Laparoscopic radical versus partial nephrectomy for tumors >4 cm: intermediate-term oncologic and functional outcomes

Matthew N Simmons, Christopher J Weight, Inderbir S Gill
Urology 2009, 73 (5): 1077-82

OBJECTIVES: To compare the oncologic and functional outcomes of laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN) for clinical Stage T1b-T3 renal cell carcinoma >4 cm in size.

METHODS: This retrospective analysis compared patients undergoing LRN (n = 75) or LPN (n = 35) at a tertiary referral center from April 2001 to December 2005 for Stage T1b-T3N0M0 renal cell carcinoma. The endpoints included radiologically verified systemic and local recurrence, cancer-specific mortality, overall mortality, and chronic kidney disease as determined from the calculated glomerular filtration rate and Kidney Foundation Dialysis Outcomes Quality Initiative diagnostic criteria.

RESULTS: The LRN group had larger tumors (5.3 vs 4.9 cm; P = .03), more T3a tumors (33% vs 9%; P = .006), and more clear cell pathologic features (85% vs 66%; P = .03). No surgical margins in either group were positive. The median follow-up was 57 months (range 27-79) for the LRN group and 44 months (range 27-85) for the LPN group (P = .1). The overall mortality (11% vs 11%), cancer-specific mortality (3% vs 3%), and recurrence (3% vs 6%) rates (P = .4) were equivalent. The postoperative decrease in the estimated glomerular filtration rate was less in the LPN group than in the LRN group at 13 and 24 mL/min, respectively (P = .03). Postoperatively, 2-stage increases in the chronic kidney disease stage occurred in 12% vs 0% of patients in the LRN and LPN groups, respectively (P < .001).

CONCLUSIONS: Our intermediate-term data have indicated that in appropriate patients with Stage T1b-T3 tumors >4 cm, LPN provides equivalent oncologic efficacy and superior renal functional outcomes compared with LRN. Future studies are required to confirm these trends.

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