Seung Hyun Jeon1, Tae Gyun Kwon1, Koon Ho Rha1, Gyung Tak Sung1, Wan Lee1, Jae Sung Lim1, Young Beom Jeong1, Sung Hoo Hong1, Hyeon Hoe Kim1, Seok-Soo Byun1. 1. Department of Urology, School of Medicine, Kyung Hee University, †Department of Urology, Yonsei University Severance Hospital, ††Department of Urology, College of Medicine, The Catholic University, ‡‡Department of Urology, Seoul National University College of Medicine, Seoul, *Department of Urology, KyungPook National University Hospital, Daegu, ‡Department of Urology, Dong-A University Hospital, §Department of Urology, Pusan National University Hospital, Pusan, ¶Department of Urology, Chungnam National University Hospital, Daejeon, and **Department of Urology, Chonbuk National University Hospital, Jeonju, Korea.
Abstract
OBJECTIVE: • To assess the feasibility and oncologic efficacy of laparoscopic radical nephrectomy (LRN) compared with open radical nephrectomy (ORN) in patients with large renal cell carcinomas (RCCs) > 7 cm in size. PATIENTS AND METHODS: • We analysed the data from 255 patients who underwent radical nephrectomies at 26 institutions in Korea between January 2000 and December 2007 for RCCs > 7 cm in size. • Eighty-eight patients who underwent LRNs were compared with 167 patients who underwent ORNs. The patients with tumor thrombi in the renal vein or IVC, and lymph node or distant metastases were excluded. • We compared the operative time, estimated blood loss, complication rates, and 2-year overall and disease-free survival rates between the LRN and ORN groups. RESULTS: • The median duration of postoperative follow-up was 19 months for the LRN group and 25.8 months for the ORN group. • The operative time was significantly longer in the LRN group than in the ORN group (241.5 ± 74.8 min vs 202.7 ± 69.6 min, P < 0.001) and blood loss was significantly lower in the LRN group than in the ORN group (439.8 ± 326.8 mL vs 604.4 ± 531.4 mL, P = 0.006). • No statistically significant difference was found in complication rates, the 2-year overall (92.7% vs 94%, P = 0.586) and disease-specific (90.1% vs 93.7%, P = 0.314) survival rates between the LRN and ORN groups. CONCLUSIONS: • Despite the longer operative time, LRN was an effective and less invasive treatment option for clinical T2 renal tumors. It achieved a degree of cancer control similar to that obtained with ORN.
OBJECTIVE: • To assess the feasibility and oncologic efficacy of laparoscopic radical nephrectomy (LRN) compared with open radical nephrectomy (ORN) in patients with large renal cell carcinomas (RCCs) > 7 cm in size. PATIENTS AND METHODS: • We analysed the data from 255 patients who underwent radical nephrectomies at 26 institutions in Korea between January 2000 and December 2007 for RCCs > 7 cm in size. • Eighty-eight patients who underwent LRNs were compared with 167 patients who underwent ORNs. The patients with tumor thrombi in the renal vein or IVC, and lymph node or distant metastases were excluded. • We compared the operative time, estimated blood loss, complication rates, and 2-year overall and disease-free survival rates between the LRN and ORN groups. RESULTS: • The median duration of postoperative follow-up was 19 months for the LRN group and 25.8 months for the ORN group. • The operative time was significantly longer in the LRN group than in the ORN group (241.5 ± 74.8 min vs 202.7 ± 69.6 min, P < 0.001) and blood loss was significantly lower in the LRN group than in the ORN group (439.8 ± 326.8 mL vs 604.4 ± 531.4 mL, P = 0.006). • No statistically significant difference was found in complication rates, the 2-year overall (92.7% vs 94%, P = 0.586) and disease-specific (90.1% vs 93.7%, P = 0.314) survival rates between the LRN and ORN groups. CONCLUSIONS: • Despite the longer operative time, LRN was an effective and less invasive treatment option for clinical T2 renal tumors. It achieved a degree of cancer control similar to that obtained with ORN.