Hand-Assisted Laparoscopic Radical Nephrectomy: Comparison with Conventional Open Radical Nephrectomy

Abstract

To compare the outcomes of hand-assisted laparoscopic radical nephrectomy (HALRN) with those of open radical nephrectomy (ORN) for renal-cell carcinoma (RCC). A total of 130 patients with stage T(1) or T(2) RCC with a maximum diameter < 10 cm underwent radical nephrectomy by HALRN (n = 63) or ORN (n = 67). Data from these two groups were reviewed retrospectively. Although the maximum tumor size treated by HALRN was significantly less than that treated by ORN, there were no significant differences in the remaining features of the two groups. One HALRN was converted to open surgery. The mean operative time for HALRN (273 minutes) was significantly longer than that for ORN (189 minutes), whereas the mean estimated blood loss (315 v 381 mL). There were significant differences in measures of postoperative recovery, including time to walking (1.4 days for HALRN v 2.2 days for ORN), time to oral intake (1.8 v 3.3 days), and time to grant of permission for hospital discharge (7.4 v 10.2 days). Postoperative complications were observed in one and four patients in the HALRN and ORN groups, respectively. There were no significant differences in the recurrence-free and cancer-specific survival rates in the two groups. Despite the longer operative time, HALRN represents an effective, safe, and less-invasive treatment option for RCC. If performed for the proper indications, HALRN could achieve cancer control similar to that available with ORN.