BACKGROUND: Laparoscopy is currently challenging the role of the open approach for nephron-sparing surgery (NSS), yet comparative studies on this issue are scant. OBJECTIVE: To compare surgical, oncologic, and functional outcomes after laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN). DESIGN, SETTING, AND PARTICIPANTS: We undertook matched-pair (age, sex, tumour size) analysis of patients who underwent elective NSS for renal masses either by laparoscopic (Klagenfurt) or open (Vienna) access. MEASUREMENTS: Surgical data, complications, histologic and oncologic data, and short- and long-term renal function of the open and laparoscopic groups were compared. RESULTS AND LIMITATIONS: In total, 200 patients matched for age, sex, and tumour size entered the study after either LPN or OPN and were followed for a mean of 3.6 yr. Surgical, ischemia, and hospitalisation times were shorter in the LPN group (p<0.001). Blood loss and complication rates were comparable in both groups. Malignant tumours were pT1 stage renal-cell cancer only in both groups. The positive surgical margin (PSM) rate was 4% after LPN and 2% after OPN (p=0.5); positive margins were not a risk factor for disease recurrence. Kaplan-Meier estimates of 5-yr local recurrence-free survival (RFS) were 97% after LPN and 98% after OPN (p=0.8); the respective numbers for distant free survival were 99% and 96% (p=0.2). Five-year overall survival (OS) for patients with pT1 stage renal cell carcinoma (RCC) was 96% after LPN and 85% after OPN. The decline in glomerular filtration rate at the last available follow-up (LPN: 10.9%; OPN: 10.6%) was similar in both groups (p=0.8). We recognise the retrospective nature, limited follow-up, and sample size as shortcomings of this study. CONCLUSIONS: In experienced hands, LPN provides similar results compared to open surgery. PSM rates were comparable after LPN and OPN. Current experience questions the indication of secondary nephrectomy in these patients.
BACKGROUND: Laparoscopy is currently challenging the role of the open approach for nephron-sparing surgery (NSS), yet comparative studies on this issue are scant. OBJECTIVE: To compare surgical, oncologic, and functional outcomes after laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN). DESIGN, SETTING, AND PARTICIPANTS: We undertook matched-pair (age, sex, tumour size) analysis of patients who underwent elective NSS for renal masses either by laparoscopic (Klagenfurt) or open (Vienna) access. MEASUREMENTS: Surgical data, complications, histologic and oncologic data, and short- and long-term renal function of the open and laparoscopic groups were compared. RESULTS AND LIMITATIONS: In total, 200 patients matched for age, sex, and tumour size entered the study after either LPN or OPN and were followed for a mean of 3.6 yr. Surgical, ischemia, and hospitalisation times were shorter in the LPN group (p<0.001). Blood loss and complication rates were comparable in both groups. Malignant tumours were pT1 stage renal-cell cancer only in both groups. The positive surgical margin (PSM) rate was 4% after LPN and 2% after OPN (p=0.5); positive margins were not a risk factor for disease recurrence. Kaplan-Meier estimates of 5-yr local recurrence-free survival (RFS) were 97% after LPN and 98% after OPN (p=0.8); the respective numbers for distant free survival were 99% and 96% (p=0.2). Five-year overall survival (OS) for patients with pT1 stage renal cell carcinoma (RCC) was 96% after LPN and 85% after OPN. The decline in glomerular filtration rate at the last available follow-up (LPN: 10.9%; OPN: 10.6%) was similar in both groups (p=0.8). We recognise the retrospective nature, limited follow-up, and sample size as shortcomings of this study. CONCLUSIONS: In experienced hands, LPN provides similar results compared to open surgery. PSM rates were comparable after LPN and OPN. Current experience questions the indication of secondary nephrectomy in these patients.
Authors: Matthias Waldert; Sandra Waalkes; Tobias Klatte; Markus A Kuczyk; Peter Weibl; Gerd Schüller; Axel S Merseburger; Mesut Remzi Journal: World J Urol Date: 2010-07-07 Impact factor: 4.226
Authors: Pari V Pandharipande; Debra A Gervais; Rebecca I Hartman; Mukesh G Harisinghani; Adam S Feldman; Peter R Mueller; G Scott Gazelle Journal: Radiology Date: 2010-09 Impact factor: 11.105
Authors: Stephan Kruck; Aristoteles G Anastasiadis; Ute Walcher; Arnulf Stenzl; Thomas R W Herrmann; Udo Nagele Journal: World J Urol Date: 2012-01-24 Impact factor: 4.226
Authors: A C Harbin; G Bandi; A A Vora; X Cheng; V Stanford; K McGeagh; J Murdock; R Ghasemian; J Lynch; F Bedell; M Verghese; J J Hwang Journal: J Robot Surg Date: 2013-06-05