Laparoscopic and Open Partial Nephrectomy: A Matched-Pair Comparison of 200 Patients

Marszalek, Martin; Meixl, H.; Polajnar, M.; Rauchenwald, Michael; Jeschke, Klaus Nielsen; Madersbacher, Stephan

doi:10.1016/j.eururo.2009.01.042

Cited by 278 publications

(210 citation statements)

References 25 publications

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“…The mean estimated blood loss was generally lower with the laparoscopic approach, but warm ischaemia time (WIT) was prolonged [56]. In a matchedpair comparison, the decline in glomerular filtration rate was greater in the laparoscopic PN group in the immediate postoperative period [55], but not after a follow-up of 3.6 yr. Retroperitoneal and transperitoneal laparoscopic PN yielded similar perioperative outcomes. In a large, retrospective, multicentre comparative study, simple tumour enucleation had similar PFS and CSS rates to standard PN and RN [58].…”

Section: Pn Techniquesmentioning

confidence: 88%

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EAU Guidelines on Renal Cell Carcinoma: The 2010 Update

Ljungberg¹,

Cowan²,

Hanbury³

et al. 2010

European Urology

1,334

1,008

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Context: The European Association of Urology Guideline Panel for Renal Cell Carcinoma (RCC) has prepared evidence-based guidelines and recommendations for RCC management. Objectives: To provide an update of the 2010 RCC guideline based on a standardised methodology that is robust, transparent, reproducible, and reliable. Evidence acquisition: For the 2014 update, the panel prioritised the following topics: percutaneous biopsy of renal masses, treatment of localised RCC (including surgical and nonsurgical management), lymph node dissection, management of venous thrombus, systemic therapy, and local treatment of metastases, for which evidence synthesis was undertaken based on systematic reviews adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant databases (Medline, Cochrane Library, trial registries, conference proceedings) were searched (January 2000 to November 2013) including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm. Risk of bias (RoB) assessment and qualitative and quantitative synthesis of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment. Evidence synthesis: All chapters of the RCC guideline were updated. For the various systematic reviews, the search identified a total of 10 862 articles. A total of 151 studies reporting on 78 792 patients were eligible for inclusion; where applicable, data from RCTs were included and meta-analyses were performed. For RCTs, there was low RoB across studies; however, clinical and methodological heterogeneity prevented data pooling for most studies. The majority of studies included were retrospective with matched or unmatched cohorts based on single or multi-institutional data or national registries. The exception was for systemic treatment of metastatic RCC, in which several RCTs have been performed, resulting in recommendations based on higher levels of evidence.

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Section: Pn Techniquesmentioning

confidence: 88%

“…Studies comparing laparoscopic PN and open PN found no difference in progression-free survival (PFS) or OS between the techniques in centres with laparoscopic expertise [55][56][57]. The mean estimated blood loss was generally lower with the laparoscopic approach, but warm ischaemia time (WIT) was prolonged [56].…”

Section: Pn Techniquesmentioning

confidence: 99%

EAU Guidelines on Renal Cell Carcinoma: The 2010 Update

Ljungberg¹,

Cowan²,

Hanbury³

et al. 2010

European Urology

1,334

1,008

View full text Add to dashboard Cite

show abstract

“…The Gill [42] and Marszalek [45] studies reported no statistically significant difference in the recurrence patterns between laparoscopic and open partial nephrectomy (Table 2).…”

Section: 24c Technique Of Partial Nephrectomy I Laparoscopic Parmentioning

confidence: 97%

Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer

MacLennan

Imamura

Lapitan³

et al. 2012

European Urology

304

174

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Context: Renal cell carcinoma (RCC) accounts for 2-3% of adult malignancies. There remain uncertainties over the oncological outcomes for the surgical management of localised RCC. Objective: To systematically review relevant literature comparing oncological outcomes of surgical management of localised RCC (T1-2N0M0). Evidence Acquisition: Relevant databases including MEDLINE, Embase and the Cochrane Library were searched up to October 2010, and an updated scoping search was performed up to January 2012. Randomised or quasi-randomised controlled trials (RCTs), prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well defined registries/databases were included. The main outcomes were overall survival, cancer-specific survival, recurrence and metastases. The Cochrane risk of bias (RoB) tool was used to assess RCTs and an extended version was used to assess Non Randomised Studies (NRS). The quality of evidence was assessed using GRADE. Evidence Synthesis: 4580 abstracts and 389 full text articles were assessed. 34 studies met the inclusion criteria (6 RCTs and 28 NRSs). Meta-analyses were planned but were deemed inappropriate due to data heterogeneity. There were high risks of bias and low quality evidence across the evidence base. Open radical nephrectomy and open partial nephrectomy showed similar cancer-specific and overall survival, but when both open and laparoscopic approaches are considered together the evidence showed improved survival for partial nephrectomy for tumours ≤4cm.Overall, the evidence suggests either equivalent or better survival with partial nephrectomy. Laparoscopic radical nephrectomy offered equivalent survival to open radical nephrectomy, and all laparoscopic approaches achieved equivalent survival. Open and laparoscopic partial nephrectomy achieved equivalent survival. The issue of ipsilateral adrenalectomy or complete lymph node dissection with radical nephrectomy or partial nephrectomy remains unresolved. Conclusions: The evidence base suggests localised RCC are best managed by nephron sparing surgery where technically feasible. However, the current evidence base has significant limitations due to studies of low methodological quality marked by high risks of bias.

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“…Therefore, larger tumours, multifocal findings and unfavourable positions can be included in NSS. This also holds true for the increasing use of laparoscopic procedures, where bleeding complications tend to be more frequent [28].…”

Section: Discussionmentioning

confidence: 91%

Risk factors and clinical management of haemorrhage after open nephron‐sparing surgery

et al. 2010

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Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo identify risk factors for relevant haemorrhage after open nephron‐sparing surgery (NSS) for renal cell carcinoma, and to evaluate its clinical management.PATIENTS AND METHODSWe evaluated bleeding complications after open NSS in 196 consecutive cases (193 patients) at our institution. The median (range) age of the patients was 64 (3–91) years and the tumour diameter was 2.7 (0.5–11.8) cm. Sex, age, body mass index, imperative vs elective indication, year of surgery, multifocality, tumour diameter and malignant vs benign pathology were tested exploratively and significant variables entered in a multivariate model. The clinical management of haemorrhage after NSS was analysed.RESULTSBleeding required conservative (six), interventional (six) or surgical (three) therapy in 15 of the 196 cases (8%). Imperative indication (P= 0.043) and multifocality (P= 0.039) were independent risk factors in a multivariate model. Compared with superselective percutaneous transarterial embolization (TAE), surgery as a primary therapeutic option was more likely within 24 h after NSS (P= 0.012). Bleeding was finally controlled in all patients, while the kidney was preserved in 11 patients. There was only a minor decline of renal function at the 3‐month follow‐up.CONCLUSIONSWe identified multifocal tumours and imperative indication as risk factors for haemorrhage after NSS. The management was very successful, relying on TAE as an effective and safe treatment for bleeding after NSS. In rare cases of severe bleeding surgical exploration is unavoidable, with a lower chance of kidney preservation.

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Laparoscopic and Open Partial Nephrectomy: A Matched-Pair Comparison of 200 Patients

Cited by 278 publications

References 25 publications

EAU Guidelines on Renal Cell Carcinoma: The 2010 Update

EAU Guidelines on Renal Cell Carcinoma: The 2010 Update

Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer

Risk factors and clinical management of haemorrhage after open nephron‐sparing surgery

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