Objective: To determine the stage specific operative, post-operative and oncologic outcomes, for patients undergoing a laparoscopic radical nephrectomy (LRN) for renal cell cancer (RCC) in a single centre, and assess changes over a generation of practice.
Patients and Methods: From December 1992 to July 2011, data was collected prospectively for 854 consecutive simple and radical laparoscopic nephrectomies, 397 of which were LRNs for RCC. The first LRN was performed in December 1997. Stage specific surgical and oncologic outcomes were assessed across the study period. Patients were then grouped into three equal, consecutive cohorts. Case mix and surgical outcomes were compared to assess changes with departmental experience.
Results: There were 206, 71, 118 and 2 patients across stages pT1, pT2, pT3 and pT4 respectively. Median operating time was significantly shorter for pT1 tumours (125, 150 and 150 min for pT1-3, p< 0.021), while median estimated blood loss (EBL) was greater for pT3 tumours (50, 50, 100ml, for pT1-3, p< 0.001). Median follow-up time was 31, 30 and 18 months respectively across pT1-pT3. There was a significant difference in 5-year overall survival (82.4%, 68.4%, 58.9%), cancer specific survival (99.5%, 83.6%, 66.5%) and progression free survival (86.5%, 66.3%, 47.5%) across these stage-specific subgroups. Over the three cohorts there was an increase in LRN performed for locally advanced disease and cytoreduction. With greater surgical experience, there was improvement in median operation time and median EBL in localised disease over the three time periods, but no significant changes for locally advanced disease.
Conclusion: This is the largest reported series of LRN in the United Kingdom. Departmental experience has resulted in improved surgical outcomes for localised RCC, with expansion of practice in more complex advanced disease. Laparoscopic nephrectomy is both operatively and oncologically safe in T1 and T2 disease, and although technically more demanding it is also safe in selected T3 disease.
Written by:
Laird A, Stewart G, Zhong J, Ang WJ, Cutress M, Riddick AC, McNeill A, Tolley D. Are you the author?
Western General Hopsital, Dept. of Urology, Edinburgh, United Kingdom.
Reference: J Endourol. 2013 May 1. Epub ahead of print.
doi: 10.1089/end.2012.0562
PubMed Abstract
PMID: 23634886
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