Influence of surgical approach on enhanced recovery after surgery in laparoscopic radical nephrectomy

Abstract

Background. Аdvantages of the retroperitoneal approach, successfully applied in some clinics, but only a few studies on direct comparison of laparoscopic and retroperitoneoscopic radical nephrectomy.The study objective: to compare transperitoneal and retroperitoneal access during laparoscopic radical nephrectomy.Materials and methods. The study included 332 patients who underwent laparoscopic radical nephrectomy for renal cell carcinoma T1a–T3b. Transperitoneal access – 134, retroperitoneal – 198.Results. The mean time of laparoscopic radical nephrectomy, as well as the time before clipping of the renal artery were significantly less in retroperitoneal access (161 ± 59 and 30 ± 24 min, respectively, compared with 178 ± 65 and 38 ± 39 min – with transperitoneal). The number of removed lymph nodes, and the number of patients detected with “positive” lymph nodes, and death from progression of disease was not significantly different between the groups transperitoneal and retroperitoneal access with an average follow-up period, 42.5 and 47.8 months respectively.Conclusion. Despite the lower popularity retroperitoneal access, the method has advantages in enhanced recovery after surgery (ERAS), particular frequency of general perioperative complications, duration of epidural anesthesia, time of normalization of bowel function and length of hospital stay compared with transperitoneal access. The method is preferred for the old age and patients with comorbidity, especially of the cardiovascular system and respiratory organs.