Transperitoneal vs retroperitoneal laparoscopic radical nephrectomy: a double-arm, parallel-group randomized clinical
Junyao Liu1, Bin Zhang1, Peng Qi1
1Department of Urology, Lanzhou University Second Hospital, No.82 Cui Ying Gate, Cheng Guan District, Lanzhou, 730030, Gansu, China.
BMC Urology
|February 3, 2024
Summary
Transperitoneal laparoscopic radical nephrectomy (TLRN) offers better specimen integrity and tumor recurrence control than retroperitoneal laparoscopic radical nephrectomy (RLRN), particularly for clinical T2 cases. Both procedures show similar overall efficacy.
Area of Science:
- Urology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Laparoscopic radical nephrectomy is a standard treatment for localized renal cell carcinoma.
- Two primary laparoscopic approaches exist: retroperitoneal (RLRN) and transperitoneal (TLRN).
- Comparative data on their long-term oncological and surgical outcomes are crucial for clinical decision-making.
Purpose of the Study:
- To compare the oncological and perioperative outcomes of RLRN and TLRN in patients with localized renal cell carcinoma.
- To evaluate differences in surgical specimen integrity and long-term survival rates between the two laparoscopic approaches.
Main Methods:
- A randomized controlled trial involving 120 patients with localized renal cell carcinoma.
- Patients were allocated to either RLRN or TLRN group (60 patients each).
- Outcomes assessed included perioperative data, surgical specimen integrity, pathological results, and tumor recurrence rates with a median follow-up of 36.4 months.
Main Results:
- Perioperative and pathological outcomes were similar between RLRN and TLRN groups.
- Surgical specimen integrity was significantly lower in the RLRN group compared to the TLRN group.
- No significant differences in overall, recurrence-free, or cancer-specific survival were observed overall. However, in the clinical T2 subgroup, RLRN showed a significantly higher recurrence rate (43.2% vs. 76.7%) and worse recurrence-free survival than TLRN (P=0.046).
- RLRN, male gender, and tumor size were identified as independent risk factors for recurrence-free survival.
Conclusions:
- TLRN demonstrates superior surgical specimen integrity compared to RLRN.
- TLRN is more effective than RLRN in managing tumor recurrence for clinical T2 and higher stage renal cell carcinoma.
- While both laparoscopic approaches offer comparable overall efficacy, TLRN presents advantages in specific oncological aspects.
