Park Yong Hyun, Lee Eun Sik, Kim Hyeon Hoe, Kwak Cheol, Ku Ja Hyeon, Lee Sang Eun, Byun Seok-Soo, Hong Sung Kyu, Kim Yong-June, Kang Seok Ho, Hong Sung Hoo
1 Department of Urology, Seoul National University College of Medicine , Seoul, Korea.
J Laparoendosc Adv Surg Tech A. 2014 Aug;24(8):556-62. doi: 10.1089/lap.2014.0035. Epub 2014 Jul 9.
We aimed to assess the long-term oncologic outcome of hand-assisted laparoscopic radical nephrectomy (HLRN) compared with open radical nephrectomy (ORN) in patients with clinically localized renal cell carcinoma (RCC).
We retrospectively reviewed the data from 1098 patients who underwent radical nephrectomy at five institutions in Korea between 2000 and 2011 for clinically localized RCC. One hundred ninety-seven patients in the HLRN group were compared with 901 patients in the ORN group. Univariate and multivariate analysis assessed the effects of operative method on oncologic outcomes.
The median duration of follow-up was 69 months for the HLRN group and 63 months for the ORN group. No statistically significant difference was found in the operative time (170.2 minutes versus 168.9 minutes, P=.793) between the HLRN and ORN groups. However, estimated blood loss was significantly lower in the HLRN group than in the ORN group (245.9 mL versus 422.4 mL, P<.001). The pathological T stage was significantly higher in patients in the ORN group: 79.9% of patients in the HLRN group derived from pT1, versus 54.7% of those in the ORN group (P<.001). A statistically significant difference was found in the 5-year disease-free (90.6% versus 79.6%, P<.001), cancer-specific (95.7% versus 91.1%, P=.019), and overall (93.4% versus 85.4%, P<.001) survival between the HLRN and ORN groups. However, multivariate analysis by Cox's proportional hazards model does not retain surgical methods as an independent predictive factor for cancer-related death or recurrence.
HLRN may be a preferable minimally invasive surgical treatment for clinically localized RCC with comparable long-term oncologic outcomes.
我们旨在评估手辅助腹腔镜根治性肾切除术（HLRN）与开放性根治性肾切除术（ORN）相比，对临床局限性肾细胞癌（RCC）患者的长期肿瘤学结局。
我们回顾性分析了2000年至2011年间在韩国五家机构接受根治性肾切除术的1098例临床局限性RCC患者的数据。将HLRN组的197例患者与ORN组的901例患者进行比较。单因素和多因素分析评估手术方法对肿瘤学结局的影响。
HLRN组的中位随访时间为69个月，ORN组为63个月。HLRN组和ORN组之间的手术时间无统计学显著差异（170.2分钟对168.9分钟，P = 0.793）。然而，HLRN组的估计失血量显著低于ORN组（245.9 mL对422.4 mL，P < 0.001）。ORN组患者的病理T分期显著更高：HLRN组79.9%的患者为pT1，而ORN组为54.7%（P < 0.001）。HLRN组和ORN组之间的5年无病生存率（90.6%对79.6%，P < 0.001）、癌症特异性生存率（95.7%对91.1%，P = 0.019）和总生存率（93.4%对85.4%，P < 0.001）存在统计学显著差异。然而，Cox比例风险模型的多因素分析未将手术方法保留为癌症相关死亡或复发的独立预测因素。
对于临床局限性RCC，HLRN可能是一种更可取的微创手术治疗方法，具有可比的长期肿瘤学结局。
