Is laparoscopic better than open partial nephrectomy for renal tumours?

Patients with renal tumours who have undergone laparoscopic partial nephrectomy (LPN) have shown similar surgical and oncologic outcomes as those treated with open partial nephrectomy (OPN), reports a study.

“Minimally invasive surgery may provide better preservation of kidney function,” the authors said.

This prospective, randomized controlled trial was conducted to compare surgical, functional, and oncologic outcomes in patients undergoing OPN or LPN. Two hundred eight patients were randomly assigned 1:1 to either OPN (n=110) or LNP (n=98) for the treatment of renal tumours <7 cm between 2012 and 2020.

Surgical complications up to 90 days after surgery was the primary endpoint, while secondary ones were comparison of surgical, oncologic, and functional results.

Based on operative data, no differences were observed in operative time, warm ischaemia time, estimated blood loss, transfusions, or length of hospital stay. Zero ischaemia, however, occurred more frequently in the OPN than the LPN group (35.4 percent vs 15.5 percent; p=0.02). OPN also resulted in more abdominal wall complications (31.2 percent vs 13.1 percent; p=0.004).

Oncologic outcomes, on the other hand, were similar between the two groups. Of note, the LPN group experienced less kidney function reduction at 3 (‒5.2 percent vs ‒10 percent; p=0.04) and 12 months after surgery (‒0.8 percent vs ‒6.3 percent; p=0.02).

The rate of downstaging on the chronic kidney disease classification at 12 months was also lower in the LPN group (14.1 percent vs 32.6 percent; p=0.006).

“More studies, especially those involving robotic surgery, are necessary to confirm our findings,” the authors said.

“Partial nephrectomy is the standard treatment for renal tumours <7 cm, and the trend toward minimally invasive surgery has increased,” they noted.