Surgical Methods in Treatment of Kidney Tumors: Open Surgery Versus Laparoscopy Versus Robotic Surgery
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.
- Breda A, Stepanian SV, Lam JS, Liao JC, Gill IS, Colombo JR, Guazzoni G, Stifelman MD, Perry KT, Celia A, Breda G, Fornara P, Jackman SV, Rosales A, Palou J, Grasso M, Pansadoro V, Disanto V, Porpiglia F, Milani C, Abbou CC, Gaston R, Janetschek G, Soomro NA, De la Rosette JJ, Laguna PM, Schulam PG. Use of haemostatic agents and glues during laparoscopic partial nephrectomy: a multi-institutional survey from the United States and Europe of 1347 cases. Eur Urol. 2007a;52:798–803.PubMedCrossRefGoogle Scholar
- Golombos DM, Chughtai B, Trinh QD, Thomas D, Mao J, Te A, O’Malley P, Scherr DS, Del Pizzo J, Hu JC, Sedrakyan A. Minimally invasive vs open nephrectomy in the modern era: does approach matter? World J Urol. 2017. https://doi.org/10.1007/s00345-017-2040-6.
- Hinman F. Atlas of urologic surgery. 2nd ed. Philadelphia: WB Saunders Co; 1998. p. 1172.Google Scholar
- Linhui W, Liang W, Yang Q, et al. Retroperitoneal laparoscopic and open radical nephrectomy. J Endourol. 2010;23(9):1509–12.Google Scholar
- Ljungberg B, Albiges L, Bensalah K, Bex A, Giles RH, Hora M, Kuczyk MA, Lam T, Marconi L, Merseburger AS, Powles T, Staehler M, Volpe A. EAU guidelines on renal cell carcinoma. 2017 update. 2017. www.uroweb.org
- MacLennan S, Imamura M, Lapitan MC, Omar MI, Lam TB, Hilvano-Cabungcal AM, Royle P, Stewart F, MacLennan G, MacLennan SJ, Canfield SE, McClinton S, Griffiths TR, Ljungberg B, N’Dow J, UCAN Systematic Review Reference Group, EAU Renal Cancer Guideline Panel. Systematic review of oncological outcomes following surgical management of localised renal cancer. Eur Urol. 2012a;61(5):972–93.PubMedCrossRefGoogle Scholar
- MacLennan S, Imamura M, Lapitan MC, Omar MI, Lam TB, Hilvano-Cabungcal AM, Royle P, Stewart F, MacLennan G, MacLennan SJ, Dahm P, Canfield SE, McClinton S, Griffiths TR, Ljungberg B, N’Dow J, UCAN Systematic Review Reference Group, EAU Renal Cancer Guideline Panel. Systematic review of perioperative and quality-of-life outcomes following surgical management of localised renal cancer. Eur Urol. 2012b;62(6):1097–117.PubMedCrossRefGoogle Scholar
- Minervini A, Siena G, Antonelli A, Bianchi G, Bocciardi AM, Cosciani Cunico S, Ficarra V, Fiori C, Fusco F, Mari A, Martorana G, Medica M, Mirone V, Morgia G, Porpiglia F, Rocco F, Rovereto B, Schiavina R, Simeone C, Terrone C, Volpe A, Carini M, Serni S, Members of the RECORd Project-LUNA Foundation. Open versus laparoscopic partial nephrectomy for clinical T1a renal masses: a matched-pair comparison of 280 patients with TRIFECTA outcomes (RECORd Project). World J Urol. 2014;32(1):257–63.PubMedCrossRefGoogle Scholar
- Novick AC, Streem SB, Pontes E. Stewart’s operative urology. 2nd ed. Philadelphia: Williams and Wilkins; 1989.Google Scholar
- Patel HD, Pierorazio PM, Johnson MH, Sharma R, Iyoha E, Allaf ME, Bass EB, Sozio SM. Renal functional outcomes after surgery, ablation, and active surveillance of localized renal tumors: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2017; pii: CJN.11941116. doi: https://doi.org/10.2215/CJN.11941116
- Porpiglia F, Mari A, Bertolo R, Antonelli A, Bianchi G, Fidanza F, Fiori C, Furlan M, Morgia G, Novara G, Rocco B, Rovereto B, Serni S, Simeone C, Carini M, Minervini A. Partial nephrectomy in clinical T1b renal tumors: multicenter comparative study of open, laparoscopic and robot-assisted approach (the RECORd Project). Urology. 2016;89:45–51.PubMedCrossRefGoogle Scholar
- Van Poppel H, Pozzo LD, Albrecht W, Matveev V, Bono A, Borkowski A, et al. A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2007;51:1606.PubMedCrossRefGoogle Scholar
- Xia L, Wang X, Xu T, Guzzo TJ. Systematic review and meta-analysis of comparative studies reporting perioperative outcomes of robot-assisted partial nephrectomy versus open partial nephrectomy. J Endourol. 2017. https://doi.org/10.1089/end.2016.0351.