Long-term oncologic outcomes of hand-assisted laparoscopic radical nephrectomy for clinically localized renal cell carcinoma: A multi-institutional comparative study

Yong Hyun Park, Eun Sik Lee, Hyeon Hoe Kim, Cheol Kwak, Ja Hyeon Ku, Sang Eun Lee, Seok Soo Byun, Sung Kyu Hong, Yong June Kim, Seok Ho Kang, Sung Hoo Hong

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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). Patients and 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 (245.9mL versus 422.4mL, 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.

Original languageEnglish
Pages (from-to)556-562
Number of pages7
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume24
Issue number8
DOIs
Publication statusPublished - 2014 Aug 1

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ASJC Scopus subject areas

  • Surgery

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