Partial nephrectomy is the standard treatment for renal tumors < 7 cm, and the trend toward minimally invasive surgery (MIS) has increased. However, data that could support its use and benefits are still lacking.
Prospective randomized controlled trial comparing surgical, functional and oncological outcomes in patients undergoing open partial nephrectomy (OPN) or laparoscopic partial nephrectomy (LPN). Randomization (1:1) to OPN or LPN for the treatment of renal tumors <7 cm. Primary endpoint was surgical complications up to 90 days after surgery. Secondary outcomes were comparison of surgical, oncological and functional results.
Randomized 208 patients between 2012 and 2020 (110 with OPN vs. 98 with LPN). Operative data showed no differences in operative time, warm ischemia time, estimated blood loss, transfusions, or length of hospital stay. Zero ischemia was more frequent in the OPN (35,4% vs 15,5%, p=0.02). OPN was associated with more abdominal wall complications (31.2% vs. 13.1%, p=0.004). Regarding oncological outcomes, no differences were noted. LPN group had less kidney function reduction at 3 (-5.2% vs. -10%, p=0.04; CI 0.09 to 9.46) and 12 months after surgery (-0.8% vs. -6.3%, p=0.02; CI 1.18 to 12.95), and a lower rate of downstaging on the chronic kidney disease classification at 12 months (14,1% vs 32,6%, p=0.006).
Surgical and oncological outcomes of LPN were similar to OPN. MIS may provide better preservation of kidney function. More studies, especially those involving robotic surgery, are necessary to confirm our findings.
The Journal of urology. 2022 Apr 11 [Epub ahead of print]
Giuliano B Guglielmetti, Gabriel C Dos Anjos S, Guilherme Sawczyn, Gilberto Rodrigues, Leonardo Cardili, Maurício D Cordeiro, Luiz C O Neves, José P Junior, Arnaldo Fazoli, Rafael F Coelho, Miguel Srougi, William C Nahas
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.