Retroperitoneal Laparoscopic Radical Nephrectomy for Large (>7 cm) Solid Renal Tumors: Comparison of Perioperative Outcomes with the Transperitoneal Approach

Purpose: To describe our technique for retroperitoneal laparoscopic radical nephrectomy (LRN) and to present the perioperative outcomes of our retroperitoneal LRN series for large (>7 cm) solid renal tumors and to compare them with those of the transperitoneal approach. Materials and Methods: A retrospective chart review was performed for patients who had undergone LRN for a solid renal tumor greater than 7 cm in size on computed tomography (CT) scans between June 2008 and January 2016. Perioperative outcomes were compared between transperitoneal and retroperitoneal approaches. Results: There were 30 cases in the transperitoneal approach group and 34 cases in the retroperitoneal group. The mean tumor size was 9.0 cm in the transperitoneal approach group and 10.3 cm in the retroperitoneal group (P = .494). In the retroperitoneal approach group, the operation time was shorter, estimated blood loss (EBL) was lower, and time to start diet was shorter (P < .001, P = .037, and P = .002, respectively). The complication rate was comparable between the two approaches. Conclusions: Retroperitoneal LRN for a large (>7 cm) solid renal tumor demonstrated a superior result in terms of operation time, estimated blood loss, and time to start diet than transperitoneal LRN. Other perioperative outcomes and complication rate were comparable between the two approaches. We believe that with sufficient experience, retroperitoneal LRN may be an effective and safe procedure for large (>7 cm) solid renal tumors.