LAPAROSCOPIC MANAGEMENT OF RENAL CELL CARCINOMA

Abstract

Renal Cell Carcinoma has an increased incidence rate every year mostly accidently discovered (silent asymptomatic RCC) by radiological imaging done for various symptoms. The success of treatment and 10-year survival rate depend mainly on tumor staging, grading and degree of tumor dissemination. Modalities of treatment of RCC are surgical intervention, radiation therapy, chemotherapy, hormonal therapy, immunotherapy, or combinations of these. Surgical intervention remains the mainstay of localized or even metastatic RCC, with open technique as only method until development of laparoscopic technique in 1991 by clayman. Laparoscopic technique shows improving in post operative data as early ambulation, shorter hospital stay, lower dose of narcotic needed, early return to normal activity and decrease rate of surgical wound infection with the same long term oncological control data, while intraoperative complications data as amount of blood loss, operation time and colon or pleural perforation are highly dependable on surgeon’s experience and these complications decrease with upwarding of his learning curve. Nephron Sparing Surgery has widely replaced radical intervention for preservation of functioning nephrons as possible, first in casae of solitary kidney with RCC or bilateral cases and then expand to all accessible tumors when techniqally feasible. This concept started with open technique and then to laparoscopic practice after great development of technique and hemostatic methods. NSS include partial nephrectomy and ablative procedures. Partial nephrectomy usually had done for tumors less than 7 cm away from the hilum. Ablative techniques include cryoablation, radiofrequency ablation and ultrasound focused ablation and it might be main therapy or adjuvant therapy for RCC. LESS and NOTES are recent methods for laparoscopic manipulations in renal surgery that need more studies to be approved for management of malignant tumors of the kidney.