Laparoscopic Radical Nephrectomy for Renal Masses 7 Centimeters or Larger

OBJECTIVE To report our operative experience and oncologic outcomes for the laparoscopic management of large renal tumors. METHODS All laparoscopic and hand-assisted laparoscopic radical nephrectomies performed at our institution were reviewed. Thirty patients with tumors >or=7cm and a pathologic diagnosis of renal cell carcinoma were included. RESULTS Mean operative time was 175.7+/-24.5 minutes, and mean estimated blood loss was 275.5+/-165.8 mL. No case required conversion to open radical nephrectomy. The mean hospital stay was 2.4+/-1.6 days. Four patients (13%) had minor complications. Of the 30 tumors, 18 were pathologic stage T2, 9 were stage T3a, 2 were stage T3b, and one was stage T4. At a mean follow-up of 30 months (range, 10 to 70), 22 patients (73%) were alive without evidence of recurrence, and 5 patients (17%) were alive with disease. One patient (3%) died of complications related to renal cell carcinoma, and 2 patients (7%) died from other causes. Overall survival was 90%, cancer-specific survival was 97%, and recurrence-free survival was 80%. CONCLUSION Laparoscopic radical nephrectomy for large tumors is a technically challenging operation. However, in experienced hands, it is a reasonable therapeutic option for the management of larger RCC neoplasms.