PD64-01 PROSPECTIVE RANDOMIZED TRIAL COMPARING OPEN TO LAPAROSCOPIC PARTIAL NEPHRECTOMY (NCT01809119)

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy VI (PD64)1 Sep 2021PD64-01 PROSPECTIVE RANDOMIZED TRIAL COMPARING OPEN TO LAPAROSCOPIC PARTIAL NEPHRECTOMY (NCT01809119) Guilherme Sawczyn, Giuliano Guglielmetti, Gilberto Rodrigues, Leonardo Cardilli, Mauricio Cordeiro, Luis Neves, Jose Pontes, Arnaldo Fazoli, Rafael Coelho, Miguel Srougi, and William Nahas Guilherme SawczynGuilherme Sawczyn More articles by this author , Giuliano GuglielmettiGiuliano Guglielmetti More articles by this author , Gilberto RodriguesGilberto Rodrigues More articles by this author , Leonardo CardilliLeonardo Cardilli More articles by this author , Mauricio CordeiroMauricio Cordeiro More articles by this author , Luis NevesLuis Neves More articles by this author , Jose PontesJose Pontes More articles by this author , Arnaldo FazoliArnaldo Fazoli More articles by this author , Rafael CoelhoRafael Coelho More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , and William NahasWilliam Nahas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002108.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy is the standard treatment for renal tumors smaller than 7 cm. Recently, we observed a trend toward minimally invasive surgery for partial nephrectomy. However, there is no robust data that could favor its use over open techniques. This is the first randomized controlled trial comparing surgical complications, functional and oncological outcomes in patients undergoing open partial nephrectomy (OPN) or laparoscopic partial nephrectomy (LPN). METHODS: From 2012 to 2020, 208 patients were randomized and assigned to either OPN or LPN for treatment of renal tumors smaller than 7 cm. Exclusion criteria included multiple tumors, solitary kidney, glomerular rate filtration (GFR) lower than 30 ml/min/1,73m2, any contraindication to open or laparoscopic surgery. Intraoperative data, functional outcomes, oncological outcomes and complications were evaluated. GFR was measured with 51Cr-EDTA and estimated GFR realized before, at 3 and 12 months after surgery. Unexpected events up to 3 months after surgery were considered surgical complications and classified following Clavien-Dindo Grading System. RESULTS: In the period, 28 patients ended up being excluded after randomization and 180 were included (84 for LPN arm and 96 for OPN arm) in the intention-to-treat analysis. Operative data showed no difference regarding operative time, warm ischemia time, estimated blood loss or transfusions. Zero ischemia was more frequent for OPN (35,4% vs 15,5%, p=0,02). No difference in hospital stay, 30 or 90-days complications were noted between groups. OPN had more abdominal wall complications (31.2% vs 13.1%). Regarding oncological outcomes, no difference was noted for positive margins, recurrence or overall survival. However, LPN group had less relative average kidney function reduction in 3 months (-5.2% vs -10%, p= 0.04) and 12 months after surgery (-0.8% vs -6.3%, p = 0.02), and a lower rate of downstage on the CKD classification in 12 months (14,1% vs 32,6%, p = 0.006) (Table 1). CONCLUSIONS: LPN has similar results to OPN regarding intraoperative data, complications and oncological outcomes. Minimally invasive partial nephrectomy appears to provide better kidney function preservation and might be the preferable surgical approach in a tertiary center with experienced and well trained surgeons. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1143-e1143 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Guilherme Sawczyn More articles by this author Giuliano Guglielmetti More articles by this author Gilberto Rodrigues More articles by this author Leonardo Cardilli More articles by this author Mauricio Cordeiro More articles by this author Luis Neves More articles by this author Jose Pontes More articles by this author Arnaldo Fazoli More articles by this author Rafael Coelho More articles by this author Miguel Srougi More articles by this author William Nahas More articles by this author Expand All Advertisement Loading ...