Long-Term Follow-up of Hand-Assisted Laparoscopic Radical Nephrectomy for Organ-Confined Renal Cell Carcinoma

Objectives: To evaluate the efficacy and long-term outcomes of hand-assisted laparoscopic radical nephrectomy (HALRN) in treating clinically localized renal cell carcinoma. Methods: We analyzed the data from 54 patients who underwent hand-assisted laparoscopic radical nephrectomy (HALRN) and 70 patients who underwent conventional open radical nephrectomy (ORN) in our institution from January 1998 to December 2002 for clinical Stage T1N0M0 or T2N0M0 renal cell carcinoma. The data were collected retrospectively by reviewing the medical records. All specimens were confirmed by pathologic examination. We compared the surgical results and long-term oncologic outcomes between the two groups. Results: The median follow-up period in the HALRN group was 44.5 months (range 16 to 73) and in the ORN group it was 68 months (range 43 to 93). Patient age, sex, body mass index, pathologic parameters, and American Society of Anesthesiologists classification were not significantly different between the two groups. The HALRN group had a significantly longer operative time (204 minutes versus 181 minutes, P = 0.03) and less blood loss (161 mL versus 630 mL, P <0.01). The complication rates for the ORN and HALRN groups were similar (10% and 7.4% respectively, P = 0.62). No conversions to an open procedure or intraoperative mortality occurred in the HALRN group. The average hospital stay, length of wound, and parenteral narcotic analgesic dose were significantly less in the HALRN group. The 5-year disease-free rate and disease-specific survival rate were comparable in the two groups. Conclusions: The results of our study have shown that HALRN is a less-invasive technique with 5-year disease-free and disease-specific survival rates comparable to those after ORN in treating patients with clinically localized renal cell carcinoma.