Abstract: Objective To compare the safety, feasibility and efficacy of transperitoneal and retroperitoneal laparoscopic partial
nephrectomy (LPN) in the treatment of renal tumors with R. E. N. A. L score more than 7. Methods The clinical data were
collected from 62 patients undergoing transperitoneal LPN (32 cases) and retroperitoneal LPN (30 cases) for a complex renal
mass (R.E.N.A.L. score≥7) between January 2012 and March 2014. The surgical and early postoperative outcomes and
complications were analyzed to evaluate the efficacy of the treatments. The mean operative time, estimated blood loss, warm
ischemia time, surgical complications, blood transfusion rate, tolerating regular diet time, postoperative hospital stay and
surgical margin were compared between the two groups. Results The operations were completed successfully in all cases
except for 1 case in transperitoneal group and 3 in retroperitoneal group that required conversion to open surgery. No
significant differences were found in age, body mass index, ASA score, Charlson comorbidity index, tumor size or R.E.N.A.L.
nephrometry score (P>0.05), nor in estimated blood loss, warm ischemia time, intraoperative complication, blood transfusion
rate or surgical margin between the two groups (P>0.05, respectively). The transperitoneal LPN group had a shorter mean
operative time than retroperitoneal LPN group (210.4±59.2 vs 252±58.3 min, P<0.05) but showed longer tolerating regular diet
time (47±10 h vs 23±6 h, P<0.05) and postoperative hospital stay time (8.4±1.9 days vs 6.5±1.6 days, P<0.05). Conclusion Both
transperitoneal LPN and retroperitoneal LPN are safe, feasible and effective for surgical management of complex localized
tumors, but the transperitoneal procedure offers larger operative space with better exposure; the retroperitoneal procedure
better promotes postoperative recovery of the patients.