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Surgical Methods in Treatment of Kidney Tumors: Open Surgery Versus Laparoscopy Versus Robotic Surgery

  • Mario Wolfgang Kramer
  • Axel Stuart Merseburger
  • Raschid Hoda
Living reference work entry

Abstract

Localized kidney tumors are mainly treated with surgery to cure renal cell cancer. Kidney tumors can be treated in various surgical fashions such as open, laparoscopic, or robot-assisted surgery. No randomized, controlled trials have assessed oncological outcomes of laparoscopic vs. open radical nephrectomy (ORN). Among available nephron-sparing surgical modalities, the open partial nephrectomy (OPN) is considered as standard of care in the treatment of localized RCC. However, with rapid and progressive improvements in minimally invasive technologies and expanding laparoscopic surgical expertise, laparoscopic partial nephrectomy (LPN) continues to develop as a viable alternative. Nevertheless, also for comparison of OPN vs. LPN, there is a lack of randomized clinical trials, and the available evidence is based largely on reported nonrandomized and retrospective comparative studies. Regarding oncologic safety, data from large published series have demonstrated comparable oncological outcomes for LPN and OPN, with a 5-year overall and cancer-specific survival rate of 86% and 100%, respectively. Also, in centers with laparoscopic expertise, no difference in PFS was found between OPN and LPN. Also, the rate of positive margin (0–3.6%) and local recurrence rates (0–2%) seem to be quite comparable to those reported in open series ranging from 0% to 14% and 0% to 10%, respectively. A randomized clinical trial is needed to validate and compare the advantages and disadvantages of LPN over OPN. In the meantime, the potential benefits of minimally invasive surgery must be weighed against the possible higher risk of complications and the possibility of longer periods of ischemia.

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Mario Wolfgang Kramer
    • 1
  • Axel Stuart Merseburger
    • 1
  • Raschid Hoda
    • 1
  1. 1.Department of UrologyUniversity Hospital of Schleswig-HolsteinLuebeckGermany

Section editors and affiliations

  • Mario W. Kramer
    • 1
  • Axel S. Merseburger
    • 2
  1. 1.Klinik für UrologieLübeckGermany
  2. 2.Department of UrologyUniversity Hospital Schleswig-HolsteinLübeckGermany

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