Seven Years After Laparoscopic Radical Nephrectomy: Oncologic and Renal Functional Outcomes

Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Urology (Impact Factor: 2.19). 07/2008; 71(6):1149-54. DOI: 10.1016/j.urology.2007.11.081
Source: PubMed


To compare the long-term oncologic and renal function outcomes in patients undergoing laparoscopic (LRN) versus open radical nephrectomy (ORN).
The medical records of 116 patients undergoing radical nephrectomy for pathologically confirmed renal cell carcinoma before January 2000 were reviewed. Of these 116 patients, 63 underwent LRN and 53 ORN. The oncologic and renal functional data were obtained from the patient charts, radiographic reports, and direct telephone calls to the patients or their families.
The median follow-up was 65 months (range 19 to 92) in the LRN group and 76 months (range 8 to 105) in the ORN group. LRN was successfully completed in all patients without open conversion. The mean tumor size was 5.4 cm in the LRN group and 6.4 cm in the ORN group (P = 0.007). The 5-year overall survival (78% versus 84%, respectively; P = 0.24), cancer-specific survival (91% versus 93%, respectively; P = 0.75), and recurrence-free survival (91% versus 93%, respectively; P = 0.75) rates were similar between the LRN and ORN groups. At 7 years, the overall survival (72% versus 84%; P = 0.24), cancer-specific survival (91% versus 93%; P = 0.75), and recurrence-free survival (91% versus 93%; P = 0.75) rates were also comparable. No port site recurrence was noted in the laparoscopic group. The long-term renal function outcomes were similar in the LRN and ORN groups, with serum creatinine increasing by 33% and 25%, and the estimated creatinine clearance decreasing by 31% and 23% from baseline, respectively. Chronic renal insufficiency developed in 4% of patients in each group.
The results of our study have shown that LRN and ORN have comparable long-term oncologic and renal functional outcomes.

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    • "Laparoscopic nephrectomy has been shown effective in removing diseased kidneys with tumors, even tumors larger than 7-cm in diameter. (Berger et al., 2008; Steinberg et al., 2004) Long-term oncologic outcomes (overall, cancer-specific, and recurrence-free survivals) of laparoscopic radical nephrectomy, either with pure laparoscopic or HAD technique, or with trans-peritoneal or trans-retroperitoneal approach, for renal cell carcinoma (RCC) are comparable to those of its open counterpart, with the obvious benefits of less pain, less blood loss and earlier recuperation (Colombo et al., 2008; Chung et al., 2007; Venkatesh et al., 2007; Desai et al., 2005; Nambirajan et al., 2004). "
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    • "It is possible that this loss of tactile feedback could hinder identification of metastatic disease in certain patients. Finally, there has been limited study of the effects of laparoscopic insufflation on the biology of malignant cells; adult data, however, show equivalent outcomes in early stage renal cell carcinoma with open and laparoscopic approaches to radical nephrectomy [8]. "
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    • "[6] "

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