Comparison of oncological outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy for the management of clear-cell renal cell carcinoma: a multi-institutional study.
OBJECTIVE
• To investigate the oncological efficacy of retroperitoneal laparoscopic radical nephrectomy (RLRN) compared with transperitoneal laparoscopic radical nephrectomy (TLRN) for the management of clear-cell renal cell carcinoma (RCC).


METHODS
• With emphasis on survival and disease recurrence, a retrospective analysis was made of 580 patients who underwent TLRN (472 patients) or RLRN (108 patients) at 23 institutions between January 1997 and December 2007. • Inclusion criteria were clear-cell RCC, stage pT1 to pT2 without any nodal involvement, and metastasis. • Overall survival and recurrence-free survival curves were estimated using the Kaplan-Meier method. • To assess the association between the surgical approach and survival outcomes, Cox proportional hazard models were constructed.


RESULTS
• The median follow-up was 30 months in the TLRN group and 35.6 months in the RLRN group. Both groups were comparable regarding age, gender, body mass index (BMI), Fuhrman's grade, size of tumours and stage. • Kaplan-Meier curves and the log-rank test showed no significant difference between the TLRN and RLRN groups in 5-year overall (92.6% vs 94.5%; P = 0.669) and recurrence-free survival (92.0% vs 96.2%; P = 0.244). • In a Cox regression model with age, gender, Eastern Cooperative Oncology Group performance status, BMI, nuclear grade and T-stage adjusted variables, no significant difference was found between the two surgical approaches.


CONCLUSIONS
• The present study is the largest oncological analysis for laparoscopic radical nephrectomy (LRN) comparing transperitoneal and retroperitoneal approaches. The data from it provide the objective evidence to suggest similar oncological outcomes for both approaches to LRN.
Ha
U-Syn
US
Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea.
Hwang
Tae-Kon
TK
Kim
Yong June
YJ
Oh
Tae Hee
TH
Jeon
Youn Soo
YS
Lee
Wan
W
Lim
Jae Sung
JS
Lee
Tchun Yong
TY
Choi
Yunhee
Y
Park
Sue K
SK
Byun
Seok-Soo
SS
D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D012187:Retroperitoneal Space; D016896:Treatment Outcome