Safety and Feasibility of Laparoscopic Nephrectomy for Big Tumors (≥ 10 cm): A Retrospective Multicentric Study

ObjectiveEvaluate the feasibility of laparoscopic nephrectomy (LN) for big tumors.Material u0026 MethodsData from 116 patients were retrospectively collected from 16 tertiary centres. Clinical and operative parameters, tumor characteristics, per and post operative parameters and renal function before and after surgery were analyzed.ResultsMean age and BMI were 61 y.o and 27.8 kg/m2, respectively. Males represented 63.8% and 54.4% presented symptoms at diagnosis. Median tumor size was 11 cm and 75% of the cases were performed by expert surgeons. Median operative time and blood loss were 180 min and 200ml respectively. Conversion to open surgery was necessary in 20.7%. Intra operative complications related to massive haemorrhage occurred in 16.4%, resulting in open conversion in 62.5%. Major postoperative complications occurred in only 10 patients (8.6%). In univariate analysis, intra operative complications, age and blood loss were predictive factors of conversion to open surgery. Positive surgical margins occurred in 6 patients (5.2%). None of them presented a local recurrence. Predictive factors of recurrence or progression were lymph node invasion, metastases and Furhman grade.ConclusionLN for tumorsu003e10 cm can be performed safely. Complication rate and positive surgical margins are similar to open surgery. In experienced hands, the benefit of a mini invasive surgery remains evident.