The operative safety and oncological outcomes of laparoscopic nephrectomy for T3 renal cell cancer
Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Laparoscopic radical nephrectomy is a well established treatment for localized RCC, where nephron‐sparing approaches are not appropriate. As surgeon and departmental experience grow...
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| creator | Stewart, Grant D. Ang, W. Jensen Laird, Alexander Tolley, David A. Riddick, Antony C. P. McNeill, S. Alan |
| description | Study Type – Therapy (case series)
Level of Evidence 4
What's known on the subject? and What does the study add?
Laparoscopic radical nephrectomy is a well established treatment for localized RCC, where nephron‐sparing approaches are not appropriate. As surgeon and departmental experience grow more extensive tumours will be tackled laparoscopically. However, little is known about the operative safety and oncological outcomes of the laparoscopic approach for locally advanced RCC.
The present study describes the largest reported cohort of patients receiving laparoscopic radical nephrectomy for locally advanced RCC. In the context of suitably experienced personnel in an established centre, we have established that this approach is safe from operative, postoperative and oncological standpoints, with comparable data to existing open series.
OBJECTIVE
•
To determine the operative, postoperative and oncological outcomes of laparoscopic radical nephrectomy (LRN) for locally advanced renal cell cancer (RCC), which, as surgeon and departmental experience increases, is being performed more often.
PATIENTS AND METHODS
•
In total, 94 consecutive patients receiving LRN for pathologically confirmed T3 or T4 RCC at a tertiary referral centre between March 2002 and May 2010 were analyzed.
•
Preoperative, operative, tumour and postoperative characteristics were evaluated together with recurrence and outcome data.
•
Survival was estimated using the Kaplan–Meier method. Cox's proportional hazards model was used for multivariate analysis.
RESULTS
•
In total, 77 patients had LRN with curative intent and 17 patients had LRN with cytoreductive intent.
•
There were six LRNs (6.4%) that were converted to open procedures.
•
Overall, there were two (2.1%) Clavien grade IIIa complications, one (1.1%) grade IVa complication and one (1.1%) postoperative death.
•
Overall median follow‐up was 17.4 months. In total, 22 (28.6%) patients receiving curative LRN developed a recurrence after a median of 13.9 months; 12 (54.5%) patients developed distant metastases, five (22.7%) patients had local recurrences and three (13.6%) patients had transcoelomic spread. Median predicted progression free survival was 48.4 months in patients undergoing LRN with curative intent. Median predicted overall survival was 65.6 months after curative LRN and 15.7 months after cytoreductive LRN.
•
Multivariate analysis did not reveal any variables influencing recurrence or survival.
CONCLUSIONS
•
In the co |
| doi_str_mv | 10.1111/j.1464-410X.2011.10850.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1036879925</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2975496301</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4940-7ed63beefbbfae2ebb62219468dc5def8601b59adc4bbfda4a9fb98c2bf6af763</originalsourceid><addsrcrecordid>eNqNkU1P3DAQhq2qFVDKX6gsVZV62dRf8cYXJEClLULiski9WbYzLlklcbATYP89DruAxAkf7JH9vDPjdxDClBQ0r5_rggopFoKSfwUjlBaUVCUpHj6gg5eHj88xUXIffU5pTUi-kOUe2meMVYrQ5QGyqxvAYYBoxuYOcDIexg02fY1D70Ib_jfOtDhMowsdJBw8bs1gYkguDI3DPQw3EdwYug32IeIVxxH6rHDQ5s30DuIX9MmbNsHR7jxE1-e_Vmd_FpdXv_-enVwunFCCLJZQS24BvLXeAANrJWNUCVnVrqzBV5JQWypTO5GJ2gijvFWVY9ZL45eSH6If27xDDLcTpFF3TZr7MD2EKWlKuKyWSrEyo9_eoOswxdx3pnjJuaRMkUxVW8rl_6YIXg-x6Uzc5FR6noNe69liPdut5znopznohyz9uisw2Q7qF-Gz8Rn4vgNMyg77mK1q0isnOa1EyTJ3vOXumxY2725An15cP4X8EYsxpaw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1353361290</pqid></control><display><type>article</type><title>The operative safety and oncological outcomes of laparoscopic nephrectomy for T3 renal cell cancer</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Stewart, Grant D. ; Ang, W. Jensen ; Laird, Alexander ; Tolley, David A. ; Riddick, Antony C. P. ; McNeill, S. Alan</creator><creatorcontrib>Stewart, Grant D. ; Ang, W. Jensen ; Laird, Alexander ; Tolley, David A. ; Riddick, Antony C. P. ; McNeill, S. Alan</creatorcontrib><description>Study Type – Therapy (case series)
Level of Evidence 4
What's known on the subject? and What does the study add?
Laparoscopic radical nephrectomy is a well established treatment for localized RCC, where nephron‐sparing approaches are not appropriate. As surgeon and departmental experience grow more extensive tumours will be tackled laparoscopically. However, little is known about the operative safety and oncological outcomes of the laparoscopic approach for locally advanced RCC.
The present study describes the largest reported cohort of patients receiving laparoscopic radical nephrectomy for locally advanced RCC. In the context of suitably experienced personnel in an established centre, we have established that this approach is safe from operative, postoperative and oncological standpoints, with comparable data to existing open series.
OBJECTIVE
•
To determine the operative, postoperative and oncological outcomes of laparoscopic radical nephrectomy (LRN) for locally advanced renal cell cancer (RCC), which, as surgeon and departmental experience increases, is being performed more often.
PATIENTS AND METHODS
•
In total, 94 consecutive patients receiving LRN for pathologically confirmed T3 or T4 RCC at a tertiary referral centre between March 2002 and May 2010 were analyzed.
•
Preoperative, operative, tumour and postoperative characteristics were evaluated together with recurrence and outcome data.
•
Survival was estimated using the Kaplan–Meier method. Cox's proportional hazards model was used for multivariate analysis.
RESULTS
•
In total, 77 patients had LRN with curative intent and 17 patients had LRN with cytoreductive intent.
•
There were six LRNs (6.4%) that were converted to open procedures.
•
Overall, there were two (2.1%) Clavien grade IIIa complications, one (1.1%) grade IVa complication and one (1.1%) postoperative death.
•
Overall median follow‐up was 17.4 months. In total, 22 (28.6%) patients receiving curative LRN developed a recurrence after a median of 13.9 months; 12 (54.5%) patients developed distant metastases, five (22.7%) patients had local recurrences and three (13.6%) patients had transcoelomic spread. Median predicted progression free survival was 48.4 months in patients undergoing LRN with curative intent. Median predicted overall survival was 65.6 months after curative LRN and 15.7 months after cytoreductive LRN.
•
Multivariate analysis did not reveal any variables influencing recurrence or survival.
CONCLUSIONS
•
In the context of suitably experienced personnel in an established centre, LRN for locally advanced RCC is safe from an operative and oncological standpoint.
•
Patients clinically staged as T3 RCC must still be selected carefully for LRN in a multidisciplinary setting.</description><identifier>ISSN: 1464-4096</identifier><identifier>EISSN: 1464-410X</identifier><identifier>DOI: 10.1111/j.1464-410X.2011.10850.x</identifier><identifier>PMID: 22289017</identifier><identifier>CODEN: BJINFO</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Carcinoma, Renal Cell - pathology ; Carcinoma, Renal Cell - surgery ; Clinical trials ; cytoreductive nephrectomy ; Drug therapy ; Female ; Humans ; Kidney cancer ; Kidney Neoplasms - pathology ; Kidney Neoplasms - surgery ; Kidneys ; laparoscopic radical nephrectomy ; Laparoscopy ; locally advanced ; Male ; Medical research ; Medical sciences ; Middle Aged ; Multivariate analysis ; Neoplasm Staging ; Nephrectomy - adverse effects ; Nephrectomy - methods ; Nephrology. Urinary tract diseases ; oncological outcome ; operative safety ; renal cell carcinoma ; Retrospective Studies ; Treatment Outcome ; Tumors of the urinary system</subject><ispartof>BJU international, 2012-09, Vol.110 (6), p.884-890</ispartof><rights>2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL</rights><rights>2015 INIST-CNRS</rights><rights>2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4940-7ed63beefbbfae2ebb62219468dc5def8601b59adc4bbfda4a9fb98c2bf6af763</citedby><cites>FETCH-LOGICAL-c4940-7ed63beefbbfae2ebb62219468dc5def8601b59adc4bbfda4a9fb98c2bf6af763</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1464-410X.2011.10850.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1464-410X.2011.10850.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26318452$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22289017$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Stewart, Grant D.</creatorcontrib><creatorcontrib>Ang, W. Jensen</creatorcontrib><creatorcontrib>Laird, Alexander</creatorcontrib><creatorcontrib>Tolley, David A.</creatorcontrib><creatorcontrib>Riddick, Antony C. P.</creatorcontrib><creatorcontrib>McNeill, S. Alan</creatorcontrib><title>The operative safety and oncological outcomes of laparoscopic nephrectomy for T3 renal cell cancer</title><title>BJU international</title><addtitle>BJU Int</addtitle><description>Study Type – Therapy (case series)
Level of Evidence 4
What's known on the subject? and What does the study add?
Laparoscopic radical nephrectomy is a well established treatment for localized RCC, where nephron‐sparing approaches are not appropriate. As surgeon and departmental experience grow more extensive tumours will be tackled laparoscopically. However, little is known about the operative safety and oncological outcomes of the laparoscopic approach for locally advanced RCC.
The present study describes the largest reported cohort of patients receiving laparoscopic radical nephrectomy for locally advanced RCC. In the context of suitably experienced personnel in an established centre, we have established that this approach is safe from operative, postoperative and oncological standpoints, with comparable data to existing open series.
OBJECTIVE
•
To determine the operative, postoperative and oncological outcomes of laparoscopic radical nephrectomy (LRN) for locally advanced renal cell cancer (RCC), which, as surgeon and departmental experience increases, is being performed more often.
PATIENTS AND METHODS
•
In total, 94 consecutive patients receiving LRN for pathologically confirmed T3 or T4 RCC at a tertiary referral centre between March 2002 and May 2010 were analyzed.
•
Preoperative, operative, tumour and postoperative characteristics were evaluated together with recurrence and outcome data.
•
Survival was estimated using the Kaplan–Meier method. Cox's proportional hazards model was used for multivariate analysis.
RESULTS
•
In total, 77 patients had LRN with curative intent and 17 patients had LRN with cytoreductive intent.
•
There were six LRNs (6.4%) that were converted to open procedures.
•
Overall, there were two (2.1%) Clavien grade IIIa complications, one (1.1%) grade IVa complication and one (1.1%) postoperative death.
•
Overall median follow‐up was 17.4 months. In total, 22 (28.6%) patients receiving curative LRN developed a recurrence after a median of 13.9 months; 12 (54.5%) patients developed distant metastases, five (22.7%) patients had local recurrences and three (13.6%) patients had transcoelomic spread. Median predicted progression free survival was 48.4 months in patients undergoing LRN with curative intent. Median predicted overall survival was 65.6 months after curative LRN and 15.7 months after cytoreductive LRN.
•
Multivariate analysis did not reveal any variables influencing recurrence or survival.
CONCLUSIONS
•
In the context of suitably experienced personnel in an established centre, LRN for locally advanced RCC is safe from an operative and oncological standpoint.
•
Patients clinically staged as T3 RCC must still be selected carefully for LRN in a multidisciplinary setting.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Carcinoma, Renal Cell - pathology</subject><subject>Carcinoma, Renal Cell - surgery</subject><subject>Clinical trials</subject><subject>cytoreductive nephrectomy</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Kidney cancer</subject><subject>Kidney Neoplasms - pathology</subject><subject>Kidney Neoplasms - surgery</subject><subject>Kidneys</subject><subject>laparoscopic radical nephrectomy</subject><subject>Laparoscopy</subject><subject>locally advanced</subject><subject>Male</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Neoplasm Staging</subject><subject>Nephrectomy - adverse effects</subject><subject>Nephrectomy - methods</subject><subject>Nephrology. Urinary tract diseases</subject><subject>oncological outcome</subject><subject>operative safety</subject><subject>renal cell carcinoma</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><subject>Tumors of the urinary system</subject><issn>1464-4096</issn><issn>1464-410X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU1P3DAQhq2qFVDKX6gsVZV62dRf8cYXJEClLULiski9WbYzLlklcbATYP89DruAxAkf7JH9vDPjdxDClBQ0r5_rggopFoKSfwUjlBaUVCUpHj6gg5eHj88xUXIffU5pTUi-kOUe2meMVYrQ5QGyqxvAYYBoxuYOcDIexg02fY1D70Ib_jfOtDhMowsdJBw8bs1gYkguDI3DPQw3EdwYug32IeIVxxH6rHDQ5s30DuIX9MmbNsHR7jxE1-e_Vmd_FpdXv_-enVwunFCCLJZQS24BvLXeAANrJWNUCVnVrqzBV5JQWypTO5GJ2gijvFWVY9ZL45eSH6If27xDDLcTpFF3TZr7MD2EKWlKuKyWSrEyo9_eoOswxdx3pnjJuaRMkUxVW8rl_6YIXg-x6Uzc5FR6noNe69liPdut5znopznohyz9uisw2Q7qF-Gz8Rn4vgNMyg77mK1q0isnOa1EyTJ3vOXumxY2725An15cP4X8EYsxpaw</recordid><startdate>201209</startdate><enddate>201209</enddate><creator>Stewart, Grant D.</creator><creator>Ang, W. Jensen</creator><creator>Laird, Alexander</creator><creator>Tolley, David A.</creator><creator>Riddick, Antony C. P.</creator><creator>McNeill, S. Alan</creator><general>Blackwell Publishing Ltd</general><general>Wiley-Blackwell</general><general>Wiley Subscription Services, Inc</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>7QP</scope><scope>7X8</scope></search><sort><creationdate>201209</creationdate><title>The operative safety and oncological outcomes of laparoscopic nephrectomy for T3 renal cell cancer</title><author>Stewart, Grant D. ; Ang, W. Jensen ; Laird, Alexander ; Tolley, David A. ; Riddick, Antony C. P. ; McNeill, S. Alan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4940-7ed63beefbbfae2ebb62219468dc5def8601b59adc4bbfda4a9fb98c2bf6af763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Carcinoma, Renal Cell - pathology</topic><topic>Carcinoma, Renal Cell - surgery</topic><topic>Clinical trials</topic><topic>cytoreductive nephrectomy</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Kidney cancer</topic><topic>Kidney Neoplasms - pathology</topic><topic>Kidney Neoplasms - surgery</topic><topic>Kidneys</topic><topic>laparoscopic radical nephrectomy</topic><topic>Laparoscopy</topic><topic>locally advanced</topic><topic>Male</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Neoplasm Staging</topic><topic>Nephrectomy - adverse effects</topic><topic>Nephrectomy - methods</topic><topic>Nephrology. Urinary tract diseases</topic><topic>oncological outcome</topic><topic>operative safety</topic><topic>renal cell carcinoma</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><topic>Tumors of the urinary system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stewart, Grant D.</creatorcontrib><creatorcontrib>Ang, W. Jensen</creatorcontrib><creatorcontrib>Laird, Alexander</creatorcontrib><creatorcontrib>Tolley, David A.</creatorcontrib><creatorcontrib>Riddick, Antony C. P.</creatorcontrib><creatorcontrib>McNeill, S. Alan</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>Calcium & Calcified Tissue Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>BJU international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stewart, Grant D.</au><au>Ang, W. Jensen</au><au>Laird, Alexander</au><au>Tolley, David A.</au><au>Riddick, Antony C. P.</au><au>McNeill, S. Alan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The operative safety and oncological outcomes of laparoscopic nephrectomy for T3 renal cell cancer</atitle><jtitle>BJU international</jtitle><addtitle>BJU Int</addtitle><date>2012-09</date><risdate>2012</risdate><volume>110</volume><issue>6</issue><spage>884</spage><epage>890</epage><pages>884-890</pages><issn>1464-4096</issn><eissn>1464-410X</eissn><coden>BJINFO</coden><abstract>Study Type – Therapy (case series)
Level of Evidence 4
What's known on the subject? and What does the study add?
Laparoscopic radical nephrectomy is a well established treatment for localized RCC, where nephron‐sparing approaches are not appropriate. As surgeon and departmental experience grow more extensive tumours will be tackled laparoscopically. However, little is known about the operative safety and oncological outcomes of the laparoscopic approach for locally advanced RCC.
The present study describes the largest reported cohort of patients receiving laparoscopic radical nephrectomy for locally advanced RCC. In the context of suitably experienced personnel in an established centre, we have established that this approach is safe from operative, postoperative and oncological standpoints, with comparable data to existing open series.
OBJECTIVE
•
To determine the operative, postoperative and oncological outcomes of laparoscopic radical nephrectomy (LRN) for locally advanced renal cell cancer (RCC), which, as surgeon and departmental experience increases, is being performed more often.
PATIENTS AND METHODS
•
In total, 94 consecutive patients receiving LRN for pathologically confirmed T3 or T4 RCC at a tertiary referral centre between March 2002 and May 2010 were analyzed.
•
Preoperative, operative, tumour and postoperative characteristics were evaluated together with recurrence and outcome data.
•
Survival was estimated using the Kaplan–Meier method. Cox's proportional hazards model was used for multivariate analysis.
RESULTS
•
In total, 77 patients had LRN with curative intent and 17 patients had LRN with cytoreductive intent.
•
There were six LRNs (6.4%) that were converted to open procedures.
•
Overall, there were two (2.1%) Clavien grade IIIa complications, one (1.1%) grade IVa complication and one (1.1%) postoperative death.
•
Overall median follow‐up was 17.4 months. In total, 22 (28.6%) patients receiving curative LRN developed a recurrence after a median of 13.9 months; 12 (54.5%) patients developed distant metastases, five (22.7%) patients had local recurrences and three (13.6%) patients had transcoelomic spread. Median predicted progression free survival was 48.4 months in patients undergoing LRN with curative intent. Median predicted overall survival was 65.6 months after curative LRN and 15.7 months after cytoreductive LRN.
•
Multivariate analysis did not reveal any variables influencing recurrence or survival.
CONCLUSIONS
•
In the context of suitably experienced personnel in an established centre, LRN for locally advanced RCC is safe from an operative and oncological standpoint.
•
Patients clinically staged as T3 RCC must still be selected carefully for LRN in a multidisciplinary setting.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>22289017</pmid><doi>10.1111/j.1464-410X.2011.10850.x</doi><tpages>7</tpages></addata></record> |
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| ispartof | BJU international, 2012-09, Vol.110 (6), p.884-890 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Carcinoma, Renal Cell - pathology Carcinoma, Renal Cell - surgery Clinical trials cytoreductive nephrectomy Drug therapy Female Humans Kidney cancer Kidney Neoplasms - pathology Kidney Neoplasms - surgery Kidneys laparoscopic radical nephrectomy Laparoscopy locally advanced Male Medical research Medical sciences Middle Aged Multivariate analysis Neoplasm Staging Nephrectomy - adverse effects Nephrectomy - methods Nephrology. Urinary tract diseases oncological outcome operative safety renal cell carcinoma Retrospective Studies Treatment Outcome Tumors of the urinary system |
| title | The operative safety and oncological outcomes of laparoscopic nephrectomy for T3 renal cell cancer |
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