title: Comparison of laparoscopic radical nephrectomy and open radical nephrectomy for pathologic stage T1 and T2 renal cell carcinoma with clear cell histologic features: a multi-institutional study.
abstract: OBJECTIVE
  To assess the oncologic efficacy of laparoscopic radical nephrectomy (LRN) compared with open radical nephrectomy (ORN) in patients with clear cell renal cell carcinoma (RCC).
  
  
  METHODS
  We analyzed the data from 2561 patients who had undergone radical nephrectomy for RCC at 26 institutions in Korea from June 1998 to December 2007. The clinical data of 631 patients with clear cell RCC in the LRN group were compared with the clinical data of 924 patients in the ORN group. The patients with Stage pT3 or greater and those with lymph node or distant metastases were excluded to avoid a selection bias. To evaluate the technical adequacy and oncologic outcome, we compared the perioperative parameters and 5-year overall and disease-free survival rates.
  
  
  RESULTS
  The operative time was significantly longer in the LRN group than in the ORN group (219 ± 77 vs 182 ± 62 minutes, P < .001), but the estimated blood loss and complication rate were significantly lower in the LRN group than in the ORN group (P < .001 and P < .001, respectively). On univariate analysis, the LRN group had 5-year overall (93.5% vs 89.8%, P = .120) and recurrence-free (94.0% vs 92.8%, P = .082) survival rates equivalent to those of the ORN group. Even after adjusting for age, sex, T stage, tumor grade, and body mass index in a Cox proportional hazards model, statistically significant differences between the 2 groups were not found for the 5-year overall (hazard ratio 1.523, P = .157) and recurrence-free (hazard ratio 0.917, P = .773) survival rates.
  
  
  CONCLUSIONS
  Our large multi-institutional data have shown that LRN provides survival outcomes equivalent to those of ORN in patients with Stage pT1-T2 clear cell RCC.
authors.affiliation: Department of Urology, Yonsei University Severans Hospital, Seoul, Korea.
authors.forename: Wooju
authors.initials: W
authors.lastname: Jeong
authors.forename: Koon H
authors.initials: KH
authors.lastname: Rha
authors.forename: Hyeon H
authors.initials: HH
authors.lastname: Kim
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.forename: Tae G
authors.initials: TG
authors.lastname: Kwon
authors.forename: Ill Y
authors.initials: IY
authors.lastname: Seo
authors.forename: Gyung T
authors.initials: GT
authors.lastname: Sung
authors.forename: Seung H
authors.initials: SH
authors.lastname: Jeon
authors.forename: Young B
authors.initials: YB
authors.lastname: Jeong
authors.forename: Sung H
authors.initials: SH
authors.lastname: Hong
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D016016:Proportional Hazards Models