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Survival of patients with nonmetastatic pT3 renal tumours: a matched comparison of laparoscopic vs open radical nephrectomy
Author(s) -
Bensalah Karim,
Salomon Laurent,
Lang Herve,
Zini Laurent,
Jacqmin Didier,
Manunta Andrea,
Crepel Maxime,
Ficarra Vincenzo,
Cindolo Luca,
De La Taille Alexandre,
Karakiewicz Pierre,
Patard JeanJacques
Publication year - 2009
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2009.08662.x
Subject(s) - medicine , nephrectomy , urology , laparoscopy , surgery , kidney
OBJECTIVES To compare the oncological outcome of patients with pT3 renal tumours treated either by laparoscopic radical nephrectomy (LRN) or open RN (ORN). PATIENTS AND METHODS In a retrospective review of a multi‐institutional database, we identified 1003 patients with a T3N0M0 renal tumour and with no vena caval invasion. Sixty‐five patients treated by LRN were matched with up to four patients treated by ORN. Exact matches were made for age, gender, tumour size, perirenal fat invasion, renal vein invasion, and histological subtype. Following the matching process there were 44 patients treated by LRN and 135 by ORN. Qualitative and continuous variables were compared using chi‐square and independent‐sample t ‐tests, respectively. Differences in survival were compared using the Kaplan‐Meier method. A Cox regression model was used to test the effect of variables on survival. RESULTS The two groups were comparable for age ( P = 0.4), gender, tumour size ( P = 0.4), tumour grade ( P = 0.25) and histological subtype ( P = 0.45). The mean follow‐up was longer in the ORN group (55 vs 28 months, P < 0.001). There was no difference in survival between the ORN and LRN groups in the whole T3 population ( P = 0.7), in those with perirenal fat invasion ( P = 0.9), or in the subset with renal vein invasion ( P = 0.31). In univariate analysis, the only predictor for death from cancer was tumour grade ( P = 0.05). In multivariate analysis, no variable was significantly associated with cancer survival. CONCLUSIONS LRN has no adverse effect on cancer survival compared to ORN in patients with microscopic T3 renal cancer. Additional prospective evaluation is warranted.