Comparison of Video-Assisted Minilaparotomy, Open, and Laparoscopic Partial Nephrectomy for Renal Masses
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Purpose: Minimally invasive management of small renal tumors has become more common. We compared the results of partial nephrectomy by video-assisted minilaparotomy surgery (VAMS), open, and laparoscopic techniques. Materials and Methods:We retrospectively compared clinicopathological, oncological, and functional outcomes in 271 patients who underwent partial nephrectomy for renal tumors at one institution from 1993 to 2007; including 138 by VAMS, 102 by open, and 31 by laparoscopic technique. Results: Mean follow-up was 47.7±29.1 months. No statistically significant differences in the three groups were found in tumor size, tumor location,estimated blood loss, complication rate, preoperative glomerular filtration rate (GFR), and GFR at last follow-up. Ischemic time was shorter in the open (26.9 min) and VAMS (29.3 min) groups than in the laparoscopic group (31.0 min, p=0.021). Time to normal diet and hospital stay were shorter in the VAMS (1.8 days and 5.4 days) and laparoscopic (1.8 days and 4.7 days) groups than in the open group (2.4 days and 7.3 days, p=0.036 and p<0.001, respectively). Of 180 patients with cancer, positive surgical margins occurred in 2 of 82 patients (2.4%) in the VAMS group, none of 75 patients in the open group, and 3 of 23 patients (13.0%) in the laparoscopic group (p=0.084). In the VAMS, open, and laparoscopic groups, 5-year disease-free survival was 94.8%, 95.8%, and 90.3% (p=0.485), and 5-year cancer-specific survival was 96.3%, 98.6%, and 100%, respectively (p=0.452). Conclusion: Partial nephrectomy using VAMS technique provides surgical, oncologic, and functional outcomes similar to open and laparoscopic techniques.
Abstract
Purpose: Minimally invasive management of small renal tumors has become more common. We compared the results of partial nephrectomy by video-assisted minilaparotomy surgery (VAMS), open, and laparoscopic techniques. Materials and Methods:We retrospectively compared clinicopathological, oncological, and functional outcomes in 271 patients who underwent partial nephrectomy for renal tumors at one institution from 1993 to 2007; including 138 by VAMS, 102 by open, and 31 by laparoscopic technique. Results: Mean follow-up was 47.7±29.1 months. No statistically significant differences in the three groups were found in tumor size, tumor location,estimated blood loss, complication rate, preoperative glomerular filtration rate (GFR), and GFR at last follow-up. Ischemic time was shorter in the open (26.9 min) and VAMS (29.3 min) groups than in the laparoscopic group (31.0 min, p=0.021). Time to normal diet and hospital stay were shorter in the VAMS (1.8 days and 5.4 days) and laparoscopic (1.8 days and 4.7 days) groups than in the open group (2.4 days and 7.3 days, p=0.036 and p<0.001, respectively). Of 180 patients with cancer, positive surgical margins occurred in 2 of 82 patients (2.4%) in the VAMS group, none of 75 patients in the open group, and 3 of 23 patients (13.0%) in the laparoscopic group (p=0.084). In the VAMS, open, and laparoscopic groups, 5-year disease-free survival was 94.8%, 95.8%, and 90.3% (p=0.485), and 5-year cancer-specific survival was 96.3%, 98.6%, and 100%, respectively (p=0.452). Conclusion: Partial nephrectomy using VAMS technique provides surgical, oncologic, and functional outcomes similar to open and laparoscopic techniques.
참고문헌 (17)
- Yang SC, "Retroperitoneoscopy assisted live donor nephrectomy: the Yonsei experience", J Urol, 165, pp.99~102 (2001)
- Yang SC, "Video-assisted minilaparotomy in urology", J Endourol, 17, pp.465~467 (2003)
- Han WK, "Quality of life comparison between open and retroperitoneal video-assisted minilaparotomy surgery for kidney donors", Transplant Proc, 42, pp.1479~1483 (2010)
- Levey AS, "A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group", Ann Intern Med, 130, pp.461~470 (1999)
- Clavien PA, "The Clavien-Dindo classification of surgical complications: five-year experience", Ann Surg, 250, pp.187~196 (2009)
- Jeong W, "Laparoscopic partial nephrectomy versus robot-assisted laparoscopic partial nephrectomy", J Endourol, 23, pp.1457~1460 (2009)
- Gill IS, "Laparoscopic partial nephrectomy for renal tumor: duplicating open surgical techniques", J Urol, 167, pp.469~467 (2002)
- Adkins KL, "Partial nephrectomy safely preserves renal function in patients with a solitary kidney", J Urol, 169, pp.79~81 (2003)
- Suzuki K, "Gasless laparoscopy-assisted nephrectomy without tissue morcellation for renal carcinoma", J Urol, 154, pp.1685~1687 (1995)
- Suzuki K, "Retroperitoneoscopic living donor nephrectomy without gas insufflation: the five-year Hamamatsu University experience", Transplant Proc, 34, pp.720~721 (2002)
- Fergany AF, "Open partial nephrectomy for tumor in a solitary kidney: experience with 400 cases", J Urol, 175, pp.1630~1633 (2006)
- Gill IS, "Tucker K, et al. Laparoscopic partial nephrectomy in solitary kidney", J Urol, 175, pp.454~458 (2006)
- Marszalek M, "Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients", Eur Urol, 55, pp.1171~1178 (2009)
- Gill IS, "Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors", J Urol, 178, pp.41~46 (2007)
- Kwon EO, "Impact of positive surgical margins in patients undergoing partial nephrectomy for renal cortical tumours", BJU Int, 99, pp.286~289 (2007)
- Porpiglia F, "Assessment of surgical margins in renal cell carcinoma after nephron sparing: a comparative study: laparoscopy vs open surgery", J Urol, 173, pp.1098~1101 (2005)
- Thompson RH, "Complications of contemporary open nephron sparing surgery: a single institution experience", J Urol, 174, pp.855~858 (2005)