Open Partial Nephrectomy Vs Laparoscopic Radical Nephrectomy

Laparoscopic radical nephrectomy is now an accepted option for treatment of Ti-T3aNMo renal tumors (44). Laparoscopic radical nephrectomy is associated with diminished postoperative discomfort and shorter recovery compared with open surgery, while providing similar local control and oncologic cure rates.

Cadeddu et al. (45) reported a multi-institutional study of 157 patients undergoing LRN for clinical stage I (T1-T2) renal cancer case. The five-year actuarial disease-free rate for patients was 91%. Matin et al. (46) retrospectively compared outcomes of 35 LRN versus 82 open nephron-sparing surgery. Strict study inclusion criteria included patients with a solitary <4 cm renal tumor, normal serum creatinine, and normal contralateral kidney. Mean blood loss, operative time, narcotic use, and hospital stay were significantly decreased in the laparoscopic group. Patients undergoing open nephron-sparing surgery experienced a lesser postoperative increase in serum creatinine (0% vs. 25%, p < 0.001). The authors concluded that the significant short- and intermediate-term benefits of the laparoscopic approach as regards superior patient recovery and decreased morbidity should be weighed against the long-term advantage of better renal function associated with nephron-sparing surgery.

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