Surgical treatment of renal neoplasia: evolving toward a laparoscopic standard of care.
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.
Bhayani
Sam B
SB
Division of Urology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Clayman
Ralph V
RV
Sundaram
Chandru P
CP
Landman
Jaime
J
Andriole
Gerald
G
Figenshau
R Sherburne
RS
Bullock
Arnold
A
Brandes
Steven
S
Shalhav
Arieh
A
McDougall
Elspeth
E
Kibel
Adam S
AS
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