A Generation of Laparoscopic Nephrectomy: Stage-Specific Surgical and Oncologic Outcomes for Laparoscopic Nephrectomy in a Single Center
| Autor: | Alexander Laird, David A. Tolley, Grant D. Stewart, W J Jensen Ang, S. Alan McNeill, Mark L. Cutress, Jim Zhong, Antony C. P. Riddick |
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| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Urology urologic and male genital diseases Single Center Nephrectomy Disease-Free Survival Case mix index Renal cell carcinoma medicine Carcinoma Humans Prospective Studies Stage specific Prospective cohort study Carcinoma Renal Cell Survival rate Aged Neoplasm Staging business.industry Laparoscopic nephrectomy Middle Aged medicine.disease Kidney Neoplasms United Kingdom female genital diseases and pregnancy complications Surgery Survival Rate Treatment Outcome Female Laparoscopy business Follow-Up Studies |
| Zdroj: | Journal of Endourology. 27:1008-1014 |
| ISSN: | 1557-900X 0892-7790 |
| Popis: | To determine the stage-specific operative, postoperative and oncologic outcomes, for patients undergoing a laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) in a single center and assess changes over a generation of practice.From December 1992 to July 2011, data were collected prospectively for 854 consecutive simple laparoscopic necphrectomies (LNs) and LRNs, 397 of which were LRNs for RCC. The first LRN was performed in December 1997. Stage-specific surgical and oncologic outcomes were assessed across the study period. Patients were then grouped into three equal consecutive cohorts. Case mix and surgical outcomes were compared to assess changes with departmental experience.There were 206, 71, 118, and 2 patients across stages pT1, pT2, pT3, and pT4, respectively. Median operative time was significantly shorter for pT1 tumors (125, 150 and 150 min for pT1-3, P0.021), while median estimated blood loss (EBL) was greater for pT3 tumors (50, 50, 100 mL, for pT1-3, P0.001). Median follow-up time was 31, 30, and 18 months, respectively, across pT1-pT3. There was a significant difference in 5-year overall survival (82.4%, 68.4%, 58.9%), cancer-specific survival (99.5%, 83.6%, 66.5%) and progression free survival (86.5%, 66.3%, 47.5%) across these stage-specific subgroups. Over the three cohorts, there was an increase in LRN performed for locally advanced disease and cytoreduction. With greater surgical experience, there was improvement in median operative time and median EBL in localized disease over the three periods, but no significant changes for locally advanced disease.This is the largest reported series of LRN in the United Kingdom. Departmental experience has resulted in improved surgical outcomes for localized RCC, with expansion of practice in more complex advanced disease. Laparoscopic nephrectomy is both operatively and oncologically safe in T1 and T2 disease, and although technically more demanding, it is also safe in selected T3 disease. |
| Databáze: | OpenAIRE |
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