OncologyLaparoscopic Radical Versus Partial Nephrectomy for Tumors >4 cm: Intermediate-term Oncologic and Functional Outcomes
Section snippets
Material and Methods
The data were obtained from an institutional review board-approved prospectively maintained database. From March 2001 to December 2005, 465 patients underwent LRN and 510 patients underwent LPN at our institution. The American Society of Anesthesiologists perioperative risk scores were assigned by staff anesthesiologists for all patients before surgery. The inclusion criteria included patients with organ-confined pathologically confirmed renal cell cancer (RCC) >4 cm in size who underwent
Results
The demographic, operative, and pathologic data are listed in Table 1. Of the 110 patients, 75 (68%) underwent LRN and 35 (32%) underwent LPN. An annual trend was seen in the decreased use of LRN and increased use of LPN throughout the study period. Both groups were equivalent in age, body mass index, American Society of Anesthesiologists performance status score, and tumor laterality. The mean operative estimated blood loss was 80 mL greater in the LPN group than in the LRN group (262 vs 179
Comment
The present study compared the intermediate-term oncologic and renal functional outcomes in patients with Stage pT1b-T3 RCC tumors treated with either LRN or LPN. These data have demonstrated that the RFS and CSS rates are equivalent and that LPN confers greater renal functional preservation. The indications for LPN can be extended to larger anatomically amenable tumors in this higher risk patient population in select patients.
The primary goal of LPN in any setting is oncologic control.
Conclusions
The results of our study have shown that LPN is equivalent to LRN in intermediate-term oncologic control for kidney tumors ≥4 cm in this cohort. LPN for these large tumors provided the benefit of renal functional preservation and decreased the incidence of postoperative Stage III or greater CKD by 34% compared with LRN. The indications for LPN can be extended to patients with anatomically amenable Stage pT1b-pT3 tumors. Careful patient selection and adequate laparoscopic expertise are
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