Laparoscopic cytoreductive nephrectomy is associated with significantly improved survival compared with open cytoreductive nephrectomy or targeted therapy alone

Abstract

The aim of the present study was to compare the survival outcomes for patients with metastatic renal cell carcinoma (mRCC) who underwent laparoscopic cytoreductive nephrectomy (CN) vs. open CN vs. targeted therapy (TT) alone at our institution. A retrospective chart review was performed at our institution for patients who underwent CN prior to TT (laparoscopic, n=48; open, n=48) or who were deemed unfit for surgery and received TT alone (n=36), between January 2007 and December 2012. Kaplan-Meier estimated survival and Cox proportional hazards analyses were performed. Laparoscopic CN was associated with significantly longer survival compared with open CN or TT alone (median survival 24 vs. <12 months, respectively; P<0.01). On multivariate analysis, laparoscopic CN was an independent predictor of survival [hazard ratio (HR)=0.48, P<0.01), controlling for preoperative risk factors, while survival was similar between open CN and TT alone (HR=0.85, P=0.54). In our experience, laparoscopic CN appears to be a significant predictor of survival in mRCC. Selection bias of the surgeon for patients with improved survival may account for clinical variables that were otherwise difficult to quantify. For patients who were not candidates for laparoscopic CN, open CN did not confer a survival benefit over TT alone, while it was associated with increased morbidity.

The role of cytoreductive nephrectomy in metastatic renal cell carcinoma in the targeted therapy and immunological therapy era: a systematic review and meta-analysis

“…Finally, 30 studies (three randomized control studies and 27 cohort studies) fulfilled the predetermined inclusion criteria and were included in this meta-analysis (Fig. 1 ) 7 – 10 , 17 – 42 .…”

“…We assessed the risk of bias in 27 cohort studies using the ROBIN-1 tool. The overall risk of bias was determined to be moderate in 21 studies 10 , 18 – 20 , 22 – 35 , 39 – 42 and serious in six studies 17 , 21 , 36 – 38 , 41 . No study was found to be at critical risk of bias (Fig.…”

The Evolving Landscape of Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma

“…The oncological results of minimally invasive CN were evaluated by Zhao et al when comparing 48 LCN and 48 OCN. They found a longer OS in LCN (23.9 vs. 10.8 months, p < 0.01) [96].…”

Place of Open Radical Nephrectomy, in the Era of Laparoscopy in Subsaharian Africa

“…Dunn et al reported that LRN can be selected for tumor size range <10 cm[15], Hemal et al tumor size range of 7 to 10 cm[12]. Zhao even advocates the LRN in cytoreductive nephrectomy[16]. However, the extent of tumor size is not a factor in determining LRN use.…”