Is laparoscopic radical nephrectomy with specimen morcellation acceptable cancer surgery?

Laparoscopic radical nephrectomy (LRN) for renal-cell carcinoma (RCC) with removal of the specimen by morcellation and suction remains controversial because precise pathologic tumor staging is lost, and there is a risk of tumor seeding. We assessed the theoretical impact of surrendering precise pathologic staging on the management of patients with low-stage RCC (T3a or less). In 22 patients who underwent open radical nephrectomy for RCC, the preoperative CT-based clinical stage was correlated with pathologic tumor staging. Possible clinical inclusion criteria for LRN were then correlated with pathologic tumor staging. When comparing clinical and pathologic staging, one patient was understaged and seven were overstaged by preoperative CT. However, if clinical stage T3a or lower was used as the inclusion criterion for LRN, 19 patients (86%) would have been so treated, none would have been underassigned, and future management would not have been compromised according to pathologic staging. Management of patients with low-stage RCC relying on clinical staging only is oncologically adequate. This would make LRN an acceptable option for this subset of patients.