Open Radical Nephrectomy Group Research Articles

Comparison of Laparoscopic Radical Nephrectomy with Open Radical Nephrectomy

Purpose: Laparoscopic surgery has become the standard surgical method within the urological community. This study was undertaken to evaluate the safety and efficacy of a standard laparoscopic radical nephrectomy (LRN) compared to an open radical nephrectomy (ORN) at a single medical center. Materials and Methods: Between January 2003 and March 2006, laparoscopic radical nephrectomies for renal cell cancer were performed in 30 patients and the results of the laparoscopic radical nephrectomy were compared with those of the open counterpart. Surgical results, such as the operation time, estimated blood loss (EBL), transfusion rate, narcotic analgesic requirement, hospital stay, complications and pathologic results, were retrospectively reviewed and analyzed using the Student's t-test. Results: There were no significant differences in the demographic data between the two groups. The pathological reports showed a clear cell type in 59 cases and a chromophobe type in 1 case. For the LRN and ORN groups, the mean operation times were 208 (120-320) vs. 206 min. (115-300) (p>0.05), EBL of 135 (100-200) vs. 318ml (100-2,000) (p=0.02), transfusion rates of 6.6 vs. 30%, narcotic analgesic requirements of 160 vs. 255mg diclofenac sodium, hospital stays of 6.7 vs. 10.5 days (p=0.04) and intraoperative complications in 0/30 (0%) vs. 2/30 cases (7%), respectively. The pathological surgical margins were all negative. The surgical and pathological parameters of the LRN group showed no significant differences to those of the ORN group, with the exception of the EBL and hospital stay. Conclusions: Laparoscopic radical nephrectomy resulted in less blood loss, a shorter hospital stay and earlier rapid recovery than an open radical nephrectomy. In our opinion, laparoscopic surgery could be a standard surgical treatment in renal cell cancer. (Korean J Urol 2007;48:259-264)

Hand-assisted laparoscopic nephrectomy for renal masses >9.5 cm: Series comparison with open radical nephrectomy

Objective To assess the feasibility of hand-assisted laparoscopic nephrectomy (HALN) for large renal masses (stage T2, mean size 9.7 cm) and compare outcomes with a similar cohort undergoing open radical nephrectomy (ORN). Methods A nonrandomized comparison of 19 consecutive patients who underwent nephrectomy for renal masses ≥7 cm was performed. The HALN group was compared to the ORN group regarding demographic parameters and perioperative data, including blood loss, operating time, narcotic usage, hematocrit change, return to standard oral intake, length of hospital stay, and complications. Data collected prospectively and statistics used 2-tailed t-test analysis. Results Patients underwent either ORN (mean tumor size 12.3 cm) or HALN (mean tumor size 9.7cm). Tumors up to 14 cm (n = 2) and pT3b, with renal vein thrombosis (n = 2), could be safely excised with HALN. There were no differences between the HALN and ORN groups regarding any demographic parameter. Blood loss, operating time, length of stay, parenteral narcotic use, and time to tolerating regular diet were all less statistically significant in the HALN group as compared to the ORN group ( P < 0.05). Tumors >15 cm necessitated ORN. Conclusions HALN is technically feasible even for tumors with mean size >9.5 cm. There is a significant advantage to HALN over ORN regarding the intraoperative and postoperative morbidity. Tumors ≥15 cm should, in most cases, be performed with an open approach.

LAPAROSCOPIC RADICAL NEPHRECTOMY: CANCER CONTROL FOR RENAL CELL CARCINOMA

We evaluated the clinical efficacy of laparoscopic versus open radical nephrectomy in patients with clinically localized renal cell carcinoma. Between 1991 and 1999, 67 laparoscopic radical nephrectomies were performed for clinically localized, stages cT1/2 NXMX, pathologically confirmed renal cell carcinoma. During this period 54 patients who underwent open radical nephrectomy with pathologically confirmed stages pT1/2 NXMX disease were also identified. Medical and operative records were retrospectively reviewed and telephone followup was done to assess patient status. In the laparoscopic and open groups average tumor size was 5.1 (range 1 to 13) and 5.4 cm. (range 0.2 to 18), respectively, which was not statistically significant. No patient had laparoscopic port site, wound or renal fossa tumor recurrence in either group. All patients were followed at least 12 months. In the laparoscopic group 2 cancer specific deaths occurred at a mean followup of 35.6 months. In the open group there were 2 cancer specific deaths and 3 cases of disease progression at a mean followup of 44 months. Kaplan-Meier disease-free survival and actuarial survival analysis revealed no significant differences in the laparoscopic and open radical nephrectomy groups. Also, no differences were noted in the complication rate. Laparoscopic radical nephrectomy is an effective alternative for localized renal cell carcinoma when the principles of surgical oncology are maintained. Initial data show shorter patient hospitalization and effective cancer control with no significant difference in survival compared with open radical nephrectomy.

LAPAROSCOPIC VERSUS OPEN RADICAL NEPHRECTOMY: A 9-YEAR EXPERIENCE

The laparoscopic approach for renal cell carcinoma is slowly evolving. We report our experience with laparoscopic radical nephrectomy and compare it to a contemporary cohort of patients with renal cell carcinoma who underwent open radical nephrectomy. From 1990 to 1999, 32 males and 28 females underwent 61 laparoscopic radical nephrectomies for suspicious renal cell carcinoma. Clinical data from a computerized database were reviewed and compared to a contemporary group of 33 patients who underwent open radical nephrectomy for renal cell carcinoma. Patients in the laparoscopic radical nephrectomy group had significantly reduced, estimated blood loss (172 versus 451 ml., p <0.001), hospital stay (3.4 versus 5.2 days, p <0.001), pain medication requirement (28.0 versus 78.3 mg., p <0.001) and quicker return to normal activity than patients in the open radical nephrectomy group (3.6 versus 8.1 weeks, p <0.001). The majority of laparoscopic specimens (65%) were morcellated. Operating time and cost were higher in the laparoscopic than the open nephrectomy group. Average followup was 25 months (range 3 to 73) for the laparoscopic and 27.5 months (range 7 to 90) for the open group. Renal cell carcinoma in 3 patients (8%) recurred in the laparoscopic group versus renal cell carcinoma in 3 (9%) in the open group. When stratified patients with tumors larger than 4 to 10 cm. experienced similar benefits and results as patients with tumors less than or equal to 4 cm. To date there have been no instances of trocar or intraperitoneal seeding in the laparoscopic radical nephrectomy group. Laparoscopic radical nephrectomy, although technically demanding, is a viable alternative for managing localized renal tumors up to 10 cm. It affords patients with renal tumors an improved postoperative course with less pain and a quicker recovery while providing similar efficacy at 2-year followup for patients with T1 and T2 tumors.