Laparoscopic vs open partial nephrectomy for T1 renal tumours: evaluation of long‐term oncological and functional outcomes in 340 patients

Abstract

What's known on the subject? and What does the study add?• Whereas open nephron-sparing surgery (NSS) represents the 'gold standard' in the surgical therapy of T1 renal tumours, with the advances in laparoscopic surgery, the refinement of intracorporeal suturing and the availability of haemosealant substances, the laparoscopic approach to NSS is increasingly used. Laparoscopic partial nephrectomy (LPN), however, is currently performed in just a few high-volume reference centres, and its diffusion has been limited by the steep learning curve. Conversely, robot-assisted LPN is emerging as a promising procedure, able to tackle the technical difficulties of LPN and leading to a broader diffusion of minimally invasive treatment of small renal masses.• Our study provides long-term follow-up outcomes concerning surgical and oncological outcomes and a detailed evaluation of the renal function in patients affected by T1 renal cancers who underwent LPN and OPN. We showed that LPN could be safely performed in the therapy of T1 renal cancer, without impairing renal function. Objective• To evaluate the long-term oncological and functional outcomes of laparoscopic partial nephrectomy (LPN) compared with open partial nephrectomy (OPN) for pT1 renal tumours. Patients and Methods• In this retrospective single-centre study, 340 consecutive patients underwent LPN and OPN for localized, incidentally discovered, renal masses of <7 cm (cT1).• The patients were matched for age, sex, body mass index, American Society of Anesthesiology score, tumour side (right or left kidney) and tumour characteristics (RENAL nephrometry score).• Demographic data, peri-and postoperative variables, including operating time, estimated blood loss, complications, hospital stay, renal function, histological tumour staging and grading, and metastasis rates were collected and analysed. Results• The median (SEM) operating time for LPN and OPN was 145.3 (45.4) min and 155.2 (35.6) min, respectively (P = 0.07). The median (SEM) warm ischaemia time was 11.7 (2.2) min in the LPN and 14.4 (1.9) min in the OPN group (P = 0.03).• The median (SEM) RENAL nephrometry scores for LPN and OPN were 5.9 (1.6) and 6.1 (0.3), respectively (P = 0.11).• During follow-up, the biochemical markers of glomerular filtration were completely normalized, showing the absence of renal injury and there was no significant difference in glomerular filtration rate between the groups, with median (SEM) rates of 79.8 (3.0) mL/min/1.72m 2 for the LPN and 80.2 (2.7) mL/min/1.72m 2 for the OPN group at 5-year follow-up.• The 5-year overall survival and cancer-specific survival rates, calculated using the Kaplan-Meier method, were 94% and 91% in the LPN group, and 92% and 88% in the OPN group. Conclusion• LPN and OPN provide similar long-term oncological outcomes in the therapy of T1 renal cancer. With regard to renal function, no damage to the kidney was found after LPN and OPN, with a complete normalization of renal function at the 5-year follow-up in both groups.

Open versus laparoscopic partial nephrectomy for clinical T1a renal masses: a matched-pair comparison of 280 patients with TRIFECTA outcomes (RECORd Project)

“…While the laparoscopic approach was associated with a significantly mean longer WIT, at multivariable analysis LPN was an independent predictors of a WIT [25 min. This is in line with most of the recent comparative studies between LPN and OPN, where LPN results constantly associated with a longer WIT, although some authors reported shorter WIT in their LPN series [6,7,18,19]. Consequently, in our LPN cohort a significantly higher eGFR variation on third postoperative day compared to the OPN cohort was observed.…”

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

“…16 Similarly, Springer and coworkers, showing results from a retrospective singleinstitutional study of 340 open and laparoscopic PNs for cT1 RCC, found comparable incidence of PSMs between the 2 groups (1.7% vs. 1.2%; P ¼ .09). 24 It appears still controversial whether the age at the time of surgery could be a predictor of PSMs. In our report, the rate of positive margins was found to be slightly greater in patients older than 65 years, even if these data were not statistically significant at univariable analysis (Table 1; P ¼ .07).…”

Laparoscopic partial nephrectomy: state of the art review

“…47 In a long-term study, Springer et al found no difference between LPN and OPN in postoperative eGFR at 5 years. 48 Similarly, in a study of RPN with intermediate-term follow-up, only an 8% mean decrease in postoperative eGFR was observed at a mean follow-up of 3 years. 49 Longer-term comparisons of functional outcomes for RPN with other surgical approaches are currently lacking.…”

“…Similarly, Springer et al reported comparable 5-year overall survival (94% versus 91%) and cancer-specific survival (92% versus 88%) in patients undergoing LPN versus OPN, respectively. 48 In a study of 134 patients treated with RPN and followed for a minimum of 2 years, Khalifeh et al reported actuarial 5-year overall survival and cancer-specific survival rates of 90% and 99%, respectively. 49 Gupta et al similarly reported no local or metastatic recurrences following RPN at a median follow-up of 22 months.…”