Laparoscopic versus open cytoreductive nephrectomy for metastatic renal cell carcinoma
John C Rabets1, Jihad Kaouk, Amr Fergany
1Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Objectives:
To compare the outcomes of those patients who underwent laparoscopic versus open cytoreductive nephrectomy. Cytoreductive nephrectomy before systemic therapy has been shown to offer a survival advantage compared with systemic therapy alone for metastatic renal cell carcinoma.
Methods:
We reviewed the outcomes of all patients who underwent either open or laparoscopic cytoreductive nephrectomy between 2000 and 2003. The inclusion criteria included patients with tumors 15 cm or less without local invasion, venous involvement, or bulky local adenopathy who had concurrent metastatic disease. A total of 64 patients (22 in the laparoscopic group and 42 in the open group) fulfilled these criteria. The parameters measured were age, tumor size, operative time, estimated blood loss, complications, length of hospital stay, percentage of patients receiving systemic therapy, and the interval to the start of systemic therapy. Kaplan-Meier survival estimates were compared.
Results:
Patients who underwent laparoscopic cytoreductive nephrectomy had a shorter length of stay (2.3 versus 6.1 days) and less operative blood loss (288 versus 1228 mL) than those who underwent open nephrectomy. Patients in the laparoscopic group received systemic therapy sooner after surgery (36 versus 61 days) than those in the open group. The Kaplan-Meier survival estimates were similar for both groups, with a 1-year survival rate of 61% in the laparoscopic group and 65% in the open group.
Conclusions:
With judicious patient selection, laparoscopic cytoreductive nephrectomy can be performed safely, with minimal morbidity, and may shorten the interval from nephrectomy to the start of systemic therapy.
