The following is a summary of “Transperitoneal vs retroperitoneal laparoscopic radical nephrectomy: a double-arm, parallel-group randomized clinical trial,” published in the February 2024 issue of Urology by Liu et al.

This study aimed to comprehensively compare the outcomes of Retroperitoneal Laparoscopic Radical Nephrectomy (RLRN) and Transperitoneal Laparoscopic Radical Nephrectomy (TLRN) in patients with localized renal cell carcinoma.

About 120 patients were randomly assigned to either the RLRN or TLRN group. The comparison involved assessing perioperative data, surgical specimen integrity, pathological results, and tumor outcomes.

The study comprised 60 patients in each group, with equivalent perioperative and pathological outcomes. However, the RLRN group exhibited a significantly lower mean integrity score for surgical specimens than the TLRN group. With a median follow-up of 36.4 months, Kaplan–Meier survival analysis revealed no significant differences 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) between RLRN and TLRN. Notably, in the clinical T2 subgroup, the RLRN group showed a significantly worse recurrence rate and recurrence-free survival than the TLRN group (43.2% vs. 76.7%, P = 0.046). Univariate and multivariate COX regression analysis identified RLRN (HR: 3.35; 95%CI: 1.12–10.03; P = 0.030), male gender (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) as independent risk factors for recurrence-free survival.

While RLRN and TLRN demonstrated similar overall efficacy, TLRN exhibited superior surgical specimen integrity. Moreover, TLRN was significantly more effective than RLRN in controlling tumor recurrence, particularly in clinical T2 and above cases.

Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-023-01364-w