TY - JOUR
T1 - Surgical treatment of renal neoplasia
T2 - Evolving toward a laparoscopic standard of care
AU - Bhayani, Sam B.
AU - Clayman, Ralph V.
AU - Sundaram, Chandru P.
AU - Landman, Jaime
AU - Andriole, Gerald
AU - Figenshau, R. Sherburne
AU - Bullock, Arnold
AU - Brandes, Steven
AU - Shalhav, Arieh
AU - McDougall, Elspeth
AU - Kibel, Adam S.
PY - 2003/11
Y1 - 2003/11
N2 - Objectives. To determine the extent to which laparoscopy has replaced open surgery for renal malignancy. Methods. The records of all 537 patients at Washington University who underwent surgery for localized renal malignancies from January 1997 to December 2001 were examined for clinical and pathologic information. Results. The total procedures per year increased from 1997 to 2001, but the distribution of pathologic stages throughout the 5 years was similar. In 1997, laparoscopic approaches were used in 15% of cases; this increased to 65% by 2001. Nephron-sparing surgery (NSS) was used in 31% to 42% of patients yearly, but laparoscopic NSS increased in frequency. By 2001, only 3.3% of T1 tumors were removed by open radical nephrectomy compared with 55% treated by laparoscopic nephrectomy. The rest of the T1 tumors in 2001 were treated by open partial nephrectomy (20.2%) or laparoscopic NSS (21.3%). In 2001, 61% of T2 lesions were treated laparoscopically, an increase from 37% in 1997. Most open radical nephrectomies in 2001 were performed for T3 disease. The number of surgeons performing laparoscopic renal surgery has increased at our institution, from two in 1997, both endourologists, to eight in 2001, representing the entire urology faculty that treats renal cancer. Conclusions. Laparoscopic radical nephrectomy has replaced open radical nephrectomy for low-stage renal neoplasia. Although laparoscopic NSS is increasing in frequency, it has not yet replaced open partial nephrectomy. At our institution, the laparoscopic approach has become the standard of care when radical nephrectomy is needed for T1 or T2 renal cancer.
AB - Objectives. To determine the extent to which laparoscopy has replaced open surgery for renal malignancy. Methods. The records of all 537 patients at Washington University who underwent surgery for localized renal malignancies from January 1997 to December 2001 were examined for clinical and pathologic information. Results. The total procedures per year increased from 1997 to 2001, but the distribution of pathologic stages throughout the 5 years was similar. In 1997, laparoscopic approaches were used in 15% of cases; this increased to 65% by 2001. Nephron-sparing surgery (NSS) was used in 31% to 42% of patients yearly, but laparoscopic NSS increased in frequency. By 2001, only 3.3% of T1 tumors were removed by open radical nephrectomy compared with 55% treated by laparoscopic nephrectomy. The rest of the T1 tumors in 2001 were treated by open partial nephrectomy (20.2%) or laparoscopic NSS (21.3%). In 2001, 61% of T2 lesions were treated laparoscopically, an increase from 37% in 1997. Most open radical nephrectomies in 2001 were performed for T3 disease. The number of surgeons performing laparoscopic renal surgery has increased at our institution, from two in 1997, both endourologists, to eight in 2001, representing the entire urology faculty that treats renal cancer. Conclusions. Laparoscopic radical nephrectomy has replaced open radical nephrectomy for low-stage renal neoplasia. Although laparoscopic NSS is increasing in frequency, it has not yet replaced open partial nephrectomy. At our institution, the laparoscopic approach has become the standard of care when radical nephrectomy is needed for T1 or T2 renal cancer.
UR - http://www.scopus.com/inward/record.url?scp=0242412485&partnerID=8YFLogxK
U2 - 10.1016/S0090-4295(03)00670-8
DO - 10.1016/S0090-4295(03)00670-8
M3 - Article
C2 - 14624901
AN - SCOPUS:0242412485
SN - 0090-4295
VL - 62
SP - 821
EP - 826
JO - Urology
JF - Urology
IS - 5
ER -