UroToday - Nephron-sparing surgery has become the well-accepted method for treating patients with localized tumor disease of the kidney. Laparoscopic partial nephrectomy (LPN) has evolved such that it is considered equivalent to open partial nephrectomy for tumors 4 cm. They had 110 patients with Stage T1b-T3N0M0 renal cell carcinoma treated with LRN (N=75) or LPN (N=35). As expected the LRN group had larger tumors and more T3a tumors with clear cell pathologic features. The median follow up was 57 months in the LRN group and 44 months in the LPN group. There was no difference between the two treatment groups with regards to overall mortality, cancer-specific mortality, or recurrence rates. However, the LPN group had significantly less reduction in estimated glomerular filtration rate compared to the LRN group. None of the LPN group patients developed second stage chronic kidney disease compared to 12% in the LRN group.

Further long term follow up will be necessary to confirm these preliminary findings, but it would appear that even for larger tumors that are organ confined, the nephron-sparing approach is oncologically justified and may be important in maintaining satisfactory renal function.

Simmons MN, Weight CJ, Gill IS
Urology. 2009 May;73(5):1077-82

UroToday Contributing Editor Elspeth M. McDougall, MD, FRCSC, MHPE

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