Survey of Endourology

Abstract

a total of 73 laparoscopic radical nephrectomies were performed by 2 surgeons for pathologically confirmed renal cell carcinoma. Data were obtained from patient charts, radiographic reports, telephone followup and a check of the Social Security Death Index.Results: Mean followup was 11.2 years (range 10 to 15). Each patient completed a minimum 10-year followup. Mean patient age at surgery was 60 years. Mean tumor size on computerized tomography was 5 cm (range 1.7 to 13). Pathological stage was pT1a in 41% of cases, pT1b in 30%, pT2 in 15%, pT3a in 10%, pT3b in 3% and pT4 in 1%. High grade tumors (Fuhrman 3 or greater) were present in 18 cases (28%). A positive surgical margin occurred in 1 case. Actual 10-year overall, cancer specific and recurrence-free survival rates were 65%, 92% and 86%, respectively. Overall, cancer specific and recurrence-free survival rates at 12 years were 35%, 78% and 77%, respectively. At a mean of 67 months 10 patients (14%) had metastatic disease, of whom 8 (11%) died.Conclusions: Long-term oncological outcomes after laparoscopic radical nephrectomy for renal cell carcinoma are excellent and appear comparable to those of open surgery. CommentaryThis retrospective, multi-institutional study evaluates the long-term oncologic outcomes of 73 patients who underwent laparoscopic radical nephrectomy (LRP) for pathologically confirmed renal cell carcinoma. This study is not a prospective comparative evaluation but it does provide important results that can be compared to the literature on open radical nephrectomy. The number seems small but acquiring meaningful data in 73 patients over 10 or more years is not an easy task.As would be expected, higher grade and stage disease results in a lower cancer-specific and recurrence-free survival. These results are very comparable to the open surgical data. The authors note that there is no correlation between complication, recurrence or survival rates whether the operation was approached by the transperitoneal or retroperitoneal route. There were no local or port site recurrences, which was an early concern with the implementation of laparoscopic kidney cancer surgery in the 1990s.Laparoscopic radical nephrectomy has become the standard of care for the vast majority of renal cell carcinomas that are not candidates for a partial nephrectomy or thermal ablative technique. Exceptions would be renal tumors that demonstrate extensive regional spread or caval involvement. Such cases should be approached with open surgery for the vast majority of urologic surgeons. A previously published study shows that LRP is taught in most U.S. and Canadian residency surgical programs and is viewed as the gold standard. 1 The last 20 years have seen an amazing shift in surgical approaches to renal masses of which the patients are the beneficiaries. Reference 1. Duchene DA, Moinzadeh A, Gill IS, Clayman RV, Winfield HN. Survey of residency training in laparoscopic and robotic surgery.Nephron-sparing surgery is equally effective to radical nephrectomy for T1BN0M0 renal cel...