肾脏黏液样小管状和梭形细胞癌(附2例报道及文献复习)

目的 探讨肾脏黏液样小管状和梭形细胞癌(Mucinous tubular and spindle cell carcinoma,MTSCC)的临床及病理学特点.方法 对本院收治的2例肾脏黏液样小管状和梭形细胞癌患者临床及病理特点进行观察和讨论并结合相关文献复习.结果 2例患者术后诊断:肾脏黏液样小管状和梭形细胞癌.临床及病理特征符合相关文献对该型肾癌的报道,术后长期严密随访无复发.结论 MTSCC是罕见的肾癌分型,症状隐匿,具有独特的病理学特征,早期手术是最佳治疗方法,预后良好,罕见预后较差报道.     

肾黏液管状梭形细胞癌的临床特征(附1例报告并文献复习)

目的:探讨肾粘液管状梭形细胞癌的临床特点。方法:报告1例左肾粘液管状梭形细胞癌患者的临床资料并复习有关文献。本例以持续高热、食欲减退等症状就诊。行肾癌根治术,肿瘤约6.0cm×6.5cm,临床分期为T4N2M0;病理表现为排列成簇的狭长小管状上皮细胞,中间充满粘液间质和梭形细胞,核分裂像少见;免疫组化E-cadherin( )、CK17( )、CD10(-)、CD15(-)。结果:术后第1天体温恢复正常,随访16个月未见肿瘤复发和转移。结论:肾粘液管状梭形细胞癌是一类低度恶性的肾上皮性肿瘤,可能来源于远端肾小管,早期手术是其首选的治疗方法。     

两种不同临床类型的肾黏液性小管状和梭形细胞癌

目的:探讨两种不同临床类型肾黏液性小管状和梭形细胞癌的临床特点。方法:报告2例不同临床类型肾黏液性小管状和梭形细胞癌患者的临床资料,进行对比分析,并复习有关文献。结果:例1为体检发现,无局部及远处转移,无病理性核分裂像,异型性小。例2以持续高热就诊,有局部及远处转移,病理性核分裂像常见,异型性明显。2例均行肾癌根治术,例1术后随访未见复发。例2患者于术后3个月死亡,此为国内首例报道因肾黏液性小管状和梭形细胞癌死亡者。结论:肾黏液性小管状和梭形细胞癌有两种不同临床类型,多数为低度恶性,亦存在恶性程度较高的病例,需区别对待。     

肾黏液小管状和梭形细胞癌的临床特点分析

目的 探讨肾黏液小管状和梭形细胞癌(MTSCCa)的临床特点、治疗和预后. 方法 MTSCCa患者4例.均为女性.年龄42～76岁,平均57岁.腰痛2例,其中伴肉眼血尿1例;体检发现肾肿瘤2例.肿瘤位于左肾3例,右肾1例.CT检查示肾内低密度影,增强后有轻度强化,且有延迟强化.肿瘤直径3.8～12.0 cm,平均6.8 cm.T1aN0M0 1例,T1bN0M0 2例,T2N0M0 1例.4例均行根治性肾切除术,其中1例行腹腔镜手术. 结果 4例手术顺利.肿瘤大体标本切面呈灰白色或灰褐色,周边有完整包膜.肿瘤内有出血区域:镜下表现为管状和梭形结构穿插于黏液样间质中,病理均诊断为肾MTSCCa.2例术后行干扰素及IL-2免疫治疗3个月.随访9～46个月,均未见复发或转移.结论 MTSCCa是一种罕见的低度恶性肾脏上皮肿瘤,多见于女性,早期手术切除是首选治疗方法,预后良好.     

肾脏黏液管状和梭形细胞癌1例并文献复习

目的 探讨黏液性管状梭形细胞癌(MTSCC)的诊断、治疗、预后.方法 报告1例37岁男性左肾占位性病变之临床资料、手术及病理结果.结果 术中见左肾上极与腹膜黏连严重,游离肾门,局部解剖不清晰,伴多发淋巴结肿大.行开放性左肾根治性切除术.病理学诊断:肾脏黏液性管状和梭形细胞癌.免疫组织化学染色:LCK++、HCK++、Vimt-、F8 -、CD34 -、CK-.结论 罕见肾脏黏液性管状梭形细胞癌恶性程度低,早期手术是首选的治疗方法,病人可长期存活.     

肾脏黏液性管状和梭形细胞癌一例报告并文献复习

目的 探讨肾脏黏液性管状和梭形细胞癌患者的临床病理特点。方法 分析1例肾脏黏液性管状和梭形细胞癌患者临床资料，结合文献复习讨论。患者，男，27岁。查体发现右肾占位性病变6d，CT及MRI示右肾上极囊实性占位，术前诊断良性病变。行右肾根治性切除术。结果 术中见肿瘤对肾组织有推挤样边界，位于右肾上极，冰冻切片诊断低度恶性黏液性上皮性肿瘤。病理检查：大体标本见右肾上极6cm×5cm×4cm类球形肿物，边界清楚，切面实性、灰白色。肿瘤细胞排列成管状、实性梁索状漂浮于黏液性基质中，Alcianblue染色（＋）。免疫组化：上皮细胞CK（＋）、CK7（＋）、EMA（＋）、Vimentin（＋）、34βE12（＋）。病理诊断：肾脏黏液性管状和梭性细胞癌。术后随访5个月未见肿瘤复发和转移。结论 肾脏黏液性管状和梭形细胞癌是一种罕见的低度恶性上皮性肿瘤，具有潜在远处转移的可能，应与其他肾脏良恶性肿瘤相鉴别。     

后腹腔镜下肾癌根治术3例报告

目的 报道后腹腔镜行肾癌根治术的体会。方法 2002年10月～2003年1月利用后腹腔镜行肾癌根治术3例。平均年龄69岁，肿瘤平均直径3．5cm，用自制水囊扩张后腹腔后，沿肾周脂肪囊游离肾脏，用直线切割器分别切断肾动脉，肾静脉，遂将肾装入自制的肾袋中，扩大切口至5cm～6cm，将肾取出。结果 3例手术均获成功，平均手术时间3．3h，出血少，均未输血。病理报告透明细胞癌2例，颗粒细胞癌1例。结论 后腹腔镜切除肾癌是一种微创安全的方法。     

成人Xp11.2易位/TFE3基因融合相关性肾癌26例报告

目的:探讨成人Xp11.2易位/TFE3基因融合相关性肾癌(简称Xp11.2肾细胞癌)的临床特征、治疗及预后。方法:回顾性分析2015年8月～2017年3月我院收治的26例Xp11.2肾细胞癌成人患者的临床资料,分析该类型肿瘤的影像学特征、诊断、治疗方法及预后。结果:26例患者中,男10例,女16例;年龄19～59岁,平均31.4岁。其中13例行腹腔镜肾癌根治术,2例行腹腔镜肾部分切除术,3例行机器人辅助腹腔镜肾癌根治术,2例行机器人辅助腹腔镜肾部分切除术,5例行开放肾癌根治术,1例肾癌根治术后因纵隔转移穿刺确诊后行靶向药物治疗。术后病理结果均提示Xp11.2肾细胞癌。术后平均随访时间12(1～36)个月,1例患者因肿瘤全身多发转移死亡,2例失访,其余23例均预后较好。结论:Xp11.2肾细胞癌临床发病率较低,诊断主要结合其特征性的影像学表现、免疫组织化学染色及FISH确诊实验,手术主要以肾癌根治性切除术为主,短期随访预后尚可,但仍需长期随访。     

腹腔镜保留肾单位手术治疗早期肾癌的临床研究（附32例报告）

目的探讨腹腔镜保留肾单位手术治疗早期肾癌的方法和疗效。方法采用腹腔镜技术，术中使用超声刀、电凝钩对32早期。肾癌患者行保留肾单位手术，患者年龄31～72岁，平均49±1．8岁。肿瘤平均直径1．5±4．5cm，平均（2．8±0．8）cm。25例行后腹腔镜保留肾单位手术，7例行经腹途径腹腔镜保留肾单位手术，影像学检查示32例肿瘤突出于肾脏表面，肾上极10例，肾下极13例，肾脏中部5例，近肾盂部位4例；偏背侧18例，腹侧14例。结果32例除1例转开放手术外，余31例为腹腔镜保留肾单位的肾肿瘤切除术。平均手术时间（105±15．4）min，平均出血量（120±21．6）ml，6例术中输血400ml。2例术后发生尿漏，予负压吸引15d后引流量小于20ml后拔出肾周引流管。术后住院时间平均7～17d，平均（9±2）d。术后病理报告：肾透明细胞癌28例，肾颗粒细胞癌3例，嗜酸性细胞癌1例。随访时间3-53个月，平均（21±4）个月，肿瘤无复发。结论腹腔镜保留肾单位术治疗早期肾癌安全、可行。     

腹腔镜保留肾脏肾肿瘤切除术

目的:探讨腹腔镜保留肾脏手术治疗肾肿瘤的临床应用价值。方法:为21例患者施行腹腔镜保留肾脏肾肿瘤切除术,其中13例经后腹腔途径,8例经腹腔途径,肿瘤直径2.5～4.0cm。术后病理为15例肾脏透明细胞癌(T1N0M0),6例肾血管平滑肌脂肪瘤。结果:21例手术均获成功,手术时间80～130min,血管阻断时间10～35min,术中失血100～400ml,术后无出血、尿漏等重要并发症发生。术后短期随访所有透明细胞癌病例5～22个月无局部复发。结论:腹腔镜保留肾脏肾肿瘤切除术治疗早期肾脏肿瘤(直径≤4cm)安全有效,患者损伤小,康复快,值得临床推广应用。     

经后腹腔自制单孔通道腹腔镜根治性肾切除术29例报告

目的总结经后腹腔自制单孔通道腹腔镜根治性肾切除术的安全性和可行性。方法2011年10月～2012年10月,采用自制通道行后腹腔单孔腹腔镜根治性肾切除术29例,肿瘤最大径3～6．8cm,平均4．3cm。健侧卧位,在腋后线第12肋下向前做5～6cm切口,从自制单孔多通道置入常规腹腔镜操作器械进行后腹腔镜根治性切除,由操作通道切口取出标本。结果手术均成功完成,无中转标准腹腔镜或开放手术。手术时间70～120min,平均90min。术中出血量20～100ml,平均50m1。术后病理：肾透明细胞癌27例,肾乳头状腺癌1例,肾嫌色细胞癌1例。29例随访3～12个月,平均7个月,无肿瘤复发。结论经后腹腔自制单孔通道腹腔镜根治性肾切除术安全、可行。     

Laparoscopic radical nephrectomy for cancer with level I renal vein involvement

PURPOSE: Venous involvement develops in 5% to 10% of patients with renal cell carcinoma and is generally considered a relative contraindication to laparoscopic radical nephrectomy. To our knowledge we report the initial clinical series of laparoscopic radical nephrectomy for renal cell carcinoma associated with level I renal vein thrombus. MATERIALS AND METHODS: At our 2 institutions 8 patients each underwent laparoscopic radical nephrectomy for level I microscopic renal vein thrombus (group 1) and level I gross thrombus (group 2). In all 8 group 2 patients the level I thrombus was preoperatively diagnosed by computerized tomography. Mean renal tumor size in groups 1 and 2 was 7.8 and 12.4 cm., respectively. After controlling the renal artery the renal vein was secured by firing an endoscopic gastrointestinal anastomosis stapler on its collapsed, uninvolved proximal part adjacent to the vena cava. Intraoperative, postoperative and pathological parameters were assessed in the 2 groups. RESULTS: In group 1 laparoscopic radical nephrectomy was technically successful in all 8 patients. Mean operative time was 3.1 hours, mean estimated blood loss was 382 cc and mean hospital stay was 1.9 days. In 1 patient each a soft tissue and a vascular margin was positive for cancer. At a mean follow up of 19.5 months (range 2 to 36) metastatic disease occurred in 3 cases (38%). In group 2 laparoscopic radical nephrectomy was technically successful in 7 cases with open conversion in 1. Mean operative time was 3.3 hours, mean estimated blood loss was 354 cc and mean hospital stay was 2.3 days. Surgical soft tissue and the renal vein vascular margin of the transected vein were negative for cancer in all 8 cases. At a mean followup of 9.4 months (range 5 to 16) pulmonary metastasis developed in 1 patient (13%). CONCLUSIONS: Although it is an advanced procedure, laparoscopic radical nephrectomy in patients with level I renal vein thrombus is feasible, safe and follows established oncological principles.     

Laparoscopic cytoreductive nephrectomy for metastatic renal cell carcinoma

OBJECTIVE: To critically analyse the results of laparoscopic cytoreductive surgery for renal cell carcinoma (RCC), as phase III evidence supports cytoreductive nephrectomy before immunotherapy, and there is an overall shift towards minimally invasive renal surgery for this disease. PATIENTS AND METHODS: Since October 2000, 22 patients were treated by laparoscopic cytoreductive nephrectomy for metastatic RCC (group 1). All patients had radiological evidence of metastatic disease, with biopsy confirmation in 10. To put the results into perspective, 25 consecutive contemporary patients with large organ-confined nonmetastatic RCC (>7 cm, clinical stage T2) undergoing laparoscopic radical nephrectomy (group 2) were compared retrospectively. The baseline demographics were comparable between the groups. RESULTS: The mean tumour size was 8 cm in group 1 and 9.6 cm in group 2 (P = 0.07). Variables during and after surgery were comparable between the groups, with a mean operative duration of 3.1 vs 3.2 h (P = 0.82), blood loss of 285 vs 308 mL (P = 0.79), complications in two vs eight (P = 0.08), morphine sulphate equivalent requirements of 51.7 vs 44.1 mg (P = 0.1) and a median length of hospital stay of 1.7 vs 1.6 days (P = 0.68). In group 1 the median (range) time to immunotherapy was 35 (13-136) days. CONCLUSIONS: Laparoscopic cytoreductive nephrectomy is safe and effective in selected patients. Currently the procedure is offered to candidates eligible for immunotherapy and with tumours of < or = 15 cm, and no evidence of adjacent organ invasion or inferior vena caval thrombus. Significant perihilar adenopathy and numerous parasitic vessels can increase the complexity of the surgery. Adequate laparoscopic experience is necessary.     

Results of retroperitoneal laparoscopic radical nephrectomy

PURPOSE: To analyze the retroperitoneal approach to laparoscopic radical nephrectomy in terms of feasibility, safety, morbidity, and cancer control. PATIENTS AND METHODS: We reviewed the records of 50 consecutive patients with renal cancer underwent radical nephrectomy via the retroperitoneal laparoscopic approach from 1995 through 1999. RESULTS: The mean operative time was 139 minutes (range 60-330 minutes) with a mean of 149.78-mL operative blood loss (0-1500 mL). The mean renal size was 100 mm (70-150 mm) with a mean tumor size of 38.6 mm (20-90 mm). The postoperative hospital was 6 days (2-13 days). Three open conversions were necessary: one for laparoscopically uncontrolled bleeding and two because obesity interfered with surgery. We noted two major complication and two minor complications. Two disease progression have been noted to date. One patient with a pT3 grade 2 renal-cell carcinoma had a local recurrence with liver metastasis 9 months after the procedure and died 19.7 months after radical nephrectomy. Another patient with a pT3aN+M+ cancer died 23.1 months after the procedure. CONCLUSION: Retroperitoneal laparoscopic nephrectomy for kidney cancer requires further assessment. It seems to have several advantages over open radical nephrectomy and to be effective and safe for small (<50-mm) renal tumors.     

Bilateral laparoscopic radical nephrectomy for renal tumors in patients with acquired cystic kidney disease

PURPOSE: We describe our experience with simultaneous bilateral laparoscopic radical nephrectomy performed in patients with acquired cystic kidney disease (ACKD) and renal tumors. MATERIALS AND METHODS: Between June 2000 and September 2002, 10 patients with ACKD underwent simultaneous bilateral laparoscopic radical nephrectomy for renal lesions suspicious for carcinoma. The lesions were discovered during pretransplant evaluation in 9 patients and incidentally in 1 renal transplant recipient. A 3- or 4-port transperitoneal approach was used for each side to mobilize the kidney and secure the renal hilum. Both specimens were extracted through a midline supraumbilical incision. Operative time, blood loss, analgesic requirements, hospital stay, and convalescence and recurrence rates were determined. RESULTS: The mean age of the patients was 41.6 years (range, 29-47 years). Mean operative time was 6.5 hours (range, 4.5-9.7 hours) and mean estimated blood loss was 164 cc (range, 50-300 cc). There was one intraoperative complication-a clotted arteriovenous (AV) graft; and 2 postoperative complications-1 fluid overload and 1 adrenal insufficiency. The average length of hospital stay was 3.1 days (range, 2-4 days) and mean convalescence was 2.8 weeks (range, 1-6 weeks). All cancers were confined to the kidneys and there has been no recurrence during follow-up ranging from 6 to 26 months. CONCLUSION: Bilateral laparoscopic radical nephrectomy in end-stage renal disease patients is safe and feasible. The advantages of the laparoscopic approach include minimal intraoperative blood loss, shorter hospital stay, minimal postoperative pain, and a rapid return to normal activity. The laparoscopic technique offers an effective, minimally invasive therapeutic alternative to open surgery in high-risk end-stage renal disease patients.     

后腹腔镜根治性肾切除术的临床应用

目的 探讨后腹腔镜根治性肾切除术的可行性、安全性及临床疗效.方法 2003年3月～2008年2月行后腹腔镜根治性肾切除术52例.男29例,女23例.年龄24～78岁,平均年龄57岁.右侧27例,左侧25例.无痛性全程肉眼血尿8例,其余44例为超声体检发现.肿瘤的大小1.5cm×1.8cm～8.7cm×9.2cm,平均3.6cm×4.3cm.肿瘤位于肾上极19例,肾中部15例,肾下极18例.52例均行CT检查.19例行MRI检查.术前临床分期:T1NOM05例,T2NOM045例,T3aNOM0 2例.结果 52例均获成功,无中转开放手术患者,有13例腹膜破裂、有6例术后肩部隐痛、有4例切口皮下气肿,病人均在短期恢复.术后均无使用镇痛剂.手术时间90～230min,平均152min;出血量50～200ml,平均120ml;术后住院时间6～9天,平均7.5天.术后病理报告:肾透明细胞癌49例,囊性肾细胞癌2例,肾颗粒细胞癌1例.随访6～36个月,平均15个月,未见肿瘤复发.结论 后腹腔镜根治性肾切除术安全可行、疗效肯定.     

Role of laparoscopy in management of renal stones: single-center experience and review of literature

BACKGROUND AND PURPOSE: Laparoscopy can be an alternative modality in the management of renal stones. We present our experience with laparoscopic renal stone surgery. PATIENTS AND METHODS: Eighteen patients (4 males, 14 females) with mean age of 51 years (range 18-86 years) underwent 19 laparoscopic procedures. The mean stone number and size, excluding five patients who had nephrectomy/heminephrectomy, were 1.9 (range 1-5) and 1.3 cm (range 0.5-4.5 cm), respectively. Three patients with ureteropelvic junction obstruction underwent pyeloplasty and concomitant pyelolithotomy. Three patients with upper-pole caliceal-diverticular stones had nephrolithotomy and fulguration of the diverticular mucosa. Three patients with stones and hydrocalix with scarred cortex had partial nephrectomy, two under cold and one under warm ischemia. Five patients, including one with a horseshoe kidney (who had one procedure on each kidney), had pyelolithotomy as an alternative to percutaneous nephrolithotomy. Patients with stones in a nonfunctioning kidney underwent nephrectomy (three patients) or heminephrectomy (one patient). RESULTS: All procedures were completed laparoscopically. The operative time was variable depending on the complexity of the procedures, from 115 minutes for Fengerplasty to 315 minutes for partial nephrectomy under cold ischemia (mean 178 minutes). The estimated blood loss was 53.2 mL (range 20-120 ml), and none of the patients received a blood transfusion. Complete stone clearance was achieved in 93% of the procedures. The mean hospital stay was 10.5 days (range 5-35 days). Three patients needed temporary pigtail-catheter drainage for obstruction after pyelolithotomy. One patient with a solitary kidney and infected staghorn calculus had prolonged urinary leak, which stopped with conservative management. One nephrectomy for nephrocutaneous fistula was complicated by a late colonic perforation necessitating colostomy. CONCLUSION: Laparoscopic surgery is effective for complex renal stones and allows for adjunctive procedures. It can also be an alternative to percutaneous nephrolithotomy. It complements other minimally invasive procedures, and a need for open stone surgery should be rare in the future.     

LAPAROSCOPIC RADICAL NEPHRECTOMY: CANCER CONTROL FOR RENAL CELL CARCINOMA

PURPOSE: We evaluated the clinical efficacy of laparoscopic versus open radical nephrectomy in patients with clinically localized renal cell carcinoma. MATERIALS AND METHODS: Between 1991 and 1999, 67 laparoscopic radical nephrectomies were performed for clinically localized, stages cT1/2 NXMX, pathologically confirmed renal cell carcinoma. During this period 54 patients who underwent open radical nephrectomy with pathologically confirmed stages pT1/2 NXMX disease were also identified. Medical and operative records were retrospectively reviewed and telephone followup was done to assess patient status. RESULTS: In the laparoscopic and open groups average tumor size was 5.1 (range 1 to 13) and 5.4 cm. (range 0.2 to 18), respectively, which was not statistically significant. No patient had laparoscopic port site, wound or renal fossa tumor recurrence in either group. All patients were followed at least 12 months. In the laparoscopic group 2 cancer specific deaths occurred at a mean followup of 35.6 months. In the open group there were 2 cancer specific deaths and 3 cases of disease progression at a mean followup of 44 months. Kaplan-Meier disease-free survival and actuarial survival analysis revealed no significant differences in the laparoscopic and open radical nephrectomy groups. Also, no differences were noted in the complication rate. CONCLUSIONS: Laparoscopic radical nephrectomy is an effective alternative for localized renal cell carcinoma when the principles of surgical oncology are maintained. Initial data show shorter patient hospitalization and effective cancer control with no significant difference in survival compared with open radical nephrectomy.     

Laparoscopic nephrectomy for nonfunctioning tuberculous kidney

BACKGROUND AND PURPOSE: Although laparoscopic nephrectomy for benign renal disease has been widely accepted, use of the operation for tubercular pyelonephritic kidney is relatively contraindicated because of difficulties in dissecting the dense fibrotic adhesions and the risk of spillage of caseous materials with subsequent dissemination of the disease. However, with the accumulation of experience, laparoscopic surgery is expanding its applications. In this study, we tried to evaluate the efficacy and safety of the laparoscopic nephrectomy for renal tuberculosis. PATIENTS AND METHODS: At three centers, 13 laparoscopic nephrectomies were performed between April 1996 and March 1999. The patients consisted of eight men and five women with a mean age of 44.8 years (range 37-51 years). All patients had known renal tuberculosis with a nonfunctioning kidney and underwent nephrectomy after at least 3 months of chemotherapy with four antituberculous drugs. Nine patients underwent the transperitoneal approach and four patients, the retroperitoneal approach. The follow-up was from 2 to 35 months with a mean of 15.8 months. RESULTS: Kidneys were removed laparoscopically in 12 patients (92%). The mean operative time was 268 minutes (range 190-500 minutes), and the mean estimated blood loss was 227 mL. Although there had been some difficulties releasing the adhesions, no significant intraoperative and postoperative complications were observed. Conversion to open surgery was needed in only one patient. The mean hospital stay was 4 days, and the patients returned to normal activity within 10 days. Neither local recurrence nor distant dissemination of the disease was observed during the follow-up period. CONCLUSION: Laparoscopic nephrectomy for renal tuberculosis was safe and effective with minor complications. Therefore, tuberculosis should not be a contraindication to a laparoscopic approach.     

Laparoscopic versus open radical nephrectomy: a 9-year experience

PURPOSE: The laparoscopic approach for renal cell carcinoma is slowly evolving. We report our experience with laparoscopic radical nephrectomy and compare it to a contemporary cohort of patients with renal cell carcinoma who underwent open radical nephrectomy. MATERIALS AND METHODS: From 1990 to 1999, 32 males and 28 females underwent 61 laparoscopic radical nephrectomies for suspicious renal cell carcinoma. Clinical data from a computerized database were reviewed and compared to a contemporary group of 33 patients who underwent open radical nephrectomy for renal cell carcinoma. RESULTS: Patients in the laparoscopic radical nephrectomy group had significantly reduced, estimated blood loss (172 versus 451 ml., p <0.001), hospital stay (3.4 versus 5.2 days, p <0.001), pain medication requirement (28.0 versus 78.3 mg., p <0.001) and quicker return to normal activity than patients in the open radical nephrectomy group (3.6 versus 8.1 weeks, p <0.001). The majority of laparoscopic specimens (65%) were morcellated. Operating time and cost were higher in the laparoscopic than the open nephrectomy group. Average followup was 25 months (range 3 to 73) for the laparoscopic and 27.5 months (range 7 to 90) for the open group. Renal cell carcinoma in 3 patients (8%) recurred in the laparoscopic group versus renal cell carcinoma in 3 (9%) in the open group. When stratified patients with tumors larger than 4 to 10 cm. experienced similar benefits and results as patients with tumors less than or equal to 4 cm. To date there have been no instances of trocar or intraperitoneal seeding in the laparoscopic radical nephrectomy group. CONCLUSIONS: Laparoscopic radical nephrectomy, although technically demanding, is a viable alternative for managing localized renal tumors up to 10 cm. It affords patients with renal tumors an improved postoperative course with less pain and a quicker recovery while providing similar efficacy at 2-year followup for patients with T1 and T2 tumors.