Laparoscopic Radical Nephrectomy Group Research Articles

Minimally invasive transperitoneal partial versus radical nephrectomy in obese patients: perioperative and long-term functional outcomes from a large perspective contemporary series (RECORd2 project).

The aim of this study is to evaluate the perioperative and long-term functional outcomes of laparoscopic (LPN) and robot-assisted partial nephrectomy (RAPN) in comparison to laparoscopic radical nephrectomy (LRN) in obese patients diagnosed with renal cell carcinoma. Clinical data of 4325 consecutive patients from The Italian REgistry of COnservative and Radical Surgery for cortical renal tumor Disease (RECORD 2 Project) were gathered. Only patients treated with transperitoneal LPN, RAPN, or LRN with Body Mass Index (BMI) ≥30 kg/m2, clinical T1 renal tumor and preoperative estimated glomerular filtration rate (eGFR) ≥60 mL/min, were included. Perioperative, and long-term functional outcomes were examined. Overall, 388 patients were included, of these 123 (31.7%), 120 (30.9%) and 145 (37.4%) patients were treated with LRN, LPN, and RAPN, respectively. No significant difference was observed in preoperative characteristics. Overall, intra and postoperative complication rates were comparable among the groups. The LRN group had a significantly increased occurrence of acute kidney injury (AKI) compared to LPN and RAPN (40.6% vs. 15.3% vs. 7.6%, P=0.001). Laparoscopic RN showed a statistically significant higher renal function decline at 60-month follow-up assessment compared to LPN and RAPN. A significant renal function loss was recorded in 30.1% of patients treated with LRN compared to 16.7% and 10.3% of patients treated with LPN and RAPN (P=0.01). In obese patients, both LPN and RAPN showcased comparable complication rates and higher renal function preservation than LRN. These findings highlighted the potential benefits of minimally invasive PN over radical surgery in the context of obese individuals.

Comparisons of survival and surgical outcomes between minimally invasive partial nephrectomy and radical nephrectomy in elderly patients with stage 1 renal cell carcinoma.

We compared survival and perioperative outcomes of robot-assisted laparoscopic partial nephrectomy (RAPN) and laparoscopic radical nephrectomy (LRN) for older patients (age 70 years or older) with stage 1 renal cell carcinoma (RCC). This retrospective, single-center study included 260 patients who underwent RAPN and 44 patients who underwent LRN. The overall survival (OS) and perioperative outcomes were compared between these two groups using an inverse probability of treatment weighting (IPTW) analysis. Compared with the LRN group, a trend of more complications was observed in the RAPN group, including a higher body mass index (24 vs. 22 kg/m2 ; P = 0.0002) and higher rates of hypertension (77% vs. 55%; P = 0.0029) and chronic kidney disease (62% vs. 36%; P = 0.0027). After adjustment by the IPTW analysis, the RAPN group had a shorter operative time (143 vs. 282 min; P = 0.033), shorter postoperative length of hospital stay (PLOS) (4.1 vs. 7.9 days; P = 0.004), and less change in the estimated glomerular filtration rate during surgery (-8.4% vs. -32%; P < 0.0001) than the LRN group; however, the perioperative complication rates were similar. Patients who underwent RAPN had better 5-year OS than those who underwent LRN (95% vs. 90%; log-rank, P = 0.017). RAPN resulted in better OS and surgical outcomes, with shorter operative time, shorter PLOS, and better renal function preservation, than LRN for older patients with stage 1 RCC. Therefore, RAPN may be the primary option for patients indicated for surgical intervention. Geriatr Gerontol Int 2024; 24: 269-274.

Laparoscopic partial versus radical nephrectomy for localized renal cell carcinoma over 4 cm

PurposeTo compare the long-term clinical and oncologic outcomes of laparoscopic partial nephrectomy (LPN) and laparoscopic radical nephrectomy (LRN) in patients with renal cell carcinoma (RCC) > 4 cm.MethodsWe retrospectively reviewed the records of all patients who underwent LPN or LRN in our department from January 2012 to December 2017. Of the 151 patients who met the study selection criteria, 54 received LPN, and 97 received LRN. After propensity-score matching, 51 matched pairs were further analyzed. Data on patients’ surgical data, complications, histologic data, renal function, and survival outcomes were collected and analyzed.ResultsCompared with the LRN group, the LPN group had a longer operative time (135 min vs. 102.5 min, p = 0.001), larger intraoperative bleeding (150 ml vs. 50 ml, p < 0.001), and required longer stays in hospital (8 days vs. 6 days, p < 0.001); however, the level of ECT-GFR was superior at 3, 6, and 12 months (all p < 0.001). Similarly, a greater number of LRN patients developed CKD compared with LPN until postoperative 12 months (58.8% vs. 19.6%, p < 0.001). In patients with preoperative CKD, LPN may delay the progression of the CKD stage and even improve it when compared to LRN treatment. There were no significant differences between the two groups for OS, CSS, MFS, and PFS (p = 0.06, p = 0.30, p = 0.90, p = 0.31, respectively). The surgical method may not be a risk factor for long-term survival prognosis.ConclusionLPN preserves renal function better than LRN and has the potential value of significantly reducing the risk of postoperative CKD, but the long-term survival prognosis of patients is comparable.

Propensity-matched pair analysis of safety and efficacy between laparoscopic and open radical nephrectomy for the treatment of large renal masses (>10 cm): a retrospective cohort study.

BackgroundOpen radical nephrectomy (ORN) is a practical procedure for treating patients with large renal carcinomas >10 cm in size, and few studies have focused on feasibility and safety of laparoscopic radical nephrectomy (LRN). The current study was to assess the safety and effectiveness of LRN and ORN in large renal carcinoma patients by propensity matched pair analysis.MethodsIn this cohort study, a retrospective review of radical nephrectomy data from October 2010 to October 2018 at Changhai Hospital was conducted. Patients with renal carcinomas >10 cm in size by pre-operative images were included. Patients’ demographics including age, gender, body mass index (BMI), tumor size, operation time, hospitalization days, etc. were collected. Renal tumor patients undergoing LRN or ORN were match-paired by gender, BMI, age, and tumor size. Peri-operative outcomes including estimated blood loss and complications were compared. The follow-up contents included survival time, disease progression, and cause of death, and cancer-specific and progression-free survival were estimated via Kaplan-Meier curve analysis.ResultsAmong 92 patients with clinical T2b renal masses, 37 pairs were matched. The average tumor sizes of the LRN and ORN groups were 11.37±0.30 and 11.67±0.33 cm (P=0.375), respectively. The average operating time for LRN was slightly longer (204.32±11.17 vs. 192.78±8.50 min, P=0.414). Estimated blood loss (EBL) (336.49±63.58 mL for LRN vs. 545.95±74.52 mL for ORN, P=0.036), the length of postoperative stay [6.0 (5.0–9.0) for LRN vs. 9.0 (6.0–11.5) days for ORN, P=0.015], and removal time of the drainage tube [4.0 (3.0–5.0) days for LRN vs. 5.0 (4.0–6.0) for ORN, P<0.001] were less than in the LRN group. The pathological subtype and Fuhrman grade were comparable. Both groups were followed up for a similar period, and no difference was observed in 5-year survival rates.ConclusionsConsidering the conversion rates and overall complication rates, it seems that LRN for large renal carcinomas demonstrated equivalent peri-operative safety and effectiveness compared with ORN, with no adverse effects on midterm oncological outcomes.

Differences in the complications according to the approach and type of nephrectomy in renal cancer CT1 treated with surgery

Objective: Comparative analysis of postoperative complications according to approach (open and laparoscopic) and surgical technique (radical and partial nephrectomy) in patients with renal cancer c T1.&#x0D; Material and methods: A retrospective analysis of 480 patients with renal cancer c T1 treated by surgery between 1990-2010. Complications in the first 60 days after surgery were evaluated (Clavien-Dindo classification).Complications Clavien≥III were severe.&#x0D; Patients was clasificated in four cohort: 1) Open radical nephrectomy (ORN);2) laparoscopic radical nephrectomy (LRN) ;3) open partial nephrectomy (OPN) ; 4) laparoscopic partial nephrectomy (LPN).&#x0D; Univariate and multivariate analysis have been performed using Cox regression to determine variables with relate to the complications.&#x0D; Results: In 198(41,3%) patients was performed ORN and in 155(32,3%)LRN. In the group of partial nephrectomies, 51 cases (10.6%) were open and 76 (15.8%) laparoscopic.&#x0D; Complications occurred in 20.2% of patients. The most frequent was Clavien II (13%). 25,8% undergoing ORN developed complications, in the LRN group 16,8% experienced complications (p=0,09). No significant difference in distribution of complications between laparoscopic and open approach in partial nephrectomy (OPN-15,7%, LPN-15,8%)&#x0D; The group of ORN had more complications than the other groups (of type Clavien-II), but there were not differences between severe complications.&#x0D; In the multivariable analysis laparoscopic radical nephrectomy behaved as independent predictive variable of complications (OR=0,41, p=0,007). In the multivariable analysis of Clavien≥III complication, no predictor or protective factor was identified.&#x0D; Conclusion: Laparoscopic radical nephrectomy decreased the total postoperative complications to more than half. In severe complications (Clavien ≥ III) no predictors of complications were identified.

Safety and oncological outcomes for large (stage ≥T2b) and locally advanced renal cell carcinoma: comparison between laparoscopic and modified hand-assisted laparoscopic radical nephrectomy.

ObjectiveTo compare the operative and oncologic outcomes between hand-assisted laparoscopic radical nephrectomy (HALRN) and laparoscopic radical nephrectomy (LRN) for large (stage ≥T2b) and locally advanced renal cell carcinoma.MethodsWe retrospectively collected data from patients who underwent HALRN or LRN for stage ≥T2b renal cell carcinoma from January 2011 to January 2018 in our institution. The patients’ demographics, perioperative parameters, and postoperative follow-up data were compared between the two groups. The survival outcome was estimated using the Kaplan–Meier method.ResultsThe HALRN group comprised 78 patients, and the LRN group comprised 63 patients. The median operative duration was significantly shorter in the HALRN than LRN group. The two groups were equivalent in terms of the incision length, blood loss, complication rate, and duration of hospitalization. In the HALRN and LRN groups, the 5-year overall survival rates were 69.4% and 73.1%, the 5-year cancer-specific survival rates were 80.0% and 83.3%, and the 5-year progression-free survival rates were 66.4% and 74.7%, respectively, with no significant differences.ConclusionsCompared with LRN, HALRN may offer a shorter operative duration and equivalent surgical outcomes without sacrificing oncological efficacy. In addition, HALRN has specific advantages for extremely large and complicated renal tumors.

Prospective analysis of laparoscopic versus open radical nephrectomy for renal tumours more than 7 cm.

Aims:To analyse the feasibility of laparoscopic radical nephrectomy (LRN) for renal tumours >7 cm and to compare the operative and oncologic outcomes with open radical nephrectomy (ORN).Settings and Design:This was a prospective, observational, comparative study.Subjects and Methods:The study was conducted at a tertiary care super-speciality hospital. All the patients who underwent radical nephrectomy for >7 cm renal tumours during a period of 2 years (April 2012 to May 2014) were included in the study. Thirty patients were included in each ORN and LRN group. Pre-operative, intra-operative and post-operative data for all these patients were collected and analysed.Statistical Analysis Used:Statistical Package for the Social Sciences (SPSS, version 11.0 for Windows, Chicago, IL).Results:Mean age of patients in ORN and LRN groups was 57.3 ± 6.1 years and 54.9 ± 5.7 years, respectively (P = 0.220). As compared to ORN, LRN had less drop in post-operative haemoglobin (1.39 ± 0.55 g/dl vs. 4.07 ± 1.023 g/dl, P < 0.05), less drop in haematocrit value (4.7 ± 3.25% vs. 9.5 ± 5.13%, P < 0.05), less analgesic requirement for tramadol hydrochloride (165 ± 74.5 mg vs. 260 ± 181.66 mg) and less mean hospital stay (4.2 days vs. 6.1 days, P < 0.05). There was no statistically significant difference in post-operative complication rate and recurrence-free survival over a median follow-up of 17 months (93.9% – LRN vs. 90% – ORN)Conclusions:LRN for large renal tumours is feasible and achieves oncologic outcomes similar to that obtained with ORN.

Comparison of Partial and Radical Laparascopic Nephrectomy: Perioperative and Oncologic Outcomes for Clinical T2 Renal Cell Carcinoma.

Nephron-sparing surgery has emerged as the treatment of choice for small renal masses. However, its role in larger tumors remains controversial. In this study, we compare the outcomes of laparoscopic partial nephrectomy (LPN) vs those of laparoscopic radical nephrectomy (LRN) for T2 renal tumors. Thirteen patients who had LPN and 16 patients who had LRN for T2 renal tumors were retrospectively analyzed for preoperative factors (age, gender, comorbidities, hemoglobin, and creatinine levels and estimated glomerular filtration rate [eGFR]), operative and perioperative characteristics (tumor characteristics, operative time [OT], warm ischemia time [WIT], estimated blood loss [EBL], length of stay [LOS], and postoperative complications), histopathologic results, and follow-up data (eGFR and recurrences). Tumor size was comparable between groups; however, tumors in the LRN group were more endophytic, central, and closer to the collecting system. There were no cases of positive surgical margins. Median OT was 160 minutes vs 230 minutes (p = 0.0029) and EBL was 25 mL vs 100 mL ([p = 0.0027], LRN vs LPN). Median WIT in the LPN group was 27 minutes, with three zero ischemias. Minor postoperative complications (≤Clavien-Dindo III) were noted in 6.25% and 23% (LRN vs LPN). Median LOS was 4.56 and 5.77 days (LRN vs LPN), respectively. Mean postsurgery eGFR was significantly lower for the LRN group (54.5 cc/[min ·1.73 m2] vs 76.3 cc/[min ·1.73 m2], p = 0.019). Within mean follow-up of 44.5 months, one tumor recurrence in the contra lateral kidney was observed in the LPN group and two cases of metastasis in the LRN group. We show that LPN is technically feasible for T2 tumors, with acceptable intra- and perioperative outcomes. Furthermore, our results show a significant advantage in preservation of renal function for LPN without compromising oncologic results. Taken together, we believe that LPN should be considered for larger tumors based on technical feasibility rather than only tumor size.

Utility of anteroposterior diameter ratio of tumor and abdomen for laparoscopic approach for radical nephrectomy in large renal masses.

Laparoscopic radical nephrectomy (LRN) is now increasingly done for tumors larger than 10 cm. Despite selection of favorable cases, LRN may not be successful due to lack of adequate working space with large tumors. We describe a new feature on Contrast Enhanced Computed Tomography (CECT) abdomen to predict feasibility of LRN for large renal masses between 10 and 15 cm. From January 2005 to December 2015, renal tumors between 10 and 15 cm were selected retrospectively for LRN. Patients with retroperitoneal lymphadenopathy, Inferior vena cava (IVC) thrombus and involvement of adjacent organs were excluded. Anteroposterior (AP) diameter ratio of renal tumor and abdomen (APROTA) was calculated by dividing the maximum AP diameter of tumor along with normal renal parenchyma, by the AP diameter of abdomen on CECT. The patients were stratified into two groups: Group A (successful LRN) and Group B (conversion to open surgery) and outcomes were compared. The reasons for conversion were also noted. Of 29 patients, 16 (55.2%) had successful LRN (Group A), while 13 (44.8%) had conversion to open surgery (group B). The median tumor size in Group A was 11.3 ± 1.8 cm and in Group B was 13.6 ± 1.26 cm. Eleven of 13 patients had conversion due to large tumor size causing failure to progress. Two conversions were due to bleeding and injury to the colon each. There was a significant difference in the APROTA in group A and B [0.43 ± 0.09 in group A and 0.64 ± 0.14 in group B (p = 0.0001)]. Patients with APROTA of more than 0.65 are unlikely to have successful outcome with LRN.

Laparoscopic Versus Open Radical Nephrectomy for Renal Cell Carcinoma: a Systematic Review and Meta-Analysis

BACKGROUND: The aim of this study is to summarize and quantify the current evidence on the therapeutic efficacy of laparoscopic radical nephrectomy (LRN) compared with open radical nephrectomy (ORN) in patients with renal cell carcinoma (RCC) in a meta-analysis. METHODS: Data were collected by searching Pubmed, Embase, Web of Science, and ScienceDirect for reports published up to September 26, 2016. Studies that reported data on comparisons of therapeutic efficacy of LRN and ORN were included. The fixed-effects model was used in this meta-analysis if there was no evidence of heterogeneity; otherwise, the random-effects model was used. RESULTS: Thirty-seven articles were included in the meta-analysis. The meta-analysis showed that the overall mortality was significantly lower in the LRN group than that in the ORN group (odds ratio [OR] =0.77, 95% confidence interval [CI]: 0.62-0.95). However, there was no statistically significant difference in cancer-specific mortality (OR=0.77, 95% CI: 0.55-1.07), local tumor recurrence (OR=0.86, 95% CI: 0.65-1.14), and intraoperative complications (OR=1.27, 95% CI: 0.83-1.94). The risk of postoperative complications was significantly lower in the LRN group (OR=0.71, 95% CI: 0.65-0.78). In addition, LRN has been shown to offer superior perioperative results to ORN, including shorter hospital stay days, time to start oral intake, and convalescence time, and less estimated blood loss, blood transfusion rate, and anesthetic consumption. CONCLUSION: LRN was associated with better surgical outcomes as assessed by overall mortality and postoperative complications compared with ORN. LRN has also been shown to offer superior perioperative results to ORN.

Comparison of the Clinical Efficacy of Retroperitoneal Laparoscopic Partial Nephrectomy and Radical Nephrectomy for Treating Small Renal Cell Carcinoma: Case Report and Literature Review.

BackgroundRenal cell carcinoma (RCC) is a common malignancy of the urinary system with high rates of morbidity and mortality.ObjectivesThis study aimed to investigate and analyze the clinical efficacy of retroperitoneal laparoscopic partial nephrectomy and laparoscopic radical nephrectomy for the treatment of small RCC.MethodsIn this retrospective study of 45 patients with small RCC, the patients were divided into two treatment groups: Group A (retroperitoneal laparoscopic partial nephrectomy, 25 cases) and Group B (retroperitoneal laparoscopic radical nephrectomy, 20 cases).ResultsThere were no statistically significant differences in the operative time, amount of intraoperative blood loss, length of hospital stay, preoperative creatinine level, postoperative creatinine level after 24 hours, and survival rate after 1, 2, and 3 years between the two groups (P > 0.05).ConclusionsThere were no significant differences in the survival rates and short-term postoperative complications between the laparoscopic partial nephrectomy group and the laparoscopic radical nephrectomy group for small RCC, but the former was slightly more effective.

LAPAROSCOPIC RADICAL NEPHRECTOMY FOR LARGE RENAL CELL CARCINOMA: RETROSPECTIVE ANALYSIS OF SAFETY AND ONCOLOGICAL OUTCOME.

(Objectives) To evaluate the safety and oncologic efficacy of laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) >7 cm, we retrospectively reviewed the clinical outcome and long-term cancer control of patients who underwent LRN in comparison to open radical nephrectomy (ORN). (Patients and methods) The clinical records of 79 patients with RCC >7 cm, who underwent radical nephrectomy (37 LRN; 42 ORN) between 1993 and 2014, were reviewed. (Results) The 2 groups (LRN and ORN) were comparable regarding age, body mass index and mean tumor size (86.5 mm vs. 94.6 mm).The operative time was significantly longer in the LRN group than ORN group (204 min vs. 168 min; p<0.05) and blood loss was significantly lower in the LRN group than in the ORN group (144 ml vs. 930 ml; p<0.05).No statistically significant difference was found in complication rate (10.8% vs. 23.8%) and the 2-year recurrence-free survival rate (85.6% vs. 83.8%). (Conclusion) Despite the longer operative time, LRN for large RCC was associated with lower blood loss. This study provides evidence of the safety and efficacy of LRN for large RCC.

Effect of retroperitoneal laparoscopic operation on immune function and neuroendocrine function in patients with renal cell carcinoma

Objective To explore the effect of retroperitoneal laparoscopic operation on immune function and neuroendocrine function in patients with renal cell carcinoma,and to evaluate clinical efficacy of retroperitoneal laparoscopic operation in treatment of renal cell carcinoma.Methods The clinical data of 36 patients subject to laparoscopic radical nephrectomy (LRN) and 27 patients with open radical nephrectomy (ORN) for renal cell carcinoma in our department from January 2010 to January 2013 were analyzed retrospectively.The renal cell carcinoma was diagnosed by preoperative ultra-sound,CT or MRI,and postoperative pathological examination.The clinical stage was T1-T2,and N0M0 in all patients.The diameter of tumors ranged 2.3-9.8 cm (5.6 cm on average),and tumor was solitary.The efficacy was evaluated by the duration of operative time,blood loss during operation and postoperative hospital stay between two groups.The changes of immune function (CD3+,CD4+,CD8+,CD4+/CD8+) and neuroendocrine function [β-endorphin,Adrenocorticotrophin (ACTH),cortisol] in patients with renal cell carcinoma before and after surgical operation were examined.Results The 63 patients were operated successfully,and there were no severe perioperative complications.Blood loss during operation was (95.0 ± 29.5) ml in LRN group and (112.8 ±31.3) ml in ORN group (P ＜0.05).The mean postoperative hospital stay was (7.1 ± 1.3) days in LRN group and (8.7 ± 1.7) days in ORN group (P＜0.05).No significant difference in operative time was noted between two groups (P ＞ 0.05).After surgical operation,the proportion of CD3 +,CD4+ and CD4 +/CD8 + in LRN group was significantly higher than in ORN group (P ＜0.05),and the levels of β-endorphin,ACTH and cortisol in LRN group were significantly lower than those in control group (P ＜0.05).Average postoperative follow-up duration was 14 months (range 3-33) in 61 patients.Imaging examinations showed no recurrence or metastasis in all patients,and no patients had longterm complication.Conclusion Retroperitoneal laparoscopic operation has advantages of clearer vision,less trauma,less blood loss,faster postoperative recovery,and shorter hospital stay.In the treatment of localized renal cell carcinoma,LRN has more advantages than ORN because LRN can protect immune function better and reduce stress response better. Key words: Renal cell carcinoma ; Laparoscopic operation ; Radical nephrectomy ; Immune function

Laparoscopic Radical Nephrectomy vs Laparoscopic or Open Partial Nephrectomy for T1 Renal Cell Carcinoma: Comparison of Complication Rates in Elderly Patients During the Initial Phase of Adoption

To assess postoperative complication profiles and 30-day mortality (30 dM) in older patients undergoing either laparoscopic radical nephrectomy (LRN) compared with open partial nephrectomy (OPN) or laparoscopic partial nephrectomy (LPN) for early stage renal cell carcinoma. Using the Surveillance, Epidemiology, and End Results-Medicare linked database, 2277 patients aged>65 years with T1 renal cell carcinoma, who underwent LRN, OPN, or LPN were identified (1992-2005). Surgical and medical complications and 30 dM after nephrectomy were abstracted. Bivariate and multivariate logistic regression analyses were performed. Relative to LRN, the rate of surgical complications was higher for OPN (28% vs 20%; P<.001) and LPN (29% vs 20%; P=.01). These differences persisted after multivariate adjustment for patient and tumor characteristics (OPN: odds ratio, 1.6; 95% confidence interval, 1.28-1.91; P<.001; LPN: odds ratio, 1.6; 95% confidence interval, 1.13-2.39; P=.01). Specifically, relative to LRN, OPN was associated with a 7% higher rate of genitourinary complications (13% vs 20%; P<.001). Similarly, relative to LRN, LPN was associated with a 7% higher rate of genitourinary complications (13% vs 20%; P=.001) and with a 4% higher rate of hemorrhagic complications (8% vs 4%; P=.02). No statistically significant differences were recorded for all other surgical and/or medical complication types and 30 dM (all P≥.2). The complication and 30-dM rates were not different between LRN, OPN, and LPN groups. Exceptions include genitourinary complications that favor LRN relative to OPN and LPN and hemorrhagic complications that favor LRN relative to LPN. It is doubtful that these results should discourage the use of partial nephrectomy relative to LRN in older patients.

Matched pair analysis of laparoscopic versus open radical nephrectomy for the treatment of T3 renal cell carcinoma

The perioperative and oncological outcomes of laparoscopic radical nephrectomy (LRN) for T1-T2 renal cell carcinoma (RCC) are well established. We aim to determine whether LRN is a comparable alternative to open radical nephrectomy (ORN) in the treatment of T3 RCC using a matched pair analysis study design. A review of a prospectively collected database at the Western General Hospital, Edinburgh, between 2000 and 2011 was conducted. Patient pairs were matched based on age at operation, gender, histological subgroup, maximal tumour diameter, TNM stage and grade. Patient demographics, operative and post-operative outcomes were compared. Overall, cancer-specific and progression-free survival [overall survival, cancer-specific survival (CSS) and progression-free survival (PFS)] were estimated using the Kaplan-Meier method. From 252 patients with T3 disease, 25 pairs were matched. Patients were of median age 66.2 years, 64 % male. Tumours were all clear cell RCC, were stage pT3a (32 %) or pT3b and had maximal tumour diameters of 8.7 cm for LRN and 10.0 cm for ORN. Estimated blood loss (100 ml LRN; 650 ml ORN, p < 0.001) and length of post-operative hospital stay (4 days LRN: 9 days ORN, p < 0.001) were lower in the LRN group. Operation time and post-operative complication rates were comparable. CSS and PFS were comparable with a mean CSS of 91.3 months for LRN and 88.7 months for ORN. This study reports the longest median follow-up in a T3 LRN cohort. In matched patients, LRN has been shown to have a superior perioperative profile to ORN for the treatment of pT3a/b RCC, with no adverse effect on midterm oncological outcomes.

838 LAPAROSCOPIC RADICAL NEPHRECTOMY VERSUS LAPAROSCOPIC RADIOFREQUENCY ABLATION: RENAL FUNCTION OUTCOMES WITH 3 YEAR FOLLOW-UP

You have accessJournal of UrologyTechnology & Instruments: Laparoscopy: Malignant & Benign Disease1 Apr 2013838 LAPAROSCOPIC RADICAL NEPHRECTOMY VERSUS LAPAROSCOPIC RADIOFREQUENCY ABLATION: RENAL FUNCTION OUTCOMES WITH 3 YEAR FOLLOW-UP Robert Carey, Christopher Martin, Mark Murnane, and Marco Ferrara Robert CareyRobert Carey Sarasota, FL More articles by this author , Christopher MartinChristopher Martin Sarasota, FL More articles by this author , Mark MurnaneMark Murnane Gainesville, FL More articles by this author , and Marco FerraraMarco Ferrara Sarasota, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.405AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To present renal function outcomes in a series of patients with solid enhancing renal masses (SERM) greater than 3 cm treated with laparoscopic radiofrequency ablation (LRFA) versus laparoscopic radical nephrectomy (LRN) performed at a tertiary care center. METHODS All patients undergoing LRFA or LRN for SERM were prospectively entered into an IRB approved database. Renal function was assessed at 3 months and annually thereafter. Changes in GFR were calculated using the Modification of Diet in Renal Disease formula. LRFA was performed with a Covidien Cooltip probe system using multiple probes and multi-pass technique. Direct real-time, fiberoptic temperature monitoring was performed for each case with temperature goals of greater than 60 degrees C achieved at the deep and peripheral margins. RESULTS The LRFA group (n = 64) had mean tumor size 3.8 cm, mean nephrometry score 6.6 (4 û 9) and mean follow up of 37.8 months. For the LRN group (n = 48), mean tumor size 5.1 cm and mean follow up 34.5 months. For LRFA the decline in GFR per year is 5.8% and for LRN is 15.4% (p < 0.001). When selecting for T1b LRFA tumors (mean size 5.1 cm), the decline in GFR is 12.9%, whereas for the T1b LRN group the decline in GFR 15.0% (p = 0.60). For LRFA, low nephrometry complexity (NS 4 - 6) shows a decline in eGFR of only 2.3% versus 9.0% for tumors with moderate complexity (NS 7 - 9, p = 0.027). Our inclusion criteria mandated that the patient have at least 12 months of follow-up. Pathology showed 72(64%) were clear cell RCC, 15(13%) were papillary RCC, 21(19%) were oncocytic neoplasm, 1(<1%) chromophobe, and 3(3%) angiomyolipoma. All biopsies were performed at the time of surgery and no biopsies were non-diagnostic. Local recurrence rate for LRFA was 4.4% in two patients that had RCC and both were re-ablated successfully. Four patients in the LRN group either progressed to or had preexisting metastasis and were excluded. There were no blood transfusions or deaths for the LRFA or LRN groups. CONCLUSIONS LRFA provides a nephron-sparing alternative to LRN for renal tumors greater than 3 cm, showing durable, markedly significant preservation of renal function over 3 years of follow up with equivalent early oncological outcomes. The benefit of renal preservation with LRFA declines with increasing tumor size, showing no signficant difference in GFR for a subset of T1b SERMs with a mean tumor size is 5.1 cm. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e343-e344 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Carey Sarasota, FL More articles by this author Christopher Martin Sarasota, FL More articles by this author Mark Murnane Gainesville, FL More articles by this author Marco Ferrara Sarasota, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Changes in Renal Function After Laparoscopic Partial Nephrectomy: Comparison With Laparoscopic Radical Nephrectomy

PurposeTo evaluate alterations in renal function after laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN) for renal tumors.Materials and MethodsFrom March 2008 to August 2011, we performed 175 cases of laparoscopic kidney resection. Among these, we excluded patients who received perioperative immunotherapy or target therapy and also patients with a preoperative estimated glomerular filtration rate (eGFR) <60 mL/min. A total of 32 patients undergoing LPN and 92 patients undergoing LRN were enrolled. We retrospectively reviewed the changes in eGFR (by the modification of diet in renal disease method) at the following time points: preoperative, postoperative 1 week, and postoperative 1, 3, 6, and 12 months.ResultsThe mean warm ischemia time of the LPN group was 22 minutes (range, 0 to 47 minutes). Mean eGFR values (mL/min/1.73 m2) during postoperative week 1 and 1, 3, 6, and 12 months were 70.8, 71.5, 76.7, 76.0, and 75.3 in the LPN group and 52.1, 50.6, 52.8, 53.4, and 52.4 in the LRN group, respectively. One year after the operation, 6.3% (2 patients) of LPN patients and 68.5% (63 patients) of LRN patients had progressed to chronic renal insufficiency (eGFR<60 mL/min/1.73 m2).ConclusionsRenal function recovered slightly after LPN and LRN and was maintained constantly after 3 months. However, renal function showed different patterns of decrease. Despite the concern for warm ischemia, LPN can preserve renal function better than can LRN. LPN should be considered for selected patients to prevent chronic renal insufficiency.

Laparoendoscopic single-site versus conventional laparoscopic radical nephrectomy for renal cell cancer in patients with increased comorbidities and previous abdominal surgery: preliminary results of a single-centre retrospective study

Laparoendoscopic single-site surgery (LESS) represents an evolution of laparoscopy for the treatment for urologic diseases. The aim of this study is to investigate the feasibility of LESS in patients with increased comorbidities and previous abdominal surgery undergoing radical nephrectomy (LESS-RN) for renal cell carcinoma. A total of 25 patients with increased comorbidities and previous abdominal surgery who underwent LESS-RN were compared to 31 patients with the same characteristics after conventional laparoscopic radical nephrectomy (LRN). LRN was performed between January 2009 and May 2010, and LESS-RNs were performed between June 2010 and November 2011. Demographic data and perioperative and postoperative variables were recorded and analysed. The mean ASA score in the LESS-RN and LRN groups was 3.2±0.4, and the mean BMI was 32.7±2.1 and 34.2±0.8kg/m(2), respectively. The mean operative time in the LESS-RN and LRN groups was 143.7±24.3 and 130.6±26.5min, (p=0.11), and the mean hospital stay was 3.8±0.8 versus 4.2±1.4days in the two groups (p=0.06), respectively. Three and four complications were recorded in the LESS-RN and in the LRN groups, for a mean complication rate of 12 and 12.9% (p=0.12), respectively All tumours were organ-confined with negative surgical margins, and the mean R.E.N.A.L nephrometry score for LESS-RN and LRN was 9.78±1.7 and 9.82±1.3 (p=0.14), respectively. LESS-RN in patients with increased comorbidities and previous abdominal surgery is equally effective as LRN without compromising on surgical, oncologic short-term and postoperative outcomes.

Transient Variations in the Serum Concentrations of Cell Adhesion Molecules Following Retroperitoneal Laparoscopic and Open Radical Nephrectomy for Localized Renal-Cell Carcinoma

To evaluate differences in the serum concentrations of cell adhesion molecules (CAMs) after retroperitoneal laparoscopic and conventional open radical nephrectomies for localized renal-cell carcinoma (RCC). A total of 62 patients with stage T(1)N(0)M(0) RCC were randomized to either a retroperitoneal laparoscopic radical nephrectomy group (n=31) or an open group (n=31). Serum levels of soluble cluster of differentiation 44 splice variant 6 (sCD44v6), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), and soluble epithelial cadherin (sE-cadherin) were determined independently by enzyme linked immunosorbent assay (ELISA) preoperatively, and on postoperative days 1 and 5. In addition, follow-up results were compared. On postoperative day 1, sCD44v6, sICAM-1, and sVCAM-1 levels increased significantly compared with preoperative levels in both groups (P<0.05). sE-cadherin levels decreased compared with preoperative levels in both groups without statistically significant differences (P>0.05). sCD44v6 levels in the retro-laparoscopy group were significantly higher than in the open group (P<0.05), while sICAM-1, sVCAM-1, and sE-cadherin levels showed no statistically significant differences between both groups (P>0.05). On postoperative day 5, all parameters in both groups were similar to preoperative values (P>0.05). Follow-up ranged from 7 to 18 months postoperatively in all 62 patients, with a 100% cancer-specific survival rate in each group. Although postoperatively higher serum concentrations of CAMs in both groups and significantly elevated sCD44v6 in the retro-laparoscopy group may be facilitated, the differences in CAMs between both groups are small and transient. Together with the similar follow-up results, this further supports previous studies that failed to show a difference in the oncologic outcomes between open and laparoscopic radical nephrectomy and provides a probable molecular mechanism.

Laparoendoscopic Single-Site and Conventional Laparoscopic Radical Nephrectomy Result in Equivalent Surgical Trauma: Preliminary Results of a Single-Centre Retrospective Controlled Study

BackgroundLaparoendoscopic single-site surgery (LESS) has been developed in an attempt to further reduce the morbidity and scarring associated with surgical intervention, and it has been proposed to result in less induced surgical trauma than conventional laparoscopy. ObjectiveInvestigate the surgical trauma after LESS radical nephrectomy (LESS-RN) and laparoscopic radical nephrectomy (LRN). Design, setting, and participantsThis was a retrospective single-centre study including 66 patients: 31 patients underwent LESS-RN and 35 historical control patients who had undergone LRN. LRNs were performed between April 2008 and May 2009; LESS-RNs were performed between May 2009 and February 2011. InterventionLESS-RN and LRN were both performed via a transperitoneal access. Blood samples were collected pre- and intraoperatively at 6, 24, and 48h, and at 5 d postoperatively. MeasurementsSerum concentrations of acute-phase markers, C-reactive protein (CRP), serum amyloid A (SAA) antibody, and interleukin 6 (IL-6) and interleukin 10 (IL-10) were measured at each time point by enzyme-linked immunosorbent assay. Clinical data were collected by reviewing the patient’s records. Results and limitationsThere were no differences in serum CRP and SAA levels between the groups (CRP: p=0.12; SAA: p=0.09) at all time points. The changes in IL-6 levels in the LRN group were statistically significantly higher compared with the LESS-RN group at 6h after surgery (p=0.02), whereas the LESS-RN group showed statistically significantly higher IL-6 levels than the LRN group at 24h after surgery (p=0.02).Also, the serum levels of the anti-inflammatory cytokine IL-10 showed different kinetics in each group, being higher in the LESS-RN during the early postoperative phase (at 6h: p=0.01) and higher in the LRN group at 48h after surgery (p=0.01). The limitations of this study were its nonrandomized character and the small cohort of patients. ConclusionsLESS-RN is as effective as LRN without compromising surgical and postoperative outcomes, but it does not add any significant advantage in comparison with traditional LRN in terms of systemic stress response and surgical trauma.