title: Laparoscopic versus open cytoreductive nephrectomy in advanced renal-cell carcinoma.
abstract: OBJECTIVE
  There is growing evidence of the benefit of cytoreductive nephrectomy prior to immunotherapy in patients with advanced renal-cell carcinoma (RCC). We compared the outcomes of patients with metastatic RCC undergoing laparoscopic and open cytoreductive nephrectomy prior to systemic therapy.
  
  
  METHODS
  We retrospectively analyzed 27 patients undergoing cytoreductive nephrectomy for metastatic RCC between 2000 and 2004, 16 laparoscopically and 11 by an open approach. Patients with inferior vena-caval tumor thrombus were excluded from analysis. The two groups were comparable with regard to tumor size, clinical stage, and performance status. Surgical, pathologic, and perioperative characteristics and outcomes were compared.
  
  
  RESULTS
  The laparoscopic technique was associated with reduced blood loss (149 v 1135 mL; P = 0.03), transfusion rate and quantity (13% v 55%; P = 0.03; 0.13 v 2.0 units of packed red blood cells; P = 0.007), shorter time to oral intake (1.2 v 2.7 days; P < 0.001), and shorter hospitalization (3.6 v 6.8 days; P < 0.001) compared with open nephrectomy. No significant differences were observed with respect to pathologic stage, operative time, complications, fraction receiving subsequent systemic therapy, time to systemic therapy, or survival.
  
  
  CONCLUSIONS
  Laparoscopic cytoreductive nephrectomy is associated with reduced morbidity and hospital stay compared with open surgery. There was no increase in complications, and the ability to proceed with subsequent systemic therapy was maintained in the majority of patients. The laparoscopic approach can be considered in patients with metastatic RCC as part of a cytoreductive and systemic-therapy regimen.
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, California 94143-1695, USA.
authors.forename: Manuel S
authors.initials: MS
authors.lastname: Eisenberg
authors.forename: Maxwell V
authors.initials: MV
authors.lastname: Meng
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Stoller
authors.forename: Brian I
authors.initials: BI
authors.lastname: Rini
authors.forename: Peter R
authors.initials: PR
authors.lastname: Carroll
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Kane
mesh_terms: D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome