Laparoscopic And Open Partial Nephrectomy: A Matched-Pair Comparison Of 164 Patients

Objectives:To compare surgical, functional, oncologic and clinical outcomes of laparoscopic nephro-sparing surgery (LNSS) and open partial nephrectomy (OPN).Measurements And Methods:This was a retrospective, matched-pair comparison of 85 patients who underwent LNSS and 79 patients who underwent OPN. We mainly aimed to compare their surgical data, intestinal function recovery time, postoperative day (POD), complications, oncologic data, renal function and 3 years recurrence-free survival (RFS). And we also hoped to find any differences between tumor size >4 cm and tumor size≤4 cm after LNSS.Results:Both groups matched for age, sex, tumor characteristics were successfully performed. No patient was converted to open surgery in LNSS group. Surgical time. ischemia time, intestinal function recovery time and postoperative day (POD) was obviously shorter in LNSS group (LNSS vs OPN:surgical time:95.0±20.7min vs 118.5±25.8min; ischemia time:24.3±7.3min vs 27.3±8.2min; intestinal function recovery time:1.87±0.71d vs 3.03±0.81d; POD:8.5±1.1d vs 13.7±5.8d) (p<0.01),respectively. And LNSS also cause a less blood loss during operation (LNSS vs OPN:119.6±81.8ml vs 227.3±186.5ml). (p<0.01). Complications of LNSS mainly were pneumothorax (6 cases), peritoneal injury (2 cases), decending colon injury (1 case). While, hemorrhea (3 cases), peritoneal injury (2 cases), pleura injury (1 case), wound infection (2 cases) were found in OPN group. We divided LNSS into two groups (tumor size >4cm and tumor size≤4cm) and found all their surgical data, intestinal function recovery time,POD were comparable. The LNSS group was fellow up with a mean time of 21.5±10.8 months and the OPN with a mean time of 21.3±8.8months. All patients were survival and their renal functions were normal. In LNSS group,67 patients were diagnosed with renal cell carcinoma (RCC) and finally two of them had local recurrences.55 RCC patients in OPN and one of them got a local recurrence. When concerning to the 3 years recurrence-free survival, the two groups were comparable (LNSS 95.8%. OPN 92.9%; p>0.05).Conclusions:Laparoscopic and open nephro-sparing surgery provide comparable results in renal functional and oncologic outcomes. But LNSS has advantages on shorter operation time, ischemia time., intestinal function recovery time, postoperative day and less blood loss.