Korean J Urol.  2010 Jul;51(7):467-471.

Comparison of Laparoscopic and Open Partial Nephrectomies in T1a Renal Cell Carcinoma: A Korean Multicenter Experience

• Park H
• Byun SS
• Kim HH
• Lee SB
• Kwon TG
• Jeon SH
• Kang SH
• Seo SI
• Oh TH
• Jeon YS
• Lee W
• Hwang TK
• Rha KH
• Seo IY
• Kwon DD
• Kim YJ
• Choi Y
• Park SK

Abstract

PURPOSE
We analyzed a series of patients who had undergone laparoscopic partial nephrectomies (LPNs) and open partial nephrectomies (OPNs) to compare outcomes of the two procedures in patients with pathologic T1a renal cell carcinomas (RCCs).
MATERIALS AND METHODS
From January 1998 to May 2009, 417 LPNs and 345 OPNs were performed on patients with small renal tumors in 15 institutions in Korea. Of the patients, 273 and 279 patients, respectively, were confirmed to have pT1a RCC. The cohorts were compared with respect to demographics, peri-operative data, and oncologic and functional outcomes.
RESULTS
The demographic data were similar between the groups. Although the tumor location was more exophytic (51% vs. 44%, p=0.047) and smaller (2.1 cm vs. 2.3 cm, p=0.026) in the LPN cohort, the OPN cohort demonstrated shorter ischemia times (23.4 min vs. 33.3 min, p<0.001). The LPN cohort was associated with less blood loss than the OPN cohort (293 ml vs. 418 ml, p<0.001). Of note, two patients who underwent LPNs had open conversions and nephrectomies were performed because of intra-operative hemorrhage. The decline in the glomerular filtration rate at the last available follow-up (LPN, 10.9%; and OPN, 10.6%) was similar in both groups (p=0.8). Kaplan-Meier estimates of 5-year local recurrence-free survival (RFS) were 96% after LPN and 94% after OPN (p=0.8).
CONCLUSIONS
The LPN group demonstrated similar rates of recurrence-free survival, complications, and postoperative GFR change compared with OPN group. The LPN may be an acceptable surgical option in patients with small RCC in Korea.

Keyword

Glomerular filtration rate; Kidney neoplasms; Nephrectomy; Outcomes assessment

MeSH Terms

Carcinoma, Renal Cell*
Cohort Studies
Demography
Follow-Up Studies
Glomerular Filtration Rate
Hemorrhage
Humans
Ischemia
Kidney Neoplasms
Korea
Nephrectomy*
Outcome Assessment (Health Care)

Figure

• 

  FIG. 1 Recurrence-free probability curves demonstrating no difference in outcomes for T1a RCC patients undergoing open and laparoscopic partial nephrectomies (log-rank p=0.332). RFS: recurrence-free survival, OPN: open partial nephrectomy, LPN: laparoscopic partial nephrectomy, NSS: nephron-sparing surgery, RCC: renal cell carcinoma.

Reference

1. Belldegrun A, Tsui KH, deKernion JB, Smith RB. Efficacy of nephron-sparing surgery for renal cell carcinoma: analysis based on the new 1997 tumor-node-metastasis staging system. J Clin Oncol. 1999. 17:2868–2875.

2. Uzzo RG, Novick AC. Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol. 2001. 166:6–18.

3. Fergany AF, Hafez KS, Novick AC. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol. 2000. 163:442–445.

4. Marszalek M, Ponholzer A, Brossner C, Wachter J, Maier U, Madersbacher S. Elective open nephron-sparing surgery for renal masses: single-center experience with 129 consecutive patients. Urology. 2004. 64:38–42.

5. Lerner SE, Hawkins CA, Blute ML, Grabner A, Wollan PC, Eickholt JT, et al. Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery. J Urol. 1996. 155:1868–1873.

6. Gill IS, Desai MM, Kaouk JH, Meraney AM, Murphy DP, Sung GT, et al. Laparoscopic partial nephrectomy for renal tumor: duplicating open surgical techniques. J Urol. 2002. 167:469–467.

7. Orvieto MA, Chien GW, Laven B, Rapp DE, Sokoloff MH, Shalhav AL. Eliminating knot tying during warm ischemia time for laparoscopic partial nephrectomy. J Urol. 2004. 172:2292–2295.

8. Thompson T, Ng CF, Tolley D. Renal parenchymal hemostatic aids: glues and things. Curr Opin Urol. 2003. 13:209–214.

9. Richter F, Schnorr D, Deger S, Trk I, Roigas J, Wille A, et al. Improvement of hemostasis in open and laparoscopically performed partial nephrectomy using a gelatin matrix-thrombin tissue sealant (FloSeal). Urology. 2003. 61:73–77.

10. Chien GW, Orvieto MA, Chuang MS, Sokoloff MH, Gerber GS, Shalhav AL. Use of suspension traction system for renal positioning during laparoscopic partial nephrectomy. J Endourol. 2005. 19:406–409.

11. Sundaram CP, Rehman J, Venkatesh R, Lee D, Rageb MM, Kibel A, et al. Hemostatic laparoscopic partial nephrectomy assisted by a water-cooled, high-density, monopolar device without renal vascular control. Urology. 2003. 61:906–909.

12. Marszalek M, Meixl H, Polajnar M, Rauchenwald M, Jeschke K, Madersbacher S. Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur Urol. 2009. 55:1171–1178.

13. Herr HW. Partial nephrectomy for unilateral renal carcinoma and a normal contralateral kidney: 10-year followup. J Urol. 1999. 161:33–34.

14. Stevens LA, Levey AS. Measured GFR as a confirmatory test for estimated GFR. J Am Soc Nephrol. 2009. 20:2305–2313.

15. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003. 139:137–147.

16. Simmons MN, Gill IS. Decreased complications of contemporary laparoscopic partial nephrectomy: use of a standardized reporting system. J Urol. 2007. 177:2067–2073.

17. Schiff JD, Palese M, Vaughan ED Jr, Sosa RE, Coll D, Del Pizzo JJ. Laparoscopic vs open partial nephrectomy in consecutive patients: the Cornell experience. BJU Int. 2005. 96:811–814.

18. Patard JJ, Shvarts O, Lam JS, Pantuck AJ, Kim HL, Ficarra V, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol. 2004. 171:2181–2185.

19. Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR Jr, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007. 178:41–46.

20. Porpiglia F, Volpe A, Billia M, Renard J, Scarpa RM. Assessment of risk factors for complications of laparoscopic partial nephrectomy. Eur Urol. 2008. 53:590–596.

21. Porpiglia F, Volpe A, Billia M, Scarpa RM. Laparoscopic versus open partial nephrectomy: analysis of the current literature. Eur Urol. 2008. 53:732–742.

22. Gong EM, Orvieto MA, Zorn KC, Lucioni A, Steinberg GD, Shalhav AL. Comparison of laparoscopic and open partial nephrectomy in clinical T1a renal tumors. J Endourol. 2008. 22:953–957.

23. Lane BR, Gill IS. 5-year outcomes of laparoscopic partial nephrectomy. J Urol. 2007. 177:70–74.

24. Canes D. Long-term oncological outcomes of laparoscopic partial nephrectomy. Curr Opin Urol. 2008. 18:145–149.

25. Lane BR, Novick AC, Babineau D, Fergany AF, Kaouk JH, Gill IS. Comparison of laparoscopic and open partial nephrectomy for tumor in a solitary kidney. J Urol. 2008. 179:847–851.

26. Kwon EO, Carver BS, Snyder ME, Russo P. Impact of positive surgical margins in patients undergoing partial nephrectomy for renal cortical tumours. BJU Int. 2007. 99:286–289.