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Liu J, Zhang B, Qi P, Ren X, Zheng D, He Y, Zheng X, Yue Z, Li Y, Yang N, Wang Z, Bao J, Tian J, Yang L, Zhai Z, Zuo L, Hou Z, Wang J, Wang W, Chang H, Ma J, Zhang Y, Dong Z, Dong Z, Zhong G, Cheng H, Lei P, Li Z, Wu G, Shang P. Transperitoneal vs retroperitoneal laparoscopic radical nephrectomy: a double-arm, parallel-group randomized clinical trial. BMC Urol 2024; 24:29. [PMID: 38310213 PMCID: PMC10838419 DOI: 10.1186/s12894-023-01364-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/09/2023] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVE To compare the outcomes of patients undergoing Retroperitoneal laparoscopic Radical nephrectomy (RLRN) and Transperitoneal laparoscopic Radical nephrectomy (TLRN). METHODS A total of 120 patients with localized renal cell carcinoma were randomized into either RLRN or TLRN group. Mainly by comparing the patient perioperative related data, surgical specimen integrity, pathological results and tumor results. RESULTS Each group comprised 60 patients. The two group were equivalent in terms of perioperative and pathological outcomes. The mean integrity score was significantly lower in the RLRN group than TLRN group. With a median follow-up of 36.4 months after the operation, Kaplan-Meier survival analysis showed no significant difference between RLRN and TLRN in overall survival (89.8% vs. 88.5%; P = 0.898), recurrence-free survival (77.9% vs. 87.7%; P = 0.180), and cancer-specific survival (91.4% vs. 98.3%; P = 0.153). In clinical T2 subgroup, the recurrence rate and recurrence-free survival in the RLRN group was significantly worse than that in the TLRN group (43.2% vs. 76.7%, P = 0.046). Univariate and multivariate COX regression analysis showed that RLRN (HR: 3.35; 95%CI: 1.12-10.03; P = 0.030), male (HR: 4.01; 95%CI: 1.07-14.99; P = 0.039) and tumor size (HR: 1.23; 95%CI: 1.01-1.51; P = 0.042) were independent risk factor for recurrence-free survival. CONCLUSIONS Our study showed that although RLRN versus TLRN had roughly similar efficacy, TLRN outperformed RLRN in terms of surgical specimen integrity. TLRN was also significantly better than RLRN in controlling tumor recurrence for clinical T2 and above cases. TRIAL REGISTRATION Chinese Clinical Trial Registry ( https://www.chictr.org.cn/showproj.html?proj=24400 ), identifier: ChiCTR1800014431, date: 13/01/2018.
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Affiliation(s)
- Junyao Liu
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Bin Zhang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Peng Qi
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Xiaowei Ren
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Duo Zheng
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Yang He
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Xu Zheng
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Zhongjin Yue
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Ye Li
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Ningqiang Yang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Zhiping Wang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Junsheng Bao
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Junqiang Tian
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Li Yang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Zhenxing Zhai
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Lingjun Zuo
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Zizhen Hou
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Jiaji Wang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Wei Wang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Hong Chang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Junhai Ma
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Yunxin Zhang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Zhichun Dong
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Zhilong Dong
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Ganping Zhong
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Hui Cheng
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China
| | - Pengyuan Lei
- Department of Urology, Xigu Branch of Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Zhongming Li
- Department of Urology, Xigu Branch of Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - GongJin Wu
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China.
| | - Panfeng Shang
- Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China.
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