Matched pair analysis of laparoscopic versus open radical nephrectomy for the treatment of T3 renal cell carcinoma

Laird, A. Douglas; Choy, Kevin; Delaney, Harry; Cutress, Mark L.; O’Connor, Kevin; Tolley, David A.; McNeill, S. Alan; Stewart, Grant D.; Riddick, Antony C. P.

doi:10.1007/s00345-014-1280-y

Cited by 45 publications

(35 citation statements)

References 21 publications

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“…17,24 One study used a prospective cohort matched analysis of 25 pairs. 23 Although a comparative group is lacking in the present study, our short-term results are concurrent with literature on open surgery. 23,24 However, the possibility than open surgery may confer a long-term survival advantage should not be disregarded.…”

Section: Discussionsupporting

confidence: 79%

“…23 Although a comparative group is lacking in the present study, our short-term results are concurrent with literature on open surgery. 23,24 However, the possibility than open surgery may confer a long-term survival advantage should not be disregarded. In fact, open surgery may be more advantageous as it affords a greater opportunity for retroperitoneal lymph node dissection that offers both diagnostic and therapeutic advantages.…”

Section: Discussionsupporting

confidence: 79%

“…Some studies have attempted to demonstrate the efficacy and safety of laparoscopic surgery in a similar population; 16,17,[21][22][23] however, single-centre analyses, minimal patient numbers or short follow-up periods limit their generalizability. Our multi-institutional design allows us to include many patients in a contemporary time period, not easily accomplished in single-centre studies.…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes following laparoscopic management of pT3 renal masses: A large, multi-institutional cohort

Nayak

Patel

Bjazevic

et al. 2015

CUAJ

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Introduction: We described the clinical and oncological outcomes of patients treated by laparoscopic surgery for non-metastatic pT3 renal cell carcinoma (RCC). Methods: We queried a multi-institutional database for patients diagnosed with non-metastatic pathological T3 RCC from 13 Canadian centres treated laparoscopically (radical or partial nephrectomy) between 2008 and 2014. Clinical and pathological outcomes were evaluated. Progression was defined as the development of recurrence or metastatic disease. Log-rank testing and Kaplan-Meier statistical methods assessed for differences and estimated progression-free survival (PFS). Results: In total, 176 patients were identified with a median age of 64 years. The median tumour size was 7.0 cm. Pre-clinical stage was cT1 to cT4 in 39%, 28%, 30% and 3%, respectively. The median blood loss was 150 mL (range: 0-6000) and the median operative time was 124 minutes (range: 60-360). Most lesions were clear cell RCC (80%). After a median follow-up of 17.6 months (range: 0.2-75.0), disease progression occurred in 26% (46/176) of patients, consisting of local recurrence in 7% (3/46), and metastatic disease in 93% (43/46). The 3-year PFS was 67%, with a median PFS of 49 months. Of those who progressed, the median time to progression was 10.3 months. Conclusions: This study is the largest cohort of pT3 RCC patients treated laparoscopically in the literature and suggests that for properly selected patients, laparoscopic management of locally advanced renal masses yields acceptable short-term oncological outcomes.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes following laparoscopic management of pT3 renal masses: A large, multi-institutional cohort

Nayak

Patel

Bjazevic

et al. 2015

CUAJ

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“…In fact, it has been considered standard of care in many cases such as cholecystectomy, appendectomy, colectomy, hysterectomy, pyeloplasty, nephrectomy, and others[1-5]. Laparoscopic approach has been associated with decreased postoperative pain, shorter hospitalization, faster recovery, and better cosmetics[1-5]. Although surgeons are interested in adopting laparoscopic techniques in their practices, most are lacking formal training in laparoscopy.…”

Section: Introductionmentioning

confidence: 99%

Impact of laparoscopic surgery training laboratory on surgeon's performance

Torricelli¹,

Barbosa²,

Marchini³

2016

WJGS

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Minimally invasive surgery has been replacing the open standard technique in several procedures. Similar or even better postoperative outcomes have been described in laparoscopic or robot-assisted procedures when compared to open surgery. Moreover, minimally invasive surgery has been providing less postoperative pain, shorter hospitalization, and thus a faster return to daily activities. However, the learning curve required to obtain laparoscopic expertise has been a barrier in laparoscopic spreading. Laparoscopic surgery training laboratory has been developed to aid surgeons to overcome the challenging learning curve. It may include tutorials, inanimate model skills training (box models and virtual reality simulators), animal laboratory, and operating room observation. Several different laparoscopic courses are available with specific characteristics and goals. Herein, we aim to describe the activities performed in a dry and animal-model training laboratory and to evaluate the impact of different kinds of laparoscopic surgery training courses on surgeon’s performance. Several tasks are performed in dry and animal laboratory to reproduce a real surgery. A short period of training can improve laparoscopic surgical skills, although most of times it is not enough to confer laparoscopic expertise for participants. Nevertheless, this short period of training is able to increase the laparoscopic practice of surgeons in their communities. Full laparoscopic training in medical residence or fellowship programs is the best way of stimulating laparoscopic dissemination.

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“…8 The laparoscopic nephrectomy has been associated with shorter LOS and lower estimated blood loss (EBL) with similar complication rate when compared with open nephrectomy. [9][10][11] To date, few studies have addressed the effect of past abdominal surgery on urological laparoscopy and results are conflicting. [12][13][14][15][16] We hypothesized that previous intraperitoneal surgery may have a detrimental effect.…”

Section: Introductionmentioning

confidence: 99%

Transperitoneal laparoscopic nephrectomy: Assessing complication risk in cases of previous abdominal surgery

Ouellet

Sabbagh

Jeldres

2017

CUAJ

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Matched pair analysis of laparoscopic versus open radical nephrectomy for the treatment of T3 renal cell carcinoma

Abstract: This study reports the longest median follow-up in a T3 LRN cohort. In matched patients, LRN has been shown to have a superior perioperative profile to ORN for the treatment of pT3a/b RCC, with no adverse effect on midterm oncological outcomes.

Cited by 45 publications

References 21 publications

Clinical outcomes following laparoscopic management of pT3 renal masses: A large, multi-institutional cohort

Clinical outcomes following laparoscopic management of pT3 renal masses: A large, multi-institutional cohort

Impact of laparoscopic surgery training laboratory on surgeon's performance

Transperitoneal laparoscopic nephrectomy: Assessing complication risk in cases of previous abdominal surgery

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