A Prospective, Randomized Trial Comparing the Outcomes of Open vs Laparoscopic Partial Nephrectomy

• Published in: The Journal of urology Vol. 208; no. 2; pp. 101097JU0000000000002695 - 267
• Main Authors: Guglielmetti, Giuliano B, Dos Anjos, Gabriel C, Sawczyn, Guilherme, Rodrigues, Gilberto, Cardili, Leonardo, Cordeiro, Maurício D, Neves, Luiz C O, Pontes Junior, José, Fazoli, Arnaldo, Coelho, Rafael F, Srougi, Miguel, Nahas, William C
• Format: Journal Article
• Language: English
• Published: United States 01-08-2022
• Subjects: carcinoma; renal cell
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1097/JU.0000000000002695

Partial nephrectomy is the standard treatment for renal tumors <7 cm, and the trend toward minimally invasive surgery has increased. However, data that could support its use and benefits are still lacking.
We conducted a prospective, randomized controlled trial comparing surgical, functional and oncological outcomes in patients undergoing open partial nephrectomy (OPN) or laparoscopic partial nephrectomy (LPN). Randomization was 1:1 to OPN or LPN for the treatment of renal tumors <7 cm. The primary endpoint was surgical complications up to 90 days after surgery. Secondary outcomes were comparison of surgical, oncological and functional results.
We randomized 208 patients between 2012 and 2020 (110 with OPN vs 98 with LPN). Operative data showed no differences in operative time, warm ischemia time, estimated blood loss, transfusions or length of hospital stay. Zero ischemia was more frequent in the OPN (35.4% vs 15.5%, p=0.02). OPN was associated with more abdominal wall complications (31.2% vs 13.1%, p=0.004). Regarding oncological outcomes, no differences were noted. The LPN group had less kidney function reduction at 3 (-5.2% vs -10%, p=0.04; CI 0.09 to 9.46) and 12 months after surgery (-0.8% vs -6.3%, p=0.02; CI 1.18 to 12.95), and a lower rate of downstaging on the chronic kidney disease classification at 12 months (14.1% vs 32.6%, p=0.006).
Surgical and oncological outcomes of LPN were similar to OPN. Minimally invasive surgery may provide better preservation of kidney function. More studies, especially those involving robotic surgery, are necessary to confirm our findings.