[The application of retroperitoneal laparoscopic nephron-sparing surgery in stage T(1b) renal cell carcinoma]

Objective: To investigate the safety and feasibility of retroperitoneal laparoscopic nephron-sparing surgery (NSS) in stage T(1b) renal cell carcinoma (RCC) patients . Methods: Between March 2014 and June 2017, 52 stage T(1b) RCC cases (36 males, 16 females) treated with retroperitoneal laparoscopic NSS in Zhongshan Hospital and Central Hospital of Minhang District were enrolled and retrospectively analyzed, with a tumor size range of 4.0 to 6.8 cm, and a mean size of(4.7±0.45)cm.The anatomic characteristics of tumors, operative time, intra-operative blood loss, warm ischemia time, intra- and post-operative complications, length of hospital stay, and oncological outcomes were reviewed. Results: Only 2 cases converted to open surgery due to uncontrollable bleeding in operation. The rest 50 cases successfully underwent retroperitoneal laparoscopic NSS, with mean operative time of (122±20.86) min (range: 100-220 min), mean blood loss of (140±128.85)ml (range: 50-800 ml), mean warm ischemia time of (30±3.52)min (range: 25-42 min), pre-operative mean serum creatinine of (100±23.54)μmol/L (range: 65-148 μmol/L), mean serum creatinine three monthsafter operation of (104±30.84)μmol/L (range: 72-224 μmol/L), mean drainage of (180±82.33)ml (range: 80-550 ml), mean length of hospital stay after operation of (8±1.56)d (range: 5-15 d). There was no significant difference in renal function between pre- and post-operation (P=0.056). One patient suffered pulmonary embolism was cured conservatively. Fifty patients were followed up, among which 47 cases with malignant pathology were followed up for 3-29 months, and two of them suffered from pulmonary metastasis. Conclusions: After pre-operative comprehensive assessment of tumors, stage T(1b) renal cell carcinoma could be treated with retroperitoneal laparoscopic NSS safely.