Analysis of long-term survival in patients with localized renal cell carcinoma: laparoscopic versus open radical nephrectomy.
OBJECTIVE
To assess the impact of surgical approaches and clinico-pathological parameters on the prognosis of localized renal cell carcinoma (RCC) after laparoscopic radical nephrectomy (LRN) or open radical nephrectomy (ORN).


METHODS
Between 2002 and 2008, 336 patients with localized RCC were treated at our two institutions. Of these, 261 were classified as clinical stage pT1 and 75 as pT2, the mean age was 52.3 years. One hundred forty-two patients underwent LRN, and 194 underwent ORN. The medical records of all patients were retrospectively reviewed.


RESULTS
The mean follow-up was 44 months (12-84 months). The 3-, 5-, and 7-year cancer-specific survival (CSS) rates of LRN group (96.3, 94.6, and 92.5%, respectively) were equivalent to ORN (97.4, 94.2, and 91.4%, respectively). The mean CSS rates were not significantly different between LRN and ORN groups for either pT1 (82.3 vs. 81.6 months, P = 0.713) or pT2 (69.0 vs. 72.1 months, P = 0.729). Univariate analysis demonstrated significant impact of tumor stage (pT1 vs. pT2, P = 0.002) and tumor grade (G1/2 vs. G3/4, P = 0.045) on CSS. Surgical approach (laparoscopic or open) was not a statistically significant factor on CSS. Multivariate analysis identified that tumor stage was an independent prognostic factor for CSS of localized RCC (P = 0.007).


CONCLUSIONS
Based on the long-term follow-up, our evaluation suggests that LRN is oncologically equivalent to ORN for patients with pT1 or pT2 tumors. Among the clinical variables, tumor stage appears to be an independent prognostic factor of CSS of localized RCC patients.
Luo
Jun-Hang
JH
Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, ZhongShan 2nd Road, Guangzhou, 510080, China.
Zhou
Fang-Jian
FJ
Xie
Dan
D
Zhang
Zhi-Ling
ZL
Liao
Bing
B
Zhao
Hong-Wei
HW
Dai
Yu-Ping
YP
Chen
Ling-Wu
LW
Chen
Wei
W
D000704:Analysis of Variance; D001707:Biopsy, Needle; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods* / Q000401:mortality; D010149:Postoperative Pain / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors