Laparoendoscopic single-site radical nephrectomy shows no clinical advantage

Paris-A recent study revealed that the use of laparoendoscopic single-site surgery to perform radical nephrectomy (LESS-RN) is just as effective as conventional laparoscopic radical nephrectomy (LRN), attaining excellent surgical and post-surgical outcomes.

Despite these encouraging early outcomes, however, researchers are unable to attribute any obvious advantages to LESS-RN at present, apart from the obvious cosmetic benefits.

"Laparoendoscopic single-site surgery radical nephrectomy is as effective as conventional laparoscopic RN, but does not add any significant advantage in terms of systemic stress response and surgical trauma," said co-author Rashid Hoda, MD, of the department of urology and renal transplantation, Martin Luther University, Halle Saale, Germany, who presented the findings at the 2012 European Association of Urology annual congress in Paris.

LESS-RN and LRN were both performed via transperitoneal access. Blood samples were collected pre- and intra-operatively, at 6 hours, 24 hours, 48 hours, and at 5 days postoperatively.

The investigators, led by Francesco Greco, MD, assessed trauma by the serum concentrations of acute-phase markers, such as C-reactive protein and serum amyloid A antibody and interleukins (IL-6, a pro-inflammatory marker, and IL-10, an anti-inflammatory cytokine). These were measured at each time point by enzyme-linked immunosorbent assay. The investigators collected the clinical data by reviewing patient records.

Comparing the surgical results, the authors noted no differences between the groups in C-reactive protein (p=.12 ) and serum amyloid A levels (p=.09) at all measurement time points. The changes in IL-6 levels in the LRN group were statistically significantly higher compared with the LESS-RN group at 6 hours after surgery (p=.02), whereas the LESS-RN group showed statistically significantly higher IL-6 levels than the LRN group at 24 hours after surgery (p=.02).

The authors noted that serum levels of IL-10 showed different kinetics in each group, with higher volumes in the LESS-RN during the early post-op phase (at 6 hours; p=.01) and higher volumes in the LRN group at 48 hours after surgery (p=.01).

Results substantiate other studies

Session co-chair Petrisor Geavlete, MD, of the urology department at St. John Emergency Clinical Hospital, Bucharest, Romania, noted that the Martin Luther researchers' results substantiated what most comparative study results claimed-that LESS-RN holds no significant advantage concerning surgical trauma over LRN. Urologists need to consult with their patients and perform the surgery that is best suited for the individual patient, Dr. Geavlete said.

"LESS has been developed in an attempt to further reduce the morbidity and scarring associated with surgical intervention," said Dr. Hoda. "We live in a time where everyone wants to be beautiful. We have a young patient group who definitely prefer this option. LESS-RN is not better from the surgical viewpoint; however, cosmetically, it is far preferable. I believe that LESS is a better procedure for this reason."