Functional, oncological outcomes and safety of laparoscopic partial nephrectomy versus open partial nephrectomy in localized renal cell carcinoma patients with high anatomical complexity.

Abstract

Partial nephrectomy (PN) is the main treatment strategy for localized renal cell carcinoma (RCC). However, for RCC with high anatomical complexity, PN remains a challenge for urologists. Therefore, this study aimed to evaluate the functional oncological outcomes and safety of laparoscopic partial nephrectomy (LPN) versus open partial nephrectomy (OPN) in localized RCC patients with highly anatomical complexity (R.E.N.A.L. score ≥ 10). We retrospectively studied 575 patients who underwent PN at our center between January 2007 and December 2017. After propensity score-matching (PSM), 137 patients treated with LPN and 54 patients treated with OPN were balanced into 97 and 44 pairs. Patient demographics, and extensive perioperative and prognostic data were recorded and compared. In the matched group, the OPN group had significantly less eGFR loss than the LPN group (2.57ml/min/1.73 m2 vs. 31.59ml/min/1.73 m2, P < 0.001). The recurrence-free survival (P = 0.287), overall survival (P = 0.296), cancer-specific survival (P = 0.664), and cardiocerebrovascular disease-specific survival (P = 0.341) were equivalent between groups. The rates of minor (P = 0.621) and major (P = 0.647) complications were also similar between groups. This PSM cohort study showed that OPN resulted in better renal function preservation than LPN in localized RCC patients with high anatomical complexity, and had comparable oncological and safety outcomes after long-term follow-up. These findings may help improve clinical decision-making for localized RCC patients with high anatomical complexity.