Editorial Comment from Dr Golebiewski to Long‐term outcome of hand‐assisted laparoscopic radical nephrectomy for T1 renal cell carcinoma

Abstract

The median duration of the follow up was 65 and 84 months in the HALS-Nx and OPEN-Nx groups, respectively. Regarding the surgical outcomes, the operation times and complication rates showed no significant difference between the two groups. However, the blood loss was significantly lower in the HALS-Nx group. During the follow-up period, no significant differences were noted in either the 7-and 10-year recurrencefree rates or the cancer-specific 7-and 10-year survival rates between the two groups. The authors conclude that the longterm safety and curability of HALS-Nx is comparable with that of OPEN-Nx. The hand-assisted laparoscopic surgical technique has not compromised oncological outcomes in the RCC patients. Furthermore, the complication rates have been shown to be comparable with the open technique. Their findings were in agreement with those of other reports. 2,3The limitations of the present study included its retrospective nature and selection bias. A prospective, randomized trial of HALS-Nx and OPEN-Nx should be considered as a more objective and informative assessment of the outcomes of those surgical techniques in RCC patients.Laparoscopic radical nephrectomy (LRN) has become a standard treatment modality for patients with localized RCC. In long-term follow up, LRN has shown excellent oncological outcome, equal to open surgery for both stage T1 and T2 renal tumors.3,4 However, no consensus has yet been established regarding the best laparoscopic access for LRN. Each technique offers advantages and disadvantages. Hand-assisted LRN offers morbidity and recovery that are comparable with those of standard laparoscopy. The benefits of hand-assisted LRN include shorter learning curve, direct manual control of operative field, easier intact specimen removal and shorter operative time. In the analysis presented by Silberstein, handassisted nephrectomy was associated with significantly less operative blood loss and risk of open conversion than was pure laparoscopic nephrectomy. 5 The data presented support the role of hand-assisted laparoscopic nephrectomy as one of the treatment options for renal cancer when nephron-sparing surgery is not suitable. To assess the true oncological efficacy of the procedure, a longer follow-up period (>10 years) is necessary. Based on the current knowledge, one could anticipate the same excellent results of hand-assisted LRN that have been shown in conventional radical laparoscopic nephrectomy.Surgeons' experience and personal preference remain the most important factors that guide their choice of laparoscopic technique, but it has to be acknowledged that the treatment for the patient with localized RCC needs to be highly individualized. Therefore, it is crucial for surgeons to access unbiased information regarding the outcome of different laparoscopic techniques to help them make the choice that best suits the individual patient.