title: Surgical treatment of renal neoplasia: evolving toward a laparoscopic standard of care.
abstract: OBJECTIVE
  To determine the extent to which laparoscopy has replaced open surgery for renal malignancy.
  
  
  METHODS
  The records of all 537 patients at Washington University who underwent surgery for localized renal malignancies from January 1997 to December 2001 were examined for clinical and pathologic information.
  
  
  RESULTS
  The total procedures per year increased from 1997 to 2001, but the distribution of pathologic stages throughout the 5 years was similar. In 1997, laparoscopic approaches were used in 15% of cases; this increased to 65% by 2001. Nephron-sparing surgery (NSS) was used in 31% to 42% of patients yearly, but laparoscopic NSS increased in frequency. By 2001, only 3.3% of T1 tumors were removed by open radical nephrectomy compared with 55% treated by laparoscopic nephrectomy. The rest of the T1 tumors in 2001 were treated by open partial nephrectomy (20.2%) or laparoscopic NSS (21.3%). In 2001, 61% of T2 lesions were treated laparoscopically, an increase from 37% in 1997. Most open radical nephrectomies in 2001 were performed for T3 disease. The number of surgeons performing laparoscopic renal surgery has increased at our institution, from two in 1997, both endourologists, to eight in 2001, representing the entire urology faculty that treats renal cancer.
  
  
  CONCLUSIONS
  Laparoscopic radical nephrectomy has replaced open radical nephrectomy for low-stage renal neoplasia. Although laparoscopic NSS is increasing in frequency, it has not yet replaced open partial nephrectomy. At our institution, the laparoscopic approach has become the standard of care when radical nephrectomy is needed for T1 or T2 renal cancer.
authors: Division of Urology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors: Sam B
authors: SB
authors: Bhayani
authors: Ralph V
authors: RV
authors: Clayman
authors: Chandru P
authors: CP
authors: Sundaram
authors: Jaime
authors: J
authors: Landman
authors: Gerald
authors: G
authors: Andriole
authors: R Sherburne
authors: RS
authors: Figenshau
authors: Arnold
authors: A
authors: Bullock
authors: Steven
authors: S
authors: Brandes
authors: Arieh
authors: A
authors: Shalhav
authors: Elspeth
authors: E
authors: McDougall
authors: Adam S
authors: AS
authors: Kibel
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery; D003452:Cryosurgery / Q000379:methods / Q000706:statistics & numerical data; D004502:Education, Medical, Continuing; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000706:statistics & numerical data; D008923:Missouri; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014573:Urology Department, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D000078329:Workforce