Comparison of retroperitoneal laparoscopic partial nephrectomy and radical nephrectomy for stage T1 renal cell carcinoma

doi:10.3877/cma.j.issn.1674-3253.2022.02.011

Abstract

Abstract:

Objective

To compare the efficacy of laparoscopic partial nephrectomy (LPN) and laparoscopic radical nephrectomy (LRN) in the treatment of stage T₁ renal cell carcinoma, and to analyze the risk factors of conversion to open surgery.

Methods

198 patients in the 983 Hospital were collected for the study. To compare the differences between the two surgical methods, the 102 patients were divided into LPN group and 96 patients into LRN group. To analyze the related risk factors, 17 patients were divided into open surgery group and 181 patients into non-open surgery group.

Results

(1) Compared with LRN group, LPN group had longer operation time and more blood loss, but shorter exhaust time, less drainage and lower VAS score (P<0.05). (2) There were 2 patients with T_1bN₀M₀ stage in each group. The serum creatinine level in LRN group was significantly higher than that in LPN group at 1, 3, 6 and 12 months after operation (P<0.05). (3) Overall survial (OS) of LPN group and LRN group were 95.1% and 96.9%, Disease free survival (DFS) were 91.2% and 93.8% respectively. There was no significant difference in DFS and OS between the two groups. (4) BMI, history of abdominal surgery and diameter of tumors were independent risk factors for conversion to open surgery (P<0.05).

Conclusion

Compared with LRN group, LPN can protect renal function better. Risk factors that may lead to conversion to open surgery should be more fully assessed.

Key words: Renal carcinoma, Retroperitoneal laparoscopy, Disease-free survival, Overall survival, Nephrectomy

Kaijun Tong, Dazhen Liu, Kunlong Tang, Changhai Yang. Comparison of retroperitoneal laparoscopic partial nephrectomy and radical nephrectomy for stage T₁ renal cell carcinoma[J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(02): 142-146.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2022.02.011

https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2022/V16/I02/142

Figures/Tables 6

References 16

[1]	Shao P, Li J, Qin C, et al. Laparoscopic radical nephrectomy and inferior vena cava thrombectomy in the treatment of renal cell carcinoma[J]. Eur Urol, 2015, 68(1): 115-122.
[2]	Tonyali S, Koni A, Yazici S, et al. The safety and efficacy of adjuvant hemostatic agents during laparoscopic nephron-sparing surgery: comparison of tachosil and floseal versus no hemostatic agents[J]. J Urol, 2017, 15(1): 21-25.
[3]	Novick AC. Nephron-sparing surgery for renal cell carcinoma[J]. Annu Rev Med, 2002, 53(3): 393-407.
[4]	董毅, 王正, 王辉, 等. 肾部分切除术与根治性肾切除术治疗老年cT1~2期肾肿瘤围手术期指标及肾功能随访分析[J]. 中华泌尿外科杂志, 2019, 40(5): 351-355.
[5]	熊三钞, 邵彦翔, 胡旭, 等. 伴远处转移T1期肾癌原发灶行减瘤性肾部分切除术与减瘤性根治性肾切除术的生存分析[J]. 四川大学学报（医学版），2020, 51(4): 546-551.
[6]	Lenis AT, Salmasi AH, Blumberg J, et al. Trends in usage of cytoreductive partial nephrectomy and effect on overall survival in patients with metastatic renal cell carcinoma[J]. Urol Oncol, 2018, 36(2): 1233-1236.
[7]	那彦群, 叶章群, 孙光, 等. 中国泌尿外科疾病诊断治疗指南手册(201l版)[M]. 北京: 人民卫生出版社, 2011: 10-19．
[8]	王林辉, 时佳子. 肾癌肾部分切除术的指征应该怎么把握[J]. 中华泌尿外科杂志, 2018, 39(6): 403-406.
[9]	杨风光, 黄超, 吴翔. 开放和后腹腔镜肾部分切除术治疗老年T1b期肾癌的临床疗效[J]. 中国老年学杂志, 2019, 39(6): 1343-1347.
[10]	罗敏, 罗欢, 蔡春明, 等. 经腹入路和经腹膜后入路机器人辅助腹腔镜肾部分切除术的医护配合[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2020, 14(6): 430-433.
[11]	Wang W, Xu J, Adams TS, et al. Pure retroperitoneal laparoscopic radical nephrectomy for left renal cell carcinoma with differential extensions of level I renal vein tumor thrombus[J]. J Endourol, 2014, 28(3): 312-317.
[12]	Keehn A, Maiman R, Agalliu I, et al. Outcomes and management considerations in patients on dialysis undergoing laparoscopic radical nephrectomy for renal-cell carcinoma[J]. J Endourol, 2014, 29(6): 691-695.
[13]	Saranchuk JW, Savage SJ. Laparoscopic radical nephrectomy: current status[J]. BJU Int, 2015, 95(s2): 21-26.
[14]	Liatsikos E, Kallidonis P, Do M, et al. Laparoscopic radical and partial nephrectomy: technical issues and outcome[J]. World J Urol, 2013, 31(4): 785-791.
[15]	Garzon S, Raffaelli R, Montin U, et al. Primary hepatic pregnancy: report of a case treated with laparoscopic approach and review of the literature[J]. Fertil Steril, 2018, 110(5): 925-931.
[16]	Polo G, Crouzet S, Poissonnier L, et al. Partial versus radical nephrectomy for renal cell carcinoma involving peri renal fat. Oncological and functional outcomes[J]. Prog Urol, 2012, 22(7): 388-396.

组别	例数	性别(例)		高血压(例)	糖尿病(例)	高脂血症(例)	腹部手术史(例)	肿瘤位置(例)			年龄[岁，(±s)]	BM[kg/m²，(±s)]	肿瘤直径[cm，(±s)]
组别	例数	男	女	高血压(例)	糖尿病(例)	高脂血症(例)	腹部手术史(例)	上极	中极	下极	年龄[岁，(±s)]	BM[kg/m²，(±s)]	肿瘤直径[cm，(±s)]
LPN组	102	79	23	10	8	6	10	90	3	9	49±6	23.4±2.6	2.9±1.3
LRN组	96	67	29	13	6	5	7	88	1	7	49±5	22.9±2.8	2.7±1.1
统计值		χ²=1.498		χ²=0.673	χ²=0.191	χ²=0.043	χ²=0.398	χ²=0.641			t=0.728	t=1.373	t=1.126
P值		0.221		0.412	0.662	0.836	0.528	0.423			0.233	0.085	0.131

组别	例数	性别(例)		高血压(例)	糖尿病(例)	高脂血症(例)	腹部手术史(例)	肿瘤位置(例)			年龄[岁，(±s)]	BM[kg/m²，(±s)]	肿瘤直径[cm，(±s)]
组别	例数	男	女	高血压(例)	糖尿病(例)	高脂血症(例)	腹部手术史(例)	上极	中极	下极	年龄[岁，(±s)]	BM[kg/m²，(±s)]	肿瘤直径[cm，(±s)]
LPN组	102	79	23	10	8	6	10	90	3	9	49±6	23.4±2.6	2.9±1.3
LRN组	96	67	29	13	6	5	7	88	1	7	49±5	22.9±2.8	2.7±1.1
统计值		χ²=1.498		χ²=0.673	χ²=0.191	χ²=0.043	χ²=0.398	χ²=0.641			t=0.728	t=1.373	t=1.126
P值		0.221		0.412	0.662	0.836	0.528	0.423			0.233	0.085	0.131

组别	例数	手术时间(min)	术中出血量(ml)	引流管时间(d)	住院时间(d)	排气时间(d)	术后引流量(ml)	术后VAS评分
LPN组	102	112±3	76±3	3.9±0.9	7.0±0.8	3.4±1.0	32±9	2.7±1.0
LRN组	96	107±3	74±3	3.7±0.9	6.9±0.3	4.6±1.1	54±10	4.2±1.8
t值		11.446	5.922	1.572	1.403	-7.598	-17.399	-7.446
P值		<0.001	<0.001	0.118	0.162	<0.001	<0.001	<0.001

组别	例数	手术时间(min)	术中出血量(ml)	引流管时间(d)	住院时间(d)	排气时间(d)	术后引流量(ml)	术后VAS评分
LPN组	102	112±3	76±3	3.9±0.9	7.0±0.8	3.4±1.0	32±9	2.7±1.0
LRN组	96	107±3	74±3	3.7±0.9	6.9±0.3	4.6±1.1	54±10	4.2±1.8
t值		11.446	5.922	1.572	1.403	-7.598	-17.399	-7.446
P值		<0.001	<0.001	0.118	0.162	<0.001	<0.001	<0.001

组别	例数	病理类型(例)		分期(例)		肌酐[mmol/L，(±s)]
组别	例数	透明细胞癌	非透明细胞癌	T_1aN₀M₀	T_1bN₀M₀	术前	术后1月	术后3月	术后6月	术后12月
LPN组	102	95	7	100	2	80.44±4.33	94.74±5.81	92.60±5.41	87.87±5.42	84.05±3.47
LRN组	96	91	5	94	2	79.98±3.97	107.07±4.05	103.84±3.42	99.32±3.53	96.28±4.82
统计值		χ²=0.238		χ²=0.004		t=0.777	t=-17.223	t=-17.351	t=-17.497	t=-20.579
P值		0.626		0.951		0.438	<0.001	<0.001	<0.001	<0.001

Please choose a citation manager

Content to export

Comparison of retroperitoneal laparoscopic partial nephrectomy and radical nephrectomy for stage T₁ renal cell carcinoma

RichHTML

PDF (PC)

Knowledge

Cited

Abstract

Cite this article

share this article

Figures/Tables 6

References 16

Related Articles 15

Recommended Articles

Metrics

Comments

指标	β	SE	Wald	P	OR	95%CI
BMI	0.64	0.29	5.74	0.01	1.95	1.074~3.348
腹部手术史	2.41	1.14	4.47	0.05	12.84	1.192~104.001
肿瘤直径	0.69	0.39	3.42	0.08	2.41	0.928~4.282

[1]	Hongtao Jia, Qingqiang Ni, Zetao Yu, Jun Lu, Hong Chang. Treatment and prognosis of spontaneous rupture hemorrhage of liver cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(04): 408-412.
[2]	Limin Shang, Mengmeng Zheng, Zhipeng Wang, Yang Yang, Wen Sun, Lei Zhang, Yichen Zhu. Learning curve of modified hand-assisted retroperitoneoscopic living donor nephrectomy [J]. Chinese Journal of Transplantation(Electronic Edition), 2022, 16(05): 285-291.
[3]	Jiahui Zhao, Yongxing Wang, Tao Peng, Mingchuan Li, Dechao Wei, Yili Han, Zhu Hou, Yongguang Jiang, Yong Luo. Risk factors of prolonged operation time and higher intraoperative blood loss in retroperitoneal laparoscopic radical nephrectomy [J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(06): 575-580.
[4]	Xiang Dong, Wenliang Ma, Changwei Ji, Xiaogong Li, Gutian Zhang, Weidong Gan, Hongqian Guo. A retrospective study to assess the pseudocapsule status of renal cell carcinomas and their influencing factors [J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(04): 356-360.
[5]	Qi Liu, Hong Zeng, Zixin Xu, Chao Fang, Ming Huang, Junjiong Zheng, Shaoxu Wu, Guangzheng Zhong, Tianxin Lin, Jian Huang, Wen Dong. Clinical diagnosis, treatment and prognosis analysis of papillary renal cell carcinoma in a single center with 11-year experiences [J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(04): 351-355.
[6]	Guojun Tang, Yude Hong, Chongyu Zhao, Liaoyuan Li. A novel prognosis model for papillary renal cell carcinoma based on Wnt-associated lncRNAs in TCGA database [J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(03): 270-275.
[7]	Ran Zhuo, Yiqi Zhu, Yanwen Lu, Wenliang Ma, Hongqian Guo, Weidong Gan. Impact of gender in clinicopathological features of Xp11.2 translocation renal cell carcinoma and clear cell renal cell carcinoma [J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(02): 105-109.
[8]	Yuming Liu, Wenwen Zhong, Hu Qu, Dejuan Wang, Jianguang Qiu. Application of aspirator blowing method in laparoscopic partial nephrectomy [J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(01): 50-53.
[9]	Sugui Wang, Genwu Hu, Fujin Jiang, Qiang Li, Ziyu Wu, Xianyun Zhang. Clinical application of perirenal fat Mayo adhesion probability (MAP) score system in retroperitoneal laparoscopic partial nephrectomy for renal cell carcinoma [J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(05): 404-407.
[10]	Jiansong Wang, Jianjun Luo, Xuecheng Wu, Ke Yang, Zhiyong Gao. Laparoscopic partial nephrectomy for reninoma: three cases report and review of the literature [J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(04): 364-366.
[11]	Yonglu Zhao, Xingsheng Zhang, Guangzhi Song, Bin Huang, Bin Zhang, Pengshou Gu, Guogan Liu. Prognostic value of transurethral secondary electrotomy in pT₁ stage non-muscular invasive bladder cancer [J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(04): 316-319.
[12]	Heqian Liu, Lingsong Tao, Jiawei Wang, Yisheng Chen, Bin Zou, Xudong Shen. Positive impact of new treatment strategy of renal pedicle on shortening the learning curve of retroperitoneoscopic radical nephrectomy [J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(02): 147-150.
[13]	Jiahui Zhao, Yong Luo, Yongxing Wang, Tao Peng, Mingchuan Li, Dechao Wei, Yili Han, Zhu Hou, Yongguang Jiang. Factors associated with complications and prolonged hospital stay after retroperitoneal laparoscopic radical nephrectomy [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2022, 15(03): 181-186.
[14]	Sugui Wang, Yan Qiao, Liyuan Huang, Ziyu Wu, Xianyun Zhang, Fujin Jiang, Qiang Li. Clinical application of renal tumor invasion index in laparoscopic partial nephrectomy for renal cancer [J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(12): 1229-1233.
[15]	Shijin Liu, Yiran Zhang, Hui Ding, Xiaoxu Zhao, Yunlong Pan. Metabolic syndrome and telomere status in the prognosis of patients with colorectal cancer [J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2022, 08(04): 231-235.

组别	例数	性别(例)		高血压(例)	糖尿病(例)	高脂血症(例)	腹部手术史(例)	手术方式(例)		肿瘤位置(例)			年龄[岁，(±s)]	BMI[kg/m²，(±s)]	肿瘤直径[cm，(±s)]
组别	例数	男	女	高血压(例)	糖尿病(例)	高脂血症(例)	腹部手术史(例)	保留肾单位	根治性肾切除	上极	中极	下极	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	肿瘤直径[cm，(±s)]
非中转组	181	134	47	17	10	8	7	93	88	168	3	10	49±6	22.6±2.8	2.7±1.4
中转组	17	12	5	6	4	3	10	9	8	10	1	6	52±6	26.7±1.9	3.8±1.1
统计值		χ²=0.095		χ²=10.155	χ²=7.667	χ²=5.182	χ²=59.799	χ²=0.015		χ²=20.414			t=-2.362	t=-5.905	t=-3.017
P值		0.758		0.001	0.006	0.023	0.000	0.902		0.000			0.019	0.000	0.003

组别	例数	性别(例)		高血压(例)	糖尿病(例)	高脂血症(例)	腹部手术史(例)	手术方式(例)		肿瘤位置(例)			年龄[岁，(±s)]	BMI[kg/m²，(±s)]	肿瘤直径[cm，(±s)]
组别	例数	男	女	高血压(例)	糖尿病(例)	高脂血症(例)	腹部手术史(例)	保留肾单位	根治性肾切除	上极	中极	下极	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	肿瘤直径[cm，(±s)]
非中转组	181	134	47	17	10	8	7	93	88	168	3	10	49±6	22.6±2.8	2.7±1.4
中转组	17	12	5	6	4	3	10	9	8	10	1	6	52±6	26.7±1.9	3.8±1.1
统计值		χ²=0.095		χ²=10.155	χ²=7.667	χ²=5.182	χ²=59.799	χ²=0.015		χ²=20.414			t=-2.362	t=-5.905	t=-3.017
P值		0.758		0.001	0.006	0.023	0.000	0.902		0.000			0.019	0.000	0.003

模态框（Modal）标题

Please choose a citation manager

Content to export