Prospective, randomized controlled study: Transperitoneal laparoscopic versus retroperitoneoscopic radical nephrectomy

Nambirajan, Thiagarajan; Jeschke, Stephan; Alzahrani, Hassan M.; Vrabec, George; Leeb, Karl; Janetschek, Günter

doi:10.1016/j.urology.2004.06.057

Cited by 124 publications

(66 citation statements)

References 16 publications

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“…A randomized controlled study by Nambirajan et al found no difference between the two approaches in terms of pathological stage, operative time, need for additional procedures such as adrenalectomy and/or lymph node sampling or estimated blood loss when the procedure was performed by an experienced laparoscopic surgeon. 10 Desai et al showed no difference in the results comparing the two approaches in the context of a prospective, randomized study. 11 Compared to the TPN, the RPN approach was associated with a shorter time to renal artery control, a shorter time to renal vein control and a shorter total operative time.…”

Section: Discussionmentioning

confidence: 97%

“…Several investigators have reported their experience with laparoscopic nephrectomy using both TPN and RPN approaches for renal cell carcinoma. [10][11][12][13][14] Three prospective randomized studies compared the TPN approach with the RPN approach for laparoscopic radical nephrectomy. A randomized controlled study by Nambirajan et al found no difference between the two approaches in terms of pathological stage, operative time, need for additional procedures such as adrenalectomy and/or lymph node sampling or estimated blood loss when the procedure was performed by an experienced laparoscopic surgeon.…”

Section: Discussionmentioning

confidence: 99%

“…15 Some investigators reported laparoscopy resulted in an outcome similar to those of open surgery as regards the actuarial cancer-specific and overall survival. [5][6][7][8]10 Recently, Ficarra et al reported that the 5-year cancer specific survival rates of open radical nephrectomy were 97.4% in patients with pT1a, 92.5% in those with pT1b, and 89.3% in those with pT2. 16 Multiple studies have reported the 5-year disease-free and actuarial survival rates of laparoscopic nephrectomy with stage T1/2 N0M0 patients ranging from 91% to 95% and 81% to 95%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma: A single‐center experience of 100 cases

et al. 2008

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Objectives: To report our experience with the retroperitoneal and transperitoneal approaches of laparoscopic nephrectomy for renal cell carcinoma (RCC). Methods: Between July 2001 and December 2007, 100 patients with RCC underwent laparoscopic radical nephrectomy at our institution for clinically localized RCC. Fifty-three patients received a retroperitoneal procedure and 47 received a transperitoneal procedure. The perioperative and oncological outcomes of these groups were reviewed retrospectively. Results: Mean follow up was 34 months. No statistically significant difference was found between the two approaches in terms of pathological stage, operative time, need for additional procedures such as adrenalectomy and/or lymph node sampling, estimated blood loss, need for blood transfusions, analgesic requirement, length of hospital stay, or the incidence of minor or major complications. The 5-year disease-free survival rate was 90% for both the retroperitoneal and transperitoneal procedures. The 5-year overall survival rates were 98% and 96%, respectively. Therefore, no significant difference was observed in the long-term oncological outcome between the two groups. Conclusions: Tumor control and surgical morbidity in laparoscopic radical nephrectomy seem not to be significantly influenced by the approach.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma: A single‐center experience of 100 cases

et al. 2008

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“…2), the result was not statistically significant. A very low number of metastatic events were reported across the studies: Nadler [23] and Nambirajan [22] reported none whilst Desai [21] reported 1/52 versus 3/50 for retroperitoneal versus transperitoneal radical nephrectomy respectively (plot 2.4, full report). No incidences of positive surgical margins were reported (plot 2.5, full report).…”

Section: 22b Retroperitoneal Vs Transperitoneal Radical Nephrecmentioning

confidence: 95%

“…Two randomised studies (Desai 2005a;Nambirajan 2004) [21,22] and one quasi-randomised study (Nadler 2006) [23] compared retroperitoneal and transperitoneal laparoscopic radical nephrectomy.…”

Section: 22b Retroperitoneal Vs Transperitoneal Radical Nephrecmentioning

confidence: 99%

Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer

MacLennan

Imamura

Lapitan³

et al. 2012

European Urology

291

170

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Context: Renal cell carcinoma (RCC) accounts for 2-3% of adult malignancies. There remain uncertainties over the oncological outcomes for the surgical management of localised RCC. Objective: To systematically review relevant literature comparing oncological outcomes of surgical management of localised RCC (T1-2N0M0). Evidence Acquisition: Relevant databases including MEDLINE, Embase and the Cochrane Library were searched up to October 2010, and an updated scoping search was performed up to January 2012. Randomised or quasi-randomised controlled trials (RCTs), prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well defined registries/databases were included. The main outcomes were overall survival, cancer-specific survival, recurrence and metastases. The Cochrane risk of bias (RoB) tool was used to assess RCTs and an extended version was used to assess Non Randomised Studies (NRS). The quality of evidence was assessed using GRADE. Evidence Synthesis: 4580 abstracts and 389 full text articles were assessed. 34 studies met the inclusion criteria (6 RCTs and 28 NRSs). Meta-analyses were planned but were deemed inappropriate due to data heterogeneity. There were high risks of bias and low quality evidence across the evidence base. Open radical nephrectomy and open partial nephrectomy showed similar cancer-specific and overall survival, but when both open and laparoscopic approaches are considered together the evidence showed improved survival for partial nephrectomy for tumours ≤4cm.Overall, the evidence suggests either equivalent or better survival with partial nephrectomy. Laparoscopic radical nephrectomy offered equivalent survival to open radical nephrectomy, and all laparoscopic approaches achieved equivalent survival. Open and laparoscopic partial nephrectomy achieved equivalent survival. The issue of ipsilateral adrenalectomy or complete lymph node dissection with radical nephrectomy or partial nephrectomy remains unresolved. Conclusions: The evidence base suggests localised RCC are best managed by nephron sparing surgery where technically feasible. However, the current evidence base has significant limitations due to studies of low methodological quality marked by high risks of bias.

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Surgical management of localised renal cell carcinoma

Nabi¹,

Shelley²

2010

Cochrane Database of Systematic Reviews

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Prospective, randomized controlled study: Transperitoneal laparoscopic versus retroperitoneoscopic radical nephrectomy

Cited by 124 publications

References 16 publications

Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma: A single‐center experience of 100 cases

Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma: A single‐center experience of 100 cases

Systematic Review of Oncological Outcomes Following Surgical Management of Localised Renal Cancer

Surgical management of localised renal cell carcinoma

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