Laparoscopic Radical Nephrectomy with Transperitoneal Approach for Large Renal Tumors: Standardized Surgical Technique and Outcomes.

Background: Minimally invasive surgery is used only in selected cases of renal masses greater than 7 cm, and few studies exist in this setting. This study aimed to evaluate the safety and effectiveness of a laparoscopic surgical approach for the treatment of large renal tumors using a standardized technique. Materials and Methods: Data of patients who underwent laparoscopic nephrectomy (LN) using the transperitoneal approach were retrospectively evaluated from December 2019 to September 2022. The study population was divided into two groups: patients with renal masses <7 cm (Group A) and those with renal masses ≥7 cm in diameter (Group B). The intraoperative and postoperative outcomes were compared. Results: Forty patients were enrolled (16 in Group A and 24 in Group B) in this study. Although significant difference in terms of age and American Society of Anesthesiologists score were detected, the two groups did not differ in mean operative time (130 minutes standard deviation [SD] ± 64 versus 148 minutes DS ± 56; P = .376), intraoperative complications (0% versus 8.3%; P = .508), need for postoperative transfusion (12% versus 12%; P > .999), and length of stay (3.38 DS ± 0.62 days versus 3.92 DS ± 2.47; P = .313). One patient had a local recurrence and died ∼13 months after surgery. Furthermore, 2 patients developed trocar-site incisional hernia in Group B. Conclusion: In this cohort of patients, LN for large renal tumors appeared to be safe and feasible. Larger mass dimension does not appear to influence the outcomes when the surgery is performed using a standardized technique by experienced surgeons.

Predictive Factors for Anastomotic Leakage after Laparoscopic and Open Total Gastrectomy: A Systematic Review.

The aim of this systematic review is to identify patient-related, perioperative and technical risk factors for esophago-jejunal anastomotic leakage (EJAL) in patients undergoing total gastrectomy for gastric cancer (GC). A comprehensive literature search of PubMed/MEDLINE, Embase and Scopus databases was performed. Studies providing factors predictive of EJAL by uni- and multivariate analysis or an estimate of association between EJAL and related risk factors were included. All studies were assessed for methodological quality, and a narrative synthesis of the results was performed. A total of 16 studies were included in the systematic review, with a total of 42,489 patients who underwent gastrectomy with esophago-jejunal anastomosis. Age, BMI, impaired respiratory function, prognostic nutritional index (PNI), alcohol consumption, chronic renal failure, diabetes and mixed-type histology were identified as patient-related risk factors for EJAL at multivariate analysis. Likewise, among operative factors, laparoscopic approach, anastomosis type, additional organ resection, blood loss, intraoperative time and surgeon experience were found to be predictive factors for the development of EJAL. In clinical setting, we are able to identify several risk factors for EJAL. This can improve the recognition of higher-risk patients and their outcomes.