Survival after minimally invasive vs. open radical nephrectomy for stage I and II renal cell carcinoma

Dursun, Furkan; Elshabrawy, Ahmed; Wang, Hanzhang; Rodríguez, Ronald; Liss, Michael A.; Kaushik, Dharam; Gelfond, Jonathan; Mansour, Ahmed M.

doi:10.1007/s10147-022-02153-5

Cited by 15 publications

(15 citation statements)

References 30 publications

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“…Compared with OS, MIS has been found to have a shorter length of hospital stay, reduced blood loss, lower rates of postoperative morbidity, reduced operative pain, improved cosmesis, and equivalent oncological outcomes. 3 , 4 , 5 , 6 Despite the widespread adoption and the documented clinical benefits of MIS for PN and RN, its long-term cost-benefit is still heavily criticized. Most studies that have evaluated the cost implication of MIS have focused on the health care expenditures in the period during and immediately after surgery, and generally have shown higher expenditures with MIS due to the initial cost of acquisition and expenditures for maintenance and disposables.…”

Section: Introductionmentioning

confidence: 99%

Comparison of 1-Year Health Care Expenditures and Utilization Following Minimally Invasive vs Open Nephrectomy

et al. 2022

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IMPORTANCEGiven the widespread adoption and clinical benefits of minimally invasive surgery approaches (MIS) in partial nephrectomy (PN) and radical nephrectomy (RN), assessment of longterm cost implications is relevant. OBJECTIVE To compare health care utilization and expenditures within 1 year after MIS and open surgery (OS). DESIGN, SETTING, AND PARTICIPANTSThis cohort study was conducted using a US commercial claims database between 2013 and 2018. A total of 5104 patients aged 18 to 64 years who underwent PN or RN for kidney cancer and were continuously insured for 180 days before and 365 days after surgery were identified. An inverse probability of treatment weighting analysis was performed to examine differences in costs and use of health care services. EXPOSURES Surgical approach (MIS or OS). MAIN OUTCOMES AND MEASURESOutcomes assessed included 1-year total health care expenditure, health care utilizations, and estimated days missed from work.

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Section: Introductionmentioning

confidence: 99%

Comparison of 1-Year Health Care Expenditures and Utilization Following Minimally Invasive vs Open Nephrectomy

et al. 2022

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“…This is because of improved operative success, lower length of stay as well as overall lower morbidity/mortality and readmission rate associated with minimally invasive nephrectomies. [28][29][30] Thus, it is difficult to make a contemporary comparison of our findings with those of developed countries as patients are benefitting from a superior treatment modality, in addition to differences in sociodemographic factors (such as race and region) and healthcare access (such as availability of screening services and access to insurance). In contrast, our findings in terms of the sociodemographic presentation (younger age with balanced sex ratio), 2,3,12 presentation (small but significant proportion with incidental diagnosis), 21,22 option of treatment (open radical nephrectomy) 24 and peri-operative outcomes are comparable to those from studies published in other developing countries.…”

Section: Discussionmentioning

confidence: 94%

Clinical Profile and Outcome of Patients Operated on for Renal Cell Carcinoma: Experience from a Tertiary Care Center in a Developing Country

Adem¹,

Hassen²,

Abdulaziz³

et al. 2022

RRU

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With nearly 500,000 new cases and over 150,000 deaths worldwide in 2020, renal cancers remain a significant component of the global burden of cancer. The aim of this study is to describe the clinical presentation, peri-operative condition and short-term outcome of patients operated with the primary diagnosis of renal cell carcinoma (RCC) at a large tertiary care referral center. Patients and Methods: A retrospective institution-based study was done. The study population consisted of all patients who were operated for a primary diagnosis of renal cell carcinoma from January 1st, 2015, to December 31st, 2020, at the Urology Unit of St Paul's Hospital Millennium Medical College. Results: The final cohort consisted of 107 patients (mean (standard deviation) age 49 (±14) years, 48% male, 46% residence in Addis Ababa). The most common presenting complaint was flank pain (65%), followed by hematuria (34%) and abdominal mass (6%). One patient had the classic triad of RCC. The median (IQR) duration of illness was 9(7-11) months. Fourteen (13%) patients were asymptomatic and diagnosed incidentally. Over half (57%) of the cohort were clinical TNM stage II, with the remaining 17%, 18% and 8% being stage I, III and IV, respectively. Nearly all patients (94%) underwent open radical nephrectomy with a transabdominal approach. Most patients (61%) had no Clavien-Dindo grade complications, and a minority (11%) experienced post-operative complications (7% postoperative bleeding, 6% hospital acquired pneumonia, 3% surgical site infection). The median (IQR) length of stay was 6 (5-7.6) days. Nearly all patients (94%) were discharged and improved. Conclusion:In this retrospective study, we have shown that patients operated for RCC are a low-risk cohort with few comorbidities, have a relatively short symptomatic course and good discharge outcome. Further prospective studies are needed to show the long-term outcome and factors associated with such outcomes in this patient population.

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“…LRN for localized RCC has shown clear benefits in terms of superior safety and prognosis, with reports of decreased blood loss, shorter hospital days, less pain, and fast recovery (5)(6)(7). The oncological equivalence of LRN to open radical nephrectomy (ORN) in T1 and T2a RCC has been confirmed by several studies (3,5,8,9). ORN is a feasible procedure for treating patients with RCC >10 cm in size, and few studies have focused on safety and efficacy of LRN.…”

Section: Introductionmentioning

confidence: 94%

“…Since laparoscopic radical nephrectomy (LRN) was first reported by Clayman et al in 1991, the procedure has been widely accepted as the recommended surgical plan for T1 and selected T2 renal cell carcinoma (RCC) cases (1)(2)(3)(4). LRN for localized RCC has shown clear benefits in terms of superior safety and prognosis, with reports of decreased blood loss, shorter hospital days, less pain, and fast recovery (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

“…And the main concern regarding LRN treating large renal tumors is whether the small operating space caused by a large tumor complicates dissection and consequently causes more complications such as bleeding and peripheral organ injury. It remains to be determined whether minimally invasive surgery for large renal tumors can achieve excellent tumor control and may affect tumor-associated prognosis (3). Moreover, there might be potential confounders such as age, tumor size that would affect procedure selection and surgical outcomes between two groups.…”

Section: Introductionmentioning

confidence: 99%

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Propensity-matched pair analysis of safety and efficacy between laparoscopic and open radical nephrectomy for the treatment of large renal masses (>10 cm): a retrospective cohort study

Nian¹,

Ye²,

Zhang³

et al. 2022

Transl Androl Urol

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Background: Open radical nephrectomy (ORN) is a practical procedure for treating patients with large renal carcinomas >10 cm in size, and few studies have focused on feasibility and safety of laparoscopic radical nephrectomy (LRN). The current study was to assess the safety and effectiveness of LRN and ORN in large renal carcinoma patients by propensity matched pair analysis. Methods: In this cohort study, a retrospective review of radical nephrectomy data from October 2010 to October 2018 at Changhai Hospital was conducted. Patients with renal carcinomas >10 cm in size by preoperative images were included. Patients' demographics including age, gender, body mass index (BMI), tumor size, operation time, hospitalization days, etc. were collected. Renal tumor patients undergoing LRN or ORN were match-paired by gender, BMI, age, and tumor size. Peri-operative outcomes including estimated blood loss and complications were compared. The follow-up contents included survival time, disease progression, and cause of death, and cancer-specific and progression-free survival were estimated via Kaplan-Meier curve analysis.Results: Among 92 patients with clinical T2b renal masses, 37 pairs were matched. The average tumor sizes of the LRN and ORN groups were 11.37±0.30 and 11.67±0.33 cm (P=0.375), respectively. The average operating time for LRN was slightly longer (204.32±11.17 vs. 192.78±8.50 min, P=0.414). Estimated blood loss (EBL) (336.49±63.58 mL for LRN vs. 545.95±74.52 mL for ORN, P=0.036), the length of postoperative stay [6.0 (5.0-9.0) for LRN vs. 9.0 (6.0-11.5) days for ORN, P=0.015], and removal time of the drainage tube [4.0 (3.0-5.0) days for LRN vs. 5.0 (4.0-6.0) for ORN, P<0.001] were less than in the LRN group.The pathological subtype and Fuhrman grade were comparable. Both groups were followed up for a similar period, and no difference was observed in 5-year survival rates.Conclusions: Considering the conversion rates and overall complication rates, it seems that LRN for large renal carcinomas demonstrated equivalent peri-operative safety and effectiveness compared with ORN, with no adverse effects on midterm oncological outcomes.

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Survival after minimally invasive vs. open radical nephrectomy for stage I and II renal cell carcinoma

Cited by 15 publications

References 30 publications

Comparison of 1-Year Health Care Expenditures and Utilization Following Minimally Invasive vs Open Nephrectomy

Comparison of 1-Year Health Care Expenditures and Utilization Following Minimally Invasive vs Open Nephrectomy

Clinical Profile and Outcome of Patients Operated on for Renal Cell Carcinoma: Experience from a Tertiary Care Center in a Developing Country

Propensity-matched pair analysis of safety and efficacy between laparoscopic and open radical nephrectomy for the treatment of large renal masses (>10 cm): a retrospective cohort study

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