ANZ J. Surg. 2005; 75: 593–596 ORIGINAL ARTICLE ORIGINAL ARTICLE ONCOLOGICAL OUTCOME OF 100 LAPAROSCOPIC RADICAL NEPHRECTOMIES FOR CLINICALLY LOCALIZED RENAL CELL CARCINOMA MAN-CHIU CHEUNG, YEE-MUN LEE, RAHUL RINDANI AND HOWARD LAU Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia Background: Laparoscopic renal surgery is now accepted within the urological community and its indication is extended to onco- logical operation. The oncological outcome and survival of patients undergoing laparoscopic radical nephrectomy for clinically localized renal cell carcinoma were evaluated. Methods: From October 1998 to July 2003, 100 patients underwent laparoscopic radical nephrectomy for clinically localized renal cell carcinoma. All operations were performed by transperitoneal approach with early vascular control. Perioperative events and pathological data were recorded prospectively. Patients were followed up by clinical examination, chest radiograph, ultrasonography and/or computed tomography where appropriate. Results: The median age of patients was 61 years. Median operating time was 120 min and blood loss was 100 mL. There were five open conversions. There was no perioperative mortality but 11 patients had complications. Resection margins were clear in all but one patient. The median tumour size was 4.6 cm. The median follow-up time was 30 months. All patients survived up to the date of review. No patient developed port-site recurrence but two patients had recurrence at the renal bed 1 year after the operation. Five patients developed distant metastases involving liver, lung and bone. Conclusion: Laparoscopic radical nephrectomy is a safe and efficacious treatment option for clinically localized renal cell carci- noma. The intermediate-term oncological outcome appears favourable. Key words: kidney, laparoscopy, minimally invasive surgery, nephrectomy, renal cancer. Abbreviations: LRN, laparoscopic radical nephrectomy; RCC, renal cell carcinoma INTRODUCTION Since the report of the first laparoscopic nephrectomy by Clayman et al. in 1991, 1 this procedure has become popular in the urology community. The advantages of better cosmesis, decreased analgesic requirement, short hospital stay, rapid con- valescence and return to work, and potential financial saving have been demonstrated. 2–5 The application of this technique to malignant renal tumours was not popular initially due to inade- quate long-term oncological results. Recently, several authors have reported long-term survival data that favour laparoscopic radical nephrectomy (LRN) as a standard treatment for T1 and T2 renal cell carcinoma (RCC). 6–9 Here we report the intermediate- term oncological outcome of 100 LRN for clinically localized RCC. METHODS From October 1998 to July 2003, 292 laparoscopic nephrec- tomies were performed by a single surgeon (HL). There were 58 simple nephrectomies, 77 donor nephrectomies and 157 nephrectomies for neoplasm. Within the 157 neoplasms, there were 18 radical nephroureterectomies for upper tract urothelial cancer, 11 partial nephrectomies and 128 radical nephrectomies for solid renal tumours. Twenty-eight radical nephrectomies were performed as cytoreductive surgery for non-organ confined or metastatic RCC, or where final histopathology of resected kidneys was found to be non-malignant. The remaining 100 radical nephrectomies were performed for clinically localized and histologically confirmed RCC, and these formed the study popu- lation of the present series. The selection of patients for LRN depended on the tumour location and anticipated technical feasi- bility of renal hilar control on preoperative computed tomogra- phy. Large tumour size was not considered as an exclusion criterion for laparoscopic nephrectomy, although in the early part of our experience, tumour size was generally <7 cm. The median age of patients was 61 years (range 23–88 years). There were 59 male and 41 female patients. The operation was performed with the patient placed in a lateral flexed position with the operative side up. We adopted the transperitoneal approach for all our patients. Three to four ports at the flank in a diamond pattern were used, with the first port inserted by open technique. Pneumoperitoneum of 12 mmHg and 30° laparoscope were used. Ascending or descending colon, spleen or liver were mobilized and reflected medially depending on the side of nephrectomy. Hilar dissection with early vascular control was obtained. Hilar lymph node dissection was not rou- tinely done unless there was obvious enlarged lymph node. The ureter was then divided followed by mobilization of the kidney together with perinephric fat outside the Gerota’s fascia. En bloc adrenalectomy was done selectively. The kidney was placed into M-C. Cheung FRCSEd (Urology); Y-M. Lee FRCSEd; R. Rindani FRACS; H. Lau FRACS. Correspondence: Dr Man-Chiu Cheung, Division of Urology, Department of Surgery, K445, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong. Email: mccheunguro@mac.com Accepted for publication 22 February 2005.