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Ji C, Zhao X, Zhang S, Liu G, Li X, Zhang G, Minervini A, Guo H. Laparoscopic Radiofrequency Ablation versus Partial Nephrectomy for cT1a Renal Tumors: Long-Term Outcome of 179 Patients. Urol Int 2016; 96:345-53. [PMID: 26780439 DOI: 10.1159/000443672] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/21/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To compare the long-term functional and oncological results between laparoscopic radiofrequency ablation (LRFA) and laparoscopic partial nephrectomy (LPN) in selected clinical T1a (cT1a) renal tumor patients. METHODS We retrospectively analyzed the medical records of patients with cT1a renal tumors who had LRFA or LPN at our institution between February 2006 and February 2015. Student's t test was used to compare the perioperative data between the two groups. Survival analyses were calculated using the Kaplan-Meier method. RESULTS A total of 179 patients were included in the study. Patients in the LRFA cohort were significantly older and had higher American Society of Anesthesiologists sore than in the LPN cohort. The LRFA group had a significantly lower mean blood loss than the LPN group (p = 0.03). The percent decrease of GFR in the LRFA group was significantly lower than in the LPN group (p = 0.021). The 5-year overall, cancer-specific and disease-free survival were 93.3 vs. 94.6%, 98.0 vs. 98.5% and 97.1 vs. 97.3%, for LRFA and LPN, respectively (all p value >0.05). CONCLUSIONS The excellent perioperative results, long-term functional and oncological outcomes of LRFA confirm that this technique is safe, nephron sparing and oncologically effective for the treatment of cT1a renal tumors.
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Affiliation(s)
- Changwei Ji
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
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103
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Zondervan PJ, van Lienden KP, van Delden OM, de la Rosette JJ, Laguna MP. Preoperative Decision Making for Nephron-Sparing Procedure in the Renal Mass: Time for Using Standard Tools? J Endourol 2016; 30:128-34. [DOI: 10.1089/end.2015.0472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
| | | | - Otto M. van Delden
- Department of Radiology, AMC University Hospital, Amsterdam, The Netherlands
| | | | - M. Pilar Laguna
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
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104
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Qian J, Li P, Qin C, Zhang S, Bao M, Liang C, Cao Q, Li J, Shao P, Yin C. Laparoscopic Partial Nephrectomy with Precise Segmental Renal Artery Clamping for Clinical T1b Tumors. J Endourol 2015; 29:1386-91. [PMID: 26153918 DOI: 10.1089/end.2015.0359] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Jian Qian
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pu Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chao Qin
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shaobo Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meiling Bao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chao Liang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Cao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengfei Shao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Changjun Yin
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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105
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Shiroki R, Fukami N, Fukaya K, Kusaka M, Natsume T, Ichihara T, Toyama H. Robot-assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy. Int J Urol 2015; 23:122-31. [DOI: 10.1111/iju.13001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/23/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Ryoichi Shiroki
- Department of Urology; Fujita Health University School of Medicine; Toyoake Aichi Japan
| | - Naohiko Fukami
- Department of Urology; Fujita Health University School of Medicine; Toyoake Aichi Japan
| | - Kosuke Fukaya
- Department of Urology; Fujita Health University School of Medicine; Toyoake Aichi Japan
| | - Mamoru Kusaka
- Department of Urology; Fujita Health University School of Medicine; Toyoake Aichi Japan
| | - Takahiro Natsume
- Faculty of Radiological Technology; Fujita Health University School of Health Sciences; Toyoake Aichi Japan
| | - Takashi Ichihara
- Faculty of Radiological Technology; Fujita Health University School of Health Sciences; Toyoake Aichi Japan
| | - Hiroshi Toyama
- Department of Radiology; Fujita Health University School of Medicine; Toyoake Aichi Japan
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106
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Kim DY, Wood CG, Karam JA. Treating the two extremes in renal cell carcinoma: management of small renal masses and cytoreductive nephrectomy in metastatic disease. Am Soc Clin Oncol Educ Book 2015:e214-21. [PMID: 24857105 DOI: 10.14694/edbook_am.2014.34.e214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The incidental renal mass represents a heterogeneous group that contains both benign and malignant pathologies. The majority of renal cell carcinomas are discovered incidentally, without the presence of symptoms directly related to the mass, and are closely associated with the term small renal masses because of the discovery before the onset of symptoms. In general, small renal masses are defined as 4 cm or smaller, and may account for greater than half of renal cell carcinoma diagnosis. The use of renal mass biopsy may offer additional pathological information but the clinician must be reminded of the technical and diagnostic limitations of renal mass biopsy. Patient-dependent factors, such as life expectancy and comorbidities, guide the management of small renal masses, which include active surveillance, partial nephrectomy, radical nephrectomy, and ablative techniques (cryoablation and radiofrequency ablation). Partial nephrectomy has demonstrated durable oncologic control for small renal masses while preserving renal function and, if feasible, is the current treatment of choice. In the other extreme of the renal cell carcinomas spectrum and in the presence of metastatic disease, the removal of the renal primary tumor is termed cytoreductive nephrectomy. Two randomized trials (SWOG 8949 and EORTC 30947) have demonstrated a survival benefit with cytoreductive nephrectomy before the initiation of immunotherapy. These two studies have also been the motivation to perform cytoreductive nephrectomy in the targeted therapy era. Currently, there are two ongoing randomized prospective trials accruing to investigate the timing and relevance of cytoreductive nephrectomy in the contemporary setting of targeted therapy.
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Affiliation(s)
- Dae Y Kim
- From the Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher G Wood
- From the Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jose A Karam
- From the Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
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107
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Domínguez A, Bellido JA, Muñoz-Rodríguez J, Abascal-Junquera JM, Hannaoui N, Banús JM. Retroperitoneal and transperitoneal laparoscopic cryotherapy for small renal masses. Actas Urol Esp 2015; 39:582-7. [PMID: 26255076 DOI: 10.1016/j.acuro.2015.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Cryotherapy is a minimally invasive ablative technique that is considered an alternative to conventional surgery for preserving renal function in small renal tumors and in selected cases. We present our results from laparoscopic renal cryotherapy. MATERIAL AND METHOD We retrospectively analyzed 17 renal tumors diagnosed in 16 patients treated with cryotherapy. The patients' mean age was 66 years (43-80). The mean tumor size was 1.8cm (0.7-3.7cm). Cryotherapy with double-freeze cycle was performed laparoscopically in all cases (10 by transperitoneal approach and 7 by retroperitoneal approach). RESULTS Perioperative biopsies were performed on all patients and were positive for malignancy in 10 cases (59%). The mean stay was 2.8 days. The mean operative time was 162 minutes. Only 1 case reverted to open surgery due to bleeding. One patient required a blood transfusion in the immediate postoperative period. The majority of complications were Clavien-Dindo grades I and II. Some 76.5% of the patients had no complications. After a mean follow-up of 31 months (6-102), 1 patient died from nontumor-related causes, and 12 patients (75%) still show no evidence of local recurrence or progression. One patient had tumor persistence and therefore underwent partial nephrectomy at 6 months. One patient had a metachronous recurrence in the same kidney at 36 months, and another patient had a recurrence at 23 months. CONCLUSIONS Laparoscopic renal cryotherapy is a safe and feasible technique and is a good alternative to surgery for selected renal tumors.
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Affiliation(s)
- A Domínguez
- Departamento de Urología, Institut Català d'Urologia i Nefrologia, Barcelona, España.
| | - J A Bellido
- Departamento de Urología, Institut Català d'Urologia i Nefrologia, Barcelona, España
| | - J Muñoz-Rodríguez
- Departamento de Urología, Institut Català d'Urologia i Nefrologia, Barcelona, España
| | - J M Abascal-Junquera
- Departamento de Urología, Institut Català d'Urologia i Nefrologia, Barcelona, España
| | - N Hannaoui
- Departamento de Urología, Institut Català d'Urologia i Nefrologia, Barcelona, España
| | - J M Banús
- Departamento de Urología, Institut Català d'Urologia i Nefrologia, Barcelona, España
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108
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Pearson J, Williamson T, Ischia J, Bolton DM, Frydenberg M, Lawrentschuk N. National nephrectomy registries: Reviewing the need for population-based data. Korean J Urol 2015; 56:607-13. [PMID: 26366272 PMCID: PMC4565894 DOI: 10.4111/kju.2015.56.9.607] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/05/2015] [Indexed: 12/16/2022] Open
Abstract
Nephrectomy is the cornerstone therapy for renal cell carcinoma (RCC) and continued refinement of the procedure through research may enhance patient outcomes. A national nephrectomy registry may provide the key information needed to assess the procedure at a national level. The aim of this study was to review nephrectomy data available at a population-based level in Australia and to benchmark these data against data from the rest of the world as an examination of the national nephrectomy registry model. A PubMed search identified records pertaining to RCC nephrectomy in Australia. A similar search identified records relating to established nephrectomy registries internationally and other surgical registries of clinical importance. These records were reviewed to address the stated aims of this article. Population-based data within Australia for nephrectomy were lacking. Key issues identified were the difficulty in benchmarking outcomes and no ongoing monitoring of trends. The care centralization debate, which questions whether small-volume centers provide comparable outcomes to high-volume centers, is ongoing. Patterns of adherence and the effectiveness of existing protocols are uncertain. A review of established international registries demonstrated that the registry model can effectively address issues comparable to those identified in the Australian literature. A national nephrectomy registry could address deficiencies identified in a given nation's nephrectomy field. The model is supported by evidence from international examples and will provide the population-based data needed for studies. Scope exists for possible integration with other registries to develop a more encompassing urological or surgical registry. Need remains for further exploration of the feasibility and practicalities of initiating such a registry including a minimum data set, outcome indicators, and auditing of data.
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Affiliation(s)
- John Pearson
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - Timothy Williamson
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - Joseph Ischia
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - Damien M Bolton
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Olivia Newton-John Cancer Research Institute, Melbourne, Australia
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Abstract
OBJECTIVE The purpose of this article is to describe the indications for and approach to image-guided percutaneous ablation of renal tumors. CONCLUSION Image-guided ablation techniques have become accepted treatment of patients with small renal tumors, a viable alternative to partial nephrectomy.
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110
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Laparoscopic partial nephrectomy without intracorporeal suturing. Surg Endosc 2015; 30:1585-91. [PMID: 26162423 DOI: 10.1007/s00464-015-4382-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/26/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Partial nephrectomy has gained wider acceptance as a surgical technique in treating small renal tumors. Laparoscopic partial nephrectomy (LPN) still remains a technically demanding surgery to this day. We present our technique of laparoscopic partial nephrectomy, one that is performed without intracorporeal suturing. METHODS We performed LPN on 31 patients with localized renal parenchymal tumor (stage T1). The procedures were done from September 2009 to March 2015 at the Kaohsiung Medical University Hospital and the Kaohsiung Municipal Ta-Tung Hospital. Our technique involves the covering of renal defect layer by layer with FloSeal, Tisseel and a fat pad after monopolar coagulation. RESULTS Thirty-one patients were included in this study. Mean patient age was 53 years old (range 39-70). Mean tumor size was 2.9 cm (range 1.8-6.3). Mean RENAL nephrometry score was 5.3 (range 4-7). The average operation time was 188 min (range 120-290), and the average warm ischemic time was 19.0 min (range 9-26). Mean estimated blood loss was 171 ml (range 10-650), with no postoperative bleeding among the total 31 patients. No recurrent tumors were identified at a mean follow-up of 29 months postoperatively. The mean change in eGFR was 6.5 (ml/min/m2). CONCLUSION Laparoscopic partial nephrectomy is a feasible surgical method for most patients with stage 1 tumor. Our technique has shown to reduce warm ischemic time significantly and provide patients with excellent functional outcomes without affecting oncological results. With this technique, surgeons can perform LPN with more efficiency and with fewer complications.
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111
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Les traitements ablatifs dans le cancer du rein localisé : revue de la littérature en 2014. Prog Urol 2015; 25:499-509. [DOI: 10.1016/j.purol.2015.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 04/27/2015] [Accepted: 04/29/2015] [Indexed: 01/25/2023]
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112
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Regier M, Chun F. Thermal Ablation of Renal Tumors: Indications, Techniques and Results. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:412-8. [PMID: 26159218 PMCID: PMC4500057 DOI: 10.3238/arztebl.2015.0412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 03/18/2015] [Accepted: 03/18/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND About 15,000 persons receive the diagnosis of kidney cancer in Germany every year. Surgical resection is the standard treatment for locally confined tumors, but minimally invasive thermoablative techniques are increasingly being used as well. METHODS This article is based on publications retrieved by a selective literature search in PubMed regarding the thermoablative techniques now used in clinical practice, with particular attention to radiofrequency ablation (RFA) and cryoablation (CA). RESULTS RFA and CA are suitable for patients who cannot undergo surgery because of comorbid illnesses or who have contralateral recurrences or a hereditary precancerous condition. The primary technical success rate of these procedures ranges from 88% to 100%. More than 95% of tumors under 3 cm in diameter can be completely ablated. Reported complication rates range from 1% to 7%. New data on long-term outcomes reveal metastasis-free survival rates of 88% to 99% five years after ablation. A major advantage of these procedures is that thermoablation does not impair renal function to any relevant extent and is thus a good option for patients with limited renal function or a single kidney. CONCLUSION The thermoablative techniques are an important addition to the armamentarium of effective treatments for locally confined renal tumors. The guidelines of the American and European urological societies now list thermoablation with RFA or CA as an option for the treatment of small renal tumors with curative intent. Thermoablation of renal tumors has not yet been studied in randomized controlled trials; these will be needed so that the efficacy of tumor control, survival rates, complication rates, and quality of life after treatment can be reliably evaluated to provide definitive confirmation of the value of interstitial techniques.
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Affiliation(s)
- Marc Regier
- Diagnostic and Interventional Radiology Department and Clinic, Universitätsklinikum Hamburg-Eppendorf
| | - Felix Chun
- Center for Surgical Sciences, Department of Urology, Universitätsklinikum Hamburg-Eppendorf
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113
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Hongo F, Kawauchi A, Ueda T, Fujihara-Iwata A, Nakamura T, Naya Y, Kamoi K, Okihara K, Miki T. Laparoscopic off-clamp partial nephrectomy using soft coagulation. Int J Urol 2015; 22:731-4. [DOI: 10.1111/iju.12808] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/30/2015] [Accepted: 04/05/2015] [Indexed: 01/20/2023]
Affiliation(s)
- Fumiya Hongo
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Akihiro Kawauchi
- Department of Urology; Shiga University of Medical Science; Otsu Shiga Japan
| | - Takashi Ueda
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | | | - Terukazu Nakamura
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Yoshio Naya
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Kazumi Kamoi
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Koji Okihara
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Tsuneharu Miki
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
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114
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Chang X, Liu T, Zhang F, Ji C, Zhao X, Wang W, Guo H. Radiofrequency Ablation Versus Partial Nephrectomy for Clinical T1a Renal-Cell Carcinoma: Long-Term Clinical and Oncologic Outcomes Based on a Propensity Score Analysis. J Endourol 2015; 29:518-25. [PMID: 25556579 DOI: 10.1089/end.2014.0864] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Xiaofeng Chang
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Tieshi Liu
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Fan Zhang
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Changwei Ji
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xiaozhi Zhao
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Wei Wang
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Hongqian Guo
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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115
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Tumor Enucleation for Renal Cell Carcinoma. J Kidney Cancer VHL 2015; 2:64-69. [PMID: 28326260 PMCID: PMC5345541 DOI: 10.15586/jkcvhl.2015.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/31/2015] [Indexed: 11/21/2022] Open
Abstract
The increased number of small renal masses (SRMs) detected annually has led to a rise in the use of nephron-sparing surgery (NSS). These techniques aim to preserve the largest amount of healthy renal tissue possible while maintaining the same oncologic outcomes as radical nephrectomy (RN). Additionally, partial nephrectomy (PN) has been linked to a lower risk of chronic kidney disease, cardiovascular morbidity, and mortality when compared to RN. There has been continual progress toward resecting less renal parenchyma. While the predominant surgical method of performing NSS is through traditional PN, simple enucleation (SE) of the tumor has increased in popularity over recent years. SE is a technique that aims to preserve the maximal amount of renal parenchyma possible by utilizing the renal tumor pseudocapsule to bluntly separate the lesion from its underlying parenchyma, offering the smallest possible margin of excised healthy renal tissue. Several studies have demonstrated the oncological safety of SE compared with PN in the treatment of SRMs, with lower overall incidence of positive surgical margins. Additionally, SE has been shown to have similar 5- and 10-year progression-free and cancer-specific survival as PN. We present a review of the literature and an argument for SE to be a routine consideration in the treatment of all renal tumors amenable to NSS.
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116
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Wagstaff PGK, de Bruin DM, Zondervan PJ, Savci Heijink CD, Engelbrecht MRW, van Delden OM, van Leeuwen TG, Wijkstra H, de la Rosette JJMCH, Laguna Pes MP. The efficacy and safety of irreversible electroporation for the ablation of renal masses: a prospective, human, in-vivo study protocol. BMC Cancer 2015; 15:165. [PMID: 25886058 PMCID: PMC4376341 DOI: 10.1186/s12885-015-1189-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/12/2015] [Indexed: 01/20/2023] Open
Abstract
Background Electroporation is a novel treatment technique utilizing electric pulses, traveling between two or more electrodes, to ablate targeted tissue. The first in human studies have proven the safety of IRE for the ablation of renal masses. However the efficacy of IRE through histopathological examination of an ablated renal tumour has not yet been studied. Before progressing to a long-term IRE follow-up study it is vital to have pathological confirmation of the efficacy of the technique. Furthermore, follow-up after IRE ablation requires a validated imaging modality. The primary objectives of this study are the safety and the efficacy of IRE ablation of renal masses. The secondary objectives are the efficacy of MRI and CEUS in the imaging of ablation result. Methods/Design 10 patients, age ≥ 18 years, presenting with a solid enhancing mass, who are candidates for radical nephrectomy will undergo IRE ablation 4 weeks prior to radical nephrectomy. MRI and CEUS imaging will be performed at baseline, one week and four weeks post IRE. After radical nephrectomy, pathological examination will be performed to evaluate IRE ablation success. Discussion The only way to truly assess short-term (4 weeks) ablation success is by histopathology of a resection specimen. In our opinion this trial will provide essential knowledge on the safety and efficacy of IRE of renal masses, guiding future research of this promising ablative technique. Trial registration Clinicaltrials.gov registration number NCT02298608. Dutch Central Committee on Research Involving Human Subjects registration number NL44785.018.13
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Affiliation(s)
- Peter G K Wagstaff
- Department of Urology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - Daniel M de Bruin
- Department of Urology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands. .,Department of Biomedical Engineering & Physics, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - Patricia J Zondervan
- Department of Urology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - C Dilara Savci Heijink
- Department of Pathology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - Marc R W Engelbrecht
- Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - Otto M van Delden
- Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - Ton G van Leeuwen
- Department of Biomedical Engineering & Physics, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
| | - Hessel Wijkstra
- Department of Urology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands. .,Department of Electrical Engineering, Eindhoven University of Technology, Den Dolech 2, 5612 AZ, Eindhoven, Netherlands.
| | | | - M Pilar Laguna Pes
- Department of Urology, Academic Medical Center, Meibergdreef 9, 1105AZ, Amsterdam, Netherlands.
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117
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Cooper CJ, Teleb M, Dwivedi A, Rangel G, Sanchez LA, Laks S, Akle N, Nahleh Z. Comparative Outcome of Computed Tomography-guided Percutaneous Radiofrequency Ablation, Partial Nephrectomy or Radical Nephrectomy in the Treatment of Stage T1 Renal Cell Carcinoma. Rare Tumors 2015; 7:5583. [PMID: 25918603 PMCID: PMC4387349 DOI: 10.4081/rt.2015.5583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 10/13/2014] [Accepted: 10/23/2014] [Indexed: 12/21/2022] Open
Abstract
Renal cell carcinoma (RCC) accounts for 3% of all cancers in adults. The indications for Radiofrequency Ablation (RFA) for renal carcinomas include T1a (tumor 4 cm or less, limited to the kidney), elderly patients, renal impairment, comorbidities, poor surgical candidate, and multiple bilateral renal masses. We retrospectively reviewed medical records, specifically investigating the indications, complications and outcomes of RFA and nephrectomy for treatment of RCC in a tertiary medical center with a predominantly Hispanic patient population. Forty-nine patients with RCC were evaluated. Nine patients had RFA, 9 had partial nephrectomy and 31 had radical nephrectomy. All patients among the 3 groups had stage T1N0M0 RCC at diagnosis. Tumor recurrence was observed in 2 (22%) patients that had RFA, one (11%) patient that had partial nephrectomy and no patients that had radical nephrectomy. One patient had recurrence of the tumor at the opposite kidney pole from the initial RFA site 4 years later. This particular patient did not have any tumor recurrence at the site of the initial RFA. A second RFA was performed on the recurrent tumor with no recurrence upon subsequent follow up visits. The second patient had recurrence of the RCC on 1 year follow that was discovered to be sarcomatoid RCC, which is an aggressive type with a poor prognosis. Our results support the clinical utility of RFA in patients with stage T1 RCC who are poor surgical candidates or those with reduced renal function. The clinical utility of RFA as an equally effective approach when compared to partial nephrectomy in patients with stage T1 RCC that meet strict indications for the procedure. The treatment choice should be individualized and based on the characteristics of the renal tumor such as size, location and histological type of RCC. We conclude that RFA presents a safe treatment choice for patients with RCC if long term follow up is maintained.
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Affiliation(s)
- Chad J Cooper
- Department of Internal Medicine, Texas Tech University Health Sciences Center of El Paso , TX, USA
| | - Mohamed Teleb
- Department of Internal Medicine, Texas Tech University Health Sciences Center of El Paso , TX, USA
| | - Alok Dwivedi
- Department of Biomedical Sciences, Division of Biostatistics and Epidemiology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center of El Paso , TX, USA
| | - Gabriela Rangel
- Department of Internal Medicine, Texas Tech University Health Sciences Center of El Paso , TX, USA
| | - Luis A Sanchez
- Department of Biomedical Sciences, Division of Biostatistics and Epidemiology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center of El Paso , TX, USA
| | - Shaked Laks
- Department of Radiology, Texas Tech University Health Sciences Center of El Paso , TX, USA
| | - Nassim Akle
- Department of Radiology, Texas Tech University Health Sciences Center of El Paso , TX, USA
| | - Zeina Nahleh
- Department of Internal Medicine, Texas Tech University Health Sciences Center of El Paso , TX, USA
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Zhou L, Cao Y, Bian T, Xiang Z, Li Y, Guo J, Lin Z, Wang G, Wang H. Number of Renal Columns Invaded by Tumor: A Novel Parameter for Predicting Complexity and Outcomes of Off-Clamp Open Partial Nephrectomy. J Am Coll Surg 2015; 221:539-49.e1. [PMID: 26141471 DOI: 10.1016/j.jamcollsurg.2015.02.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The number of renal columns invaded by tumor (NRC) can determine the tumor complexity and perioperative outcomes of off-clamp open partial nephrectomy (OPN). We aimed to propose a novel and simple scoring system and examine the relationship between NRC and perioperative outcomes after off-clamp OPN. STUDY DESIGN We retrospectively evaluated 202 patients with contrast-enhanced CT imaging who underwent off-clamp OPN between January 2008 and November 2014. The number of renal columns invaded by tumor was correlated to baseline demographics and perioperative outcomes as a categorical variable using multivariable logistic regression analysis. RESULTS The mean tumor size was 2.5 cm (±1.3 cm). The number of renal columns invaded by tumor had the highest correlation coefficients with estimated blood loss (coefficient = 0.485; p < 0.001), operative time (coefficient = 0.310; p < 0.001), postoperative drainage (coefficient = 0.307; p < 0.001), and hospital length of stay (coefficient = 0.144; p = 0.041). Multivariable logistic regression demonstrated NRC to be an independent predictor of estimated blood loss ≥500 mL, postoperative renal function, operative time, and surgical complications. This predictive ability of NRC was superior to the R.E.N.A.L. (radius exophyic/endophytic nearness anterior/posterior location) score and PADUA (preoperative aspects and dimensions used for an anatomical) score. Spearman correlation coefficient of NRC calculations between the 2 observers was 0.941 (p < 0.001). CONCLUSIONS The number of renal columns invaded by tumor is a novel, intuitive, and practical parameter that could be used to quantify renal tumor complexity and predict the risk of perioperative outcomes after off-clamp OPN. Specifically, NRC correlates with estimated blood loss, operative time, surgical complications, renal function, and conversion to on-clamp. In the future, NRC can be integrated with other parameters, such as tumor location, to assemble a new scoring system.
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Affiliation(s)
- Lin Zhou
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yingli Cao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tingchang Bian
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhuoyi Xiang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yaohui Li
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianming Guo
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zongming Lin
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guomin Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hang Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.
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Rodríguez-Faba O, Palou J, Rosales A, de la Torre P, Martí J, Palazzetti A, Villavicencio H. Prospective study of ultrasound-guided percutaneous renal cryotherapy: case selection as an optimization factor for a technique. Actas Urol Esp 2015; 39:8-12. [PMID: 25124045 DOI: 10.1016/j.acuro.2014.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/05/2014] [Accepted: 03/31/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the technical and oncological effectiveness of ultrasound-guided percutaneous renal cryotherapy (PRC) in a selected group of patients with renal cancer. MATERIAL AND METHODS We conducted a prospective study of 28 patients with posterior-facing T1a renal tumors with middle and inferior external borders. All patients underwent ultrasound-guided PRC. Follow-up was conducted with computed tomography at 1 month and then every 6 months, with a good result defined as the total absence of contrast incorporation. We performed a descriptive and survival study using the Kaplan-Meier estimator. RESULTS The 28 patients had a mean age (SD) of 68.3 (10.1) years, and the group underwent 28 procedures. The mean (SD) size of the tumors was 25.5 (7.5) mm, the mean nephrometry score was 1.41 (0.52) and the mean preoperative creatinine level was 133.5 (144.1) mmol/L. There were no intraoperative complications. In terms of postoperative complications, there was only 1 case (3.5%) of a skin lesion resulting from treating a tumor in a transplanted kidney (Clavien II). The median follow-up was 25 months, and the mean (SD) postoperative creatinine level was 135.5 (110.3) mmol/L. Two cases presented radiological recurrence (93% efficacy), with a mean time to recurrence of 12 and 19 months, respectively. There were no tumor-related deaths. CONCLUSIONS Our series (the largest on PRC in our country to date) shows that, with an appropriate selection of tumors, PRC is a safe technique with minimal morbidity. Ultrasonography enables the controlled performance of the procedure and saves the patient from radiation and reduces costs.
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Rodríguez-Faba O, Palou J, Rosales A, de la Torre P, Martí J, Palazzetti A, Villavicencio H. Prospective study of ultrasound-guided percutaneous renal cryotherapy: Case selection as an optimization factor for a technique. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.acuroe.2014.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Devereux T, Pham D, Kron T, Foroudi F, Supple J, Siva S. A planning study investigating dual-gated volumetric arc stereotactic treatment of primary renal cell carcinoma. Med Dosim 2014; 40:82-8. [PMID: 25498837 DOI: 10.1016/j.meddos.2014.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/27/2014] [Accepted: 11/04/2014] [Indexed: 12/25/2022]
Abstract
This is a planning study investigating the dosimetric advantages of gated volumetric-modulated arc therapy (VMAT) to the end-exhale and end-inhale breathing phases for patients undergoing stereotactic treatment of primary renal cell carcinoma. VMAT plans were developed from the end-inhale (VMATinh) and the end-exhale (VMATexh) phases of the breathing cycle as well as a VMAT plan and 3-dimensional conformal radiation therapy plan based on an internal target volume (ITV) (VMATitv). An additional VMAT plan was created by giving the respective gated VMAT plan a 50% weighting and summing the inhale and exhale plans together to create a summed gated plan. Dose to organs at risk (OARs) as well as comparison of intermediate and low-dose conformity was evaluated. There was no difference in the volume of healthy tissue receiving the prescribed dose for the planned target volume (PTV) (CI100%) for all the VMAT plans; however, the mean volume of healthy tissue receiving 50% of the prescribed dose for the PTV (CI50%) values were 4.7 (± 0.2), 4.6 (± 0.2), and 4.7 (± 0.6) for the VMATitv, VMATinh, and VMATexh plans, respectively. The VMAT plans based on the exhale and inhale breathing phases showed a 4.8% and 2.4% reduction in dose to 30cm(3) of the small bowel, respectively, compared with that of the ITV-based VMAT plan. The summed gated VMAT plans showed a 6.2% reduction in dose to 30cm(3) of the small bowel compared with that of the VMAT plans based on the ITV. Additionally, when compared with the inhale and the exhale VMAT plans, a 4% and 1.5%, respectively, reduction was observed. Gating VMAT was able to reduce the amount of prescribed, intermediate, and integral dose to healthy tissue when compared with VMAT plans based on an ITV. When summing the inhale and exhale plans together, dose to healthy tissue and OARs was optimized. However, gating VMAT plans would take longer to treat and is a factor that needs to be considered.
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Affiliation(s)
- Thomas Devereux
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Daniel Pham
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Melbourne, Australia
| | - Farshad Foroudi
- Sir Peter MacCallum Department of Oncology, Melbourne University, Melbourne, Australia; Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jeremy Supple
- School of Applied Sciences, Royal Melbourne Institute of Technology, Melbourne, Australia
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, Melbourne University, Melbourne, Australia; Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
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Okhunov Z, Juncal S, Ordon M, George AK, Lusch A, del Junco M, Nguyentat M, Lobko II, Kavoussi L, Landman J. Comparison of outcomes in patients undergoing percutaneous renal cryoablation with sedation vs general anesthesia. Urology 2014; 85:130-4. [PMID: 25440762 DOI: 10.1016/j.urology.2014.09.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/30/2014] [Accepted: 09/16/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of local anesthesia with conscious sedation (LACS) with general anesthesia (GA) in patients undergoing percutaneous renal cryoablation (PRC) for renal cortical neoplasms. METHODS We performed a retrospective review of patients undergoing PRC between 2003 and 2013. Patient demographics, tumor characteristics, and perioperative and postoperative follow-up data were recorded and analyzed. We compared 3 principal outcomes across the GA and LACS groups: anesthesia-related outcomes, treatment failure, and complications. RESULTS A total of 235 patients with available data were included. Of these, 82 underwent PRC under GA and 153 patients under LACS. The 2 groups were similar with regard to age, gender, body mass index, American Society of Anesthesiologists score, tumor features, preoperative serum creatinine level, and hematocrit value. The GA and LACS groups had a similar percentage of patients with biopsy-proven renal cell carcinoma (68.5% and 64.2%, respectively; P = .62). The mean follow-up time for GA and LACS was 37 and 21 months, respectively (P <.0001). The mean procedure time for GA was significantly longer compared with LACS (133 vs 102 minutes; P <.001), and the mean hospital stay was shorter under LACS (1.08 vs 1.95 days; P <.0001). There was no difference in immediate failure (0% and 1.9%; P = .051) or recurrences (11% and 3.9%, respectively; P = .051) between GA and LACS groups. There was no difference in intraoperative and postoperative treatment-related complications between the 2 groups. CONCLUSION PRC for small renal masses under LACS is effective and safe. PRC with LACS has the advantage of decreased procedure time and a shorter hospital stay.
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Affiliation(s)
- Zhamshid Okhunov
- Department of Urology, University of California, Irvine, Orange, CA
| | - Samuel Juncal
- Department of Urology, University of California, Irvine, Orange, CA
| | - Michael Ordon
- Department of Urology, University of California, Irvine, Orange, CA
| | - Arvin K George
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY
| | - Achim Lusch
- Department of Urology, University of California, Irvine, Orange, CA
| | | | | | - Igor I Lobko
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY
| | - Louis Kavoussi
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, CA.
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Mo CQ, Yu Z, Tan WL, Mao XP, Chen X, Liu JC, Qiu SP. Comparison between laparoscopic partial nephrectomy and laparoscopic ablation therapy: a meta-analysis. MINIM INVASIV THER 2014; 23:317-25. [PMID: 25180534 DOI: 10.3109/13645706.2014.925930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To conduct a meta-analysis of the literature evaluating comparisons on the peri-operative and oncological outcomes between laparoscopic partial nephrectomy (LPN) and laparoscopic ablation therapy (LAT) in the treatment of small renal masses (SRMs). MATERIAL AND METHODS MEDLINE, EMBASE, Google Scholar, Cochrane Library, and CNKI were searched for clinical trials comparing LPN with LAT. Data of peri-operative and follow-up outcomes were extracted and compared. Publication bias was identified and sensitivity analysis was also performed. RESULTS Data from 11 studies including 928 patients (525 patients in the LPN group and 403 in the LAT group) were collected. Baseline characteristics were compared and differences were found in age, preoperative renal function and proportion of solitary kidney (p < 0.05 respectively). For peri-operative outcomes, the LPN group had greater estimated blood loss, longer operative duration and length of hospital stay, and more peri-operative complications (p < 0.05, respectively). The LAT group had a significantly higher local recurrence (p < 0.05). There was no significant difference in postoperative change of renal function (p = 0.21). CONCLUSION In comparison with LPN, LAT provides better peri-operative outcomes, but a higher local recurrence rate. LAT does not seem to provide an obvious advantage in protecting renal function. Further clinical trials with randomized design and long-term follow-up are needed.
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Affiliation(s)
- Cheng-Qiang Mo
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
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Valsechi MC, Oliveira ABB, Conceição ALG, Stuqui B, Candido NM, Provazzi PJS, de Araújo LF, Silva WA, Calmon MDF, Rahal P. GPC3 reduces cell proliferation in renal carcinoma cell lines. BMC Cancer 2014; 14:631. [PMID: 25168166 PMCID: PMC4161903 DOI: 10.1186/1471-2407-14-631] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 08/21/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Glypican 3 (GPC3) is a member of the family of glypican heparan sulfate proteoglycans (HSPGs). The GPC3 gene may play a role in controlling cell migration, negatively regulating cell growth and inducing apoptosis. GPC3 is downregulated in several cancers, which can result in uncontrolled cell growth and can also contribute to the malignant phenotype of some tumors. The purpose of this study was to analyze the mechanism of action of the GPC3 gene in clear cell renal cell carcinoma. METHODS Five clear cell renal cell carcinoma cell lines and carcinoma samples were used to analyze GPC3 mRNA expression (qRT-PCR). Then, representative cell lines, one primary renal carcinoma (786-O) and one metastatic renal carcinoma (ACHN), were chosen to carry out functional studies. We constructed a GPC3 expression vector and transfected the renal carcinoma cell lines, 786-O and ACHN. GPC3 overexpression was analyzed using qRT-PCR and immunocytochemistry. We evaluated cell proliferation using MTT and colony formation assays. Flow cytometry was used to evaluate apoptosis and perform cell cycle analyses. RESULTS We observed that GPC3 is downregulated in clear cell renal cell carcinoma samples and cell lines compared with normal renal samples. GPC3 mRNA expression and protein levels in 786-O and ACHN cell lines increased after transfection with the GPC3 expression construct, and the cell proliferation rate decreased in both cell lines following overexpression of GPC3. Further, apoptosis was not induced in the renal cell carcinoma cell lines overexpressing GPC3, and there was an increase in the cell population during the G1 phase in the cell cycle. CONCLUSION We suggest that the GPC3 gene reduces the rate of cell proliferation through cell cycle arrest during the G1 phase in renal cell carcinoma.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Paula Rahal
- Department of Biology, Instituto de Biociências, Letras e Ciências Exatas - IBILCE/UNESP, Rua Cristóvão Colombo, 2265, 15054-000 São José do Rio Preto, SP, Brazil.
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125
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Tomaszewski JJ, Smaldone MC, Uzzo RG, Kutikov A. Is radical nephrectomy a legitimate therapeutic option in patients with renal masses amenable to nephron-sparing surgery? BJU Int 2014; 115:357-63. [PMID: 25195528 DOI: 10.1111/bju.12696] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The decision to perform a radical nephrectomy (RN) or a partial nephrectomy (PN), not unlike most decisions in clinical practice, ultimately hinges on the balance of risk. Do the higher risks of a more complex surgery (PN) justify the theoretical benefits of kidney tissue preservation? Data suggest that for patients with an anatomically complex renal mass and a normal contralateral kidney, for whom additional surgical intensity may be risky, such as the elderly and comorbid, RN presents a robust treatment option. Nevertheless, PN, especially for small and anatomically simple renal masses in young patients without comorbidities should remain the surgical reference standard, as preservation of renal tissue can serve as an 'insurance policy' not only against future renal functional decline, but also against the possibility of tumour development in the contralateral kidney. In the present review, we outline the ongoing debate between the role of RN and PN in treatment of the enhancing renal mass.
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Affiliation(s)
- Jeffrey J Tomaszewski
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
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Rendon RA, Kapoor A, Breau R, Leveridge M, Feifer A, Black PC, So A. Surgical management of renal cell carcinoma: Canadian Kidney Cancer Forum Consensus. Can Urol Assoc J 2014; 8:E398-412. [PMID: 25024794 DOI: 10.5489/cuaj.1894] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Anil Kapoor
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON
| | - Rodney Breau
- Division of Urology, University of Ottawa, Ottawa, ON
| | - Michael Leveridge
- Departments of Urology and Oncology, Queen's University, Kingston, ON
| | | | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
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Xu L, Yang R, Wang W, Zhang Y, Gan W. Laparoscopic radiofrequency ablation-assisted enucleation of Xp11.2 translocation renal cell carcinoma: A case report. Oncol Lett 2014; 8:1237-1239. [PMID: 25120696 PMCID: PMC4114629 DOI: 10.3892/ol.2014.2267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 06/05/2014] [Indexed: 12/17/2022] Open
Abstract
The current study presents a case of Xp11.2 translocation renal cell carcinoma (Xp11.2 RCC) in a 30-year-old female. The patient was referred to The Affiliated Drum Tower Hospital of the Medical College of Nanjing University (Nanjing, Jiangsu, China) due to a right renal tumor without evident symptoms, which was found by a routine physical examination. A computed tomography (CT) scan indicated that the mass exhibited cystic and solid components. The patient underwent laparoscopic radiofrequency ablation-assisted enucleation. Immunohistochemistry revealed intense nuclear staining for transcription factor E3 protein in the cancer cells. The patient was diagnosed with Xp11.2 RCC. The urological and radiological outcomes remained satisfactory after >2.5 years of follow-up.
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Affiliation(s)
- Linfeng Xu
- Department of Urology, The Affiliated Drum Tower Hospital of the Medical College of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Rong Yang
- Department of Urology, The Affiliated Drum Tower Hospital of the Medical College of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Wei Wang
- Department of Urology, The Affiliated Drum Tower Hospital of the Medical College of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Yifen Zhang
- Department of Urology, The Affiliated Drum Tower Hospital of the Medical College of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Weidong Gan
- Department of Urology, The Affiliated Drum Tower Hospital of the Medical College of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
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Romao RLP, Weber B, Gerstle JT, Grant R, Pippi Salle JL, Bägli DJ, Figueroa VH, Braga LHP, Farhat WA, Koyle MA, Lorenzo AJ. Comparison between laparoscopic and open radical nephrectomy for the treatment of primary renal tumors in children: single-center experience over a 5-year period. J Pediatr Urol 2014; 10:488-94. [PMID: 24331167 DOI: 10.1016/j.jpurol.2013.11.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 11/01/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare the outcomes of laparoscopic nephrectomy (LN) with open radical nephrectomy (ORN) in the management of consecutive pediatric neoplasms. PATIENTS AND METHODS Retrospective cohort study of consecutive children treated for primary renal tumors between 2006 and 2011, segregated based on surgical modality (LN/ORN). Pre-, intra- and postoperative data and outcomes were collected. RESULTS Demographics from the 45 patients (13 LN, 32 ORN) were similar, and tumors in the LN group were smaller [6.59 ± 1.8 cm vs. 10.99 ± 2.99 cm ORN (p < 0.05)]. Six patients had preoperative chemotherapy (two LN, four ORN). No tumor ruptures occurred with either technique. Wilms tumor (seven LN, 24 ORN) was the most common diagnosis, followed by renal cell carcinoma (four LN, four ORN). Procedure length was similar between groups (282 ± 79 LN, 263 ± 81 min ORN). Mean length of stay was significantly shorter for LN (2.9 vs. 5.9 days; p = 0.002). Postoperative narcotic requirements and use of nasogastric tube were higher in the ORN group. After a median follow-up of 18 (LN) and 33 months (ORN), 1 and 4 recurrences occurred, respectively. CONCLUSIONS LN is an attractive alternative to open surgery in carefully selected cases of pediatric renal tumors. Procedure length and incidence of intra-operative rupture were not increased, while post-operative recovery and hospital stay were shorter for LN. Longer follow-up is mandatory to confirm comparable oncological outcomes to ORN.
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Affiliation(s)
- R L P Romao
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Divisions of Urology and General Surgery, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - B Weber
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Division of Urology, Alberta Children's Hospital, University of Alberta, Calgary, AB, Canada
| | - J T Gerstle
- Division of General and Thoracic Surgery, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - R Grant
- Department of Pediatrics, Division of Oncology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - J L Pippi Salle
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - D J Bägli
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - V H Figueroa
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - L H P Braga
- Division of Urology, McMaster Children's Hospital and McMaster University, Hamilton, ON, Canada
| | - W A Farhat
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - M A Koyle
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - A J Lorenzo
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
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Robot-assisted Partial Nephrectomy in Patients with Baseline Chronic Kidney Disease: A Multi-institutional Propensity Score–Matched Analysis. Eur Urol 2014; 65:1205-10. [DOI: 10.1016/j.eururo.2013.12.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/04/2013] [Indexed: 11/20/2022]
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130
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Sevcenco S, Heinz-Peer G, Ponhold L, Javor D, Kuehhas F, Klingler H, Remzi M, Weibl P, Shariat S, Baltzer P. Utility and limitations of 3-Tesla diffusion-weighted magnetic resonance imaging for differentiation of renal tumors. Eur J Radiol 2014; 83:909-913. [DOI: 10.1016/j.ejrad.2014.02.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 02/21/2014] [Accepted: 02/27/2014] [Indexed: 01/25/2023]
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Roos FC, Steffens S, Junker K, Janssen M, Becker F, Wegener G, Brenner W, Steinestel J, Schnoeller TJ, Schrader M, Hofmann R, Thüroff JW, Kuczyk MA, Wunderlich H, Siemer S, Hartmann A, Stöckle M, Schrader AJ. Survival advantage of partial over radical nephrectomy in patients presenting with localized renal cell carcinoma. BMC Cancer 2014; 14:372. [PMID: 24885955 PMCID: PMC4038042 DOI: 10.1186/1471-2407-14-372] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/16/2014] [Indexed: 01/11/2023] Open
Abstract
Background Partial nephrectomy (PN) preserves renal function and has become the standard approach for T1a renal cell carcinoma (RCC). However, there is still an ongoing debate as to which patients will actually derive greater benefit from partial than from radical nephrectomy (RN). The aim of this study was to retrospectively evaluate the impact of the type of surgery on overall survival (OS) in patients with localized RCC. Methods Renal surgery was performed in 4326 patients with localized RCC (pT ≤ 3a N/M0) at six German tertiary care centers from 1980 to 2010: RN in 2955 cases (68.3%), elective (ePN) in 1108 (25.6%), and imperative partial nephrectomy (iPN) in 263 (6.1%) cases. The median follow-up for all patients was 63 months. Kaplan-Meier and Cox regression analyses were carried out to identify prognosticators for OS. Results PN was performed significantly more often than RN in patients presenting with lower tumor stages, higher RCC differentiation, and non-clear cell histology. Accordingly, the calculated 5 (10)-year OS rates were 90.0 (74.6)% for ePN, 83.9 (57.5)% for iPN, and 81.2 (64.7)% for RN (p < 0.001). However, multivariate analysis including age, sex, tumor diameter and differentiation, histological subtype, and the year of surgery showed that ePN compared to RN still qualified as an independent factor for improved OS (HR 0.79, 95% CI 0.66-0.94, p = 0.008). Conclusion Even allowing for the weaknesses of this retrospective analysis, our multicenter study indicates that in patients with localized RCC, PN appears to be associated with better OS than RN irrespective of age or tumor size.
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Affiliation(s)
| | - Sandra Steffens
- Department of Urology and Urological Oncology, Medical School Hannover, Hannover D-30625, Germany.
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132
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Tietze S, Herms M, Behrendt W, Krause J, Hamza A. [Controversies of partial nephrectomy for renal cell carcinoma : survey in the German-speaking countries]. Urologe A 2014; 53:1181-5. [PMID: 24824467 DOI: 10.1007/s00120-014-3469-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The goal of this study was to evaluate how partial nephrectomy is technically performed in Germany, Austria, and Switzerland. METHODS A one-page anonymous questionnaire was designed to evaluate the indication, the technical procedure, and the follow-up of R1 situation after partial nephrectomy. Furthermore, the size of the hospitals and their catchment areas were recorded. The questionnaire was sent to 341 clinics and a statistical analysis was performed. RESULTS The response rate was 69 %. Up to 99 % of the clinics also perform partial resection in T1b tumors. Of those responding, 58 % perform this surgery laparoscopically, and 83 % of the surgeries are performed in warm ischemia. For the follow-up, 29 % suggest imaging within the first 6 weeks. According to this survey, maximum care clinics perform laparoscopic nephrectomy more frequently (p = 0.003). CONCLUSION The survey of 236 hospitals performing partial nephrectomy shows great variability in the indication, technique, and aftercare of organ-preserving renal tumor surgery. It also shows that a large proportion of tumors >4 cm undergo organ-preserving surgery, many of them minimally invasive. The diverse handling with positive instantaneous section and R1 results suggest the need for further studies concerning long-term follow-up after minimally invasive surgery with R1 situation and renal tumors > T1a.
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Affiliation(s)
- S Tietze
- Klinik für Urologie und Andrologie, Klinikum St. Georg gGmbH, Delitzscher Straße 141, 04129, Leipzig, Deutschland,
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133
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Comparison of Laparoscopic and Percutaneous Cryoablation for Treatment of Renal Masses. Urology 2014; 83:1081-7. [DOI: 10.1016/j.urology.2013.10.081] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/30/2013] [Accepted: 10/26/2013] [Indexed: 11/23/2022]
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134
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Kroeger N, Seligson DB, Signoretti S, Yu H, Magyar CE, Huang J, Belldegrun AS, Pantuck AJ. Poor prognosis and advanced clinicopathological features of clear cell renal cell carcinoma (ccRCC) are associated with cytoplasmic subcellular localisation of Hypoxia inducible factor-2α. Eur J Cancer 2014; 50:1531-40. [DOI: 10.1016/j.ejca.2014.01.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/19/2013] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
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135
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Klatte T, Kroeger N, Zimmermann U, Burchardt M, Belldegrun AS, Pantuck AJ. The contemporary role of ablative treatment approaches in the management of renal cell carcinoma (RCC): focus on radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation. World J Urol 2014; 32:597-605. [PMID: 24700308 DOI: 10.1007/s00345-014-1284-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/17/2014] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Currently, most of renal tumors are small, low grade, with a slow growth rate, a low metastatic potential, and with up to 30 % of these tumors being benign on the final pathology. Moreover, they are often diagnosed in elderly patients with preexisting medical comorbidities in whom the underlying medical conditions may pose a greater risk of death than the small renal mass. Concerns regarding overdiagnosis and overtreatment of patients with indolent small renal tumors have led to an increasing interest in minimally invasive, ablative as an alternative to extirpative interventions for selected patients. OBJECTIVE To provide an overview about the state of the art in radiofrequency ablation (RFA), high-intensity focused ultrasound, and cryoablation in the clinical management of renal cell carcinoma. METHODS A PubMed wide the literature search of was conducted. RESULTS International consensus panels recommend ablative techniques in patients who are unfit for surgery, who are not considered candidates for or elect against elective surveillance, and who have small renal masses. The most often used techniques are cryoablation and RFA. These ablative techniques offer potentially curative outcomes while conferring several advantages over extirpative surgery, including improved patient procedural tolerance, faster recovery, preservation of renal function, and reduction in the risk of intraoperative and postsurgical complications. While it is likely that outcomes associated with ablative modalities will improve with further advances in technology, their application will expand to more elective indications as longer-term efficacy data become available. CONCLUSION Ablative techniques pose a valid treatment option in selected patients.
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Affiliation(s)
- Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna, Austria
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136
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Laguna MP, Algaba F, Cadeddu J, Clayman R, Gill I, Gueglio G, Hohenfellner M, Joyce A, Landman J, Lee B, van Poppel H. Current patterns of presentation and treatment of renal masses: a clinical research office of the endourological society prospective study. J Endourol 2014; 28:861-70. [PMID: 24555480 DOI: 10.1089/end.2013.0724] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To assess epidemiologic characteristics, clinical and pathologic patterns of presentation, and treatment strategies in a contemporary population with renal masses (RMs). METHODS The Clinical Research Office of the Endourological Society collected prospective epidemiologic, clinical, and pathologic data on consecutive patients with RMs who were treated during a 1-year period in 98 centers worldwide. Preoperative assessment and treatment were performed according to local clinical practice guidelines. RESULTS From January 2010 to February 2012, 4288 patients (4355 cases, 4815 tumors) were treated for a RM. The mean age of the cohort was 61.5 years, and the ratio male:female 1.8:1. Caucasians represented 75% of the population, and the median body mass index was 27. The cohort exhibited a high rate of comorbidity (65.6%), including a 48.5% rate of hypertension; one-third of patients had a combination of two or more comorbidities. One-third of patients (36%) had risk factors for renal-cell carcinoma (RCC), of which smoking and obesity were the most common. Diagnosis was incidental in 67% of cases, and 22.2% of cases had chronic kidney disease stage ≥III at presentation. Median radiologic size was 44 mm (range 2-300 mm) and 68% were cT1. Radical nephrectomy and nephron-sparing surgery (NSS) including ablation were performed in 52% and 46% of cases, respectively, while 3.6% of cases were actively surveyed. Median pathologic size was 43 mm (range 2-300 mm) and 63% of the RCCs were pT1. CONCLUSIONS Current patterns of presentation of RMs are consistent with the decreasing trends in age and clinical or pathologic size and increasing incidental diagnosis. Patients exhibit a considerable basal comorbidity and presence of risk factors for RCC. Half of the cases are treated by a nephron-sparing modality with an increase in the penetration of NSS techniques in the contemporary urologic practice.
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Affiliation(s)
- M Pilar Laguna
- 1 Department of Urology, AMC University of Amsterdam , Amsterdam, The Netherlands
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137
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Youssef FR, Smith DJ, Oakley NE. Laparoscopic and open partial nephrectomy: a UK centre's experience. JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415813495678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Laparoscopy allows minimally invasive approaches for procedures traditionally performed openly, with associated lower morbidity. Nephron-sparing surgery (NSS) is mostly regarded as an open procedure because laparoscopic partial nephrectomy (LPN) is technically challenging. We evaluated our centre's experience with LPN and open partial nephrectomy (OPN). Methods All patients over five years (2005–2010) undergoing NSS were identified retrospectively from our operating room management information system. Case notes, diagnostic and post-operative surveillance imaging were reviewed. Post-operative morbidity, histopathology and serum full blood count and urea and electrolyte reports were recorded. Results A total of 97 OPNs and 23 LPNs were performed. Median length of stay was six days for OPNs and three days for LPNs (p= 0.005). Mean drop in haemoglobin (Hb) was 2.6 g/dl for both OPNs and LPNs. No significant difference in transfusion rates was observed. Median warm ischaemia time (WIT) for OPNs was 14 minutes and 32 minutes for LPNs (p < 0.0001). No significant difference was seen in changes from baseline serum creatinine when comparing OPNs with LPNs at day 1 (p = 0.7572) and at 12 months (p = 0.7406) post-operatively. Surgical margins were positive in 20 (21.5%) OPNs and negative in all LPNs (p = 0.038). One patient developed local recurrence following OPN (clear margins) and two patients developed distant metastases. Conclusions Benefits of LPN include shorter hospital stay and satisfactory long-term preservation of renal function, despite longer WITs. This demonstrates the benefits of LPNs in patients with single exophytic renal tumours performed by highly experienced, regionally selected laparoscopists.
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Affiliation(s)
- FR Youssef
- Department of Urology, Royal Hallamshire Hospital, UK
| | - DJ Smith
- Department of Urology, Royal Hallamshire Hospital, UK
| | - NE Oakley
- Department of Urology, Royal Hallamshire Hospital, UK
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Do we need to clamp the renal hilum liberally during the initial phase of the learning curve of robot-assisted nephron-sparing surgery? ScientificWorldJournal 2014; 2014:498917. [PMID: 24688393 PMCID: PMC3944210 DOI: 10.1155/2014/498917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/02/2014] [Indexed: 01/20/2023] Open
Abstract
Objective. We aimed to compare the results of our initial robot-assisted nephron-sparing surgeries (RANSS) performed with or without hilar clamping. Material and Method. Charts of the initial RANSSs (n = 44), which were performed by a single surgeon, were retrospectively reviewed. R.E.N.A.L. nephrometry system, modified Clavien classification, and M.D.R.D. equation were used to record tumoral complexity, complications, and estimated glomerular filtration rate (eGFR), respectively. Outcomes of the clamped (group 1, n = 14) versus off-clamp (group 2, n = 30) RANSSs were compared. Results. The difference between the two groups was insignificant regarding mean patient age, mean tumor size, and mean R.E.N.A.L. nephrometry score. Mean operative time, mean estimated blood loss amount, and mean length of hospitalization were similar between groups. A total of 4 patients in each group suffered 11 Clavien grade ≥2 complications early postoperatively. Open conversion rates were similar. The difference between the 2 groups in terms of the mean postoperative change in eGFR was insignificant. We did not encounter any local recurrence after a mean follow-up of 18.9 months. Conclusions. Creating warm-ischemic conditions during RANSS should not be a liberal decision, even in the initial phases of the learning curve for a highly experienced open surgeon.
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Yang R, Lian H, Zhang G, Wang W, Gan W, Li X, Yan X, Zhang S, Zhao X, Guo H. Laparoscopic Radiofrequency Ablation with Intraoperative Contrast-Enhanced Ultrasonography for T1bN0M0 Renal Tumors: Initial Functional and Oncologic Outcomes. J Endourol 2014; 28:4-9. [PMID: 23998802 DOI: 10.1089/end.2013.0397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Rong Yang
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Huibo Lian
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Gutian Zhang
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Wei Wang
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Weidong Gan
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Xiaogong Li
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Xiang Yan
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Shiwei Zhang
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Xiaozhi Zhao
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Hongqian Guo
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
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Small renal cell carcinomas--how dangerous are they really? Results of a large multicenter study. Eur J Cancer 2013; 50:739-45. [PMID: 24321262 DOI: 10.1016/j.ejca.2013.11.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 10/27/2013] [Accepted: 11/19/2013] [Indexed: 12/18/2022]
Abstract
AIM OF THE STUDY Modern diagnostic ultrasound and cross-sectional imaging has enabled the detection of increasing numbers of renal tumours. The aim of this study was to investigate the tumour- and patient-specific characteristics and prognosis of small renal cell carcinomas (RCCs) after surgical resection. METHODS The study included 2197 patients who underwent surgical resection of histologically confirmed RCC ⩽ 4 cm between 1990 and 2011. Median (mean) follow-up was 56.2 (65.5) months. RESULTS At the time of surgery, tumours were staged as pT ⩾ 3a in 175 (8.0%) cases, 134 (6.2%) were poorly differentiated and 75 (3.5%) were metastasised. The larger the tumour size, the higher was the risk of presenting with stage pT ⩾ 3a (p<0.001), poor tumour differentiation (p = 0.004), microscopic vascular involvement (p = 0.001) and collecting system invasion (p = 0.03). The 5-year cancer-specific survival (CSS) rate was 93.8% for stage pT1a versus 79.4% for stage pT ⩾ 3a (p<0.001), and it was 93.7% for G1-2 versus 76.8% for G3-4 differentiation (p<0.001). Multivariate analysis identified age in years (hazard ratio (HR) 1.04, p<0.001), metastatic disease (HR 12.5, p < 0.001), tumour differentiation (HR 2.8, p<0.001) and non-clear cell histology (HR 0.51, p = 0.02) as independent prognosticators for CSS in patients with small RCC. Interestingly, the 5-year cancer-specific mortality rate for pT1a N/M0 patients was 5.8%. CONCLUSIONS This large multicenter study has clearly shown that, though most small RCC have a low pathological stage and a good prognosis, there is also a small but significant subgroup of these tumours that are already locally advanced or poorly differentiated.
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141
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Kaczmarek BF, Tanagho YS, Hillyer SP, Mullins JK, Diaz M, Trinh QD, Bhayani SB, Allaf ME, Stifelman MD, Kaouk JH, Rogers CG. Off-clamp Robot-assisted Partial Nephrectomy Preserves Renal Function: A Multi-institutional Propensity Score Analysis. Eur Urol 2013; 64:988-93. [DOI: 10.1016/j.eururo.2012.10.009] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 10/08/2012] [Indexed: 11/27/2022]
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142
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Shin TY, Kim J, Koo KC, Lim SK, Kim DW, Kang MW, Rha KH, Choi YD, Ham WS. Assessing the anatomical characteristics of renal masses has a limited effect on the prediction of pathological outcomes in solid, enhancing, small renal masses: results using the PADUA classification system. BJU Int 2013; 113:754-61. [DOI: 10.1111/bju.12446] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Tae Young Shin
- Department of Urology; Hallym University College of Medicine; Chuncheon Korea
| | - Jongchan Kim
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Kyo Chul Koo
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Sey Kiat Lim
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Dong Wook Kim
- Department of Urology; Hallym University College of Medicine; Chuncheon Korea
| | - Min Woong Kang
- Biostatistics Collaboration Unit; Yonsei University College of Medicine; Seoul Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Young Deuk Choi
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Won Sik Ham
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
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143
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Branger N, Maurin C, Daniel L, André M, Coulange C, Vacher-Coponnat H, Lechevallier E. [Treatment by radiofrequency ablation for a renin-secreting juxtaglomerular tumour: a case report]. Prog Urol 2013; 24:349-52. [PMID: 24821557 DOI: 10.1016/j.purol.2013.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 09/29/2013] [Accepted: 10/01/2013] [Indexed: 11/26/2022]
Abstract
Juxtaglomerular cell tumors are rare and benign tumors, occurring in young patients. The standard treatment is partial nephrectomy. We report the case of a young 22-year-old patient with a renin-secreting tumor diagnosed during an exploration of severe hypertension associated with hypokalemia that we treated by radiofrequency ablation.
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Affiliation(s)
- N Branger
- Service d'urologie, CHU Conception, Assistance Publique des hôpitaux de Marseille, 147, boulevard Baille, 13385 Marseille cedex 5, France.
| | - C Maurin
- Service d'urologie, CHU Conception, Assistance Publique des hôpitaux de Marseille, 147, boulevard Baille, 13385 Marseille cedex 5, France
| | - L Daniel
- Service d'anatomie pathologique, CHU Timone, Assistance Publique des hôpitaux de Marseille, 13005 Marseille, France
| | - M André
- Service de radiologie, CHU Conception, Assistance Publique des hôpitaux de Marseille, 13005 Marseille, France
| | - C Coulange
- Service d'urologie, CHU Conception, Assistance Publique des hôpitaux de Marseille, 147, boulevard Baille, 13385 Marseille cedex 5, France
| | - H Vacher-Coponnat
- Service de néphrologie, CHU Conception, Assistance Publique des hôpitaux de Marseille, 13005 Marseille, France
| | - E Lechevallier
- Service d'urologie, CHU Conception, Assistance Publique des hôpitaux de Marseille, 147, boulevard Baille, 13385 Marseille cedex 5, France
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144
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Kim SH, Lee SE, Hong SK, Jeong CW, Park YH, Kim YJ, Kang SH, Hong SH, Choi WS, Byun SS. Incidence and risk factors of chronic kidney disease in korean patients with t1a renal cell carcinoma before and after radical or partial nephrectomy. Jpn J Clin Oncol 2013; 43:1243-8. [PMID: 24198287 DOI: 10.1093/jjco/hyt149] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of the study was to investigate the incidence of chronic kidney disease in patients with T1a renal cell carcinoma both before and after partial or radical nephrectomy, and to assess risk factors for chronic kidney disease. METHODS From January 2001 to December 2011, 1928 patients with a single renal mass ≤4 cm undergoing partial nephrectomy or radical nephrectomy with the existence of a normal contralateral kidney were retrospectively reviewed for the evaluation of preoperative chronic kidney disease, and reviewed only 1676 patients for the postoperative chronic kidney disease. The estimated glomerular filtration rates were used to define chronic kidney disease <60 ml/min/1.73 m(2) by the Modification of Diet in Renal Disease equation. Demographics and clinicopathological parameters were evaluated to determine the risk factors with the development of chronic kidney disease both before and after surgery. RESULTS Chronic kidney disease was found preoperatively in 10.0% (n = 192) of patients; 16.1% (n = 269) of patients developed chronic kidney disease postoperatively, including 102 (6.1%) chronic kidney disease patients >65 years of age. Between the non-chronic kidney disease and chronic kidney disease patients, male gender (odds ratio 3.55 vs. 3.78, respectively) and diagnostic age (odds ratio 1.04 vs. 1.05) were significantly distinctive common risk factors for chronic kidney disease both before and after surgery (P < 0.002). In addition, hypertension (odds ratio 0.46), serum albumin (odds ratio 0.23) and calcium (odds ratio 2.06) were significant as preoperative risk factors (P < 0.015), and preoperative serum creatinine (odds ratio 1.90) and surgical type (partial nephrectomy or radical nephrectomy; odds ratio 11.89) were significant as postoperative risk factors (P < 0.030). CONCLUSIONS Old, male hypertensive patients with a small renal mass would be better candidates for partial nephrectomy to prevent postoperative chronic kidney disease.
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Affiliation(s)
- Sung Han Kim
- *Department of Urology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 463-707, Korea.
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145
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Theodore JE, Paterdis J. Malrotated kidney as a complication of partial nephrectomy. ANZ J Surg 2013; 85:287-9. [PMID: 24165008 DOI: 10.1111/ans.12420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jane E Theodore
- Department of Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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146
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Arnold ML, Thiel DD, Diehl N, Wu KJ, Ames S, Parker AS. Comparison of baseline quality of life measures between renal cell carcinoma patients undergoing partial versus radical nephrectomy. BMC Urol 2013; 13:52. [PMID: 24148752 PMCID: PMC3816591 DOI: 10.1186/1471-2490-13-52] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/11/2013] [Indexed: 11/10/2022] Open
Abstract
Background To compare demographics, pathologic features, performance scores, comorbidities, symptoms and responses to quality of life (QoL) surveys between nephron-sparing surgery (NSS) and radical nephrectomy (RN) patients prior to surgical intervention. Previous investigators have compared QoL outcomes for patients undergoing RN and NSS; however, there are limited data comparing QoL-related characteristics at baseline between these groups. Methods We identified 144 patients with localized RCC who underwent either NSS (n = 71) or RN (n = 73) between May ‘07-November ‘12. We abstracted baseline data on demographic and clinic-pathologic variables as well as responses to the SF-36 and FACT-G surveys from our prospective registry. We amended the FACT-G with 8 additional questions designed to address RCC-specific QoL. For comparisons between the two groups, we employed Wilcoxon rank-sum and Fisher's Exact tests where appropriate. Results We observed RN patients to have more aggressive pathology. We noted no difference in performance scores between the two groups; however, RN patients were more likely to have higher Charlson scores (p = 0.022) and various symptoms at presentation (all p <0.001). For the QoL surveys, we did not observe differences on the FACT-G; however, we noted evidence of differential scores between the two groups on specific domains of the SF-36 (e.g. Mental Health; p 0.022) and the RCC-specific QoL questions added to the FACT-G. Conclusions We report baseline differences between RN and NSS patients on clinico-pathologic as well as QoL-related metrics. As issues of survivorship become increasingly important, our results underscore the need to consider baseline status in evaluations of QoL-related outcomes for patients undergoing surgery for RCC.
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Affiliation(s)
| | | | | | | | | | - Alexander S Parker
- Department of Health Sciences Research, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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Wah TM, Irving HC, Gregory W, Cartledge J, Joyce AD, Selby PJ. Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): experience in 200 tumours. BJU Int 2013; 113:416-28. [PMID: 24053769 PMCID: PMC4233988 DOI: 10.1111/bju.12349] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objectives Patients and Methods Results Conclusions
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Affiliation(s)
- Tze M Wah
- Department of Diagnostic and Interventional Radiology, Institute of Oncology, Leeds Teaching Hospitals Trust, St. James's University Hospital, Leeds, UK
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Kroeger N. Editorial Comment to Renal function after radical nephrectomy: development and validation of predictive models in Japanese patients. Int J Urol 2013; 21:243. [PMID: 24118533 DOI: 10.1111/iju.12279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nils Kroeger
- Department of Urology, University Medicine, Greifswald, Ernst Moritz Arndt University, Greifswald, Germany.
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149
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Yang KW, Xiong GY, Li XS, Tang Y, Tang Q, Zhang CJ, He ZS, Zhou LQ. Prevalence of baseline chronic kidney disease in 2,769 Chinese patients with renal cancer: Nephron-sparing treatment is still underutilized. World J Urol 2013; 32:1027-31. [DOI: 10.1007/s00345-013-1178-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/01/2013] [Indexed: 10/26/2022] Open
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150
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Three-Tesla dynamic contrast-enhanced MRI: a critical assessment of its use for differentiation of renal lesion subtypes. World J Urol 2013; 32:215-20. [DOI: 10.1007/s00345-013-1177-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/28/2013] [Indexed: 12/31/2022] Open
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