Transperitoneal Nephrectomy Offers Better Tumor Recurrence Than Retroperitoneal Procedure

For patients with localized renal cell carcinoma (RCC) who undergo nephrectomy, the most common surgical techniques are retroperitoneal laparoscopic radical nephrectomy (RLRN) and transperitoneal laparoscopic radical nephrectomy (TLRN). However, current guidelines do not offer specific criteria for choosing which surgical approach to take, and there is potentially little difference between them.

In the first trial to prospectively compare patient outcomes of RLRN and TLRN while following CONSORT guidelines, researchers led by Junyao Liu, Bin Zhang, and Peng Qi analyzed the data of patients who underwent these procedures to determine their efficacy.

A total of 120 patients with localized RCC were equally divided into an RLRN group or a TLRN group. Perioperative data, specimen integrity, and pathological and tumor results were compared.

The median follow-up was 36.4 months after operation. Both patient groups were found to be similar in their perioperative and pathological outcomes. A Kaplan-Meier analysis demonstrated no significant difference between the RLRN and TLRN procedures in overall survival (89.8% vs 88.5%; P=.898), recurrence-free survival (RFS; 77.9% vs 87.7%; P=.180), or cancer-specific survival (91.4% vs 98.3%; P=.153).

In a subgroup consisting of patients with cT2 tumors, the recurrence rate and RFS were significantly lower in the RLRN group than in the TLRN group (43.2% vs 76.7%; P=.046). A Cox regression analysis determined that the independent risk factors of RFS for the subgroup included RLRN (hazard ratio [HR], 3.35; 95% CI, 1.12-10.03; P=.030), male (HR, 4.01; 95% CI, 1.07-14.99; P=.039), and tumor size (HR, 1.23; 95% CI, 1.01-1.51; P=.042).

While RLRN and TLRN procedures were found to have similar efficacy, TLRN demonstrated better surgical specimen integrity and better controlled tumor recurrence for patients with cT2 or higher disease.