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Laparoscopic vs open partial nephrectomy in consecutive patients: the Cornell experience
OBJECTIVE To compare a contemporary series of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) at one institution, to evaluate the size and types of tumour in each group and the early outcome after each procedure, as LPN is replacing open radical nephrectomy as the standard...
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| Published in: | BJU international 2005-10, Vol.96 (6), p.811-814 |
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| creator | Schiff, Jonathan D. Palese, Michael Vaughan, E. Darracott Sosa, R. Ernest Coll, Diedre Del Pizzo, Joseph J. |
| description | OBJECTIVE
To compare a contemporary series of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) at one institution, to evaluate the size and types of tumour in each group and the early outcome after each procedure, as LPN is replacing open radical nephrectomy as the standard of care for uncomplicated renal tumours but partial nephrectomy remains significantly more difficult laparoscopically, especially if the goal is to duplicate the open surgical technique.
PATIENTS AND METHODS
We retrospectively analysed the records of all patients who underwent partial nephrectomy at our institution from January 2000 to April 2004, identifying 66 who had LPN and compared them with 59 who had OPN (mean age at LPN and OPN, 62.1 and 64.2 years, respectively; 70% men in each group). Variables analysed included operative time, blood loss, creatinine levels before and after partial nephrectomy, time to resuming clear liquids and regular diet, length of stay, tumour size, tumour pathological type and complications. Groups were compared using Student's t‐test, with P |
| doi_str_mv | 10.1111/j.1464-410X.2005.05718.x |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_68568407</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>68568407</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4478-a479c23ed2af146bb1298f933db83083fe36a2ef90420a49f5e5933fb0dc07e3</originalsourceid><addsrcrecordid>eNqNkMtOwzAQRS0EglL4BeQN7BrGsfNCYgEVT1ViAxI7y3HHwlWaBDst7d_j0EK3eOPRnTPj60sIZRCxcC5nEROpGAkG71EMkESQZCyPVntk8NfY_62hSI_IsfczgCCkySE5YilLeAzZgLxPVKtc43XTWk2XnjYt1jRInVUVrbH9cKi7Zr6mtqa6qT3qRWeXGJDOYt35K9p9IB03rsaqorhq0QVd4wk5MKryeLq9h-T1_u51_DiavDw8jW8mIy1Elo-UyAodc5zGygR3ZcniIjcF59My55BzgzxVMZoCRAxKFCbBJHRNCVMNGfIhudisbV3zuUDfybn1OlhRNTYLL9M8SXMBWQDzDajDb71DI1tn58qtJQPZhypnss9L9tnJPlT5E6pchdGz7RuLco7T3eA2xQCcbwHltaqMU7W2fsdlUGRFwgN3veG-bIXrfxuQt89vfcW_AetvlAM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>68568407</pqid></control><display><type>article</type><title>Laparoscopic vs open partial nephrectomy in consecutive patients: the Cornell experience</title><source>Wiley</source><creator>Schiff, Jonathan D. ; Palese, Michael ; Vaughan, E. Darracott ; Sosa, R. Ernest ; Coll, Diedre ; Del Pizzo, Joseph J.</creator><creatorcontrib>Schiff, Jonathan D. ; Palese, Michael ; Vaughan, E. Darracott ; Sosa, R. Ernest ; Coll, Diedre ; Del Pizzo, Joseph J.</creatorcontrib><description>OBJECTIVE
To compare a contemporary series of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) at one institution, to evaluate the size and types of tumour in each group and the early outcome after each procedure, as LPN is replacing open radical nephrectomy as the standard of care for uncomplicated renal tumours but partial nephrectomy remains significantly more difficult laparoscopically, especially if the goal is to duplicate the open surgical technique.
PATIENTS AND METHODS
We retrospectively analysed the records of all patients who underwent partial nephrectomy at our institution from January 2000 to April 2004, identifying 66 who had LPN and compared them with 59 who had OPN (mean age at LPN and OPN, 62.1 and 64.2 years, respectively; 70% men in each group). Variables analysed included operative time, blood loss, creatinine levels before and after partial nephrectomy, time to resuming clear liquids and regular diet, length of stay, tumour size, tumour pathological type and complications. Groups were compared using Student's t‐test, with P < 0.05 taken to indicate significance.
RESULTS
Of those having LPN, 59% had right‐sided tumours, vs 53% in the OPN group; the respective mean tumour size was 2.2 and 3.4 cm, the mean operative duration 144 and 239 min (both P < 0.001), and the mean estimated blood loss 236 and 363 mL (P = 0.09). Seven patients in the OPN group had obligatory partial nephrectomy for either a solitary kidney (two) or azotaemia (five). No patient in the LPN group required an obligatory partial nephrectomy. Serum creatinine levels were measured before and 1 and 2 days after surgery, and were 88, 88 and 97 µmol/L for the LPN group, and 97, 106 and 106 µmol/L for the OPN group. Clear fluids were started a mean of 41 h after surgery, a regular diet resumed 76 h after and discharge was 129 h after surgery in the OPN group; the respective values for the LPN group were 24 h (P = 0.01), 49 h (P = 0.2) and 82 h (P < 0.001). Complications were similar in both groups but the pathological subtypes differed.
CONCLUSIONS
LPN offers early functional advantages over OPN in terms of earlier resumption of diet and slightly earlier discharge. However, the two groups of patients were clearly not evenly matched for size nor pathological subtypes, with larger, malignant subtypes more predominant in the OPN group. These results suggest that while LPN is a safe, effective treatment for small renal tumours, obligatory partial nephrectomy or large tumours continue to be performed using open techniques with good results.</description><identifier>ISSN: 1464-4096</identifier><identifier>EISSN: 1464-410X</identifier><identifier>DOI: 10.1111/j.1464-410X.2005.05718.x</identifier><identifier>PMID: 16153207</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science Ltd</publisher><subject>Biological and medical sciences ; clear cell carcinoma ; Female ; Humans ; kidney ; Kidney Neoplasms - pathology ; Kidney Neoplasms - surgery ; Kidneys ; laparoscopy ; Laparoscopy - methods ; Length of Stay ; Male ; Medical sciences ; Middle Aged ; Nephrectomy - methods ; Nephrology. Urinary tract diseases ; oncocytoma ; partial nephrectomy ; Postoperative Complications - etiology ; Prospective Studies ; renal cell carcinoma ; Retrospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; Tumors of the urinary system</subject><ispartof>BJU international, 2005-10, Vol.96 (6), p.811-814</ispartof><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4478-a479c23ed2af146bb1298f933db83083fe36a2ef90420a49f5e5933fb0dc07e3</citedby><cites>FETCH-LOGICAL-c4478-a479c23ed2af146bb1298f933db83083fe36a2ef90420a49f5e5933fb0dc07e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17097953$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16153207$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schiff, Jonathan D.</creatorcontrib><creatorcontrib>Palese, Michael</creatorcontrib><creatorcontrib>Vaughan, E. Darracott</creatorcontrib><creatorcontrib>Sosa, R. Ernest</creatorcontrib><creatorcontrib>Coll, Diedre</creatorcontrib><creatorcontrib>Del Pizzo, Joseph J.</creatorcontrib><title>Laparoscopic vs open partial nephrectomy in consecutive patients: the Cornell experience</title><title>BJU international</title><addtitle>BJU Int</addtitle><description>OBJECTIVE
To compare a contemporary series of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) at one institution, to evaluate the size and types of tumour in each group and the early outcome after each procedure, as LPN is replacing open radical nephrectomy as the standard of care for uncomplicated renal tumours but partial nephrectomy remains significantly more difficult laparoscopically, especially if the goal is to duplicate the open surgical technique.
PATIENTS AND METHODS
We retrospectively analysed the records of all patients who underwent partial nephrectomy at our institution from January 2000 to April 2004, identifying 66 who had LPN and compared them with 59 who had OPN (mean age at LPN and OPN, 62.1 and 64.2 years, respectively; 70% men in each group). Variables analysed included operative time, blood loss, creatinine levels before and after partial nephrectomy, time to resuming clear liquids and regular diet, length of stay, tumour size, tumour pathological type and complications. Groups were compared using Student's t‐test, with P < 0.05 taken to indicate significance.
RESULTS
Of those having LPN, 59% had right‐sided tumours, vs 53% in the OPN group; the respective mean tumour size was 2.2 and 3.4 cm, the mean operative duration 144 and 239 min (both P < 0.001), and the mean estimated blood loss 236 and 363 mL (P = 0.09). Seven patients in the OPN group had obligatory partial nephrectomy for either a solitary kidney (two) or azotaemia (five). No patient in the LPN group required an obligatory partial nephrectomy. Serum creatinine levels were measured before and 1 and 2 days after surgery, and were 88, 88 and 97 µmol/L for the LPN group, and 97, 106 and 106 µmol/L for the OPN group. Clear fluids were started a mean of 41 h after surgery, a regular diet resumed 76 h after and discharge was 129 h after surgery in the OPN group; the respective values for the LPN group were 24 h (P = 0.01), 49 h (P = 0.2) and 82 h (P < 0.001). Complications were similar in both groups but the pathological subtypes differed.
CONCLUSIONS
LPN offers early functional advantages over OPN in terms of earlier resumption of diet and slightly earlier discharge. However, the two groups of patients were clearly not evenly matched for size nor pathological subtypes, with larger, malignant subtypes more predominant in the OPN group. These results suggest that while LPN is a safe, effective treatment for small renal tumours, obligatory partial nephrectomy or large tumours continue to be performed using open techniques with good results.</description><subject>Biological and medical sciences</subject><subject>clear cell carcinoma</subject><subject>Female</subject><subject>Humans</subject><subject>kidney</subject><subject>Kidney Neoplasms - pathology</subject><subject>Kidney Neoplasms - surgery</subject><subject>Kidneys</subject><subject>laparoscopy</subject><subject>Laparoscopy - methods</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nephrectomy - methods</subject><subject>Nephrology. Urinary tract diseases</subject><subject>oncocytoma</subject><subject>partial nephrectomy</subject><subject>Postoperative Complications - etiology</subject><subject>Prospective Studies</subject><subject>renal cell carcinoma</subject><subject>Retrospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>Tumors of the urinary system</subject><issn>1464-4096</issn><issn>1464-410X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><recordid>eNqNkMtOwzAQRS0EglL4BeQN7BrGsfNCYgEVT1ViAxI7y3HHwlWaBDst7d_j0EK3eOPRnTPj60sIZRCxcC5nEROpGAkG71EMkESQZCyPVntk8NfY_62hSI_IsfczgCCkySE5YilLeAzZgLxPVKtc43XTWk2XnjYt1jRInVUVrbH9cKi7Zr6mtqa6qT3qRWeXGJDOYt35K9p9IB03rsaqorhq0QVd4wk5MKryeLq9h-T1_u51_DiavDw8jW8mIy1Elo-UyAodc5zGygR3ZcniIjcF59My55BzgzxVMZoCRAxKFCbBJHRNCVMNGfIhudisbV3zuUDfybn1OlhRNTYLL9M8SXMBWQDzDajDb71DI1tn58qtJQPZhypnss9L9tnJPlT5E6pchdGz7RuLco7T3eA2xQCcbwHltaqMU7W2fsdlUGRFwgN3veG-bIXrfxuQt89vfcW_AetvlAM</recordid><startdate>200510</startdate><enddate>200510</enddate><creator>Schiff, Jonathan D.</creator><creator>Palese, Michael</creator><creator>Vaughan, E. Darracott</creator><creator>Sosa, R. Ernest</creator><creator>Coll, Diedre</creator><creator>Del Pizzo, Joseph J.</creator><general>Blackwell Science Ltd</general><general>Blackwell</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200510</creationdate><title>Laparoscopic vs open partial nephrectomy in consecutive patients: the Cornell experience</title><author>Schiff, Jonathan D. ; Palese, Michael ; Vaughan, E. Darracott ; Sosa, R. Ernest ; Coll, Diedre ; Del Pizzo, Joseph J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4478-a479c23ed2af146bb1298f933db83083fe36a2ef90420a49f5e5933fb0dc07e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Biological and medical sciences</topic><topic>clear cell carcinoma</topic><topic>Female</topic><topic>Humans</topic><topic>kidney</topic><topic>Kidney Neoplasms - pathology</topic><topic>Kidney Neoplasms - surgery</topic><topic>Kidneys</topic><topic>laparoscopy</topic><topic>Laparoscopy - methods</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nephrectomy - methods</topic><topic>Nephrology. Urinary tract diseases</topic><topic>oncocytoma</topic><topic>partial nephrectomy</topic><topic>Postoperative Complications - etiology</topic><topic>Prospective Studies</topic><topic>renal cell carcinoma</topic><topic>Retrospective Studies</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>Tumors of the urinary system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schiff, Jonathan D.</creatorcontrib><creatorcontrib>Palese, Michael</creatorcontrib><creatorcontrib>Vaughan, E. Darracott</creatorcontrib><creatorcontrib>Sosa, R. Ernest</creatorcontrib><creatorcontrib>Coll, Diedre</creatorcontrib><creatorcontrib>Del Pizzo, Joseph J.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>BJU international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schiff, Jonathan D.</au><au>Palese, Michael</au><au>Vaughan, E. Darracott</au><au>Sosa, R. Ernest</au><au>Coll, Diedre</au><au>Del Pizzo, Joseph J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Laparoscopic vs open partial nephrectomy in consecutive patients: the Cornell experience</atitle><jtitle>BJU international</jtitle><addtitle>BJU Int</addtitle><date>2005-10</date><risdate>2005</risdate><volume>96</volume><issue>6</issue><spage>811</spage><epage>814</epage><pages>811-814</pages><issn>1464-4096</issn><eissn>1464-410X</eissn><abstract>OBJECTIVE
To compare a contemporary series of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) at one institution, to evaluate the size and types of tumour in each group and the early outcome after each procedure, as LPN is replacing open radical nephrectomy as the standard of care for uncomplicated renal tumours but partial nephrectomy remains significantly more difficult laparoscopically, especially if the goal is to duplicate the open surgical technique.
PATIENTS AND METHODS
We retrospectively analysed the records of all patients who underwent partial nephrectomy at our institution from January 2000 to April 2004, identifying 66 who had LPN and compared them with 59 who had OPN (mean age at LPN and OPN, 62.1 and 64.2 years, respectively; 70% men in each group). Variables analysed included operative time, blood loss, creatinine levels before and after partial nephrectomy, time to resuming clear liquids and regular diet, length of stay, tumour size, tumour pathological type and complications. Groups were compared using Student's t‐test, with P < 0.05 taken to indicate significance.
RESULTS
Of those having LPN, 59% had right‐sided tumours, vs 53% in the OPN group; the respective mean tumour size was 2.2 and 3.4 cm, the mean operative duration 144 and 239 min (both P < 0.001), and the mean estimated blood loss 236 and 363 mL (P = 0.09). Seven patients in the OPN group had obligatory partial nephrectomy for either a solitary kidney (two) or azotaemia (five). No patient in the LPN group required an obligatory partial nephrectomy. Serum creatinine levels were measured before and 1 and 2 days after surgery, and were 88, 88 and 97 µmol/L for the LPN group, and 97, 106 and 106 µmol/L for the OPN group. Clear fluids were started a mean of 41 h after surgery, a regular diet resumed 76 h after and discharge was 129 h after surgery in the OPN group; the respective values for the LPN group were 24 h (P = 0.01), 49 h (P = 0.2) and 82 h (P < 0.001). Complications were similar in both groups but the pathological subtypes differed.
CONCLUSIONS
LPN offers early functional advantages over OPN in terms of earlier resumption of diet and slightly earlier discharge. However, the two groups of patients were clearly not evenly matched for size nor pathological subtypes, with larger, malignant subtypes more predominant in the OPN group. These results suggest that while LPN is a safe, effective treatment for small renal tumours, obligatory partial nephrectomy or large tumours continue to be performed using open techniques with good results.</abstract><cop>Oxford, UK</cop><pub>Blackwell Science Ltd</pub><pmid>16153207</pmid><doi>10.1111/j.1464-410X.2005.05718.x</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| source | Wiley |
| subjects | Biological and medical sciences clear cell carcinoma Female Humans kidney Kidney Neoplasms - pathology Kidney Neoplasms - surgery Kidneys laparoscopy Laparoscopy - methods Length of Stay Male Medical sciences Middle Aged Nephrectomy - methods Nephrology. Urinary tract diseases oncocytoma partial nephrectomy Postoperative Complications - etiology Prospective Studies renal cell carcinoma Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Tumors of the urinary system |
| title | Laparoscopic vs open partial nephrectomy in consecutive patients: the Cornell experience |
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