Comparisons of oncological outcomes and perioperative complications between laparoscopic and open radical nephrectomies in patients with clinical T2 renal cell carcinoma (≥7cm).

Hakmin Lee,Han-Yong Choi,Seong Soo Jeon,Byong Chang Jeong,Hyun Hwan Sung,Chung Un Lee,Hyun Moo Lee,Cheol Kwak,Jae Ho Yoo,Chang Wook Jeong,Seong Il Seo,Sarah P Psutka

doi:10.1371/journal.pone.0191786

Abstract

PurposeAlthough minimal invasive techniques have been widely accepted in contemporary urology, the perioperative outcomes of laparoscopy in patients with clinical T2 renal cell carcinoma (RCC) have not been clearly evaluated. We aimed to compare the outcomes of laparoscopic radical nephrectomy (LRN) with those of open radical nephrectomy (ORN) in patients with clinical T2 RCC.MethodsWe retrospectively analyzed the data of 835 patients who underwent radical nephrectomy for localized clinical T2 RCC (≥7 cm). The survival rates and postoperative complications were compared between the LRN and ORN groups. Multivariate Cox regression tests were performed to identify the independent predictors of each survival outcome.ResultsThere were 578 (69.2%) subjects in ORN group and 257 (30.8%) in LRN group, respectively. The LRN group showed a significant male predominance (p = 0.013), higher pathological stage (p = 0.02), and higher cellular grade (p = 0.010) compared with the ORN group. No significant differences in progression-free (p = 0.070), cancer-specific (p = 0.472), or overall survival (p = 0.249) were found between the two groups. In the multivariate analysis, the type of surgery did not show any significant associations with all three survival outcomes (all p > 0.2). Furthermore, there was no significant difference in postoperative complication rate between the two groups (p = 0.595). In the subgroup analysis according to tumor histology, no significant relationships were observed between survival outcome and surgery type.ConclusionThe LRN and ORN groups showed similar oncological outcomes in patients with clinical T2 RCC. Early postoperative complications were also comparable between LRN and ORN.

Highlights

With the advent of modern imaging technology, more than 300,000 patients were diagnosed as having renal cell carcinoma (RCC) worldwide in 2012 [1]
There was no significant difference in postoperative complication
Postoperative complications were comparable between laparoscopic radical nephrectomy (LRN) and open radical nephrectomy (ORN)

Summary

Introduction

With the advent of modern imaging technology, more than 300,000 patients were diagnosed as having renal cell carcinoma (RCC) worldwide in 2012 [1]. The incidence of RCC has been constantly increasing and almost doubled in the past 2 decades in North America (7.6 per 100,000 person-years in 1988 to 11.7 per 100,000 person-years in 2006) [2]. Because of modern, advanced imaging modalities, an increased rate of incidental detection of small renal tumors has resulted in an overall downward stage migration [4,5]. Mathew et al demonstrated global trends of an increasing incidence of RCCs after analyzing data from several worldwide databases [5]. About 25–30% of patients are found to have huge or metastatic disease at the time of diagnosis even with advances in imaging technology [6]

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