Laparoscopic radical nephrectomy for suspected renal cell carcinoma in dialysis-dependent patients.

OBJECTIVES

To characterize the treatment and outcomes of laparoscopic nephrectomy for suspected renal cancer in patients with dialysis-dependent renal failure. Laparoscopic nephrectomy is currently an accepted modality in the treatment of renal cell carcinoma in many patients. However, the indications for the minimally invasive approach in patients with renal dysfunction are unclear. End-stage renal disease has multiple manifestations associated with increased operative morbidity that are potentially amplified during laparoscopy.

METHODS

We reviewed our single-center experience for performing laparoscopic nephrectomy in patients with renal failure. Of patients receiving dialysis and having a kidney removed laparoscopically, 7 underwent the operation for suspected renal carcinoma because of a solid mass on imaging. The preoperative, intraoperative, and postoperative considerations were reviewed.

RESULTS

Of the 7 patients, 5 (71%) underwent successful removal of the kidney by laparoscopy. The amount of blood loss (120 mL) and the median time to discharge after surgery (3 days) were comparable to published data and our experience in patients with normal renal function; however, the operative time (mean 294 minutes) was longer. No recurrences had been detected at the last follow-up examination (median 21 months, range 18 to 51). Despite meticulous attention to perioperative and anesthetic considerations, two complications were observed-ileus and necrotizing fasciitis of the flank.

CONCLUSIONS

Pure laparoscopic nephrectomy for renal malignancy is feasible in patients with end-stage renal failure. However, this population is at increased risk of complications, despite maintaining the advantages of reduced blood loss and shorter hospitalization. The decision to proceed with laparoscopy and the selection of the specific surgical approach (transperitoneal or retroperitoneal) should be based on both surgeon experience and patient factors. In addition, careful preoperative preparation and intraoperative anesthetic management are crucial.