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Outcomes After Minimally Invasive Versus Open Radical Nephrectomy: Technique Matters

By: Celeste L. Dixon
Posted: Wednesday, November 3, 2021

Results of a large study indicate that minimally invasive techniques—laparoscopic or robotic—for radical nephrectomy in patients with stage I or II renal cell carcinoma resulted in lower all-cause mortality than did open radical nephrectomy. In fact, all outcomes analyzed were better for the minimally invasive cohort, reported Furkan Dursun, MD, of The University of Texas Health Science Center at San Antonio, and colleagues, in work presented during the 2021 American Urological Association Annual Meeting (Abstract PD64-02) and published in The Journal of Urology.

Findings of this analysis were dissimilar to those of a phase III randomized trial comparing open and minimally invasive hysterectomies, the authors noted, which showed significantly higher rates of local recurrence after minimally invasive surgery for cervical cancer. For their work, the team used information from the National Cancer Database about patients who, between 2010 and 2013, underwent either laparoscopic or robotic radical nephrectomy (including those whose surgeries were converted to open) and those who underwent open radical nephrectomy from the start. In total, data on 27,642 patients were included; 11,524 (41.7%) and 16,118 (58.3%) had minimally invasive and open radical nephrectomies, respectively.

At a median follow-up of 44.7 months, patients who had undergone minimally invasive surgery had a statistically significant overall survival advantage (89.6% vs. 87.5% were alive 3 years after surgery; P < .001). “Furthermore, the length of hospital stay (3 vs. 4 days), 30-day readmission rates (2.4% vs. 2.87%), 30-day mortality rates (0.53% vs. 0.96%), and 90-day mortality rates (1.04% vs. 1.77%) were significantly higher in the open radical nephrectomy group ([all] P < .001),” said Dr. Dursun and co-researchers.

The data also revealed that being treated at an academic center or having the highest quartile median household income seemed to be linked to increased odds of having minimally invasive radical nephrectomy (both P < .001). On the other hand, Black race and clinical T2 disease appeared to be associated with less likelihood of having minimally invasive surgery (P = .001 and P < .001, respectively).

Disclosure: The study authors reported no conflicts of interest.



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