Five-year review of laparoscopic radical nephrectomies: initial experience with en bloc hilar ligation using an Endo GIA stapler

Abstract

Purpose: This study aimed to present the outcomes of patients undergoing laparoscopic radical nephrectomy (LRN) and hilar ligation with an endovascular gastrointestinal anastomosis (Endo GIA) stapler for malignant renal tumours.

Materials and methods: A retrospective review of patients who underwent LRN at Groote Schuur Hospital, Cape Town, between January 2018 and December 2022, focusing on those with renal cell carcinoma (RCC) and upper tract transitional cell carcinoma. Data on demographics, operative, and histopathological outcomes were collected.

Results: The final cohort consisted of 69 patients with a mean (standard deviation) age of 57.9 years (± 12.7), with 49.3% male (34 patients) and 50.7% female (35 patients). The most common presenting complaint was flank pain (49.3%). Of the patients, 29 (41.4%) were asymptomatic and diagnosed incidentally. Of the cohort, 23 (33.3%) were clinical tumour, node, and metastasis (TNM) stage III. All patients underwent LRN and hilar ligation using Endo GIA staplers, mostly performed via the transperitoneal approach. Most patients (63.7%) had no Clavien–Dindo grade complications, and a minority (16, 23.2%) developed complications. The median operating time was 221.58 minutes, with a mean (interquartile range) hospital stay of 5.8 days. The most common histopathological variation was clear-cell carcinoma in patients with RCC, consisting of 56.5%, and 20.3% of patients had transitional cell carcinoma (TCC). Most of the RCC had Fuhrman grade 2 (34.8%) and a negative surgical margin at resection (95.2%). The most common pathological stage of the disease was pT3, constituting 25 (38.5%).

Conclusion: The en bloc ligation of the renal hilum using an Endo GIA stapler is a practicable and advocated method that should be institutionalised.