Laparoscopic vs open partial nephrectomy for T1 renal tumours: evaluation of long-term oncological and functional outcomes in 340 patients


Nephron-sparing surgery (NSS) is now the standard of care for most small renal masses, providing oncological outcomes equivalent to those of radical nephrectomy [1]. Since Gill et al. [2] reported the largest multi-institutional study to date, comparing open with laparoscopic partial nephrectomy (LPN), several studies have reported comparison of the two techniques [3, 4]. The study by Springer et al. is a comparison of the two techniques with long-term follow-up but, more importantly, the authors have to be commended for using standardized scoring systems for characterizing the renal tumors (nephrometry score) and for grading complications (Clavien system). The authors have reported similar outcomes and complication rates between the patients undergoing both techniques. There is no doubt that LPN is an excellent operation in expert hands. LPN is a tremendously difficult procedure, with a significant learning curve. For surgeons who lack the proficiency to perform LPN (which includes the vast majority of practising urologists), the desire to offer minimally invasive surgery often trumps the indications for NSS. With the advent of robot-assisted laparoscopic partial nephrectomy [5], it is to be hoped that this trend will reverse, and preserving renal function will remain the paramount concern.