Сравнительная оценка результатов радикальных нефрэктомий, выполненных открытым, лапароскопическим и лапароскопически ассистированным доступами

Аннотация

Objectives. To compare the results of traditional open-, laparoscopic-, and laparoscopically assisted radical nephrectomies in the treatment of patients with renal cancer. One of the goals was to define the roll of laparoscopic operations and their advantages over open procedures.

Subjects and methods. Seventy-four patients with renal cancer age of 36 to 79 years (mean age 58/7 years) were divided into 3 groups: 1) open radical nephrectomy (n = 32); 2) radical nephrectomy via laparoscopic transabdominal access (n = 17); and 3) radical nephrectomy via laparoscopically assisted access (n = 25). All the patient groups were comparable with regard to the T stage and the size of a tumor.

Results. In the open nephrectomy group mean duration of surgery was 152 min; mean blood loss — 264 ml; mean hospital stay — 15.8 days; early postoperative complications were not observed. In the laparoscopic transabdominal surgery, these were 117 min, 138 ml, and 7.5, respectively; early postoperative complications were also absent. In laparoscopically assisted transabdominal access, the duration of an operation was 80 to 300 min (at the stage of procedure mastering) and averaged 123.1 min; blood loss was 50 to 700 ml (mean 228.5 ml). There were no intraoperative complications. The average postoperative hospital stay — 9.4 days.

Conclusion. The results of open- and laparoscopic-access nephrectomies are comparable in the duration of an operation, the volume of blood loss, and the presence of intraoperative complications. The parameters of the early and late postoperative periods are also identical. Recovery is shorter when endovideo-assisted interventions are applied.