To compare outcomes following laparoscopic renal surgery (LRS) and open renal surgery (ORS) in the treatment of pathological T3a (pT3a) renal cell carcinoma (RCC) using a propensity matched analysis.
The Canadian Kidney Cancer Information System is a prospectively maintained database for patients diagnosed with RCC from 15 Canadian institutions. Patients treated for non-metastatic pT3a RCC between 2008-2015 were included. Propensity score matching for age, gender, tumor size, grade, histology and surgical approach were performed to compare laparoscopic radical and partial nephrectomy (LRN or LPN) with open radical or partial nephrectomy (ORN or OPN). The primary endpoint was recurrence-free-survival (RFS).
226 (45%) patients underwent LRS (88% LRN and 12% LPN) and 275 (55%) underwent ORS (75% ORN and 25% OPN). After a median follow-up of 21.1 months, 155 (72 LRS and 83 ORS) patients experienced recurrence. The 3-year RFS was 63% and 50% for the LRS and ORS groups, respectively, p = 0.36. On subgroup analysis, there was no significant difference in RFS among patients who underwent radical nephrectomy (3 year RFS 61% in LRN compared with 46% in ORN group, p= 0.32) or partial nephrectomy (77% in LPN compared with 79% in OPN group, p= 0.82).
This study is the largest matched analysis comparing laparoscopic and open renal surgery for pT3a RCC. In matched patients, LRS showed no difference in oncological outcomes compared with ORS and should be considered when technically feasible.
Journal of endourology. 2017 Apr 05 [Epub ahead of print]
Premal Patel, Jasmir G Nayak, Zhihui Liu, Olli Saarela, Michael Jewett, Ricardo A Rendon, Anil Kapoor, Peter Black, Simon Tanguay, Jun Kawakami, Ronald Moore, Rodney H Breau, Chris Morash, Frederic Pouliot, Darrel Drachenberg
University of Manitoba, Section of Urology , 820 Sherbrook Street , Winnipeg , WINNIPEG, Manitoba, Canada , R3A 1R9 ; ., University of Manitoba, Surgery , AD203-820 Sherbrook St , Winnipeg, Manitoba, Canada , R3A 1R9 ; ., Cancer Care Ontario, Toronto, Ontario, Canada ; ., University of Toronto Dalla Lana School of Public Health, 274071, Toronto, Ontario, Canada ; ., University of Toronto, Surgery(Urology) , 11 Rose Ave , Toronto , Toronto, Ontario, Canada , m4x1n6 ; ., Dalhousie University, Department of Urology, Halifax, Nova Scotia, Canada ; ., St. Josephs Healthcare, Urology , 50 Charlton Ave E , Hamilton, Ontario, Canada , L8N4A6 ; ., University of British Columbia, Vancouver, British Columbia, Canada ; ., McGill University Health Centre, Urology, Montreal, Quebec, Canada ; ., Calgary, Alberta, Canada ; ., Edmonton, Canada ; ., University of Ottawa, Division of Urology, Ottawa, Ontario, Canada ; ., University of Ottawa, 6363, Division of Urology, Ottawa, Ontario, Canada ; ., Laval University Hospital Center, Urology , 11 Côte du Palais , Quebec, Quebec, Canada , G1R2J6 ; ., University of Manitoba, 8664, Section of Urology, Winnipeg, Manitoba, Canada ; .