Introduction and Objectives
Laparoscopy is currently challenging the role of the open approach for nephron-sparing surgery, yet comparative studies on this issue are scant. Aim of this study was to compare surgical, oncological and functional outcome after laparoscopic (LPN) and open (OPN) partial nephrectomy.
Material and Methods
Matched-pair (age, sex, tumour size) analysis of patients who underwent elective nephron-sparing surgery for renal masses either by laparoscopic (Klagenfurt) or open (Vienna) access. Surgical data, complications, histological and oncological data and short and long-term renal function of the open and laparoscopic group were compared.
Results
In total, 200 patients after either LPN or OPN, matched for age, sex and tumour size, entered the study and were followed for a mean of 3.6 years. Surgical-, ischemia- and hospitalization times were shorter in LPN (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. Positive surgical margin 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-year local recurrence free survival was 97% after LPN and 98% after OPN (p = 0.8), the respective numbers for distant free survival were 99% and 96%, respectively (p = 0.2). 5-year overall survival for patients with pT1 stage RCC was 96% (LPN) and 85% (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).
Conclusions
In experienced hands, LPN provides similar results compared to open surgery. Positive surgical margin rates were similar after LPN and OPN. Current experience in these patients does not seem to justify a secondary nephrectomy.
Article info
Identification
Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
