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Eur Urol. 2009 May;55(5):1171-8. doi: 10.1016/j.eururo.2009.01.042. Epub 2009 Feb 20.

Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients.

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  • 1Department of Urology and Andrology, Donauspital, Vienna, Austria. martin.marszalek@wienkav.at

Abstract

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.

PMID:
19232819
DOI:
10.1016/j.eururo.2009.01.042
[PubMed - indexed for MEDLINE]
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