Renal cancer. Contemporary management. Editor John A. Libertino. Springer New York 2013.
Open versus minimally invasive partial nephrectomy
The goal of minimally invasive technology is to minimize perioperative morbidity while maintaining oncologic principles. The established benefits of laparoscopic over open partial nephrectomy are shorter hospital stay, faster convalescence, and decreased narcotic requirements. In the largest retrospective study to date, Gill et al.. compared open and laparoscopic partial nephrectomy in 1,800 patients with a unifocal clinical T1 renal tumor. Patients in the laparoscopic group had significantly shorter operative times and less blood loss, but longer warm ischemia time than open partial nephrectomy. Each procedure had a small number of intraoperative complications precluding statistical analysis. LPN had a total of 14 and open partial nephrectomy (OPN) had ten intraoperative complications including vascular (n = 10), ureteral (n = 8), spleen (n = 1), and bowel (n = 1) injuries. Sixteen (2.1%) cases converted to open. The LPN group was three times more likely to undergo a secondary procedure, which was attributed to the higher rate of postoperative hemorrhage. Patients undergoing LPN had a shorter hospital stay by an average of 2.2 days. There was no difference in postoperative serum creatinine and oncologic outcomes with a median follow-up time of 1.2 years.
Excellent long-term oncologic outcomes have been established by Lane and Gill in their comparison of LPN to OPN for T1 tumors. Seven-year metastasis-free survival was 93% and 95% (p = 0.7), for LPN and OPN, respectively. Seven-year cancer-specific survival was equal between the groups at 95%. Equivalent renal functional and oncologic outcomes, with the benefits of shorter hospital stay, underscore the effectiveness of LPN as an option for experienced surgeons.