A Prospective, Randomized Trial Comparing the Outcomes of Open vs Laparoscopic Partial Nephrectomy

No AccessJournal of UrologyAdult Urology1 Aug 2022A Prospective, Randomized Trial Comparing the Outcomes of Open vs Laparoscopic Partial NephrectomyThis article is commented on by the following:Editorial CommentEditorial Comment Giuliano B. Guglielmetti, Gabriel C. dos Anjos, Guilherme Sawczyn, Gilberto Rodrigues, Leonardo Cardili, , Maurício D. Cordeiro, Luiz C. O. Neves, José Pontes Junior, Arnaldo Fazoli, Rafael F. Coelho, Miguel Srougi, and William C. Nahas Giuliano B. GuglielmettiGiuliano B. Guglielmetti Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author , Gabriel C. dos AnjosGabriel C. dos Anjos *Correspondence: Department of Urology, Instituto do Câncer do Estado de São Paulo (ICESP), Av. Dr. Arnaldo, 251—4th floor, São Paulo01246-000, Brazil telephone: +55 11 3052 3558; E-mail Address: [email protected] https://orcid.org/0000-0002-0866-6937 Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author , Guilherme SawczynGuilherme Sawczyn Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author , Gilberto RodriguesGilberto Rodrigues Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author , Leonardo CardiliLeonardo Cardili Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author , More articles by this author , Maurício D. CordeiroMaurício D. Cordeiro Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author , Luiz C. O. NevesLuiz C. O. Neves Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author , José Pontes JuniorJosé Pontes Junior Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author , Arnaldo FazoliArnaldo Fazoli Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author , Rafael F. CoelhoRafael F. Coelho Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author , Miguel SrougiMiguel Srougi Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author , and William C. NahasWilliam C. Nahas Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002695AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Partial nephrectomy is the standard treatment for renal tumors <7 cm, and the trend toward minimally invasive surgery has increased. However, data that could support its use and benefits are still lacking. Materials and Methods: We conducted a prospective, randomized controlled trial comparing surgical, functional and oncologic outcomes in patients undergoing open partial nephrectomy (OPN) or laparoscopic partial nephrectomy (LPN). Randomization was 1:1 to OPN or LPN for the treatment of renal tumors <7 cm. The primary endpoint was surgical complications up to 90 days after surgery. Secondary outcomes were comparison of surgical, oncologic and functional results. Results: We randomized 208 patients between 2012 and 2020 (110 with OPN vs 98 with LPN). Operative data showed no differences in operative time, warm ischemia time, estimated blood loss, transfusions or length of hospital stay. Zero ischemia was more frequent in the OPN (35.4% vs 15.5%, p=0.02). OPN was associated with more abdominal wall complications (31.2% vs 13.1%, p=0.004). Regarding oncologic outcomes, no differences were noted. The LPN group had less kidney function reduction at 3 (−5.2% vs −10%, p=0.04; CI 0.09 to 9.46) and 12 months after surgery (−0.8% vs −6.3%, p=0.02; CI 1.18 to 12.95), and a lower rate of downstaging on the chronic kidney disease classification at 12 months (14.1% vs 32.6%, p=0.006). Conclusions: Surgical and oncologic outcomes of LPN were similar to OPN. Minimally invasive surgery may provide better preservation of kidney function. More studies, especially those involving robotic surgery, are necessary to confirm our findings. References 1. : Radical versus partial nephrectomy: effect on overall and noncancer mortality. Cancer 2009; 115: 1465. Google Scholar 2. : Partial nephrectomy: a contemporary review regarding outcomes and different techniques. Cancer J 2008; 14: 302. Google Scholar 3. : Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 41296. Google Scholar 4. : EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 2015; 67: 913. Google Scholar 5. : Radio frequency ablation versus partial nephrectomy for clinical T1b renal cell carcinoma: long-term clinical and oncologic outcomes. J Urol 2015; 193: 430. Link, Google Scholar 6. : Image guided percutaneous probe ablation for renal tumors in 65 solitary kidneys: functional and oncological outcomes. J Urol 2011; 186: 35. Link, Google Scholar 7. : National trends and disparities of minimally invasive surgery for localized renal cancer, 2010 to 2015. Urol Oncol 2019; 37: 182.e17. Google Scholar 8. : A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373. Google Scholar 9. : Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205. Google Scholar 10. : Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 2007; 178: 41. Link, Google Scholar 11. : Laparoscopic versus open partial nephrectomy: a systemic review and meta-analysis of surgical, oncological, and functional outcomes. Front Oncol 2020; 10: 583979. Google Scholar 12. : Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur Urol 2009; 55: 1171. Google Scholar 13. : Perioperative morbidity of open versus minimally invasive partial nephrectomy: a contemporary analysis of the national surgical quality improvement program. J Endourol 2018; 32: 116. Google Scholar 14. : Measuring GFR: a systematic review. Am J Kidney Dis 2014; 64: 411. Google Scholar 15. : Validation of plasma clearance of 51Cr-EDTA in adult renal transplant recipients: comparison with inulin renal clearance. Transpl Int 2009; 22: 323. Google Scholar 16. : Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol 2010; 58: 340. Google Scholar 17. : The correlation between affected renal function and affected renal residual volume: a retrospective outcome of laparoscopic nephron-sparing partial nephrectomy with segmental renal artery blocking-up for localized renal tumors. Medicine (Baltimore) 2019; 98: e13927. Google Scholar 18. : Ischemia techniques in nephron-sparing surgery: a systematic review and meta-analysis of surgical, oncological, and functional outcomes. Eur Urol 2019; 75: 477. Google Scholar 19. : Outcome of kidney function after ischaemic and zero-ischaemic laparoscopic and open nephron-sparing surgery for renal cell cancer. BMC Nephrol 2019; 20: 40. Google Scholar 20. : Functional and oncological outcomes of open, laparoscopic and robot-assisted partial nephrectomy: a multicentre comparative matched-pair analyses with a median of 5 years' follow-up. BJU Int 2018; 122: 618. Google Scholar 21. : Partial nephrectomy in clinical T1b renal tumors: multicenter comparative study of open, laparoscopic and robot-assisted approach (the RECORd project). Urology 2016; 89: 45. Google Scholar Support: none. Conflict of Interest: The Authors have no conflicts of interest to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. CAPPESQ FMUSP 83503, August 22, 2012). Editor's Note: This article is the first of 5 published in this issue for which Category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 487 and 488. © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byDos Anjos G, Guglielmetti G, Junior J, Cordeiro M, Coelho R and Nahas W A Prospective, Randomized Trial Comparing the Outcomes of Open vs Laparoscopic Partial Nephrectomy. Reply.Journal of Urology, Oefelein M A Prospective, Randomized Trial Comparing the Outcomes of Open vs Laparoscopic Partial Nephrectomy. Letter.Journal of Urology, Related articlesJournal of Urology24 May 2022Editorial CommentJournal of Urology24 May 2022Editorial Comment Volume 208Issue 2August 2022Page: 259-267Supplementary Materials Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.Keywordslaparoscopykidney neoplasmsprospective studiesMetricsAuthor Information Giuliano B. Guglielmetti Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author Gabriel C. dos Anjos Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil *Correspondence: Department of Urology, Instituto do Câncer do Estado de São Paulo (ICESP), Av. Dr. Arnaldo, 251—4th floor, São Paulo01246-000, Brazil telephone: +55 11 3052 3558; E-mail Address: [email protected] More articles by this author Guilherme Sawczyn Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author Gilberto Rodrigues Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author Leonardo Cardili Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author More articles by this author Maurício D. Cordeiro Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author Luiz C. O. Neves Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author José Pontes Junior Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author Arnaldo Fazoli Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author Rafael F. Coelho Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author Miguel Srougi Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author William C. Nahas Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil More articles by this author Expand All Support: none. Conflict of Interest: The Authors have no conflicts of interest to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. CAPPESQ FMUSP 83503, August 22, 2012). Editor's Note: This article is the first of 5 published in this issue for which Category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 487 and 488. Advertisement PDF downloadLoading ...