Comparison of hand-assisted laparoscopic radical nephrectomy with open radical nephrectomy for pT1-2 clear cell renal-cell carcinoma: a multi-institutional study.
OBJECTIVE
This multiinstitutional report assesses the oncologic efficacy of hand-assisted laparoscopic radical nephrectomy (HLRN) compared with open radical nephrectomy (ORN) in patients with localized clear cell renal-cell carcinoma (RCC).


METHODS
We analyzed the data from 2561 patients who underwent radical nephrectomy at 26 institutions in Korea between June 1998 and December 2007 for localized RCC. One hundred ninety-seven patients with clear cell RCC in the HLRN group were compared with 917 patients with clear cell RCC in the ORN group. To evaluate the technical adequacy and oncologic outcome, we compared the operative time, estimated blood loss, and 5-year overall and disease-free survival rates.


RESULTS
The median follow-up was 36 months for the HLRN group and 27 months for the ORN group. The operative time was significantly longer in the HLRN group than in the ORN group (206.8 +/- 68.7 minutes vs. 179.1 +/- 61.5 minutes, p < 0.001), and blood loss was significantly lower in the HLRN group than in the ORN group (311.6 +/- 238.7 mL vs. 372.4 +/- 367.3 mL, p = 0.003). There was no significant difference in pathologic T stage and Fuhrman's nuclear grade in the two groups. No statistically significant difference was found in the 5-year overall (91.2% vs. 90.3%, p = 0.286) and disease-specific (95.2% vs. 92.1%, p = 0.222) survival rates between the HLRN and ORN groups.


CONCLUSIONS
Despite the longer operative time, HLRN was an effective and less-invasive treatment option for localized clear cell RCC. HLRN could achieve cancer control similar to that obtained with ORN.
Park
Yong Hyun
YH
Department of Urology, Seoul National University Hospital, Seoul, Korea.
Byun
Seok-Soo
SS
Kang
Seok Ho
SH
Koh
Jun Sung
JS
Park
Hyoung Keun
HK
Paick
Sung Hyun
SH
Seo
Young Jin
YJ
Yoo
Tag Geun
TG
Jung
Han
H
Cho
Jin Seon
JS
Jeon
Seong Soo
SS
Choi
Yunhee
Y
Park
Sue Kyung
SK
D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery; D003710:Demography; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D016896:Treatment Outcome