18
Views
5
CrossRef citations to date
0
Altmetric
Article

Prospective randomized trial comparing high lumbotomic with laparotomic access in renal cell carcinoma surgery

, , , , &
Pages 306-314 | Received 17 Jul 2003, Accepted 22 Jan 2004, Published online: 09 Jul 2009
 

Abstract

Objective: We compared laparotomic with lumbotomic access in renal cell carcinoma (RCC) surgery by means of a prospective randomized trial, in order to evaluate differences in surgical time, blood loss, number of lymph nodes removed, duration of postoperative ileus and hospitalization, perioperative complications and progression‐free and cancer‐specific survival rates.

Material and Methods: Between November 1991 and November 1996, 94 patients with RCC were recruited and randomly assigned to undergo surgery by lumbotomic (n = 50) or laparotomic (n = 44) access. All patients underwent radical nephrectomy and lymph node dissection.

Results: The mean surgical time was 59.1 min (range 20–140 min) and 84.4 min (range 40–180 min) for lumbotomic and laparotomic access, respectively (p < 0.01). Blood loss was 502 ml (range 200–1800 ml) for lumbotomic and 648 ml (range 200–2000 ml) for laparotomic access (p < 0.005). Mean hospital stay was 6.8 days (range 3–13 days) for lumbotomic and 8.2 days (range 5–15 days) for laparotomic access (p < 0.001). The perioperative complication rates were 6.1% and 13.6% for lumbotomic and laparotomic access, respectively. After a mean follow‐up period of 7.5 years, cancer‐specific and progression‐free survival rates were 88% and 75%, respectively for lumbotomic and 88% and 72.7%, respectively for laparotomic access (p = NS). Multivariate analysis of risk factors showed that pathological stage was the best prognostic indicator of tumor progression, while other variables (age, tumor grade, surgical access, tumor size and incidental diagnosis of tumor) were not predictive of the prognosis of patients with RCC.

Conclusions: During radical nephrectomy, control of the renal vessels is easier and faster with high lumbotomic access. The suggested risk of tumor cell spread due to manipulation of the kidney before vessel ligature was not confirmed in our study. Because of the shorter surgical time, lower blood loss, lower perioperative and late complication rates and shorter hospital stay involved, lumbotomic access should be preferred to laparotomic access in radical nephrectomy for RCC.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.