We have compared the laparotomie (LAP) versus the lombotomic (LOM) access in the surgery of renal cell carcinoma (RCC) by a prospective randomized trial in order to observe differences in surgical time, blood loss, number of lymph nodes removed, lenght of postoperative ileus and hospitalization, perioperative complications and survival. Since novernber 1991 to november 1996 94 patients with a diagnosis of RCC were randomized. 49 in the group of LOM and 45 in the group of LAP. Exclusion criteria were: upper pole lesion exceeding 15cm of diameter, bilateral lesions, RCC in solitary kidney, metastatic RCC, caval thrombus, severe scheletal malformations, concomitant surgical pathology. All patients underwent radical nephrectomy e retroperitoneal lymph node dissection, including hylar and paraortic nodes for left-side tumor and hylar, paracaval and aortocaval nodes for right-side tumors. Surgical time has been 59.1 minutes (range 20-140) and 84.4 minutes (range 40-180) for LOM and LAP respectively (P<0.01). Mean lymph nodes removed were 12.8 and 17.5 for LOM and LAP respectively (P<0.05). Blood loss were 502 ml (range 200-1800) for LOM and 648 ml (range 200-2000) for LAP (P<0.005). Mean hospital stay has been 8 days (range 4-16) for LOM and 9.7 days (range 6-16) for LAP (P<0.001). Complication rate has been 6.1% and 15.6% for the LOM and LAP respectively. Four tumor progression and 3 cancer-related death in the LOM and 8 tumor progression and 4 cancer-related death were observed. Survival evaluated by Kaplan-Meier method and logrank test did not show difference in survival globally and separately by stage. Renal vessel control is easier and shorter through the LOM access even if there is a manipulation of renal loggia, suggesting the possibility of tumor ceil spread before vessel ligature is performed However, up to now, this study did not show difference in survival after nearly 3 years of follow-up. If these data will be confirmed by longer follow-up, the LOM access, because of shorter surgical time, minor blood loss, lower complication rate and hospital stay, should be the preferred access to the kidney for RCC not exceeding 15cm of diameter.
Prospective randomized trial comparing lombotomic versus laparotomic access in the surgery of renal cell carcinoma
DITONNO, Pasquale;BATTAGLIA, Michele;
1997-01-01
Abstract
We have compared the laparotomie (LAP) versus the lombotomic (LOM) access in the surgery of renal cell carcinoma (RCC) by a prospective randomized trial in order to observe differences in surgical time, blood loss, number of lymph nodes removed, lenght of postoperative ileus and hospitalization, perioperative complications and survival. Since novernber 1991 to november 1996 94 patients with a diagnosis of RCC were randomized. 49 in the group of LOM and 45 in the group of LAP. Exclusion criteria were: upper pole lesion exceeding 15cm of diameter, bilateral lesions, RCC in solitary kidney, metastatic RCC, caval thrombus, severe scheletal malformations, concomitant surgical pathology. All patients underwent radical nephrectomy e retroperitoneal lymph node dissection, including hylar and paraortic nodes for left-side tumor and hylar, paracaval and aortocaval nodes for right-side tumors. Surgical time has been 59.1 minutes (range 20-140) and 84.4 minutes (range 40-180) for LOM and LAP respectively (P<0.01). Mean lymph nodes removed were 12.8 and 17.5 for LOM and LAP respectively (P<0.05). Blood loss were 502 ml (range 200-1800) for LOM and 648 ml (range 200-2000) for LAP (P<0.005). Mean hospital stay has been 8 days (range 4-16) for LOM and 9.7 days (range 6-16) for LAP (P<0.001). Complication rate has been 6.1% and 15.6% for the LOM and LAP respectively. Four tumor progression and 3 cancer-related death in the LOM and 8 tumor progression and 4 cancer-related death were observed. Survival evaluated by Kaplan-Meier method and logrank test did not show difference in survival globally and separately by stage. Renal vessel control is easier and shorter through the LOM access even if there is a manipulation of renal loggia, suggesting the possibility of tumor ceil spread before vessel ligature is performed However, up to now, this study did not show difference in survival after nearly 3 years of follow-up. If these data will be confirmed by longer follow-up, the LOM access, because of shorter surgical time, minor blood loss, lower complication rate and hospital stay, should be the preferred access to the kidney for RCC not exceeding 15cm of diameter.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
