Comparison of Standard and Hand-Assisted Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma

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A laparoscopic radical nephrectomy(LRN)for renal cancer can be performedusing two methods,hand-assisted laparoscopic surgery(HALS)and standard laparoscopicsurgery(SLS). This institute initially used HALS to perform all radical nephrectomy,butgradually shifted to SLS. This study compared the two methods of radical nephrectomy:HALS vs. SLS, which were performed at a single institute. From March 1999 toNovember 2006, a total 129 patients with pathologically confirmed renal cell carcinomaunderwent LRN, including 73 patients with the HALS and 56 patients with SLS. Themedian operative time was 264 minutes,and median estimated blood loss was 200ml in theHALS group,respectively. The median operative time and median estimated blood lossin the SLS were 215 minutes and 100 ml,respectively. There was no significant differencein either the operative time or estimated blood loss between HALS and SLS. The mediantime to both postoperative oral intake and ambulation in the SLS were 1 day. Neitherof these events after SLS was significantly shorter than that after HALS. The 4-yeardisease-free and overall survival rates in the HALS patients were 97.5% and 98.2%,respectively. Both the 4-year disease-free and overall survival rates in the SLS patientswere 100%. Since no significant differences were observed between the two operativemethods (SLS and HALS) regarding the operative data, postoperative course and oncologicaloutcome,the surgical method for LRN can be selected according to characteristicsof each surgical method【目的】腎癌に対する鏡視下根治的腎摘除術には，ハンドアシスト（hand-assisted laparoscopicsurgery：HALS）法とスタンダード（standard laparoscopic surgery：SLS）法がある．鏡視下根治的腎摘除術におけるHALS 法とSLS 法について比較した．【方法】99 年３月から06年11月までに計129 例（HALS：73例，SLS：53例）の鏡視下根治的腎摘除術を行った．手術成績・術後経過・合併症・非再発率・生存率について比較検討した．【結果】HALS とSLS の手術時間/出血量は，それぞれ264・215分，および200・100mlであった．経口摂取・歩行開始までの期間および術後入院期間について差はなかった．HALS における４年非再発率は97.5％，４年生存率は98.2％であり，SLS の４年非再発率・生存率はともに100％であった．【結語】手術時間・出血量・術後経過について，HALS とSLS で有意差はなく，それぞれの手術の特徴を考慮し術式を選択すべきと思われた．
福岡医学会,Fukuoka Medical Associationの論文
2007-11-25

Comparison of Standard and Hand-Assisted Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma

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