Outcome of laparoscopic radical and open partial nephrectomy for the sporadic 4 cm. or less XXXX with a normal contralateral kidney.

@entity1 @entity190 @entity5 @entity1358 @entity15296 @entity86 @entity1011 @entity703
PURPOSE: Nephron sparing surgery provides effective therapy in @entity1 with a @entity703 4 cm. or less and a normal contralateral kidney. Laparoscopic radical nephrectomy has been applied as a newer alternative therapy in these @entity1 . These 2 contemporary approaches represent divergent treatment alternatives at centers where laparoscopic nephron sparing surgery is not offered. We compared the short-term and long-term impact of these 2 treatment modalities in @entity1 with a sporadic localized solitary @entity703 4 cm. or less and a normal opposite kidney. MATERIALS AND METHODS: A retrospective review of a contemporary series of @entity1 (1996 to 2001) who underwent open nephron sparing surgery and met study inclusion criteria was performed and compared with a similar cohort (1997 to 2001) that underwent laparoscopic radical nephrectomy. Only @entity1 with a single @entity703 of 4 cm. or less, normal serum @entity1011 less than 1.5 mg./dl. and a normal contralateral kidney were included in analysis. The 2 groups were compared in regard to demographic, clinical and pathological variables using parametric and nonparametric tests. Linear regression analysis was done to compare the percent change in serum @entity1011 , while adjusting for demographic and clinical variables, and followup. RESULTS: A total of 35 @entity1 who underwent laparoscopic radical nephrectomy and 82 who underwent open nephron sparing surgery met study inclusion criteria. Mean @entity1 age in the laparoscopic group was significantly greater (67.3 versus 56.2 years, p <0.001), mean American Society of Anesthesiologists class score was higher (p = 0.04) and mean @entity5 size was greater (3.1 versus 2.6 cm., p = 0.003) than in the nephron sparing group. The laparoscopic group had significantly decreased mean @entity190 (100 versus 200 ml., p <0.001), hospital stay (1 versus 5 days, p <0.001), narcotic use (16.5 versus 224 mg., p <0.001) and operative time (184.4 versus 216.2 minutes, p <0.007) compared with the nephron sparing group. @entity1 who underwent nephron sparing surgery experienced less @entity86 in renal function, as measured by the percent increase in serum @entity1011 postoperatively (0% versus 25%, p <0.001). The results of regression analyses at 4 and 6 months of followup indicated that open nephron sparing surgery is associated with significantly lower serum @entity1011 than laparoscopic radical nephrectomy after adjusting for demographic and clinical variables, and followup. CONCLUSIONS: Open nephron sparing surgery and laparoscopic radical nephrectomy are relatively recent and significant developments for @entity15296 @entity1 with @entity1358 and they represent accepted standards of care in those with a small renal mass and normal contralateral kidney. In @entity1 presenting with a @entity703 of 4 cm. or less and a normal contralateral kidney the significant short-term and intermediate term benefits of the laparoscopic approach must be weighed against the long-term advantage of better renal function associated with open nephron sparing surgery. The distinct advantages of these 2 approaches may ultimately be realized with the standardization of laparoscopic partial nephrectomy.
