Oncological outcome of 100 laparoscopic radical nephrectomies for clinically localized renal cell carcinoma

Retroperitoneal Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma: Indications and Long-term Outcome of a Cohort Study in Vietnam

OBJECTIVE: Laparoscopic radical nephrectomy (LRN) has been suggested as the standard care for cancer patients in the T1-2 stage. However, whether this advanced technique is most indicated suitable for renal tumors higher than T3a and N1 is unclear, especially in different regions and countries, such as the difference between European and Asia. METHODS: From 2013 to 2021, the data of pathologically diagnosed renal cell carcinoma (RCC) patients who received laparoscopic retroperitoneal radical nephrectomy was subjected to the present study. RESULTS: Overall, all the registered Vietnamese patients were eligible for the study. The average operative time was 86.8 ± 21.2 min and the percentage number of patients in stages 1, 2, and 3 were 134 (70.2%), 30 (15.7%), and 27 (14.1%), respectively. Patients in the 3rd stage had a significantly longer operative time than stages 1–2 (p = 0.0001). No Lymph-node dissection (LND) was recorded in 10 patients (5.2%), limited LND in 163 patients (85.3%), regional LND in 13 patients (6.8%), extended LND (eLND) in 5 patients (2.6%). eLND showed only prolongation of operative time (p = 0.000), however, did not increase intraoperative complications as well as prolonged the duration of analgesia and hospital stay when compared with the other 2 groups (p = 0.82, 0.85, 0.91). Mean follow-up time: 42.3 ± 24.7 months. The 5-year recurrent free survival and 5-year overall survival of the stage 1, 2, 3 were: 98.3%, 100%, 87.8%, and 98.9%, 100%, and 91.3%, respectively. (p = 0.0011, p = 0.0082). CONCLUSION: Retroperitoneal LRN could be an important technique in improving long-term oncological outcomes for Vietnamese patients, especially in the stage of T1-3N0-1M0 tumors. Radical retroperitoneal nephrectomy is safe and technically feasible as well as providing favorable long-term oncological outcomes for stage T1-2-3aN1M0 RCC.

National nephrectomy registries: Reviewing the need for population-based data

Nephrectomy is the cornerstone therapy for renal cell carcinoma (RCC) and continued refinement of the procedure through research may enhance patient outcomes. A national nephrectomy registry may provide the key information needed to assess the procedure at a national level. The aim of this study was to review nephrectomy data available at a population-based level in Australia and to benchmark these data against data from the rest of the world as an examination of the national nephrectomy registry model. A PubMed search identified records pertaining to RCC nephrectomy in Australia. A similar search identified records relating to established nephrectomy registries internationally and other surgical registries of clinical importance. These records were reviewed to address the stated aims of this article. Population-based data within Australia for nephrectomy were lacking. Key issues identified were the difficulty in benchmarking outcomes and no ongoing monitoring of trends. The care centralization debate, which questions whether small-volume centers provide comparable outcomes to high-volume centers, is ongoing. Patterns of adherence and the effectiveness of existing protocols are uncertain. A review of established international registries demonstrated that the registry model can effectively address issues comparable to those identified in the Australian literature. A national nephrectomy registry could address deficiencies identified in a given nation's nephrectomy field. The model is supported by evidence from international examples and will provide the population-based data needed for studies. Scope exists for possible integration with other registries to develop a more encompassing urological or surgical registry. Need remains for further exploration of the feasibility and practicalities of initiating such a registry including a minimum data set, outcome indicators, and auditing of data.

Oncologic outcome of 132 cases of laparoscopic radical nephrectomy with intact specimen removal for T1-2N0M0 renal cell carcinoma

We present the short and long-term oncologic outcome of 132 patients with pathologically confirmed T1-T2, N0M0 renal cell carcinoma (RCC), who underwent laparoscopic radical nephrectomy with intact specimen removal at our institution. Beginning January 1998, we prospectively collected data of 132 patients undergoing laparoscopic radical nephrectomy, whose final pathologic stage was T1 or T2, N0M0, RCC. The clinical data of three groups categorized as group (pT1a)--36 patients, group (pT1b)--51 patients and group (pT2)--45 patients were analyzed statistically to assess oncological outcome. The specimens were removed intact without morcellation in all patients in a homemade plastic bag. The total median follow-up was 56 months (range 3-80 months) and there were no local or port-site recurrences or hernia. Patients with pT2 tumors had significantly greater operating time, blood loss and analgesic requirements than pT1a/pT1b tumor patients. The distant metastases were found in 1, 4 and 5 patients in group pT1a, pT1b and pT2, respectively. The 5-year cancer-specific survival was 97.2, 86.3 and 82.2%, respectively, in pT1a, pT1b and pT2 tumor patients (significantly lower in pT2 than pT1a, P = 0.008). The 5-year recurrence-free survival was 97.2, 84.3 and 82.2%, respectively, in pT1a, pT1b and pT2 tumor patients (significantly lower in pT2 than pT1a, P = 0.02). Laparoscopic radical nephrectomy (retroperitoneal and transperitoneal route) with intact specimen removal for localized renal cell carcinoma (T1-2N0M0) provides satisfactory short and long-term oncologic efficacy.