Comparative analysis of the results of laparoscopic and open nephrectomies in renal parenchymal tumors

Objective. To compare the immediate and long-term results of laparoscopic and open radical nephrectomies in renal parenchymal tumors.

Subjects and methods. The study covered 195 patients who underwent nephrectomy in 1986 to 2006. Their median age was 54,1 years; male/female ratio was 1,5:1. All the patients were divided into 2 groups. A study group comprised 102 (52,3%) patients with renal tumors, including 93 (91,2%) with renal-cell carcinoma (pT1-3N0-1M0-1) and 9 (8,8%) with benign tumors, who had undergone laparoscopic nephrectomy. Ninety-three (47,7%) patients who had undergone open radical nephrectomy for localized renal cancer were retrospectively selected for a control group. The median follow-up in the laparoscopic and open surgery groups were 19,6±13,2 and 62,3±35,9 months, respectively.

Results. The median time of laparoscopic nephrectomy was significantly more than that of open surgery (170 and 100 min, respectively; p < 0,001). The median blood loss volume did not differ in the groups (280,1 and 283,5 ml, respectively; p = 0,342). In the study and control groups, the frequency of intraoperative complications was 10,9 and 4,3% (p = 0,075) and that of postoperative ones was 10,8 and 7,5%, respectively (p > 0,05). In 8 (7,9%) cases, conversion was required to suture defects of large vessels. In the laparoscopic group, the median length of stay was significantly less than that in the control group (7,0±3,6 and 12,0±3,1 days, respectively; p < 0,001). The differences were insignificant in the average cost of endoscopic and open surgeries. Questionnaire survey revealed a significant improvement in the quality of life after surgery via laparoscopic access. Relapses were detected in 2 (2,2%) patients from the study group: a local recurrence in 1 (1,1%) patient and metastases in 1 (1,1%); and in 5 (5,4%) control patients: metastases in 4 (4,3%), local relapse and distant metastases in 1 (1,1%; p = 0,271). In renal cancer patients undergoing laparoscopic and open nephrectomies, overall, specific, and relapse-free 4-year survival rates were 100; 100, and 94,9% and 96,4, 97,5, and 96,2%, respectively (p > 0,05).

Conclusion. Laparoscopic nephrectomy is the method of choice in treating renal cancer — pT1—3aN0M0, which yields the same long-term results as open surgery and provides a better quality of life.