Indications and contraindications for the use of laparoscopic surgery for renal cell carcinoma

Abstract

Surgery remains the only treatment with a chance of cure for renal cell carcinoma. Laparoscopic radical nephrectomy (LRN) has developed to be a standard treatment for the management of suspected renal malignancy in many centers worldwide, with oncologic efficacy equal to that of open radical nephrectomy. LRN has considerable advantages over open surgery, such as decreased postoperative morbidity, decreased analgesic requirements, and shorter hospital stay and convalescence. Current indications for LRN include all patients with localized stage T1-2 renal tumors. LRN for stage T3 renal tumors may be technically feasible in individual situations, but cannot be considered standard treatment. Open radical nephrectomy is reserved for advanced renal tumors, according to the surgeon's judgment. Partial nephrectomy is well established and considered to be the standard management for all organ-confined tumors of <or=4 cm in diameter. The scope of partial nephrectomy, however, is expanding, and now includes patients with organ-confined renal tumors of <or=7 cm. Laparoscopic partial nephrectomy is a continuously evolving technique. Continuing developments allow the experienced laparoscopist to use laparoscopic surgery for virtually all patients who are eligible for elective partial nephrectomy. This review evaluates the current indications and contraindications for laparoscopic radical and partial nephrectomy.

Effects of Open versus Laparoscopic Nephrectomy Techniques on Oxidative Stress Markers in Patients with Renal Cell Carcinoma

“…Since its introduction, laparoscopic radical nephrectomy has been established as a standard care for the surgical management of localized renal cell carcinoma [5, 6]. Laparoscopic surgery seems to have considerable advantages over open surgery, such as decreased blood loss, decreased postoperative pain, and less morbidity, as well as shorter hospital stay [7–9]. However, laparoscopy requires special skills using unfamiliar devices, and there is a limited pool of urologist, trained in laparoscopy [6, 9].…”

Outcomes of open partial nephrectomies performed by Australian trainees

“…The smaller incisions associated with minimally invasive PN have further reduced morbidity . Previously, patient factors such as morbid obesity, previous renal surgery, deep vein thrombosis, severe cardiovascular disease and uncontrolled bleeding diathesis were initially considered relative contra‐indications to an LPN, often requiring an open approach. However, with advances in technology, robotics, image processing and specialist equipment in minimal access surgery, these factors no longer prohibit minimal access techniques.…”

“…With minimal access PN becoming the standard of care for small renal tumours in Australia, the opportunity for trainees to gain experience and skills in open renal surgery is limited. However, in a small cohort of patients, minimally invasive PN may not be an appropriate or feasible technique because of specific patient and tumour factors . In such cases, OPN is an acceptable approach, despite the increased morbidity associated from a larger loin incision.…”

Aktuelle chirurgische Aspekte des Nierenzellkarzinoms

“…Die Limitationen der Laparoskopie werden einerseits durch die Größe und Lokalisation des Tumors bestimmt [17]. Eine absolute Obergrenze hinsichtlich der Tumorgröße existiert nicht, die Indikation zur Laparoskopie muss nach Durchsicht der Bildgebung und in Abhängigkeit von der eigenen Expertise gestellt werden.…”