Korean J Urol.  2009 May;50(5):457-462.

Oncological and Surgical Outcomes of Pure Laparoscopic Radical Nephrectomy and Hand-Assisted Laparoscopic Radical Nephrectomy for pT1 Renal Cell Carcinoma: Comparison with Open Radical Nephrectomy

• Kim M
• Park YH
• Lee SE
• Kwak C
• Kim HH

Abstract

PURPOSE: We compared the surgical and oncologic outcomes of pure laparoscopic radical nephrectomy (PLRN) and hand-assisted laparoscopic radical nephrectomy (HLRN) with those of open radical nephrectomy (ORN) in patients with pT1 renal cell carcinoma (RCC).
MATERIALS AND METHODS
Between 1999 and 2007, a total of 269 patients underwent PLRN (n=77), HLRN (n=87), and ORN (n=105) for pT1 RCC. Follow-up data consisted of clinical, pathologic, and oncologic results and were reviewed retrospectively. Kaplan-Meier survival curves were constructed for progression and survival endpoints.
RESULTS
Mean operative time was 184.0, 164.0, and 132.6 minutes (p<0.001); mean estimated blood loss was 196.7, 147.8, and 232.6 ml (p<0.001); and mean postoperative hospital stay was 5.7, 7.2, and 7.8 days (p<0.001) for the PLRN, HLRN and ORN groups, respectively. The major complication rate after surgery was 2.6%, 2.3%, and 3.8%, respectively (p=0.807). Median follow-up periods were 32 months in the PLRN group, 48 months in the HLRN group, and 37 months in the ORN group. Five-year progression-free survival was 97.4%, 96.6%, and 98.1% (p=0.557), and 5-year cancer-specific survival was 98.7%, 96.6%, and 98.1% (p=0.508), respectively.
CONCLUSIONS
PLRN and HLRN are safe treatment options with comparable oncologic results to ORN for pT1 RCC.

Keyword

Renal cell carcinoma; Nephrectomy; Laparoscopic surgery; Treatment outcome

MeSH Terms

Carcinoma, Renal Cell
Disease-Free Survival
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Laparoscopy
Length of Stay
Nephrectomy
Operative Time
Retrospective Studies
Treatment Outcome

Figure

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  Fig. 1 Trocar placement for pure laparoscopic radical nephrectomy (PLRN) and hand-assisted laparoscopic nephrectomy (HLRN).

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  Fig. 2 Kaplan-Meier curve indicating the proportions free of disease recurrences and overall survival (log rank analysis, p<0.05). PLRN: pure laparoscopic radical nephrectomy, HLRN: hand-assisted laparoscopic nephrectomy, ORN: open radical nephrectomy.

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