TY - JOUR
T1 - Long-term oncologic outcomes of hand-assisted laparoscopic radical nephrectomy for clinically localized renal cell carcinoma
T2 - A multi-institutional comparative study
AU - Park, Yong Hyun
AU - Lee, Eun Sik
AU - Kim, Hyeon Hoe
AU - Kwak, Cheol
AU - Ku, Ja Hyeon
AU - Lee, Sang Eun
AU - Byun, Seok Soo
AU - Hong, Sung Kyu
AU - Kim, Yong June
AU - Kang, Seok Ho
AU - Hong, Sung Hoo
N1 - Copyright:
Copyright 2015 Elsevier B.V., All rights reserved.
PY - 2014/8/1
Y1 - 2014/8/1
N2 - 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.
AB - 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.
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U2 - 10.1089/lap.2014.0035
DO - 10.1089/lap.2014.0035
M3 - Article
C2 - 25007232
AN - SCOPUS:84904973285
VL - 24
SP - 556
EP - 562
JO - Journal of Laparoendoscopic and Advanced Surgical Techniques - Part A
JF - Journal of Laparoendoscopic and Advanced Surgical Techniques - Part A
SN - 1092-6429
IS - 8
ER -