June 2001

From Washington University School of Medicine

Laparoscopic kidney removal is effective treatment for renal cancer

Anaheim, Calif., June 2, 2001 – Minimally invasive surgery can remove a cancerous kidney just as effectively as traditional open surgery while providing patients with equivalent long-term survival, a new study finds.

“Patients who had a kidney removed by laparoscopic, minimally invasive surgery had virtually the same five-year, cancer-free survival rate and recurrence rate as those who underwent open surgery,” says senior investigator Ralph V. Clayman, M.D. “The overall effectiveness of the laparoscopic procedure is absolutely equal to that of the open procedure.”

Clayman and colleagues will report the results today at the annual meeting of the American Urological Association in Anaheim, Calif. He is professor of urology and radiology and co-director of the Division of Minimally Invasive Surgery at Washington University School of Medicine in St. Louis.

The traditional procedure for removing a kidney, called open radical nephrectomy, requires a large incision just below the ribs. Sometimes, the surgeon even has to remove a rib to extract the kidney. The minimally invasive procedure, called laparoscopic radical nephrectomy, involves several very small incisions that admit tools that are only 1/4 to 1/2 inch wide and a similarly sized telescope called a laparoscope, which is connected to a camera.

The surgeon, working off of the camera image displayed on a television screen, frees the kidney from attached blood vessels and places it into an impermeable pouch. The surgeon then passes the drawstrings of the pouch through one of the incisions. Once the neck of the sack has been delivered to the surface of the abdomen, the sack is carefully opened, and the cancerous kidney is fragmented into small pieces and removed. Using this technique, the authors have been able to remove kidneys bearing tumors that weigh as much as 2 pounds through a 1/2-inch incision.

Clayman pioneered the laparoscopic kidney removal procedure, performing it for the first time in 1990 with former Washington University colleague Louis Kavoussi, M.D., who now is at Johns Hopkins, and Nathaniel Soper, M.D., professor of surgery and co-director of the Division of Minimally Invasive Surgery at Washington University.

The current study pooled survival data from patients who had a kidney removed at either Barnes-Jewish Hospital in St. Louis, the University of Saskatchewan in Canada or Komaki Shimin Hospital in Japan. Sixty-four of the patients who had undergone laparoscopy were compared with 69 contemporary patients who had been treated at the same three hospitals with open surgery for similar forms of renal cancer.

Five years later, 92 percent of the patients in the laparoscopy group were still alive. The survival rate for the patients who had open surgery was 91 percent. Many of the patients who had laparoscopic surgery have been followed longer than five years -- some as many as10 years -- without a relapse, similar to the cure rates for patients who had open surgery.

“But there’s more to it than that,” says Clayman. “The patients who underwent laparoscopic nephrectomy lost less blood, left the hospital sooner and went back to work earlier than those who had open surgery. They also took 80 percent less pain medication. Every aspect of their recovery was favorably influenced by the laparoscopic approach.”

Clayman believes it is too soon to recommend laparoscopy for all patients who must part with a cancerous kidney. There are too many variables, such as tumor size, involvement of the vena cava and the surgeon’s experience that may influence a decision on whether to proceed with a laparoscopic nephrectomy. Clayman believes, however, that the minimally invasive approach is usually feasible in the hands of a well-trained laparoscopic surgeon.

“If I or someone in my family developed renal cell cancer and needed a radical nephrectomy, there is no doubt that, barring a very unusual circumstance, it would be removed laparoscopically,” he said.

The full-time and volunteer faculty of Washington University School of Medicine are the physicians of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.












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