Thesis Type: Expertise In Medicine
Institution Of The Thesis: Gazi University, Tıp Fakültesi, Turkey
Approval Date: 2010
Thesis Language: Turkish
Student: İYİMSER ÜRE
Supervisor: TEVFİK SİNAN SÖZENAbstract:
Renal cell carcinoma (RCC) accounts for 3 % of all cancers in adults and is the third commonest urological malignancy. Robson presented the operative principles of radical nephrectomy in the 1960s, which became the “gold standard” treatment for localized RCC. Since Clayman and colleagues in 1990 performed their first laparoscopic nephrectomy, the method has reached increasing enthusiasm and radical nephrectomy has been started to be made with laparoscopic method in most of the centers. In this study we aimed to retrospectively assess the operational and oncologic data’s of the patients who were performed laparoscopic or open radical nephrectomy in our clinic and to reveal the differences of these techniques in terms of these parameters. Gazi University and urooncology files of 39 patients who were performed open radical nephrectomy (ORN) and 42 patients who were performed laparoscopic radical nephrectomy (LRN) in Gazi University, Faculty of Medicine, Department of Urology were analyzed. The demographic parameters, the clinic data’s such as operation time, estimated blood loss, incision length, complications and hospitalization time and data’s obtained from histopathologic analyzes were recorded. The mean age of the patients were; 56,9 (36,85) in LRN group and 61,6 (33- 83) in ORN group (p:0,097). In the LRN group mean tumor size was 47,4 mm (10- 135) and it was 73,6 mm (20-140) in ORN group (p<0,001). Mean operation time was 130,3 minutes in LRN group and 141,79 minutes in ORN group (p:0,281). Estimated blood loss was 579 ml in ORN and 138 ml in LRN group (p<0,001). Mean incision length was 10,7 cm in LRN group and 20, 3 cm in ORN group (p<0,001). Mean hospitalization time was 3,05 days in LRN and 4,33 days in ORN group (p:0,001). Mean follow-up time of LRN group was 23,4 (3-55) months and ORN group was 14,7 (3-39) months. In 4 (%4) patients local recurrens was occurred after operation and all of these patients were in the group of ORN. In 6 patients who weren’t metastatic at the time of operation, distant metastases were appeared after operation and all of these patients were included in ORN group as well. Laparoscopic radical nephrectomy has become the new gold standard treatment choice for the patients with RCC at the stage of T1 and T2 and which are not suitable for nephron sparing surgery, in terms of less hospitalization and recovery time, less amount of bleeding and with similar operation times and oncologic outcomes in contrast to open surgery. However, open radical nephrectomy still remains to be the first treatment choice for stage T3 renal cell carcinoma.