Cirugía laparoscópica en el carcinoma renal: de la cirugía radical a la conservadora de nefronas

Introduction: Renal carcinoma represents 85 % of solid masses. Objective: To describe the results of laparascopic radical nephrectomy and laparoscopic nephron-sparing surgery in patients with renal cell carcinoma. Materials and methods: A cohort, retrospective, analytic study of a probability sample of 154 patients with renal carcinoma, Centro Nacional de Cirugía de Mínimo Acceso, Cuba, 2010-2022. Percentages, means and standard deviation were utilized; mean comparisons and to prove associations Ji- square test and Student’s t-test. Survival function was estimated by Kaplan Meier (reliability 95 %). Results: 59.7 % underwent radical nephrectomy and 40.3 % nephron-sparing surgery. Mean age 57.9 years. 66.2 % were male, 61,7 % ASA II. Incidental diagnosis was more frequent in nephron-sparing surgery (74.2 %). Mean size of the masses was less in nephron–sparing surgery (34.3 mm vs. 53.4 mm), higher postoperative glomerular filtrate (p<0.05) and R.E.N.A.L. score was of low complexity in 58,1 %. 20.1 % of the patients presented complicacions, more frequent in nephron-sparing surgery (p=0,00). Clear-cell carcinoma prevailed (69.5 %), tumoral stage I (86.4 % ). Estimated recurrence at 10 years was lower in patients who had nephron-sparing surgery (94.2 % vs 85.9 %). Cancer-specific survival in patients who underwent radical nephrectomy was 90.2 % (10 years follow-up) vs. nephron-sparing surgery 100 %. Conclusions: Laparoscopic surgery for renal carcinoma was feasible and safe, with better postoperative renal function, lower recurrence rate and higher cancer-specífic survival in nephron-sparing surgery, albeit presented more postoperative complications.