title: Matched pair analysis of laparoscopic versus open radical nephrectomy for the treatment of T3 renal cell carcinoma.
abstract: OBJECTIVE
  The perioperative and oncological outcomes of laparoscopic radical nephrectomy (LRN) for T1-T2 renal cell carcinoma (RCC) are well established. We aim to determine whether LRN is a comparable alternative to open radical nephrectomy (ORN) in the treatment of T3 RCC using a matched pair analysis study design.
  
  
  METHODS
  A review of a prospectively collected database at the Western General Hospital, Edinburgh, between 2000 and 2011 was conducted. Patient pairs were matched based on age at operation, gender, histological subgroup, maximal tumour diameter, TNM stage and grade. Patient demographics, operative and post-operative outcomes were compared. Overall, cancer-specific and progression-free survival [overall survival, cancer-specific survival (CSS) and progression-free survival (PFS)] were estimated using the Kaplan-Meier method.
  
  
  RESULTS
  From 252 patients with T3 disease, 25 pairs were matched. Patients were of median age 66.2 years, 64 % male. Tumours were all clear cell RCC, were stage pT3a (32 %) or pT3b and had maximal tumour diameters of 8.7 cm for LRN and 10.0 cm for ORN. Estimated blood loss (100 ml LRN; 650 ml ORN, p < 0.001) and length of post-operative hospital stay (4 days LRN: 9 days ORN, p < 0.001) were lower in the LRN group. Operation time and post-operative complication rates were comparable. CSS and PFS were comparable with a mean CSS of 91.3 months for LRN and 88.7 months for ORN.
  
  
  CONCLUSIONS
  This study reports the longest median follow-up in a T3 LRN cohort. In matched patients, LRN has been shown to have a superior perioperative profile to ORN for the treatment of pT3a/b RCC, with no adverse effect on midterm oncological outcomes.
authors.affiliation: Edinburgh Urological Cancer Group, The University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK, alex.laird@ed.ac.uk.
authors.forename: A
authors.initials: A
authors.lastname: Laird
authors.forename: K C C
authors.initials: KC
authors.lastname: Choy
authors.forename: H
authors.initials: H
authors.lastname: Delaney
authors.forename: M L
authors.initials: ML
authors.lastname: Cutress
authors.forename: K M
authors.initials: KM
authors.lastname: O'Connor
authors.forename: D A
authors.initials: DA
authors.lastname: Tolley
authors.forename: S A
authors.initials: SA
authors.lastname: McNeill
authors.forename: G D
authors.initials: GD
authors.lastname: Stewart
authors.forename: A C P
authors.initials: AC
authors.lastname: Riddick
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009392:Nephrectomy; D061646:Operative Time; D016019:Survival Analysis; D016896:Treatment Outcome