Laparoscopic partial nephrectomy versus laparoscopic ablative therapy: a comparison of surgical and functional outcomes in a matched control study

J Endourol. 2011 Dec;25(12):1867-72. doi: 10.1089/end.2011.0087. Epub 2011 Sep 8.

Abstract

Background and purpose: Patients who are undergoing laparoscopic ablative therapy (LAT) are often older with more comorbidities in comparison with patients who are undergoing laparoscopic partial nephrectomy (LPN). A matched control study was performed to compare the surgical and functional outcomes of LPN and LAT.

Patients and methods: A prospectively maintained database of 250 patients who underwent nephron-sparing surgery was explored. Fifty-one LAT patients (21 and 30 laparoscopic radiofrequency and cryoablation, respectively) were matched with 51 LPN patients. A comparison of preoperative, operative, and postoperative outcomes was performed.

Results: The groups were similar in age, sex, body mass index, preoperative estimated glomerular filtration rate (eGFR), number of comorbidities and tumor size. Patients who were undergoing LAT had a lower incidence of endophytic tumor and higher incidence of upper pole and midpolar tumors. Hilar vessels clamping was performed in LPN (47/51 patients). Mean estimated blood loss and operative time were higher in those undergoing LPN (P<0.01). There was no significant difference in transfusion rate and hospital stay, however. Mean follow-up was 27 and 18 months in LAT and LPN, respectively (P<0.01). The mean percent decline of eGFR at the last follow-up was 10 (95% confidence interval [CI]: 4-15) and 7.5 (95% CI: 4-11), respectively (P<0.43). In comparison with baseline, eGFR declined significantly (P<0. 01), but there was no difference between the groups.

Conclusion: Despite renal ischemia, longer operative time, and higher blood loss associated with LPN, the hospital stay and long-term functional outcomes are similar to those of LAT in a matched control study.

Publication types

  • Comparative Study

MeSH terms

  • Ablation Techniques / methods*
  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Kidney Function Tests
  • Kidney Neoplasms / pathology
  • Kidney Neoplasms / physiopathology*
  • Kidney Neoplasms / surgery*
  • Laparoscopy*
  • Male
  • Middle Aged
  • Nephrectomy / methods*
  • Postoperative Complications / etiology
  • Preoperative Care
  • Treatment Outcome
  • Young Adult