Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma: Oncological Outcomes at 10 Years or More

Berger, Andre; Brandina, Ricardo; Atalla, Mohamed A.; Herati, Amin S.; Kamoi, Kazumi; Aron, Monish; Haber, Georges-Pascal; Stein, Robert J.; Desai, Mihir M.; Kavoussi, Louis R.; Gill, Inderbir S.

doi:10.1016/j.juro.2009.07.047

« Previous Next »The Journal of Urology
Volume 182, Issue 5 , Pages 2172-2176, November 2009

Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma: Oncological Outcomes at 10 Years or More

Andre Berger
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
Ricardo Brandina
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
Mohamed A. Atalla
- Smith Institute for Urology, North Shore Long Island Jewish Health System, New Hyde Park, New York
Amin S. Herati
- Smith Institute for Urology, North Shore Long Island Jewish Health System, New Hyde Park, New York
Kazumi Kamoi
- Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
Monish Aron
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
Georges-Pascal Haber
- Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
Robert J. Stein
- Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
Mihir M. Desai
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Financial interest and/or other relationship with Hansen Medical.
Louis R. Kavoussi
- Smith Institute for Urology, North Shore Long Island Jewish Health System, New Hyde Park, New York
Inderbir S. Gill
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Financial interest and/or other relationship with Hansen Medical.
- Correspondence and requests for reprints: USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, Los Angeles, California 90080

Received 26 March 2009 published online 16 September 2009.

Purpose

We present oncological outcomes at a followup of 10 years or greater after laparoscopic radical nephrectomy for cancer.

Materials and Methods

Between February 1994 and March 1999 a total of 73 laparoscopic radical nephrectomies were performed by 2 surgeons for pathologically confirmed renal cell carcinoma. Data were obtained from patient charts, radiographic reports, telephone followup and a check of the Social Security Death Index.

Results

Mean followup was 11.2 years (range 10 to 15). Each patient completed a minimum 10-year followup. Mean patient age at surgery was 60 years. Mean tumor size on computerized tomography was 5 cm (range 1.7 to 13). Pathological stage was pT1a in 41% of cases, pT1b in 30%, pT2 in 15%, pT3a in 10%, pT3b in 3% and pT4 in 1%. High grade tumors (Fuhrman 3 or greater) were present in 18 cases (28%). A positive surgical margin occurred in 1 case. Actual 10-year overall, cancer specific and recurrence-free survival rates were 65%, 92% and 86%, respectively. Overall, cancer specific and recurrence-free survival rates at 12 years were 35%, 78% and 77%, respectively. At a mean of 67 months 10 patients (14%) had metastatic disease, of whom 8 (11%) died.

Conclusions

Long-term oncological outcomes after laparoscopic radical nephrectomy for renal cell carcinoma are excellent and appear comparable to those of open surgery.

Key Words: kidney, nephrectomy, carcinoma, renal cell, laparoscopy, outcome assessment (health care)

Abbreviations and Acronyms: LRN, laparoscopic radical nephrectomy, OPN, open radical nephrectomy, RCC, renal cell carcinoma