Laparoscopic Radical Nephrectomy : Cancer Control in Renal Cell Carcinoma
Y. Chan, Jeffrey A. Cadeddu, Thomas W. Jarrett, Fray F. Marshall and Louis R. Kavoussi

PURPOSE
We evaluate the clinical efficacy of laparoscopic radical nephrectomy as compared with open radical nephrectomy for patients with clinically localized renal cell carcinoma.

MATERIALS AND METHODS
Between 1991 and 1999, sixty-seven laparoscopic radical nephrectomies were performed for clinically localized, cT1-2 N0 M0, pathologically confirmed renal cell carcinoma. During this period, 54 patients who underwent open radical nephrectomy with pathologically confirmed pT1-2 N0 M0 were also identified. Medical and operative records were retrospectively reviewed and telephone follow-ups were made to assess patient status.

RESULTS
The average tumor sizes were 5.1 cm (range 1-13 cm) and 5.4 cm (range 0.2-18 cm) for the laparoscopic and open group, respectively, (p = NS). No patients developed laparoscopic port site, wound, or renal fossa tumor recurrences in either group. In both groups all patients were followed for at least 12 months. In the laparoscopic group, two cancer specific mortalities were noted with a mean follow-up of 35.6 months. In the open group, there were 2 cancer specific mortalities and 3 disease progressions with a mean follow-up of 44.0 months. No significant differences were found in the Kaplan Meier disease-free survival and actuarial survival analysis between the laparoscopic and open radical nephrectomy series. Also no differences in complication rates were noted.

CONCLUSIONS
Laparoscopic radical nephrectomy is an effective alternative for the treatment of localized RCC when the principles of surgical oncology are maintained. Initial data demonstrate shorter patient hospitalization and effective cancer control with no significant difference in survival when compared with open radical nephrectomy.