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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 ≤4 cm in diameter. The scope of partial nephrectomy, however, is expanding, and now includes patients with organ-confined renal tumors of ≤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.

Key Points

  • Surgery provides the only chance of cure for patients with renal cell carcinoma, and the type of surgery offered to patients is dependent on the size, location and stage of the tumor, and the general condition of the patient

  • Compared to open radical nephrectomy, laparoscopic radical nephrectomy offers patients improved postoperative morbidity, shorter hospital stay and recovery time, and decreased need for analgesia

  • Laparoscopic radical nephrectomy is the standard treatment of renal tumors >4 cm in size, of clinical stage T1–2 N0 M0, and can be performed in some T3 tumors (depending on the clinical evaluation of the patient and Sargon's experience); for large tumors a transperitoneal approach is both easier and safer than a retroperitoneal approach

  • Laparoscopic partial nephrectomy performed under ischemia is feasible and effective for the treatment of organ-confined renal tumors of ≤4 cm in diameter

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Correspondence to Günter Janetschek.

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Albqami, N., Janetschek, G. Indications and contraindications for the use of laparoscopic surgery for renal cell carcinoma. Nat Rev Urol 3, 32–37 (2006). https://doi.org/10.1038/ncpuro0384

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  • DOI: https://doi.org/10.1038/ncpuro0384

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