Comparison of Cancer Specific Outcomes following Minimally Invasive and Open Surgical Resection of Early Stage Kidney Cancer from a National Cancer Registry

Abstract

Purpose: With anecdotal observations of atypical recurrences following minimally-invasive surgery (MIS) and alongside new concerns following cervical cancer surgery, there is a need to evaluate cancer-specific outcomes for MIS kidney cancer surgery using national data. We sought to evaluate cancer-specific outcomes following MIS versus open surgery for early-stage kidney cancer Materials and Methods: We performed a retrospective population-based cohort study using data from the Surveillance, Epidemiology and End Results (SEER) program linked with Medicare claims that included beneficiaries, at least 66 years old, diagnosed between 2004 and 2013 with early-stage, non-urothelial kidney cancer who underwent surgical resection within a year of diagnosis. We compared overall survival, disease-specific survival, rate of second kidney cancer surgery, and rate of post-operative systemic cancer therapy based on whether surgery was MIS or an open resection. Multivariable regression was used to account for confounders.Results: 5,150 patients were included and 3,062 (59.5%) underwent MIS. On multivariable analysis, MIS was not associated with differences in overall survival (HR 0.94, 95% CI 0.84-1.06) or disease-specific survival (HR 0.96, 95% CI 0.83-1.11). MIS recipients were more likely to receive systemic cancer therapy (HR 1.31,. No difference in the rate of second surgery associated with surgical approach was observed.Conclusions: Use of MIS for early-stage kidney cancer was not associated with differences in overall or disease-specific survival, or the rate of second kidney cancer surgery. MIS recipients received more post-operative systemic therapy. This could represent a disparate cancer-specific outcome associated with MIS.

Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-Up: AUA Guideline: Part I

“…31 The current data suggest that the benefits of minimally invasive surgery are realized in the short-term, perioperative period and are equivalent to open surgery with intermediate-and long-term follow-up. 32 While minimally-invasive approaches have also been reported in increasingly complex indications (large renal masses, renal vein thrombi and patients with solitary kidneys), patient safety and adherence to prior guideline statements regarding oncologic outcomes, indications for nephron-sparing surgery, and preservation of renal function should be prioritized relative to the choice of surgical access approach. 7 Other Considerations.…”

Laparoscopic Retrograde Nephrectomy as a Troubleshooting Technique to Prevent Open Conversion: The Technique Description With a Review of 40 Cases

“…Where it’s a well-known fact that most catastrophes occur at this juncture, having a bail-out method like the retrograde technique is always a better option prior to open conversion in the discussed indications [ 11 ]. Though there were two complications noted in this study, it cannot be assured that the same could have been avoided if the procedure was converted into open; this could be attributed to the pre-existing difficulty in distorted anatomy rather than the technique.…”

Real-world outcomes of patients with renal cell carcinoma, surgically treated at regional hospitals, based on a prospective long-term survey of the pre-robotic era

“…The factors contributing to the late occurrence of RFC include young age, BMI, and DM [ 9 ]. Although PN has less benefit for patients with non-pre-existing CKD [ 10 ], the management of postoperative comorbidities is important, regardless of the status of RN and PN (especially in patients with HT and proteinuria), contributing to survival benefits [ 11 , 12 ]. Although AUA guidelines recommend PN for patients with cT1, the survival benefit of PN was not clear in our study, partly due to the small number of severe cases of DM and HT, and partly due to the inclusion of patients in good general condition.…”