Laparoscopic Versus Open Surgery for Renal Masses with Infrahepatic Tumor Thrombus: The Largest Series of Retroperitoneal Experience from China

Objective: To compare the treatment outcome of laparoscopic versus open surgery for renal masses with infrahepatic (levels I and II) tumor thrombus and analyze the largest series of retroperitoneal experience in such cases from China. Materials and Methods: Forty-nine patients with renal masses with infrahepatic tumor thrombus were analyzed retrospectively between January 2009 and January 2013 at our institution. The diagnosis was confirmed by computed tomography and/or magnetic resonance imaging preoperatively. They were divided into two groups based on the detailed surgical approach applied. Group 1 (A, pure laparoscopic; B, laparoscopic nephrectomy with open thrombectomy) consisted of 17 patients (34.7%) and group 2 (pure open) consisted of 32 patients (65.3%). Results: The two groups were comparable with regard to all of the patients' baseline characteristics. All operations were performed successfully without severe complications. In group 1, the mean operative time was 208.5 minutes, the mean estimated blood loss was 147.1mL, the mean postoperative hospital stay was 5.8 days, and only two patients (11.8%) accepted blood transfusion with a mean quantity of 300mL. In group 2, the figures were 268.3 minutes, 1345.3mL, 12.5 days, respectively, and a total of 17 patients (53.1%) received transfusion with a mean quantity of 1488.2mL. The differences of all these parameters were statistically significant between both groups (p<0.05). However, comparisons between the group 1A and 1B in all of the perioperative characteristics were not statistically significant. During a mean follow-up of 18.2 months, 13 patients in group 1 and 26 patients in group 2 survived. The difference in the cancer-survival rates between both groups was not statistically significant. Conclusions: Although it remains technically complex, demanding and challenging for renal masses with infrahepatic tumor thrombus, laparoscopic surgery with a retroperitoneal approach can make favorable perioperative results and comparable survival rates in selectively less complex patients compared with the traditional open surgery.