Background and Purpose: Retrospective studies have shown laparoscopic cytoreductive nephrectomy (LCN) to be a safe procedure in selected patients. The objective of this article is to identify characteristics that may predict when a laparoscopic procedure may offer improved postoperative outcome and whether it affects the timing of postoperative systemic therapy compared with open surgery. Patients and Methods: A cohort of 43 LCN cases were matched with 43 open cytoreductive nephrectomy (OCN) cases based on both pathologic size of tumor and stage. Eleven cases were laparoscopic converted to open nephrectomy. Cases excluded from the analysis were adjacent organ involvement, inferior vena cava involvement, and bulky lymphadenopathy. Data analysis of 11 variables was performed using the t test, log-rank, and Wilcoxon tests. Significance was at P = 0.05. Survival data were calculated using the Kaplan-Meier estimate. Results: Significant differences between LCN vs OCN were estimated blood loss (mean 277ml vs 816ml) and length of hospitalization (3.2 days vs 5.1 days). The median size of tumor for LCN cases was 7.5cm and for OCN, 9.5cm. The mean size of tumor of LCN vs laparoscopic converted to open cases was 6.8cm vs 11.2cm, and this difference was significant. There was no significant difference in postoperative performance status, time to commencement of systemic treatment, or in survival time between both groups. This study provides further evidence that a laparoscopic approach with cytoreductive nephrectomy in metastatic renal-cell carcinoma is a safe option for tumors 10cm and smaller. The approach (laparoscopic vs open) had no effect on postoperative complications or time to systemic therapy. Conclusion: Procedures with tumors larger than 10cm were more likely to be converted to an open procedure. Tumors larger than 10cm may be best approached via an open procedure, especially in the presence of involvement of adjacent organs or bulky lymphadenopathy.
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