title: Laparoscopic radical versus partial nephrectomy for tumors >4 cm: intermediate-term oncologic and functional outcomes.
abstract: OBJECTIVE
  To compare the oncologic and functional outcomes of laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN) for clinical Stage T1b-T3 renal cell carcinoma >4 cm in size.
  
  
  METHODS
  This retrospective analysis compared patients undergoing LRN (n = 75) or LPN (n = 35) at a tertiary referral center from April 2001 to December 2005 for Stage T1b-T3N0M0 renal cell carcinoma. The endpoints included radiologically verified systemic and local recurrence, cancer-specific mortality, overall mortality, and chronic kidney disease as determined from the calculated glomerular filtration rate and Kidney Foundation Dialysis Outcomes Quality Initiative diagnostic criteria.
  
  
  RESULTS
  The LRN group had larger tumors (5.3 vs 4.9 cm; P = .03), more T3a tumors (33% vs 9%; P = .006), and more clear cell pathologic features (85% vs 66%; P = .03). No surgical margins in either group were positive. The median follow-up was 57 months (range 27-79) for the LRN group and 44 months (range 27-85) for the LPN group (P = .1). The overall mortality (11% vs 11%), cancer-specific mortality (3% vs 3%), and recurrence (3% vs 6%) rates (P = .4) were equivalent. The postoperative decrease in the estimated glomerular filtration rate was less in the LPN group than in the LRN group at 13 and 24 mL/min, respectively (P = .03). Postoperatively, 2-stage increases in the chronic kidney disease stage occurred in 12% vs 0% of patients in the LRN and LPN groups, respectively (P < .001).
  
  
  CONCLUSIONS
  Our intermediate-term data have indicated that in appropriate patients with Stage T1b-T3 tumors >4 cm, LPN provides equivalent oncologic efficacy and superior renal functional outcomes compared with LRN. Future studies are required to confirm these trends.
authors.affiliation: Department of Urology, Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Matthew N
authors.initials: MN
authors.lastname: Simmons
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Weight
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome