neoplasms; 3. Good health; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Humans; Female; Laparoscopy; Carcinoma, Renal Cell; Aged; Neoplasm Staging

To analyze the perioperative and oncologic outcomes of >7 cm renal tumors treated with laparoscopic radical nephrectomy (LRN) at a high-volume academic center. The indications for LRN have expanded to include larger (>7 cm) lesions.The Institutional Minimally Invasive Urologic Surgery Database (1994 to the present) was reviewed for patients undergoing LRN for >7-cm masses (American Joint Committee on Cancer clinical Stage T2N0M0).Of 200 patients, 138 (69.0%) had tumors >7.0-10 cm and 62 (31.0%) had tumors >10 cm. The patients with tumors >10 cm presented more often with symptoms, most often hematuria, and more often had high-grade tumors (68% vs 44%, P = .005). Also, a greater proportion were papillary renal cell carcinoma (23% vs 14%, P = .09) and were more often upstaged (21% vs 9%, P = .02). Of the 200 tumors, 74 (37%) were upstaged, 58 (29%) with perinephric extension and 26 (13%) with renal vein invasion. Larger tumors had greater blood loss on average (406 vs 288 mL, respectively, P = .1) and were converted to open surgery more often (13.8% vs 2.1%, P = .001). A total of 47 patients (22.3%) experienced a postoperative complication. The 5-year recurrence-free survival and cancer-specific survival rate was 62.4% and 92.9%, respectively. The significant predictors of recurrence-free survival in the multivariate model were clear cell histologic type, high Fuhrman grade, renal vein invasion, and perinephric extension. Of note, pT2b was not a predictor of recurrence.LRN can have favorable perioperative and oncologic outcomes for large (>7 cm) renal masses, with an open conversion rate and complication rate of 5% and 20%, respectively. Clear cell histologic features, high-grade tumors, renal vein invasion, and perinephric extension, but not tumor size, were poor prognostic indicators in this cohort.