title: Long-term oncologic outcomes of hand-assisted laparoscopic radical nephrectomy for clinically localized renal cell carcinoma: a multi-institutional comparative study.
abstract: BACKGROUND
  We aimed to assess the long-term oncologic outcome of hand-assisted laparoscopic radical nephrectomy (HLRN) compared with open radical nephrectomy (ORN) in patients with clinically localized renal cell carcinoma (RCC).
  
  
  METHODS
  We retrospectively reviewed the data from 1098 patients who underwent radical nephrectomy at five institutions in Korea between 2000 and 2011 for clinically localized RCC. One hundred ninety-seven patients in the HLRN group were compared with 901 patients in the ORN group. Univariate and multivariate analysis assessed the effects of operative method on oncologic outcomes.
  
  
  RESULTS
  The median duration of follow-up was 69 months for the HLRN group and 63 months for the ORN group. No statistically significant difference was found in the operative time (170.2 minutes versus 168.9 minutes, P=.793) between the HLRN and ORN groups. However, estimated blood loss was significantly lower in the HLRN group than in the ORN group (245.9 mL versus 422.4 mL, P<.001). The pathological T stage was significantly higher in patients in the ORN group: 79.9% of patients in the HLRN group derived from pT1, versus 54.7% of those in the ORN group (P<.001). A statistically significant difference was found in the 5-year disease-free (90.6% versus 79.6%, P<.001), cancer-specific (95.7% versus 91.1%, P=.019), and overall (93.4% versus 85.4%, P<.001) survival between the HLRN and ORN groups. However, multivariate analysis by Cox's proportional hazards model does not retain surgical methods as an independent predictive factor for cancer-related death or recurrence.
  
  
  CONCLUSIONS
  HLRN may be a preferable minimally invasive surgical treatment for clinically localized RCC with comparable long-term oncologic outcomes.
authors.affiliation: 1 Department of Urology, Seoul National University College of Medicine , Seoul, Korea.
authors.forename: Yong Hyun
authors.initials: YH
authors.lastname: Park
authors.forename: Eun Sik
authors.initials: ES
authors.lastname: Lee
authors.forename: Hyeon Hoe
authors.initials: HH
authors.lastname: Kim
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Seok-Soo
authors.initials: SS
authors.lastname: Byun
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
authors.forename: Yong-June
authors.initials: YJ
authors.lastname: Kim
authors.forename: Seok Ho
authors.initials: SH
authors.lastname: Kang
authors.forename: Sung Hoo
authors.initials: SH
authors.lastname: Hong
mesh_terms: D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome