Análisis comparativo entre la nefrectomía radical abierta y la laparoscópica en los pacientes con carcinoma renal

Abstract

Incidence of renal cancer is still raising nowadays. There are several factors that have influenced this phenomenon such as the better quality and availability of multiple diagnostic tools or the ageing population in developed countries. The first laparoscopic radical nephrectomy (LRN) was performed by Clayman et al in 1990. Nowadays, laparoscopic access to radical nephrectomy is considered to have some advantages over the open access. This is why the guidelines of the European Association of Urology (EAU) recommend it for tumours in a cT2 stage or lower with a level of evidence 1b and a B level of recommendation. These recommendations are based in retrospective studies mainly. In those studies, it is suggested that laparoscopic access to nephrectomy presents: less blood loss, less analgesic requirements in the postoperative period and shorter hospital stay. Despite this, review of the literature reveals no differences in terms of overall (OS), cancer-specific (CSS) or recurrence free survival (RFS) with a level of evidence 2a in EAU guidelines. Unfortunately, despite finding several retrospective studies comparing both techniques, most of them have been carried out with small populations and few prospective, non-randomized studies can be found with low methodological quality. The aim of this thesis was to make a comparative analysis of the effectivity of the laparoscopic approach to radical nephrectomy compared with open radical nephrectomy (ORN) in patients with renal cancer in a cT3a stage or lower. We analyzed the evolution over time of: clinical manifestations, tumoral size at diagnosis and surgical access to nephrectomy. Furthermore, an evaluation of surgical time, postoperative complications, hospital stay, OS, CSS and RFS was performed...