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Kim, Park, Lee, Kwak, and Kim: Oncological and Surgical Outcomes of Pure Laparoscopic Radical Nephrectomy and Hand-Assisted Laparoscopic Radical Nephrectomy for pT1 Renal Cell Carcinoma: Comparison with Open Radical Nephrectomy
Original Article
Endourology/Urolithiasis
Korean Journal of Urology

Korean Journal of Urology 2009; 50(5): 457-462.

Published online: 26 May 2009

DOI: https://doi.org/10.4111/kju.2009.50.5.457

Oncological and Surgical Outcomes of Pure Laparoscopic Radical Nephrectomy and Hand-Assisted Laparoscopic Radical Nephrectomy for pT1 Renal Cell Carcinoma: Comparison with Open Radical Nephrectomy

Myong Kim, Yong Hyun Park, Sang Eun Lee, Cheol Kwak, Hyeon Hoe Kim

Department of Urology, Seoul National University College of Medicine, Seoul, Korea.

Correspondence to: Hyeon Hoe Kim. Department of Urology, Seoul National University Hospital, 28, Yongon-dong, Chongno-gu, Seoul 100-799, Korea. TEL: 02-2072-2425, FAX: 02-742-4665, hhkim@snu.ac.kr

Received 9 January 2009       Accepted 6 May 2009

Copyright © The Korean Urological Association, 2009

Abstract

Purpose

We compared the surgical and oncologic outcomes of pure laparoscopic radical nephrectomy (PLRN) and hand-assisted laparoscopic radical nephrectomy (HLRN) with those of open radical nephrectomy (ORN) in patients with pT1 renal cell carcinoma (RCC).

Materials and Methods

Between 1999 and 2007, a total of 269 patients underwent PLRN (n=77), HLRN (n=87), and ORN (n=105) for pT1 RCC. Follow-up data consisted of clinical, pathologic, and oncologic results and were reviewed retrospectively. Kaplan-Meier survival curves were constructed for progression and survival endpoints.

Results

Mean operative time was 184.0, 164.0, and 132.6 minutes (p<0.001); mean estimated blood loss was 196.7, 147.8, and 232.6 ml (p<0.001); and mean postoperative hospital stay was 5.7, 7.2, and 7.8 days (p<0.001) for the PLRN, HLRN and ORN groups, respectively. The major complication rate after surgery was 2.6%, 2.3%, and 3.8%, respectively (p=0.807). Median follow-up periods were 32 months in the PLRN group, 48 months in the HLRN group, and 37 months in the ORN group. Five-year progression-free survival was 97.4%, 96.6%, and 98.1% (p=0.557), and 5-year cancer-specific survival was 98.7%, 96.6%, and 98.1% (p=0.508), respectively.

Conclusions

PLRN and HLRN are safe treatment options with comparable oncologic results to ORN for pT1 RCC.

Keywords: Renal cell carcinoma, Nephrectomy, Laparoscopic surgery, Treatment outcome

Figures and Tables

Fig. 1
Trocar placement for pure laparoscopic radical nephrectomy (PLRN) and hand-assisted laparoscopic nephrectomy (HLRN).
kju-50-457-g001
Fig. 2
Kaplan-Meier curve indicating the proportions free of disease recurrences and overall survival (log rank analysis, p<0.05). PLRN: pure laparoscopic radical nephrectomy, HLRN: hand-assisted laparoscopic nephrectomy, ORN: open radical nephrectomy.
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Table 1
Patient characteristics
kju-50-457-i001

PLRN: pure laparoscopic radical nephrectomy, HLRN: hand-assisted laparoscopic nephrectomy, ORN: open radical nephrectomy, BMI: body mass index, ASA score: Score of the American society of Anesthesiologists physical status classification system, Age, BMI, ASA score: one way ANOVA test, gender, operative side: chi-square test (p<0.05)

Table 2
Pathologic outcomes
kju-50-457-i002

PLRN: pure laparoscopic radical nephrectomy, HLRN: hand-assisted laparoscopic nephrectomy, ORN: open radical nephrectomy, Tumor size: one way ANOVA test, histologic subtype, Fuhrman's nuclear grade: chi-square test (p<0.05)

Table 3
Surgical outcomes
kju-50-457-i003

PLRN: pure laparoscopic radical nephrectomy, HLRN: hand-assisted laparoscopic nephrectomy, ORN: open radical nephrectomy, EBL: estimated blood loss, operation time, EBL, hospital stay, Complication: one way ANOVA test (p<0.05)

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