Elective Nephron-Sparing Surgery For Renal Masses

Main Category: Urology / Nephrology
Also Included In: Clinical Trials / Drug Trials
Article Date: 20 Apr 2008 - 0:00 PDT

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UroToday.com - Comparison of Open and Laparoscopic Approach in a Bi-Center Analysis

Dr. Marszalek from Klagenfurt, Austria presented a study comparing the outcome of patients undergoing elective open vs. laparoscopic (lap) nephron-sparing surgery in two consecutive series. Open surgery was performed in Vienna, and the lap surgery in Klagenfurt. In this retrospective study the files of all patients who underwent elective nephron-sparing surgery over 10 years between 01/1996 and 05/2006 at both institutions were reviewed. Preoperative work-up included renal ultrasonography and abdominal CT. Histological findings, complications and oncological outcome were studied. Surgical technique was open retroperitoneal (Vienna) and laparoscopic retroperitoneoscopic (Klagenfurt) approach, respectively. Patients were either followed at one of the participating departments, the referring urologist or the family doctor.

A total of 310 patients, 131 in the open and 179 in the lap group were analyzed (mean age: 61.7 vs. 62.6 yrs; p=0.7) at a mean follow up of 28.7 months. Mean tumor size on pathological evaluation was smaller in the lap group (open: 3.9 vs. lap: 2.3 cm; p<0.001). Arterial occlusion time was comparable in both groups (open: 25.2 vs. lap: 22.2 mins), but operative time was shorter in the lap group (open: 142 vs. lap: 84 mins, p<0.001) as was time of hospitalization (open: 8.1 vs. lap: 6.3 d, p=0.003). The rate of intra-operative complications was similar in both groups (open: 5.3% vs. lap: 7.8%) whereas postoperative complications were more common in the open group (13.7% vs. 3.9%;p=0.002). The rate of positive postoperative margins also was similar in the open and the lap group (2.2 % vs. 3.4 %). On pathological workup, benign histology was present in 32.1 % (open group) and 19.8% (lap group) respectively (p=0.014). Malignancies accounted for renal cell carcinoma in the majority of cases in both groups (open: 98.9%, lap: 98.6%). After a mean follow-up of 28.7 months (median: 25 months), two local recurrences were observed (both in the lap group), one patient developed lymph node metastases (open group) and four failed distantly (open: n=3, lap: n=1). At conclusion (1.2 vs. 1.1 mg/dl; p=0.6) as well as at the last follow up (1.2 vs. 1.2 mg/dl; p=0.7) serum creatinine levels were comparable between the open and the laparoscopic group.

This comparative analysis demonstrates similar outcome of open and laparoscopic nephron-sparing surgery. Pros of the laparoscopic approach are the shorter operative and hospitalization time in this group, yet the trend to a slightly higher rate of positive margins may warrant a closer follow-up.

Presented by: M. Marszalek, MD, et al, at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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