Objective To compare the surgical characteristics and clinical outcomes of laparoscopic nephron-sparing surgery (LNSS) and open nephron-sparing surgery (NSS) for T1a stage renal cell carcinoma. MethodsWe retrospectively analyzed the clinical data of 115 patients with T1a stage renal cell carcinoma, who were treated with NSS. Fifty-five patients received LNSS and 60 received open NSS. The operation time, renal ischemia time, blood loss, hospital stay, complications and renal function recovery were compared between the two groups. ResultsThe mean operation time periods in LNSS and open NSS group were 165-255 min (a mean of \[212.0±45.3\] min) and 95-138 min (a mean of \[140.7±25.6\] min, P=0.000), the renal ischemia time periods were 25-45 min (a mean of \[41.3±5.4\] min) and 15-26 min (\[24.4±5.7\] min, P=0.000), the blood losses were 100-250 ml (a mean of \[168.8±51.7\] ml) and 200-550 (a mean of \[285.3±77.9\] ml, P=0.000), the periods of hospital stay were 6-10 d (a mean of \[6.2±0.5\] d) and 7-15 d(a mean of \[7.1±0.6\] d, P=0.001), and the complication rates were 7.3%(4/55) and 18.3%(11/60, P=0.044), respectively. The patients were followed up for a median of 18(6-32) months. Except for the cases who were lost to follow-up or dead because of other reasons, there were no local recurrence or distant metastasis. The postoperative double glomerular filtration rates were not statistically different between the two groups(P=0.105).ConclusionLNSS has less blood loss, shorter hospital stay and less complication than open NSS, and longer operation time and renal ischemia time have little influence on renal function and long-term prognosis.