Purpose: We assessed the impact of approach (standard vs hand assisted) and specimen handling (morcellation vs intact extraction) on laparoscopic radical nephrectomy short-term recovery and long-term oncological outcome.
Materials and methods: Of 255 patients with pathologically confirmed and presumed localized renal cell carcinoma 147 underwent standard and 108 underwent hand assisted laparoscopic radical nephrectomy. Specimen handling was done by intact extraction in 132 cases and morcellation in 123. Perioperative data were recorded prospectively and oncological surveillance was reviewed retrospectively.
Results: Despite significant differences in body mass index, mass size, T stage and pathological risk between the groups there were no statistically significant differences in perioperative outcome by approach or specimen handling except greater estimated blood loss (mean 406 vs 283 ml), longer hospital stay (mean 2.8 vs 2.4 days) and greater time to recovery (mean 13 vs 9.9 days) in the hand assisted vs the standard group. Discovery of pT3 disease was not significantly different between the specimen handling groups after controlling for mass size. Multivariate analysis of 5-year Kaplan-Meier survival curves revealed that neither approach nor specimen handling impacted recurrence-free, cancer specific or overall survival.
Conclusions: Differences in perioperative outcomes attributable to the specific approach (standard vs hand assisted) and the method of specimen handling (morcellation vs intact extraction) at laparoscopic radical nephrectomy have minimal clinical significance. There are no discernible differences in long-term oncological efficacy. The choice of approach and specimen handling for laparoscopic radical nephrectomy can be based on surgeon and patient preference, cosmetic considerations and other factors.