Long-Term Follow-up of Hand-Assisted Laparoscopic Radical Nephrectomy for Organ-Confined Renal Cell Carcinoma

Long-term outcome of hand-assisted laparoscopic radical nephrectomy for T1 renal cell carcinoma

OBJECTIVES

To investigate the long-term outcomes of hand-assisted laparoscopic radical nephrectomy compared with those of open nephrectomy.

METHODS

Hand-assisted laparoscopic radical nephrectomy was carried out in 132 patients with T1 renal cell carcinoma (between November 1999 and November 2008). Their outcomes were compared with those of 61 patients treated with open nephrectomy. The durations of follow up were 6-121 months (median 65 months) and 7-146 months (median 84 months) in the hand-assisted laparoscopic radical nephrectomy and open nephrectomy groups, respectively.

RESULTS

The 7-year recurrence-free rates were 88.5 and 85.6% in the hand-assisted laparoscopic radical nephrectomy and open nephrectomy groups, respectively, showing no significant difference between the two groups. The 7-year cancer-specific survival rates were 92.3 and 91.4% in the hand-assisted laparoscopic radical nephrectomy and open nephrectomy groups, respectively, showing no significant difference between the two groups. Also, the 10-year recurrence-free rates were 85.4 and 78.1% in the hand-assisted laparoscopic radical nephrectomy and open nephrectomy groups, respectively. When changes in the recurrence-free rate were analyzed using the Kaplan-Meier method, no significant difference was observed between the two groups. The 10-year cancer-specific survival rates were 91.8 and 87.9% for hand-assisted laparoscopic radical nephrectomy and open nephrectomy, respectively, showing no significant difference between the groups.

CONCLUSIONS

Hand-assisted laparoscopic radical nephrectomy might be comparable with open nephrectomy with regard to long-term cancer control.

Long-term oncologic outcomes of hand-assisted retroperitoneoscopic radical nephrectomy to treat clinically localized renal cell carcinoma

BACKGROUND/PURPOSE

To evaluate the long-term oncological outcomes of hand-assisted retroperitoneoscopic radical nephrectomy (HARRN) for treating clinically localized renal cell carcinoma.

METHODS

We retrospectively collected and analyzed the data and clinical outcomes of 46 patients who underwent HARRN and 50 patients who underwent conventional open radical nephrectomy (ORN) at our institution for clinical localized renal cell carcinoma (RCC).

RESULTS

The median follow-up period of the HARRN group was 56.5 months (range: 14.6-78.7 months); for the ORN group, the median follow-up period was 110.8 months (range: 15.5-123 months). Patient age, sex, body mass index, pathologic parameters, and classification based on the guidelines of the American Society of Anesthesiologists were not significantly different between the two groups. The HARRN group had a significantly longer operative time (218 minutes vs. 178 minutes, p = 0.003) and less blood loss (203 mL vs. 670 mL, p < 0.001). The complication rates of the ORN and HARRN groups were similar (8% and 4.3%, respectively, p = 0.46). No conversions to an open procedure or intraoperative mortality occurred in the HARRN group. The disease-free and disease-specific survival rates were comparable between the two groups.

CONCLUSION

The results of our study indicate that HARRN is a feasible, minimally invasive treatment for managing clinically organ-confined RCC with a good long-term oncological outcome.

Laparoscopic radical nephrectomy for renal cell carcinoma: oncological outcomes at 10 years or more

PURPOSE

We present oncological outcomes at a followup of 10 years or greater after laparoscopic radical nephrectomy for cancer.

MATERIALS AND METHODS

Between February 1994 and March 1999 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.

Patient and pathologic correlates with perioperative and long-term outcomes of laparoscopic radical nephrectomy

OBJECTIVES

To comprehensively analyze and compare patient and pathologic correlates with perioperative events and with the long-term results of laparoscopic radical nephrectomy.

METHODS

Laparoscopic radical nephrectomy was performed in 255 patients with renal cell carcinoma. Mean follow-up time was 35.2 months; for 39 patients, it was 5 or more years.

RESULTS

Multivariate analysis revealed that major intraoperative complications were associated with increased body mass index and that major postoperative complications were associated with a higher American Society of Anesthesiologists (ASA) score. Older age and higher ASA score were associated with longer hospitalization. Patients were classified using a risk group stratification that incorporated grade and stage; 118 patients were low risk, 93 were intermediate risk, and 44 patients were high risk. No pathologic features were associated with perioperative outcomes. Kaplan-Meier recurrence-free, cancer-specific, and overall survival at 5 years were 79.2%, 88%, and 76.2%, respectively. Multivariate analysis revealed that pathologic risk group, mass size, and high-risk histologic subtype were associated with recurrence-free survival, and cancer-specific survival was associated with pathologic risk group and mass size. Age, high-risk pathologic risk group, and a high-risk histologic subtype were associated with overall survival.

CONCLUSIONS

Our results indicate that perioperative outcomes of laparoscopic radical nephrectomy are associated with body mass index, ASA score, and age, but not with tumor characteristics. Recurrence-free and cancer-specific survival rates were associated with the expected pathologic parameters, confirming the oncologic efficacy of the procedure. Overall survival is associated not only with tumor pathology but also with age, suggesting that competing-cause mortality is important in this setting.

Prospective comparative study between retroperitoneoscopic and hand-assisted laparoscopic approach for radical nephrectomy

OBJECTIVE

No consensus has yet been established regarding the best minimally invasive access for radical ablation of renal tumors. Our objective was to prospectively compare the surgical results and oncologic management of two currently used endoscopic techniques.

MATERIALS AND METHODS

Over a four-year period, 50 patients with renal tumors and clinical stage T1b-T2, smaller than 12 cm, underwent a radical nephrectomy at two reference institutions, 25 underwent retroperitoneoscopic radical nephrectomy (RRN) and 25 a hand-assisted laparoscopic radical nephrectomy (HALRN). Mean follow-up of both cohorts was 50 months. Operative parameters and oncological management were compared.

RESULTS

The mean operative time was 180 min in RRN and 108 min in HALRN (p < 0.001). The time required to access the renal pedicle in RRN was 30 min. and in HALRN 40 min., Learning curve was shorter in HALRN than RRN. Mean blood loss was 100 mL in RRN and 242 mL in HALRN. Mean incision size for specimen retrieval in RRN was 6.5 cm and in HALRN 7.5 cm. One patient with intra operative occurrence of ascites and subsequent pathological stage pT2N0M0 grade 3 operated via HALRN, had neoplasic implants in the Hand-port incision 3 months after surgery followed by death 4 months after recurrence. One patient, with pathological stage pT3N0M0 grade 3 in RRN had metastasis after 36 months.

CONCLUSION

Both, RRN and HALRN techniques are accepted minimally invasive options for endoscopic radical nephrectomy with equivalent long term oncological outcome in the treatment of renal tumors.

The contemporary role of surgery in kidney cancer

The diagnosis and treatment of renal cell carcinoma (RCC) has been the subject of major changes since the late 1980s. Initially, surgery was the only treatment available, but more recently, systemic therapies have been developed, and their introduction has modified some of the surgical indications for rcc. In addition, refinements in surgical technique and the introduction of minimally invasive approaches have revolutionized patient care and bear the promise of even more improvements to come. This paper provides an up-to-date overview of recent developments in the surgical treatment of RCC.

No improvement in renal cell carcinoma survival: a population-based study in the Netherlands

BACKGROUND

The increased finding of kidney 'incidentalomas' and more frequent surgery in patients with renal cell cancer (RCC) metastases may have improved survival from the disease. However, recent data on survival of unselected population-based series of patients with RCC are sparse.

METHODS

We collected the follow-up data for all the patients registered with RCC in the population-based cancer registry held by the Comprehensive Cancer Centre East, the Netherlands.

RESULTS

Patients (1504) diagnosed with RCC between 1989 and 2002 were included. Eighty-three percent of all tumours were histologically confirmed; 17% of all diagnoses were based on clinical examination only. The latter group was older, had a worse stage distribution, often did not receive any kind of therapy and showed a 5-year relative survival of 8%. Five-year relative survival for patients with a histologically confirmed RCC was 60% and did not improve over the last 15 years. A low resection rate in patients with metastasis was observed, most pronounced in elderly, without a tendency of increase in more recent years.

CONCLUSION

The relative survival of RCC did not improve over the years. The resection rate in patients with metastasised disease did not increase over time, despite current knowledge concerning its benefit on tumour complications, time to progression and response to immunotherapy.