Department of Urology, Yonsei University Severans Hospital, Seoul, Korea.
Urology. 2011 Apr;77(4):819-24. doi: 10.1016/j.urology.2010.06.024. Epub 2010 Sep 9.
To assess the oncologic efficacy of laparoscopic radical nephrectomy (LRN) compared with open radical nephrectomy (ORN) in patients with clear cell renal cell carcinoma (RCC).
We analyzed the data from 2561 patients who had undergone radical nephrectomy for RCC at 26 institutions in Korea from June 1998 to December 2007. The clinical data of 631 patients with clear cell RCC in the LRN group were compared with the clinical data of 924 patients in the ORN group. The patients with Stage pT3 or greater and those with lymph node or distant metastases were excluded to avoid a selection bias. To evaluate the technical adequacy and oncologic outcome, we compared the perioperative parameters and 5-year overall and disease-free survival rates.
The operative time was significantly longer in the LRN group than in the ORN group (219 ± 77 vs 182 ± 62 minutes, P < .001), but the estimated blood loss and complication rate were significantly lower in the LRN group than in the ORN group (P < .001 and P < .001, respectively). On univariate analysis, the LRN group had 5-year overall (93.5% vs 89.8%, P = .120) and recurrence-free (94.0% vs 92.8%, P = .082) survival rates equivalent to those of the ORN group. Even after adjusting for age, sex, T stage, tumor grade, and body mass index in a Cox proportional hazards model, statistically significant differences between the 2 groups were not found for the 5-year overall (hazard ratio 1.523, P = .157) and recurrence-free (hazard ratio 0.917, P = .773) survival rates.
Our large multi-institutional data have shown that LRN provides survival outcomes equivalent to those of ORN in patients with Stage pT1-T2 clear cell RCC.
评估腹腔镜根治性肾切除术（LRN）与开放性根治性肾切除术（ORN）治疗透明细胞肾细胞癌（RCC）患者的肿瘤疗效。
我们分析了 1998 年 6 月至 2007 年 12 月在韩国 26 家机构接受根治性肾切除术治疗 RCC 的 2561 例患者的数据。将 LRN 组中 631 例透明细胞 RCC 患者的临床资料与 ORN 组 924 例患者的临床资料进行比较。排除了 T3 期及以上、淋巴结或远处转移的患者，以避免选择偏倚。为了评估技术的充分性和肿瘤学结果，我们比较了围手术期参数和 5 年总生存率和无病生存率。
LRN 组的手术时间明显长于 ORN 组（219 ± 77 分钟比 182 ± 62 分钟，P <.001），但 LRN 组的估计出血量和并发症发生率明显低于 ORN 组（P <.001 和 P <.001）。单因素分析显示，LRN 组的 5 年总生存率（93.5%比 89.8%，P =.120）和无复发生存率（94.0%比 92.8%，P =.082）与 ORN 组相当。即使在校正了年龄、性别、T 分期、肿瘤分级和体重指数后，在 Cox 比例风险模型中，两组的 5 年总生存率（风险比 1.523，P =.157）和无复发生存率（风险比 0.917，P =.773）也无统计学差异。
我们的大型多机构数据表明，LRN 为 T1-T2 期透明细胞 RCC 患者提供了与 ORN 相当的生存结果。
