ENDOUROLOGY & LAPAROSCOPY

doi: 10.1590/S1677-553820100001000016

7-year oncological outcomes after laparoscopic and open partial nephrectomy
Lane BR, Gill IS
Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
J Urol. 2010; 183: 473-9

• Purpose: Open partial nephrectomy has proven long-term oncological efficacy. Long-term outcomes of laparoscopic partial nephrectomy are pending. We present the long-term outcomes of patients undergoing laparoscopic or open partial nephrectomy for a single cT1 renal cortical tumor 7 cm or less.
  Materials and Methods: Of 2,246 patients undergoing partial nephrectomy for a single cT1 tumor (1999 to 2008), minimum 7-year followup was available in 77 and 310, and minimum 1-year followup was available in 672 and 944 after laparoscopic and open partial nephrectomy, respectively. Survival and recurrence data obtained from medical records, radiographic reports and patient contact were analyzed retrospectively.
  Results: Median followup after laparoscopic and open partial nephrectomy was 4.0 and 5.7 years, respectively. Oncological outcomes were excellent in both groups. On multivariable analysis predictors of all cause mortality included advancing age (p <0.0001), comorbidity (p <0.0001) and preoperative renal dysfunction (p = 0.0001) but not tumor size (p = 0.6) or operative approach (laparoscopic vs open partial nephrectomy, p = 0.06). Cancer recurred infrequently and only rarely caused mortality after laparoscopic or open partial nephrectomy. At 7 years metastasis-free survival was 97.5% and 97.3% (p = 0.47) after laparoscopic and open partial nephrectomy, respectively. After accounting for baseline differences between the cohorts using propensity score matching 7-year metastasis-free survival was similar after laparoscopic and open partial nephrectomy.
  Conclusions: Laparoscopic and open partial nephrectomy appear to provide similar long-term overall and cancer specific survival in patients undergoing partial nephrectomy for clinical stage T1 (7 cm or less) renal cortical tumors. Oncological outcomes at 7 years after laparoscopic and open partial nephrectomy are excellent with the majority (97%) of patients experiencing metastasis-free survival.

• Editorial Comment
  The authors have demonstrated that laparoscopic and open partial nephrectomy appear to provide similar long-term overall and cancer specific survival in patients undergoing partial nephrectomy for clinical stage T1. This manuscript describes a well known fact that the laparoscopic surgical technique has not compromised oncological outcomes particularly in renal cancer and renal surgery. Moreover, the complication rates with the laparoscopic technique have been demonstrated to be comparable to the open technique.

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med. Ctr.
Associate Professor, Univ. Colorado Health Sci. Ctr.
Director of Minimally Invasive Urol. Oncology, UCHSC
Denver, Colorado, USA
E-mail: fernando.kim@dhha.org