Laparoscopic nephrectomy: Not just for localized renal cell carcinoma?

Intermediate-term oncologic results after laparoscopic radical nephrectomy for locally advanced renal cell carcinoma are similar to those of open nephrectomy.

The retrospective study, presented by Monish Aron, MD, a clinical fellow in advanced laparoscopic urology at the Cleveland Clinic, represents one of the largest series to date specifically evaluating laparoscopic nephrectomy for higher-stage renal masses.

Although the procedure is a well-established treatment modality for organ-confined clinical stage T1-2 renal tumors that are not treatable by nephron-sparing surgery, its role in the management of higher-stage tumors, although, is not yet established. Several small studies have shown the feasibility of laparoscopy for stage ≥T2 tumors, but with short-term follow-up. Traditionally, most T3 lesions have been treated with open radical nephrectomy, with 5-year survival rates in the 40% to 80% range.

"The data show that laparoscopy is as effective as open surgery for the management of locally advanced renal cancers," said Dr. Aron, who worked on the study with Inderbir S. Gill, MD, MCh. "Laparoscopy should no longer be considered standard of care just for early kidney cancer. Laparoscopy should also be the option of first resort for locally advanced lesions, taking into account the technical ability of the surgeon and individual tumor characteristics."

Indeed, practice patterns are evolving toward a laparoscopic standard of care for many renal tumors, yet there will likely always be a role for open surgery.

"In the future, laparoscopy and open surgery will coexist in a synergistic fashion to provide the most effective and the least invasive treatment for a specific clinical situation. The ultimate goal should always be that the patient should benefit unequivocally," Dr. Aron concluded.