Comparison of laparoscopic radical and partial nephrectomy: effects on long-term serum creatinine

Laparoscopic partial nephrectomy (LPN) and radical nephrectomy (LRN) have been shown to be safe and effective treatment options for renal tumors. However, limited data are available regarding the long-term effect on postoperative renal function in patients undergoing LPN and LRN who have a normal preoperative serum creatinine (sCr) less than 1.5 mg/dL and a two-kidney system. We compared the long-term sCr in patients who were treated with LPN and LRN.

From October 2002 to April 2006, a total of 93 and 171 patients with a single, unilateral, sporadic renal tumor, a normal contralateral kidney and sCr less than 1.5 mg/dL underwent LPN and LRN, respectively. Perioperative, pathologic data and sCr at least 6 months after surgery were compared between the two groups.

A total of 42 and 55 patients with at least 6 months of follow-up after LPN and LRN were evaluated. Tumors treated with LPN were significantly smaller (2.4 versus 5.4 cm, P <0.001) than those in the LRN group. The mean age, body mass index, sex, tumor location, and sCr (0.91 and 0.91 mg/dL, P = 0.93) were similar between the two groups. The mean operative time was longer for LPN (222 versus 182 minutes, P = 0.002) with a mean warm ischemia time of 37 minutes (range 13 to 55). The mean 6-month sCr was significantly greater for patients undergoing LRN (1.4 versus 1.0 mg/dL, P <0.001). Similarly, a greater number of LRN patients developed renal insufficiency (sCr 1.5 mg/dL or greater) compared with LPN (36.4% versus 0%, P <0.001).

Despite the warm ischemia and longer operative times, LPN preserves the kidney function better than LRN. In properly selected patients, LPN should be preferentially performed to prevent chronic renal insufficiency.