Comparison of oncological outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy for the management of clear-cell renal cell carcinoma: A multi-institutional study

U. Syn Ha, Tae Kon Hwang, Yong June Kim, Tae Hee Oh, Youn Soo Jeon, Wan Lee, Jae Sung Lim, Tchun Yong Lee, Yunhee Choi, Sue K. Park, Seok Soo Byun

Research output: Contribution to journalArticle

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Abstract

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Laparoscopic radical nephrectomy (LRN) can be performed by a retroperitoneal approach with similar efficacy compared to the transperitoneal approach. However, the oncological acceptance of LRN has been based on studies which have been carried out primarily by transperitoneal approach, and oncological results of the retroperitoneal approach alone are lacking. Our study confirmed that retroperitoneal laparoscopic radical nephrectomy is oncologically-equivalent to transperitoneal approach in homogeneous group with the final pathological diagnosis of clear cell RCC. Objective: To investigate the oncological efficacy of retroperitoneal laparoscopic radical nephrectomy (RLRN) compared with transperitoneal laparoscopic radical nephrectomy (TLRN) for the management of clear-cell renal cell carcinoma (RCC). Patients and methods: With emphasis on survival and disease recurrence, a retrospective analysis was made of 580 patients who underwent TLRN (472 patients) or RLRN (108 patients) at 23 institutions between January 1997 and December 2007. Inclusion criteria were clear-cell RCC, stage pT1 to pT2 without any nodal involvement, and metastasis. Overall survival and recurrence-free survival curves were estimated using the Kaplan-Meier method. To assess the association between the surgical approach and survival outcomes, Cox proportional hazard models were constructed. Results: The median follow-up was 30 months in the TLRN group and 35.6 months in the RLRN group. Both groups were comparable regarding age, gender, body mass index (BMI), Fuhrman's grade, size of tumours and stage. Kaplan-Meier curves and the log-rank test showed no significant difference between the TLRN and RLRN groups in 5-year overall (92.6% vs 94.5%; P = 0.669) and recurrence-free survival (92.0% vs 96.2%; P = 0.244). In a Cox regression model with age, gender, Eastern Cooperative Oncology Group performance status, BMI, nuclear grade and T-stage adjusted variables, no significant difference was found between the two surgical approaches. Conclusion: The present study is the largest oncological analysis for laparoscopic radical nephrectomy (LRN) comparing transperitoneal and retroperitoneal approaches. The data from it provide the objective evidence to suggest similar oncological outcomes for both approaches to LRN.

Original languageEnglish
Pages (from-to)1467-1472
Number of pages6
JournalBJU International
Volume107
Issue number9
DOIs
StatePublished - 1 May 2011

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Nephrectomy
Renal Cell Carcinoma
Survival
Proportional Hazards Models
Recurrence
Body Mass Index
Neoplasm Metastasis

Keywords

  • carcinoma
  • laparoscopy
  • nephrectomy
  • renal cell

Cite this

Ha, U. Syn ; Hwang, Tae Kon ; Kim, Yong June ; Oh, Tae Hee ; Jeon, Youn Soo ; Lee, Wan ; Lim, Jae Sung ; Lee, Tchun Yong ; Choi, Yunhee ; Park, Sue K. ; Byun, Seok Soo. / Comparison of oncological outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy for the management of clear-cell renal cell carcinoma : A multi-institutional study. In: BJU International. 2011 ; Vol. 107, No. 9. pp. 1467-1472.
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title = "Comparison of oncological outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy for the management of clear-cell renal cell carcinoma: A multi-institutional study",
abstract = "Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Laparoscopic radical nephrectomy (LRN) can be performed by a retroperitoneal approach with similar efficacy compared to the transperitoneal approach. However, the oncological acceptance of LRN has been based on studies which have been carried out primarily by transperitoneal approach, and oncological results of the retroperitoneal approach alone are lacking. Our study confirmed that retroperitoneal laparoscopic radical nephrectomy is oncologically-equivalent to transperitoneal approach in homogeneous group with the final pathological diagnosis of clear cell RCC. Objective: To investigate the oncological efficacy of retroperitoneal laparoscopic radical nephrectomy (RLRN) compared with transperitoneal laparoscopic radical nephrectomy (TLRN) for the management of clear-cell renal cell carcinoma (RCC). Patients and methods: With emphasis on survival and disease recurrence, a retrospective analysis was made of 580 patients who underwent TLRN (472 patients) or RLRN (108 patients) at 23 institutions between January 1997 and December 2007. Inclusion criteria were clear-cell RCC, stage pT1 to pT2 without any nodal involvement, and metastasis. Overall survival and recurrence-free survival curves were estimated using the Kaplan-Meier method. To assess the association between the surgical approach and survival outcomes, Cox proportional hazard models were constructed. Results: The median follow-up was 30 months in the TLRN group and 35.6 months in the RLRN group. Both groups were comparable regarding age, gender, body mass index (BMI), Fuhrman's grade, size of tumours and stage. Kaplan-Meier curves and the log-rank test showed no significant difference between the TLRN and RLRN groups in 5-year overall (92.6{\%} vs 94.5{\%}; P = 0.669) and recurrence-free survival (92.0{\%} vs 96.2{\%}; P = 0.244). In a Cox regression model with age, gender, Eastern Cooperative Oncology Group performance status, BMI, nuclear grade and T-stage adjusted variables, no significant difference was found between the two surgical approaches. Conclusion: The present study is the largest oncological analysis for laparoscopic radical nephrectomy (LRN) comparing transperitoneal and retroperitoneal approaches. The data from it provide the objective evidence to suggest similar oncological outcomes for both approaches to LRN.",
keywords = "carcinoma, laparoscopy, nephrectomy, renal cell",
author = "Ha, {U. Syn} and Hwang, {Tae Kon} and Kim, {Yong June} and Oh, {Tae Hee} and Jeon, {Youn Soo} and Wan Lee and Lim, {Jae Sung} and Lee, {Tchun Yong} and Yunhee Choi and Park, {Sue K.} and Byun, {Seok Soo}",
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Comparison of oncological outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy for the management of clear-cell renal cell carcinoma : A multi-institutional study. / Ha, U. Syn; Hwang, Tae Kon; Kim, Yong June; Oh, Tae Hee; Jeon, Youn Soo; Lee, Wan; Lim, Jae Sung; Lee, Tchun Yong; Choi, Yunhee; Park, Sue K.; Byun, Seok Soo.

In: BJU International, Vol. 107, No. 9, 01.05.2011, p. 1467-1472.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of oncological outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy for the management of clear-cell renal cell carcinoma

T2 - A multi-institutional study

AU - Ha, U. Syn

AU - Hwang, Tae Kon

AU - Kim, Yong June

AU - Oh, Tae Hee

AU - Jeon, Youn Soo

AU - Lee, Wan

AU - Lim, Jae Sung

AU - Lee, Tchun Yong

AU - Choi, Yunhee

AU - Park, Sue K.

AU - Byun, Seok Soo

PY - 2011/5/1

Y1 - 2011/5/1

N2 - Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Laparoscopic radical nephrectomy (LRN) can be performed by a retroperitoneal approach with similar efficacy compared to the transperitoneal approach. However, the oncological acceptance of LRN has been based on studies which have been carried out primarily by transperitoneal approach, and oncological results of the retroperitoneal approach alone are lacking. Our study confirmed that retroperitoneal laparoscopic radical nephrectomy is oncologically-equivalent to transperitoneal approach in homogeneous group with the final pathological diagnosis of clear cell RCC. Objective: To investigate the oncological efficacy of retroperitoneal laparoscopic radical nephrectomy (RLRN) compared with transperitoneal laparoscopic radical nephrectomy (TLRN) for the management of clear-cell renal cell carcinoma (RCC). Patients and methods: With emphasis on survival and disease recurrence, a retrospective analysis was made of 580 patients who underwent TLRN (472 patients) or RLRN (108 patients) at 23 institutions between January 1997 and December 2007. Inclusion criteria were clear-cell RCC, stage pT1 to pT2 without any nodal involvement, and metastasis. Overall survival and recurrence-free survival curves were estimated using the Kaplan-Meier method. To assess the association between the surgical approach and survival outcomes, Cox proportional hazard models were constructed. Results: The median follow-up was 30 months in the TLRN group and 35.6 months in the RLRN group. Both groups were comparable regarding age, gender, body mass index (BMI), Fuhrman's grade, size of tumours and stage. Kaplan-Meier curves and the log-rank test showed no significant difference between the TLRN and RLRN groups in 5-year overall (92.6% vs 94.5%; P = 0.669) and recurrence-free survival (92.0% vs 96.2%; P = 0.244). In a Cox regression model with age, gender, Eastern Cooperative Oncology Group performance status, BMI, nuclear grade and T-stage adjusted variables, no significant difference was found between the two surgical approaches. Conclusion: The present study is the largest oncological analysis for laparoscopic radical nephrectomy (LRN) comparing transperitoneal and retroperitoneal approaches. The data from it provide the objective evidence to suggest similar oncological outcomes for both approaches to LRN.

AB - Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Laparoscopic radical nephrectomy (LRN) can be performed by a retroperitoneal approach with similar efficacy compared to the transperitoneal approach. However, the oncological acceptance of LRN has been based on studies which have been carried out primarily by transperitoneal approach, and oncological results of the retroperitoneal approach alone are lacking. Our study confirmed that retroperitoneal laparoscopic radical nephrectomy is oncologically-equivalent to transperitoneal approach in homogeneous group with the final pathological diagnosis of clear cell RCC. Objective: To investigate the oncological efficacy of retroperitoneal laparoscopic radical nephrectomy (RLRN) compared with transperitoneal laparoscopic radical nephrectomy (TLRN) for the management of clear-cell renal cell carcinoma (RCC). Patients and methods: With emphasis on survival and disease recurrence, a retrospective analysis was made of 580 patients who underwent TLRN (472 patients) or RLRN (108 patients) at 23 institutions between January 1997 and December 2007. Inclusion criteria were clear-cell RCC, stage pT1 to pT2 without any nodal involvement, and metastasis. Overall survival and recurrence-free survival curves were estimated using the Kaplan-Meier method. To assess the association between the surgical approach and survival outcomes, Cox proportional hazard models were constructed. Results: The median follow-up was 30 months in the TLRN group and 35.6 months in the RLRN group. Both groups were comparable regarding age, gender, body mass index (BMI), Fuhrman's grade, size of tumours and stage. Kaplan-Meier curves and the log-rank test showed no significant difference between the TLRN and RLRN groups in 5-year overall (92.6% vs 94.5%; P = 0.669) and recurrence-free survival (92.0% vs 96.2%; P = 0.244). In a Cox regression model with age, gender, Eastern Cooperative Oncology Group performance status, BMI, nuclear grade and T-stage adjusted variables, no significant difference was found between the two surgical approaches. Conclusion: The present study is the largest oncological analysis for laparoscopic radical nephrectomy (LRN) comparing transperitoneal and retroperitoneal approaches. The data from it provide the objective evidence to suggest similar oncological outcomes for both approaches to LRN.

KW - carcinoma

KW - laparoscopy

KW - nephrectomy

KW - renal cell

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