Safety and feasibility of laparoscopic nephrectomy for big tumors •10 cm: a retrospective multicentric studyReportar como inadecuado

Safety and feasibility of laparoscopic nephrectomy for big tumors •10 cm: a retrospective multicentric study - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

* Corresponding author 1 Service d-urologie 2 IGDR - Institut de Génétique et Développement de Rennes 3 Service d-anatomie et cytologie pathologiques Rennes 4 Hôpital Bicêtre 5 Division of Molecular Biology 6 Service d-urologie 7 University of West Bohemia Plzeň 8 Charles University Hospital 9 Ege University 10 CHU Nantes 11 CHU Caen 12 CHU Cochin APHP 13 Service d-urologie et transplantation rénales CHU Pitié-Salpétrière 14 Service d-urologie, andrologie et transplantation rénale 15 ICG ICMMM - Institut Charles Gerhardt - Institut de Chimie Moléculaire et des Matériaux de Montpellier 16 CHU Limoges 17 CHU Lyon sud 18 Applications des ultrasons à la thérapie 19 Service d-urologie Mondor 20 IMRB - Institut Mondor de Recherche Biomédicale 21 Samaritan Medical Center

Abstract : ObjectiveEvaluate the feasibility of laparoscopic nephrectomy LN for big tumors.Material & MethodsData from 116 patients were retrospectively collected from 16 tertiary centres. Clinical and operative parameters, tumor characteristics, per and post operative parameters and renal function before and after surgery were analyzed.ResultsMean age and BMI were 61 y.o and 27.8 kg-m2, respectively. Males represented 63.8% and 54.4% presented symptoms at diagnosis. Median tumor size was 11 cm and 75% of the cases were performed by expert surgeons. Median operative time and blood loss were 180 min and 200ml respectively. Conversion to open surgery was necessary in 20.7%. Intra operative complications related to massive haemorrhage occurred in 16.4%, resulting in open conversion in 62.5%. Major postoperative complications occurred in only 10 patients 8.6%. In univariate analysis, intra operative complications, age and blood loss were predictive factors of conversion to open surgery. Positive surgical margins occurred in 6 patients 5.2%. None of them presented a local recurrence. Predictive factors of recurrence or progression were lymph node invasion, metastases and Furhman grade.ConclusionLN for tumors>10 cm can be performed safely. Complication rate and positive surgical margins are similar to open surgery. In experienced hands, the benefit of a mini invasive surgery remains evident.

Keywords : renal failure laparoscopy renal cell carcinoma kidney cancer

Autor: Grégory Verhoest - Jean-Philippe Couapel - Emmanuel Oger - Nathalie Rioux-Leclercq - Géraldine Pignot - Jean-Jacques Patard - A



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