Newswise — Open partial nephrectomy has been shown, with long-term follow-up from a variety of institutions, to have oncologic equipoise with radical nephrectomy, when patients are properly selected.
However, there remain no series with long-term follow-up that confirm the same principle in patients undergoing nephron sparing tumor excision through minimally invasive approaches. Here, the group from Cleveland Clinic report on their experience with laparoscopic partial nephrectomy in patients with at least 5 years of post-surgical follow-up.
The authors report on 56 patients out of their series of 557 laparoscopic partial nephrectomies performed since September 1999, who had at least 5 years of follow-up after surgery. Mean patient age was 64 (range 20-85), mean tumor size was 2.9 cm, and the median follow-up was 5.7 years (range 5-6.9). Of these 56 patients, 41% underwent partial nephrectomy for elective indications, with the remainder having relative or absolute indications. Sixty-six percent of the patients had renal cell carcinoma and 86% were noted on final pathologic examination to be stage T1a. There were two positive margins, one in a patient with RCC and one in a patient with oncocytoma. Neither has recurred. There was one local recurrence (2.7%) in a patient who had a negative margin, but was thought to have multifocal papillary RCC and the recurrence was most likely a separate growing tumor. The complication rates were 6% for intra-operative and 13% for post-operative complications. There were no procedure related or disease related deaths. The 5 year overall survival for the group was 86% and the cancer specific survival was 100%.
This study demonstrates that, in experienced hands, outcomes with laparoscopic partial nephrectomy are equivalent to open approaches. Those familiar with the procedure would note that it is technically demanding and that these results were achieved by perhaps one of the best laparoscopic surgeons in the world. They may not be germane to the practicing urologist in the community.
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