Transperitoneal vs retroperitoneal laparoscopic radical nephrectomy: a double-arm, parallel-group randomized clinical trial

Author:

Liu Junyao,Zhang Bin,Qi Peng,Ren Xiaowei,Zheng Duo,He Yang,Zheng Xu,Yue Zhongjin,Li Ye,Yang Ningqiang,Wang Zhiping,Bao Junsheng,Tian Junqiang,Yang Li,Zhai Zhenxing,Zuo Lingjun,Hou Zizhen,Wang Jiaji,Wang Wei,Chang Hong,Ma Junhai,Zhang Yunxin,Dong Zhichun,Dong Zhilong,Zhong Ganping,Cheng Hui,Lei Pengyuan,Li Zhongming,Wu GongJin,Shang Panfeng

Abstract

Abstract Objective To compare the outcomes of patients undergoing Retroperitoneal laparoscopic Radical nephrectomy (RLRN) and Transperitoneal laparoscopic Radical nephrectomy (TLRN). Methods A total of 120 patients with localized renal cell carcinoma were randomized into either RLRN or TLRN group. Mainly by comparing the patient perioperative related data, surgical specimen integrity, pathological results and tumor results. Results Each group comprised 60 patients. The two group were equivalent in terms of perioperative and pathological outcomes. The mean integrity score was significantly lower in the RLRN group than TLRN group. With a median follow-up of 36.4 months after the operation, Kaplan–Meier survival analysis showed no significant difference between RLRN and TLRN in overall survival (89.8% vs. 88.5%; P = 0.898), recurrence-free survival (77.9% vs. 87.7%; P = 0.180), and cancer-specific survival (91.4% vs. 98.3%; P = 0.153). In clinical T2 subgroup, the recurrence rate and recurrence-free survival in the RLRN group was significantly worse than that in the TLRN group (43.2% vs. 76.7%, P = 0.046). Univariate and multivariate COX regression analysis showed that RLRN (HR: 3.35; 95%CI: 1.12–10.03; P = 0.030), male (HR: 4.01; 95%CI: 1.07–14.99; P = 0.039) and tumor size (HR: 1.23; 95%CI: 1.01–1.51; P = 0.042) were independent risk factor for recurrence-free survival. Conclusions Our study showed that although RLRN versus TLRN had roughly similar efficacy, TLRN outperformed RLRN in terms of surgical specimen integrity. TLRN was also significantly better than RLRN in controlling tumor recurrence for clinical T2 and above cases. Trial registration Chinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=24400), identifier: ChiCTR1800014431, date: 13/01/2018.

Funder

Natural Science Foundation of Gansu Province

Special fund project for doctoral training program of Lanzhou University Second Hospital

Publisher

Springer Science and Business Media LLC

Subject

Urology,Reproductive Medicine,General Medicine

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