Laparoscopic versus open radical nephrectomy for large renal tumors: a long-term prospective comparison

The role of laparoscopy in the management of large renal tumors (more than 7 cm) is not clearly established. We prospectively evaluated the feasibility, safety and long-term results of laparoscopic radical nephrectomy for large renal tumors (T2N0M0) and compared the results with those of open radical nephrectomy.

Between 1998 and 2006, 112 patients with clinical stage T2N0M0 renal carcinoma underwent radical nephrectomy at our institution. Clinical data were prospectively collected after categorizing the patients into group 1-41 with laparoscopy and group 2-71 with open surgery. The choice of procedure was nonrandomized and it depended on patient and surgeon preference and experience.

The 2 groups were contemporary and comparable in terms of age, body mass index and mean tumor size (9.9 and 10.1 cm, respectively). Concomitant adrenalectomy was performed in 14 patients (34%) in group 1 and in 29 (41%) in group 2. Limited (hilar) lymphadenectomy was performed in 30 patients (73%) in group 1 and in 58 (81%) in group 2. Group 1 patients experienced significantly less blood loss, and had a decreased analgesic requirement, shorter hospital stay and more rapid convalescence, although they required longer operative time (180.8 vs 165.3 minutes, p=0.029). The 2 groups were followed for a similar period (mean 51.4 vs 57.2 months) and there was no difference in 5-year survival data. There were no local or port site recurrences.

Laparoscopic radical nephrectomy for clinical stage T2 renal tumors is effective with the advantages of less blood loss, shorter hospital stay, decreased analgesic requirement and rapid recovery compared with open radical nephrectomy. Long-term results are also similar in the 2 groups of patients. Laparoscopic radical nephrectomy for large tumors is a technically difficult, challenging procedure and it should be attempted by surgeons with significant experience.