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

  • 1Department of Urology, Seoul National University College of Medicine, Seoul, Korea. hhkim@snu.ac.kr


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).
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.
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.
PLRN and HLRN are safe treatment options with comparable oncologic results to ORN for pT1 RCC.


Renal cell carcinoma; Nephrectomy; Laparoscopic surgery; Treatment outcome

MeSH Terms

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


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

  • 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.


1. Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, et al. Laparoscopic nephrectomy: initial case report. J Urol. 1991. 146:278–282.
2. Kavoussi LR, Kerbl K, Capelouto CC, McDougall EM, Clayman RV. Laparoscopic nephrectomy for renal neoplasms. Urology. 1993. 42:603–609.
3. Dunn MD, Portis AJ, Shalhav AL, Elbahnasy AM, Heidorn C, McDougall EM, et al. Laparoscopic versus open radical nephrectomy: a 9-year experience. J Urol. 2000. 164:1153–1159.
4. Chan DY, Cadeddu JA, Jarrett TW, Marshall FF, Kavoussi LR. Laparoscopic radical nephrectomy: cancer control for renal cell carcinoma. J Urol. 2001. 166:2095–2099.
5. Cicco A, Salomon L, Hoznek A, Saint F, Alame W, Gasman D, et al. Results of retroperitoneal laparoscopic radical nephrectomy. J Endourol. 2001. 15:355–359.
6. Nakada SY, Moon TD, Gist M, Mahvi D. Use of pneumo sleeve as an adjunct in laparoscopic nephrectomy. Urology. 1997. 49:612–613.
7. Choi HS, Lee JH, Hong SH, Hwang TK. Laparoscopic radical nephrectomy: results and oncological outcome. Korean J Urol. 2006. 47:1144–1148.
8. Kim TH, Cho WY, Kwak JJ, Yoon JH, Sung GT. Comparison of laparoscopic radical nephrectomy with open radical nephrectomy. Korean J Urol. 2007. 48:259–264.
9. Lee SE, Ku JH, Kwak C, Kim HH, Paick SH. Hand assisted laparoscopic radical nephrectomy: comparison with open radical nephrectomy. J Urol. 2003. 170:756–759.
10. Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, et al. AJCC cancer staging manual. 2002. 6th ed. New York: Springer Press;323–328.
11. Steinberg AP, Finelli A, Desai MM, Abreu SC, Remani AP, Spaliviero M, et al. Laparoscopic radical nephrectomy for large (greater than 7 cm, T2) renal tumors. J Urol. 2004. 172:2172–2176.
12. Venkatesh R, Belani JS, Chen C, Sundaram CP, Bhayani SB, Figenshau RS, et al. Prospective randomized comparison of laparoscopic and hand-assisted laparoscopic radical nephrectomy. Urology. 2007. 70:873–877.
13. Busby E, Das S, Rao Tunuguntla HS, Evans CP. Hand-assisted laparoscopic vs the open (flank incision) approach to radical nephrectomy. BJU Int. 2003. 91:341–344.
14. Lee SE, Ku JH, Kwak C, Kim HH, Paick SH. Hand assisted laparoscopic radical nephrectomy: comparison with open radical nephrectomy. J Urol. 2003. 170:756–759.
15. Chung SD, Huang KH, Lai MK, Huang CY, Pu YS, Yu HJ, et al. Long-term follow-up of hand-assisted laparoscopic radical nephrectomy for organ-confined renal cell carcinoma. Urology. 2007. 69:652–655.
16. Makhoul B, De La Taille A, Vordos D, Salomon L, Sebe P, Audet JF, et al. Laparoscopic radical nephrectomy for T1 renal cancer: the gold standard? A comparison of laparoscopic vs open nephrectomy. BJU Int. 2004. 93:67–70.
17. Permpongkosol S, Chan DY, Link RE, Sroka M, Allaf M, Varkarakis I, et al. Long-term survival analysis after laparoscopic radical nephrectomy. J Urol. 2005. 174:1222–1225.
18. Colombo JR Jr, Haber GP, Jelovsek JE, Lane B, Novick AC, Gill IS. Seven years after laparoscopic radical nephrectomy: oncologic and renal functional outcomes. Urology. 2008. 71:1149–1154.
19. Kawauchi A, Yoneda K, Fujito A, Okihara K, Soh J, Naitoh Y, et al. Oncologic outcome of hand-assisted laparoscopic radical nephrectomy. Urology. 2007. 69:53–56.
20. Paick SH, Kim HH, Lee SE. Initial experience of hand assisted laparoscopic radical nephrectomy for renal cell carcinoma. Korean J Urol. 2001. 42:465–470.
21. Lee SW, Lee JJ, Lee TY. The early experience of laparoscopic radical nephrectomy: laparoscopic versus open radical nephrectomy. Korean J Urol. 2002. 43:818–823.
22. Kim SH, Seo SI, Hwang TK. Comparison of hand-assisted laparoscopic versus reteroperitoneoscopic radical nephrectomy. Korean J Urol. 2003. 44:1135–1139.
23. Berger AD, Kanofsky JA, O'Malley RL, Hyams ES, Chang C, Taneja SS, et al. Transperitoneal laparoscopic radical nephrectomy for large (more than 7 cm) renal masses. Urology. 2008. 71:421–424.
24. Savage SJ, Gill IS. Laparoscopic radical nephrectomy for renal cell carcinoma in a patient with level I renal vein tumor thrombus. J Urol. 2000. 163:1243–1244.
25. Henderson A, Murphy D, Jaganathan K, Roberts WW, Wolf JS Jr, Rané A. Hand-assisted laparoscopic nephrectomy for renal cell cancer with renal vein tumor thrombus. Urology. 2008. 72:268–272.
26. Kim JS, Kown TG, Kim BW. Laparoscopic radical nephrectomy for T2 renal cell carcinomas. Korean J Urol. 2006. 47:1139–1143.
Full Text Links
  • KJU
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr