Functional and Oncologic Outcomes of Bilateral Open Partial Nephrectomy Versus Bilateral Laparoscopic Partial Nephrectomy

Abstract

Purpose:

This study compared operative data and outcomes in patients undergoing either bilateral open partial nephrectomy (BOPN) or bilateral laparoscopic partial nephrectomy (BLPN) for synchronous bilateral kidney tumors.

Patients and Methods:

Patients who had undergone bilateral partial nephrectomy at our institution between 1992 and 2008 were reviewed retrospectively; 114 patients underwent either BOPN or BLPN. Ischemia time, tumor size, and renal function outcomes immediately after each surgery, at an intermediate time point (≤12 months), and at a late time point (>12 months) were compared. Oncologic outcomes were also evaluated using Kaplan-Meier analysis.

Results:

BOPN and BLPN were conducted in 92 and 22 patients, respectively. Average tumor size was larger in the BOPN group (4.1 vs 2.7 cm; P=0.001); however, pathologic stage was equivalent (P=0.52). Hospital stay was longer in the BOPN group (5.6 vs 4.0 d; P<0.001). Preoperative estimated glomerular filtration rates (eGFR) in the BOPN and BLPN groups were both ≥60 mL/min/1.73m². Percent decrease in eGFR between the two groups was 38% in the BLPN group and 27% in the BOPN group (P=0.03). Cancer-specific and recurrence-free survival rates were equivalent between groups over a mean follow-up of 5.5 years.

Conclusions:

BOPN and BLPN resulted in equivalent intermediate-term oncologic control. BLPN was associated with a larger percent decrease in eGFR. As ischemia times shorten for contemporary laparoscopic partial nephrectomies, it is expected that functional outcomes will be equivalent.