Laparoscopic versus open radical nephrectomy in T2 renal cell carcinoma: A randomized control trial

Background: Laparoscopic Radical Nephrectomy (LRN) is the standard for treating patients with T1 Renal Cell Carcinoma (RCC) who are not candidates for nephron-sparing surgery. However, LRN is still considered controversial in patients with T2 tumors. The aim of the study was to compare the surgical and oncologic outcomes of LRN vs Open Radical Nephrectomy (ORN) in T2 RCC. Material and Methods: Herein, 56 T2 patients with RCC were prospectively randomized to LRN or conventional ORN. The operative time, blood loss, perioperative complications, duration of hospital stay, postoperative pain score and duration, analgesic consumption, and short-term oncologic results were carefully reported. Results: Demographic data including age, gender, weight, height and BMI were similar for both arms with p values= 0.251, 0.769, 0.645, 0.382 and 0.336 respectively. The LRN group had less median operative blood loss (190 vs 500 ml, P=0.001), similar median operative time (150 min for ORN vs 180 min for LRN, p=0.102), similar time to start oral feeding (p=0.198) and lower postoperative pain score (3 vs 4.5, p=0.015). The median hospital stays were not statistically significant when comparing the ORN vs LRN (3 vs 2 days respectively, p=0.073), with no differences in perioperative morbidity rate (p=0.193). The Overall Survival (OS) was similar in both arms, 1 and 2 years OS for ORN and LRN was 77.3 %, 69% vs 87.6% and 74.1% respectively, p=0.615. Prognostic factors influencing the OS and LRFS showed that lymph node metastasis, medical comorbidities, amount of intraoperative blood loss, and age at presentation were independent prognostic factors. Conclusion: LRN was superior in decreasing blood loss and postoperative pain while yielding similar oncologic outcomes. Keywords Laparoscopic radical nephrectomy, open radical nephrectomy, minimal invasive surgery, renal cell carcinoma.