Laparoscopic Versus Open Radical Nephrectomy: A 9-Year Experience

Abstract

Laparoscopic radical nephrectomy, although technically demanding, is a viable alternative for managing localized renal tumors up to 10 cm. It affords patients with renal tumors an improved postoperative course with less pain and a quicker recovery while providing similar efficacy at 2-year followup for patients with T1 and T2 tumors.

Population‐level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer

“…31 Accordingly, although LRN undoubtedly provides many patients with an easier convalescence, it appears that there is an opportunity for even greater population-level efficiency in the postoperative care of these patients. Although they generally enjoy a more rapid and less intense recovery, the in-hospital mortality rate among Medicare beneficiaries treated with LRN, although still uncommon, is both substantially higher than that reported in early case series [9][10][11]30 and 51% greater than that observed for beneficiaries undergoing ORN. This finding is particularly noteworthy given the more favorable tumor characteristics observed for those patients treated with LRN.…”

“…[9][10][11] Accordingly, the recently released American Urological Association (AUA) Guidelines advocate for laparoscopy as the preferred surgical approach for most patients undergoing radical nephrectomy. 29 However, the evidence for this recommendation is based mainly on the experience and outcomes reported by early innovators and adopters with established expertise in this advanced surgical technique.…”

“…9,10,30 In particular, reports from centers with extensive laparoscopic experience suggest that a shorter LOS can be achieved on a national basis for patients treated with LRN. 9,10 As for the relatively higher rates of intensive care use, 1 explanation is that we include in our definition of ICU utilization patients admitted to intermediate and/or coronary care units. Although these settings may not be ICUs in the most traditional sense, they nonetheless provide higherintensity and higher-cost care and, therefore, represent clinically important outcomes.…”

“…In this context, and because our study coincided with a period of escalating adoption, the higher in-hospital mortality among patients treated with LRN suggests that significant adverse events may, in fact, be more common during the initial phase (ie, the learning curve) of a surgeon's laparoscopic experience. 10 Although further studies are needed to clarify the cascade of events responsible for this mortality difference, this finding alone highlights the need for long-term monitoring of the safety and comparative effectiveness of novel surgical therapies.…”

“…When compared with open radical nephrectomy (ORN), the available evidence indicates that LRN provides equivalent cancer control while affording an easier and more rapid convalescence. [9][10][11] Importantly, however, the actual empirical data supporting this conclusion come mainly from case series reported by innovators and early adopters. Moreover, because there is a substantial learning curve associated with this technique, 10,12 it can be argued that LRN represents a quintessential procedure for which additional data are needed to clarify whether the comparative benefits of LRN have been achieved at a populationlevel and/or whether unintended consequences have occurred during its widespread adoption.…”