Retroperitoneal laparoscopic radical nephrectomy and nephroureterectomy and comparison with open surgery

To compare the efficacy, safety and oncological completeness of retroperitoneoscopic radical nephrectomy (RPRN) and nephroureterectomy (RPRNU) with that of the open retroperitoneal approach for radical surgery for localised renal cell carcinoma and upper tract transitional cell carcinoma. Eighteen patients of RPRN, nine of RPRNU, 11 of open radical nephrectomy (ORN) and five patients who underwent open radical nephroureterectomy (ORNU) were evaluated. The groups were similar to each other. The mean operative times in the laparoscopic group were longer (147 and 188.7 min for RPRN and RPRNU vs 127.7 and 184 min for ORN and ORNU, respectively); however, the mean analgesic requirement (203.3 and 275 mg for RPRN and RPRNU vs 400 and 650 mg pethidine for ORN and ORNU, respectively), hospital stay (3.2 and 5.1 days for RPRN and RPRNU vs 7.6 and 9.2 days for ORN and ORNU, respectively) and return to normal activities (2 and 2 weeks in RPRN and RPRNU vs 4.3 and 4.6 weeks for ORN and ORNU, respectively) were lower in the retroperitoneoscopic group. Tumour-free margins could be achieved in all the cases. The mean duration of follow-up for RPRN and RPRNU was 17.7 and 15.0 months and for ORN and ORNU were 32.5 and 19.0 months, respectively. There was no port site or local recurrences. Distant metastasis developed in one case of RPRN and in two cases of RPRNU. The retroperitoneoscopic approach for a localised malignancy of the upper urinary tract appears to be effective and safe. An oncologically complete removal of the tumour is possible as in open surgery. The retroperitoneoscopic approach is associated with less morbidity and faster recovery.