Brian R Lane1, Inderbir S Gill. 1. Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Abstract
PURPOSE: Laparoscopic partial nephrectomy is increasingly a definitive therapeutic option in patients with a small renal mass. Intermediate term oncological outcomes after laparoscopic partial nephrectomy are excellent up to a mean followup of 3 years. We present outcomes in 56 patients, each of whom has now completed a minimum of 5 years of followup after laparoscopic partial nephrectomy. MATERIALS AND METHODS: Of the 557 laparoscopic partial nephrectomies performed at our institution 58 patients with a localized tumor have completed more than 5 years since surgery. Clinical and renal functional data on 56 patients (97%) were obtained from medical records, radiographic reports and patient contact via telephone. RESULTS: Average patient age was 64 years and 9% were symptomatic at presentation. Average tumor size was 2.9 cm. On histopathology renal cell carcinoma was confirmed in 37 cases (66%) and pathological tumor stage was pT1a in 32 (86%). Final surgical margin was positive for cancer in 1 patient. Median serum creatinine preoperatively and postoperatively was 0.9 and 1.0 mg/dl, respectively. No patient with normal baseline serum creatinine undergoing elective laparoscopic partial nephrectomy had postoperative chronic renal insufficiency (serum creatinine more than 2 mg/dl). At a median followup of 5.7 years (range 5.0 to 6.9) no distant recurrence (0%) and a single local recurrence (2.7%) were detected. Overall and cancer specific survival was 86% and 100%, respectively, at 5 years. CONCLUSIONS: To our knowledge this is the initial report in the literature of oncological and renal functional outcomes 5 years after laparoscopic partial nephrectomy with excellent results comparable to those of open nephron sparing surgery. At our center laparoscopic partial nephrectomy is an established alternative to open partial nephrectomy.
PURPOSE: Laparoscopic partial nephrectomy is increasingly a definitive therapeutic option in patients with a small renal mass. Intermediate term oncological outcomes after laparoscopic partial nephrectomy are excellent up to a mean followup of 3 years. We present outcomes in 56 patients, each of whom has now completed a minimum of 5 years of followup after laparoscopic partial nephrectomy. MATERIALS AND METHODS: Of the 557 laparoscopic partial nephrectomies performed at our institution 58 patients with a localized tumor have completed more than 5 years since surgery. Clinical and renal functional data on 56 patients (97%) were obtained from medical records, radiographic reports and patient contact via telephone. RESULTS: Average patient age was 64 years and 9% were symptomatic at presentation. Average tumor size was 2.9 cm. On histopathology renal cell carcinoma was confirmed in 37 cases (66%) and pathological tumor stage was pT1a in 32 (86%). Final surgical margin was positive for cancer in 1 patient. Median serum creatinine preoperatively and postoperatively was 0.9 and 1.0 mg/dl, respectively. No patient with normal baseline serum creatinine undergoing elective laparoscopic partial nephrectomy had postoperative chronic renal insufficiency (serum creatinine more than 2 mg/dl). At a median followup of 5.7 years (range 5.0 to 6.9) no distant recurrence (0%) and a single local recurrence (2.7%) were detected. Overall and cancer specific survival was 86% and 100%, respectively, at 5 years. CONCLUSIONS: To our knowledge this is the initial report in the literature of oncological and renal functional outcomes 5 years after laparoscopic partial nephrectomy with excellent results comparable to those of open nephron sparing surgery. At our center laparoscopic partial nephrectomy is an established alternative to open partial nephrectomy.
Authors: Nicole J Crane; Suzanne M Gillern; Kambiz Tajkarimi; Ira W Levin; Peter A Pinto; Eric A Elster Journal: J Urol Date: 2010-08-17 Impact factor: 7.450
Authors: C G Rogers; M Menon; E S Weise; M T Gettman; I Frank; D L Shephard; H M Abrahams; J M Green; D J Savatta; S B Bhayani Journal: J Robot Surg Date: 2008-07-26