title: Comparison of hand-assisted laparoscopic radical nephrectomy with open radical nephrectomy for pT1-2 clear cell renal-cell carcinoma: a multi-institutional study.
abstract: 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.
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Yong Hyun
authors.initials: YH
authors.lastname: Park
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.forename: Seok Ho
authors.initials: SH
authors.lastname: Kang
authors.forename: Jun Sung
authors.initials: JS
authors.lastname: Koh
authors.forename: Hyoung Keun
authors.initials: HK
authors.lastname: Park
authors.forename: Sung Hyun
authors.initials: SH
authors.lastname: Paick
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Seo
authors.forename: Tag Geun
authors.initials: TG
authors.lastname: Yoo
authors.forename: Han
authors.initials: H
authors.lastname: Jung
authors.forename: Jin Seon
authors.initials: JS
authors.lastname: Cho
authors.forename: Seong Soo
authors.initials: SS
authors.lastname: Jeon
authors.forename: Yunhee
authors.initials: Y
authors.lastname: Choi
authors.forename: Sue Kyung
authors.initials: SK
authors.lastname: Park
mesh_terms: 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