Laparoendoscopic single-site versus conventional laparoscopic radical nephrectomy for renal cell cancer in patients with
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ORIGINAL ARTICLE
Laparoendoscopic single-site versus conventional laparoscopic radical nephrectomy for renal cell cancer in patients with increased comorbidities and previous abdominal surgery: preliminary results of a single-centre retrospective study Christopher Springer • Antonino Inferrera • Felix Kawan • Andre´ Schumann • Paolo Fornara Francesco Greco
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Received: 30 July 2012 / Accepted: 30 November 2012 / Published online: 16 December 2012 Springer-Verlag Berlin Heidelberg 2012
Abstract Objective Laparoendoscopic single-site surgery (LESS) represents an evolution of laparoscopy for the treatment for urologic diseases. The aim of this study is to investigate the feasibility of LESS in patients with increased comorbidities and previous abdominal surgery undergoing radical nephrectomy (LESS-RN) for renal cell carcinoma. Materials and methods A total of 25 patients with increased comorbidities and previous abdominal surgery who underwent LESS-RN were compared to 31 patients with the same characteristics after conventional laparoscopic radical nephrectomy (LRN). LRN was performed between January 2009 and May 2010, and LESS-RNs were performed between June 2010 and November 2011. Demographic data and perioperative and postoperative variables were recorded and analysed. Results •
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The mean ASA score in the LESS-RN and LRN groups was 3.2 ± 0.4, and the mean BMI was 32.7 ± 2.1 and 34.2 ± 0.8 kg/m2, respectively. The mean operative time in the LESS-RN and LRN groups was 143.7 ± 24.3 and 130.6 ± 26.5 min, (p = 0.11), and the mean hospital stay was 3.8 ± 0.8 versus 4.2 ± 1.4 days in the two groups (p = 0.06), respectively. Three and four complications were recorded in the LESS-RN and in the LRN groups, for a mean
C. Springer A. Inferrera F. Kawan A. Schumann P. Fornara F. Greco (&) Department of Urology and Kidney Transplantation, Martin-Luther-University, Ernst-Grube-Strasse 40, 06120 Halle, Saale, Germany e-mail: [email protected]
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complication rate of 12 and 12.9 % (p = 0.12), respectively All tumours were organ-confined with negative surgical margins, and the mean R.E.N.A.L nephrometry score for LESS-RN and LRN was 9.78 ± 1.7 and 9.82 ± 1.3 (p = 0.14), respectively.
Conclusions LESS-RN in patients with increased comorbidities and previous abdominal surgery is equally effective as LRN without compromising on surgical, oncologic short-term and postoperative outcomes. Keywords Laparoendoscopic single-site surgery Laparoscopy Outcomes Renal cell carcinoma Risk factors
Introduction The advent of laparoscopic surgery has all greatly influenced urologic surgery, resulting in smaller incisions, reduction in tissue injury and less blood loss. Decreased perioperative stress is particularly important when performing oncologic surgery as exacerbated activation or reactive suppression of the immune system might affect tumour growth and dissemination [1, 2]. Recent developments in laparoscopy have been aimed at further reducing morbidity and improving the cosmetic outcome. These developme
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