OPEN VERSUS LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR CLINICAL T1A RENAL TUMORS: A PROSPECTIVE MULTICENTER COMPARATIVE STUDY (RECORD PROJECT)

Aim of the study Aim of this study is to evaluate surgical and postoperative out- comes of open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN) for clinical T1a renal masses in a prospective multicenter dataset. Materials and methods The RECORd Project is a 4-year prospective observational multicenter study promoted by SIU. The study includes all patients who underwent open or laparoscopic nephron-sparing surgical treatment for kidney cancers between January 2009 and January 2011 at 19 Italian centers. Approval of the study protocol by the local ethical committee was obtained at each centre. Conservative surgery was performed in the form of standard enucleoresection and tumor enucleation (SE) according to center’s and surgeon’s preference. The OPN group and the LPN group were compared regarding clinical, surgical, and pathologic outcome variables. Multivariable logistic regression models were applied to analyze predictors of WIT>20 minutes and surgical complications. Results In our study, 450 patients were the subject of the final analysis. Overall, 301 had OPN and 149 LPN. LPN was performed by SE in a significantly larger set of patients (p=0.001) and was associated with a significantly longer WIT (19.9 min vs. 15.1 min). The incidence of PSM was not significantly different between the OPN and LPN (4.2% vs. 2.2%). Overall, 86 postoperative complications were recorded (19.1%). Surgical and medical complications were 68 (15.1%) and 24 (5.3%). Surgical complication rate was higher after OPN vs. LPN but this difference did not reach the statistical signifi- cance (17.7% vs. 10.9%) and at multivariate analysis the factors independently associated with surgical complications were clinical tumor size and indication for surgery (relative/absolute vs. elective).Discussion This study confirms that LPN is associated with longer WIT and has similar surgical margins rate compared to OPN. Conclusions The laparoscopic surgical approach is an independent predictor of a WIT>20 minutes after conservative surgery for kidney cancer. In our series of T1a RCC the incidence of positive surgical margins was similar in patients treated with LPN and OPN. Surgical complication rate was higher after OPN versus LPN but this difference did not reach the statistical significance.