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Ganpule AP, Sharma R, Thimmegowda M, Veeramani M, Desai MR. Laparoscopic radical nephrectomy versus open radical nephrectomy in T1-T3 renal tumors: An outcome analysis. Indian J Urol 2011; 24:39-43. [PMID: 19468357 PMCID: PMC2684245 DOI: 10.4103/0970-1591.38602] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aims: To compare laparoscopic radical nephrectomy (LRN) with open radical nephrectomy (ORN) in T1-T3 renal lesions. Materials and Methods: The records of 65 patients who underwent LRN between January 2002 and December 2006 were entered prospectively in a database. The patients were compared with 56 patients who had undergone ORN between January 2000 and December 2005. The two groups were comparable in terms of age, body mass index (BMI) and tumor size. LRN was compared with ORN in terms of operative room time, blood loss, complications, analgesic requirement, hospital stay and start of oral intake. The oncologic efficacy was evaluated in stages T1 and T2 in terms of cancer-free and overall survival. Results: The laparoscopy group had a significantly shorter hospital stay (5.72, range 3-23 days vs. 9.18, range 4-23 days, p value: < 0.0001), analgesia requirement (175.65, range 50-550 mg vs. 236, range 0-1100 mg of tramadol, p value: < 0.03), hemoglobin decline (1.55, range 0.1 to 4.4 mg/dl vs. 2.25, range 0.2 - 7 mg/dL, p value: < 0.001) and hematocrit drop (4.83, range 0.3 - 12.9 vs. 7.06 range 2 -18, p value: < 0.0001). The majority of specimens showed renal cell carcinoma. In the laparoscopy group, 29 tumors were T1 stage, 18 were T2, while eight were T3. In the open surgery group, 25 tumors were T1, 19 were T2 and 12 were T3. The cancer-free survival rate at 24 months for ORN and LRN in T1 lesions was 91.7% and 93.15% respectively and the patient survival rate was 100% in both groups. The cancer-free survival rate at 24 months for ORN and LRN in T2 lesions was 88.9% and 94.1%, respectively and the patient survival was 100% and 94%, respectively. After LRN, there was one instance of port site metastasis, local recurrence and distant metastasis. All recurrences were distant after ORN. Conclusion: Laparoscopic radical nephrectomy has advantages in terms of shorter hospitalization and a lower analgesia requirement. It is feasible and produces effective cancer control in T1 lesions, comparable to that of its open counterpart in T2 and selected cases of T3 lesions.
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Affiliation(s)
- Arvind P Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad - 387 001, Gujarat, India
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102
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Best SL, Cadeddu JA. Development of magnetic anchoring and guidance systems for minimally invasive surgery. Indian J Urol 2011; 26:418-22. [PMID: 21116365 PMCID: PMC2978445 DOI: 10.4103/0970-1591.70585] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Recent advances in urology have included natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). These techniques seek to minimize morbidity by reducing the number of transabdominal port sites, but this comes at a cost of decreased instrument agility and other technical challenges that have prevented LESS and NOTES from entering mainstream urologic practice. Magnetic anchoring and guidance systems (MAGS) consist of instruments that are inserted laparoscopically through an entry in the peritoneal cavity at one point and then driven into position elsewhere and controlled with magnets. These instruments improve the ergonomics of minimally invasive surgery and may help make LESS and NOTES more accessible to urologists across experience levels.
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Affiliation(s)
- Sara L Best
- Department of Urology, University of Texas Southwestern Medical Centre, Texas, USA
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103
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Long-term oncologic outcomes of laparoscopic radical nephrectomy for kidney cancer resection: Dundee cohort and metaanalysis of observational studies. Surg Endosc 2011; 25:3154-61. [PMID: 21594741 DOI: 10.1007/s00464-011-1736-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The long-term oncologic outcome of laparoscopic radical nephrectomy compared with that of open radical nephrectomy remains unclear. A few case series with follow-up periods longer than 5 years are reported in the literature. The existing literature is focused primarily on early and intermediate outcomes of laparoscopic radical nephrectomy. This study aimed to assess the outcome of laparoscopic radical nephrectomy for localized disease compared with open surgery. METHODS The search strategy was designed to identify observational and experimental studies conducted in any country that investigated the long-term oncologic outcomes of laparoscopic radical nephrectomy compared with open surgical resection, published in any language. We searched the MEDLINE (1996 to May 2010), EMBASE (1996 to May 2010), and Cochrane databases using the OVID interrogation software. The study included 77 men from the Dundee cohort referred for clinically localized renal cell carcinoma who underwent open or laparoscopic radical nephrectomy between January 1998 and 2004, with at least 5 years of follow-up evaluation for each. These men were included in a metaanalysis of observational studies reporting on 438 patients with a mean or median follow-up period of 5 years. The data was analyzed using Minitab statistical software and Cochrane RevMan 5.4 using the random model. RESULTS The five studies (including the Dundee cohort) investigating the effects of the laparoscopic approach on renal cancer management showed no significant differences in 5 years survival between laparoscopic and open surgical approaches for the resection of kidney cancer. The resulting pooled odds ratio (OR) did not differ markedly between the two groups (pooled OR, 0.82; 95% confidence interval [CI], 0.48-1.39). Similar to overall survival, the laparoscopic and open surgical approaches for renal cancer surgery did not differ significantly (Figs. 4, 5). The pooled ORs for the two outcomes were 0.76 (955 CI, 0.36-1.56) for laparoscopic surgery and 0.73 (95% CI, 0.32-1.69) for open surgery. The quality of the studies was poor. The reported designs of the studies were prone to selection, confounding, and reporting biases. CONCLUSIONS The current retrospective data (observational studies) comparing long-term oncologic outcomes between laparoscopic and open radical nephrectomy did not demonstrate any significant differences during a follow-up period of 5 years.
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104
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Robotic surgery and minimally invasive management of renal tumors with vena caval extension. Curr Opin Urol 2011; 21:104-9. [DOI: 10.1097/mou.0b013e32834350ff] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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105
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Mues AC, Haramis G, Rothberg MB, Okhunov Z, Casazza C, Landman J. Contemporary Experience with Laparoscopic Radical Nephrectomy. J Laparoendosc Adv Surg Tech A 2011; 21:15-8. [DOI: 10.1089/lap.2010.0345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adam C. Mues
- Department of Urology, Columbia University Medical Center, New York, New York
| | - George Haramis
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Michael B. Rothberg
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Zhamshid Okhunov
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Cristin Casazza
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Jaime Landman
- Department of Urology, Columbia University Medical Center, New York, New York
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106
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Szydełko T, Tupikowski K, Dembowski J, Niezgoda T, Wojciechowski A, Zdrojowy R. Laparoscopic radical nephrectomy for large renal tumor - a case report and technical considerations. Cent European J Urol 2011; 64:39-41. [PMID: 24578859 PMCID: PMC3921705 DOI: 10.5173/ceju.2011.01.art8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 01/07/2011] [Accepted: 01/09/2011] [Indexed: 11/22/2022] Open
Abstract
In comparison to an open procedure, the laparoscopic radical nephrectomy has demonstrated advantages in regard to perioperative morbidity, postoperative pain, time of hospitalization, and convalescence. However, most series of laparoscopic radical nephrectomy are confined to T1 tumors. The authors present a case of a large-volume- T2 renal tumor treated laparoscopically. The aim of the study is to present the operative technique and to discuss several unique problems that arise during the laparoscopic procedure in patients with large renal masses.
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Affiliation(s)
- Tomasz Szydełko
- Department of Urology and Urological Oncology, Wrocław University of Medicine, Wrocław, Poland
| | - Krzysztof Tupikowski
- Department of Urology and Urological Oncology, Wrocław University of Medicine, Wrocław, Poland
| | - Janusz Dembowski
- Department of Urology and Urological Oncology, Wrocław University of Medicine, Wrocław, Poland
| | - Tadeusz Niezgoda
- Department of Urology and Urological Oncology, Wrocław University of Medicine, Wrocław, Poland
| | - Adam Wojciechowski
- Department of Urology and Urological Oncology, Wrocław University of Medicine, Wrocław, Poland
| | - Romuald Zdrojowy
- Department of Urology and Urological Oncology, Wrocław University of Medicine, Wrocław, Poland
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107
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Uffort EE, Jensen JC. Two-year outcomes after robotic renal surgery: a single surgeon's experience. J Robot Surg 2010; 4:205-10. [PMID: 27627946 DOI: 10.1007/s11701-010-0198-7] [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: 03/08/2010] [Accepted: 05/26/2010] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to validate the feasibility of the robotic technology for various types of renal surgery and to outline the 2-year clinical and pathological outcomes post surgery. In a retrospective chart review with IRB approval of 55 robotic renal surgeries, clinical data and pathological outcomes were recorded, including estimated glomerular filtration rate (eGFR), serum creatinine, radiological surveillance of tumor recurrences and overall quality of life on pre- and postoperative visits at 6, 12, 18 and 24 months. There were 26 robotic partial nephrectomy (RPN), 23 radical nephrectomy (RRN), 3 simple nephrectomy (RSN), and 3 radical nephroureterectomy (RNU) procedures. Twelve patients in the RPN group, 17 in the RRN group and all in the RSN and RNU groups had eGFR <60 ml/min/1.73 m(2) and one or more risk factors for chronic kidney disease (CKD) preoperatively. Mean serum creatinine was 1.2, 1.3, 1.2, and 1.8, and eGFR was 66.4, 61.2, 55.8, and 41.0, respectively. There were two distant metastasis and four local recurrences in the RRN group, and two local recurrences in the RNU group. Serum creatinine and changes in eGFR were statistically similar in all groups postoperatively. Cancer-specific survival was 100% for RPN, 83% for RRN, and 100% for RNU while overall survival was 100% for RPN, 76% for RRN, 100% for RSN, and 100% for RNU at 2 years. Robotic renal surgery is a feasible, minimally invasive alternative with promising outcomes in our short-term follow-up. Long-term and comparative studies with open or conventional laparoscopic approaches are needed.
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Affiliation(s)
- Ekong E Uffort
- Department of Surgery, Marshall University, Joan C Edwards School of Medicine, Huntington, WV, USA.
| | - James C Jensen
- Department of Surgery, Division of Urology, Marshall University, Joan C Edwards School of Medicine, Huntington, WV, USA
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108
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Patard JJ, Baumert H, Corréas JM, Escudier B, Lang H, Long JA, Neuzillet Y, Paparel P, Poissonnier L, Rioux-Leclercq N, Soulié M. Recommandations en Onco-Urologie 2010 : Cancer du rein. Prog Urol 2010; 20 Suppl 4:S319-39. [DOI: 10.1016/s1166-7087(10)70048-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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109
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Jeon SH, Kwon TG, Rha KH, Sung GT, Lee W, Lim JS, Jeong YB, Hong SH, Kim HH, Byun SS. Comparison of laparoscopic versus open radical nephrectomy for large renal tumors: a retrospective analysis of multi-center results. BJU Int 2010; 107:817-821. [DOI: 10.1111/j.1464-410x.2010.09688.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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110
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Ha US, Hwang TK, Kim YJ, Oh TH, Jeon YS, Lee W, Lim JS, Lee TY, Choi Y, Park SK, Byun SS. Comparison of oncological outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy for the management of clear-cell renal cell carcinoma: a multi-institutional study. BJU Int 2010; 107:1467-72. [DOI: 10.1111/j.1464-410x.2010.09636.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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111
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Weizer AZ, Montgomery JS. The Role of Lymphadenectomy in Minimally Invasive Urologic Oncology. J Endourol 2010; 24:1229-40. [DOI: 10.1089/end.2009.0562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alon Z. Weizer
- Division of Urologic Oncology and Minimally Invasive Surgery, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Jeffrey S. Montgomery
- Division of Urologic Oncology and Minimally Invasive Surgery, Department of Urology, University of Michigan, Ann Arbor, Michigan
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112
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Park YH, Park JH, Jeong CW, Kim HH. Comparison of Laparoendoscopic Single-Site Radical Nephrectomy with Conventional Laparoscopic Radical Nephrectomy for Localized Renal-Cell Carcinoma. J Endourol 2010; 24:997-1003. [DOI: 10.1089/end.2009.0554] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yong Hyun Park
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hyun Park
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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113
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Abstract
BACKGROUND Surgical excision remains the core to the management of localised renal cancer and several studies have evaluated the safety and clinical effectiveness of laparoscopic surgery and other recently introduced interventions for the localised disease. OBJECTIVES To identify and review the evidence from randomised trials comparing different surgical interventions in localised renal cell carcinoma. SEARCH STRATEGY Randomised or quasi randomised trials comparing various surgical interventions in the management of adults with surgically resectable localised renal cancer. RCTs were identified by searching The Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2009), MEDLINE (Silver Platter, from 1966 to August 2009), EMBASE via Ovid (from 1980 to August 2009), and a number of other data bases. SELECTION CRITERIA Studies were assessed for eligibility and quality, and data from published trials were extracted by two reviewers. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS No randomised trials were identified meeting the inclusion criteria reporting on the comparison between open radical nephrectomy with laparoscopic approach or new modalities of treatment such as radiofrequency or cryoablation. Three randomised controlled trials compared the different laparoscopic approaches to nephrectomy (transperitoneal versus retroperitoneal) and found no statistical difference in operative or perioperative outcomes between the two treatment groups. There were several non-randomised and retrospective case series reporting various advantages of laparoscopic renal cancer surgery such as less blood loss, early recovery and shorter hospital stay AUTHORS' CONCLUSIONS The main source of evidence for the current practice of laparoscopic excision of renal cancer is drawn from case series, small retrospective studies and very few small randomised controlled trials. The results and conclusions of these studies must therefore be interpreted with caution.
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Affiliation(s)
- Ghulam Nabi
- Department of Surgery, University of Dundee, Dundee, Scotland, UK, DD1 9SY
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114
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Luo JH, Zhou FJ, Xie D, Zhang ZL, Liao B, Zhao HW, Dai YP, Chen LW, Chen W. Analysis of long-term survival in patients with localized renal cell carcinoma: laparoscopic versus open radical nephrectomy. World J Urol 2009; 28:289-93. [DOI: 10.1007/s00345-009-0487-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 10/22/2009] [Indexed: 11/29/2022] Open
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115
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Heldwein FL, McCullough TC, Souto CAV, Galiano M, Barret E. Localized renal cell carcinoma management: an update. Int Braz J Urol 2009; 34:676-89; discussion 689-90. [PMID: 19111072 DOI: 10.1590/s1677-55382008000600002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2008] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To review the current modalities of treatment for localized renal cell carcinoma. MATERIALS AND METHODS A literature search for keywords: renal cell carcinoma, radical nephrectomy, nephron sparing surgery, minimally invasive surgery, and cryoablation was performed for the years 2000 through 2008. The most relevant publications were examined. RESULTS New epidemiologic data and current treatment of renal cancer were covered. Concerning the treatment of clinically localized disease, the literature supports the standardization of partial nephrectomy and laparoscopic approaches as therapeutic options with better functional results and oncologic success comparable to standard radical resection. Promising initial results are now available for minimally invasive therapies, such as cryotherapy and radiofrequency ablation. Active surveillance has been reported with acceptable results, including for those who are poor surgical candidates. CONCLUSIONS This review covers current advances in radical and conservative treatments of localized kidney cancer. The current status of nephron-sparing surgery, ablative therapies, and active surveillance based on natural history has resulted in great progress in the management of localized renal cell carcinoma.
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116
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Zigeuner R, Pummer K. Aktuelle chirurgische Aspekte des Nierenzellkarzinoms. Wien Med Wochenschr 2009; 159:535-42. [DOI: 10.1007/s10354-009-0720-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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117
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A critical analysis of the actual role of minimally invasive surgery and active surveillance for kidney cancer. Eur Urol 2009; 57:223-32. [PMID: 19853989 DOI: 10.1016/j.eururo.2009.10.023] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Accepted: 10/13/2009] [Indexed: 12/28/2022]
Abstract
CONTEXT The incidence of renal cell carcinomas (RCCs) has increased steadily-most rapidly for small renal masses (SRMs). Paralleling the changing face of RCC in the past 2 decades, new, less invasive surgical options have been developed. Laparoscopic radical nephrectomy (LRN) is an established procedure for the treatment of RCC. Treatment of SRMs includes open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), thermal ablation, and active surveillance. OBJECTIVE To present an overview of minimally invasive treatment options and data on surveillance for kidney cancer. EVIDENCE ACQUISITION Literature and meeting abstracts were searched using the terms renal cell carcinoma, minimally invasive surgery, laparoscopic surgery, thermal ablation, surveillance, and robotic surgery. The articles with the highest level of evidence were identified with the consensus of all the collaborative authors and reviewed. EVIDENCE SYNTHESIS Renal insufficiency, as measured by the glomerular filtration rate, occurs more often after radical nephrectomy than partial nephrectomy (PN). OPN and LPN show comparable results in long-term oncologic outcomes. The treatment modality for SRMs should therefore be nephron-sparing surgery (NSS). In select patients, thermal ablation or active surveillance of SRMs is an alternative. CONCLUSIONS LRN has become the standard of care for most organ-confined tumours not amenable to NSS. Amongst NSS options, PN is the treatment of choice, yet remains underutilised in the community. Initial data during its learning curve revealed that LPN had higher urologic morbidity. However, current emerging data indicate that in experienced hands, LPN has shorter ischaemia times, a lower complication rate, and equivalent long-term oncologic and renal functional outcomes, yet with decreased patient morbidity compared to OPN. Robotic partial nephrectomy is being explored at select centres, and cryotherapy and radiofrequency ablation are options for carefully selected tumours. Active surveillance is an option for selected high-risk patients. Percutaneous needle biopsy is likely to gain increasing relevance in the management of small renal tumours.
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118
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Berger A, Brandina R, Atalla MA, Herati AS, Kamoi K, Aron M, Haber GP, Stein RJ, Desai MM, Kavoussi LR, Gill IS. Laparoscopic radical nephrectomy for renal cell carcinoma: oncological outcomes at 10 years or more. J Urol 2009; 182:2172-6. [PMID: 19758651 DOI: 10.1016/j.juro.2009.07.047] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE We present oncological outcomes at a followup of 10 years or greater after laparoscopic radical nephrectomy for cancer. MATERIALS AND METHODS Between February 1994 and March 1999 a total of 73 laparoscopic radical nephrectomies were performed by 2 surgeons for pathologically confirmed renal cell carcinoma. Data were obtained from patient charts, radiographic reports, telephone followup and a check of the Social Security Death Index. RESULTS Mean followup was 11.2 years (range 10 to 15). Each patient completed a minimum 10-year followup. Mean patient age at surgery was 60 years. Mean tumor size on computerized tomography was 5 cm (range 1.7 to 13). Pathological stage was pT1a in 41% of cases, pT1b in 30%, pT2 in 15%, pT3a in 10%, pT3b in 3% and pT4 in 1%. High grade tumors (Fuhrman 3 or greater) were present in 18 cases (28%). A positive surgical margin occurred in 1 case. Actual 10-year overall, cancer specific and recurrence-free survival rates were 65%, 92% and 86%, respectively. Overall, cancer specific and recurrence-free survival rates at 12 years were 35%, 78% and 77%, respectively. At a mean of 67 months 10 patients (14%) had metastatic disease, of whom 8 (11%) died. CONCLUSIONS Long-term oncological outcomes after laparoscopic radical nephrectomy for renal cell carcinoma are excellent and appear comparable to those of open surgery.
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Affiliation(s)
- Andre Berger
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California 90080, USA
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119
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Strope SA, Wolf JS, Hafez KS, Dunn RL, Hollingsworth JM, Gilbert SM, Hollenbeck BK. Understanding the relationship between health care quality and the renal mass. Urol Oncol 2009; 27:443-7. [PMID: 19573776 DOI: 10.1016/j.urolonc.2009.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Quality is increasingly important to all stakeholders of the U.S. health care system. Endeavors to measure and improve quality have moved forward in cardiovascular disease, diabetes care, and surgical wound infections. However, in urology, such efforts have lagged. As a specialty, we are now faced with pressures, exerted primarily by payors, to roll out performance measures, or quality indicators, in the absence of science to support them. In this review, we discuss the broad concepts of health care quality and describe their relationships with small renal tumors.
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Affiliation(s)
- Seth A Strope
- Department of Urology, Divisions of Oncology, University of Michigan, Ann Arbor, MI 48109, USA
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120
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121
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Park YH, Byun SS, Kang SH, Koh JS, Park HK, Paick SH, Seo YJ, Yoo TG, Jung H, Cho JS, Jeon SS, Choi Y, Park SK. Comparison of Hand-Assisted Laparoscopic Radical Nephrectomy with Open Radical Nephrectomy for pT1-2 Clear Cell Renal-Cell Carcinoma: A Multi-Institutional Study. J Endourol 2009; 23:1485-9. [DOI: 10.1089/end.2009.0375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yong Hyun Park
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, Seoul, Korea
| | - Jun Sung Koh
- Department of Urology, Holy Family Hospital, Bucheon, Korea
| | - Hyoung Keun Park
- Department of Urology, Dongguk University International Hospital, Goyang, Korea
| | - Sung Hyun Paick
- Department of Urology, Konkuk University Hospital, Seoul, Korea
| | - Young Jin Seo
- Department of Urology, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Tag Geun Yoo
- Department of Urology, Eulji General Hospital, Seoul, Korea
| | - Han Jung
- Department of Urology, Gachon University Gil Hospital, Incheon, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Seoul, Korea
| | - Yunhee Choi
- Division of Clinical Epidemiology, Medical Research Collaborating Center Seoul National University Hospital, Seoul, Korea
| | - Sue Kyung Park
- Division of Clinical Epidemiology, Medical Research Collaborating Center Seoul National University Hospital, Seoul, Korea
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122
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Hattori R, Osamu K, Yoshino Y, Tsuchiya F, Fujita T, Yamada S, Funahashi Y, Ono Y, Gotoh M. Laparoscopic Radical Nephrectomy for Large Renal-Cell Carcinomas. J Endourol 2009; 23:1523-6. [DOI: 10.1089/end.2009.0393] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ryohei Hattori
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kamihira Osamu
- Department of Urology, Komaki Shimin Hospital, Komaki, Japan
| | - Yasushi Yoshino
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Futoshi Tsuchiya
- Department of Urology, Yokohama City Minato Red Cross Hospital, Nagoya University Graduate School of Medicine, Yokohama, Japan
| | - Takashi Fujita
- Department of Urology, Shakai Hoken Chykyo Hospital, Nagoya, Japan
| | - Shin Yamada
- Department of Urology, Okazaki City Hospital, Okazaki, Japan
| | - Yasuhito Funahashi
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinari Ono
- Aichi Shukutoku University School of Medical Welfare, Nagoya City, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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123
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Bird VG, Shields JM, Aziz M, Ayyathurai R, De Los Santos R, Roeter DH. Laparoscopic Radical Nephrectomy for Patients with T2 and T3 Renal-Cell Carcinoma: Evaluation of Perioperative Outcomes. J Endourol 2009; 23:1527-33. [DOI: 10.1089/end.2009.0399] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Vincent G. Bird
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - John M. Shields
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Mohammed Aziz
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rajnikanth Ayyathurai
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rosely De Los Santos
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Daniel H. Roeter
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
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Keeley FX, Minervini A. Editorial comment. Urology 2009; 74:640-1; author reply 642. [PMID: 19716920 DOI: 10.1016/j.urology.2009.02.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 02/19/2009] [Accepted: 02/20/2009] [Indexed: 10/20/2022]
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Pouliot F, Belldegrun A. Editorial comment. Urology 2009; 74:641-2; author reply 642. [PMID: 19716921 DOI: 10.1016/j.urology.2009.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 04/03/2009] [Accepted: 04/05/2009] [Indexed: 11/18/2022]
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Cabello JM, Bhayani SB, Figenshau RS, Benway BM. Camera and trocar placement for robot-assisted radical and partial nephrectomy: which configuration provides optimal visualization and instrument mobility? J Robot Surg 2009; 3:155. [DOI: 10.1007/s11701-009-0152-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 07/12/2009] [Indexed: 11/30/2022]
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Transperitoneal Laparoscopic Radical Nephrectomy is an Effective Procedure for Large (More Than 7 cm) Renal Masses. Surg Laparosc Endosc Percutan Tech 2009; 19:353-5. [DOI: 10.1097/sle.0b013e3181ac7e8d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gabr AH, Gdor Y, Strope SA, Roberts WW, Wolf JS. Patient and pathologic correlates with perioperative and long-term outcomes of laparoscopic radical nephrectomy. Urology 2009; 74:635-40. [PMID: 19616826 DOI: 10.1016/j.urology.2009.01.091] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 11/29/2008] [Accepted: 01/14/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To comprehensively analyze and compare patient and pathologic correlates with perioperative events and with the long-term results of laparoscopic radical nephrectomy. METHODS Laparoscopic radical nephrectomy was performed in 255 patients with renal cell carcinoma. Mean follow-up time was 35.2 months; for 39 patients, it was 5 or more years. RESULTS Multivariate analysis revealed that major intraoperative complications were associated with increased body mass index and that major postoperative complications were associated with a higher American Society of Anesthesiologists (ASA) score. Older age and higher ASA score were associated with longer hospitalization. Patients were classified using a risk group stratification that incorporated grade and stage; 118 patients were low risk, 93 were intermediate risk, and 44 patients were high risk. No pathologic features were associated with perioperative outcomes. Kaplan-Meier recurrence-free, cancer-specific, and overall survival at 5 years were 79.2%, 88%, and 76.2%, respectively. Multivariate analysis revealed that pathologic risk group, mass size, and high-risk histologic subtype were associated with recurrence-free survival, and cancer-specific survival was associated with pathologic risk group and mass size. Age, high-risk pathologic risk group, and a high-risk histologic subtype were associated with overall survival. CONCLUSIONS Our results indicate that perioperative outcomes of laparoscopic radical nephrectomy are associated with body mass index, ASA score, and age, but not with tumor characteristics. Recurrence-free and cancer-specific survival rates were associated with the expected pathologic parameters, confirming the oncologic efficacy of the procedure. Overall survival is associated not only with tumor pathology but also with age, suggesting that competing-cause mortality is important in this setting.
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Affiliation(s)
- Ahmed H Gabr
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan 48109-0330, USA
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Bensalah K, Salomon L, Lang H, Zini L, Jacqmin D, Manunta A, Crepel M, Ficarra V, Cindolo L, de La Taille A, Karakiewicz P, Patard JJ. Survival of patients with nonmetastatic pT3 renal tumours: a matched comparison of laparoscopic vs open radical nephrectomy. BJU Int 2009; 104:1714-7. [PMID: 19624536 DOI: 10.1111/j.1464-410x.2009.08662.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To compare the oncological outcome of patients with pT3 renal tumours treated either by laparoscopic radical nephrectomy (LRN) or open RN (ORN). PATIENTS AND METHODS In a retrospective review of a multi-institutional database, we identified 1003 patients with a T3N0M0 renal tumour and with no vena caval invasion. Sixty-five patients treated by LRN were matched with up to four patients treated by ORN. Exact matches were made for age, gender, tumour size, perirenal fat invasion, renal vein invasion, and histological subtype. Following the matching process there were 44 patients treated by LRN and 135 by ORN. Qualitative and continuous variables were compared using chi-square and independent-sample t-tests, respectively. Differences in survival were compared using the Kaplan-Meier method. A Cox regression model was used to test the effect of variables on survival. RESULTS The two groups were comparable for age (P = 0.4), gender, tumour size (P = 0.4), tumour grade (P = 0.25) and histological subtype (P = 0.45). The mean follow-up was longer in the ORN group (55 vs 28 months, P < 0.001). There was no difference in survival between the ORN and LRN groups in the whole T3 population (P = 0.7), in those with perirenal fat invasion (P = 0.9), or in the subset with renal vein invasion (P = 0.31). In univariate analysis, the only predictor for death from cancer was tumour grade (P = 0.05). In multivariate analysis, no variable was significantly associated with cancer survival. CONCLUSIONS LRN has no adverse effect on cancer survival compared to ORN in patients with microscopic T3 renal cancer. Additional prospective evaluation is warranted.
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Abstract
The diagnosis and treatment of renal cell carcinoma (RCC) has been the subject of major changes since the late 1980s. Initially, surgery was the only treatment available, but more recently, systemic therapies have been developed, and their introduction has modified some of the surgical indications for rcc. In addition, refinements in surgical technique and the introduction of minimally invasive approaches have revolutionized patient care and bear the promise of even more improvements to come. This paper provides an up-to-date overview of recent developments in the surgical treatment of RCC.
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Affiliation(s)
- J.B. Lattouf
- Correspondence to: Jean-Baptiste Lattouf, Department of Surgery–Urology, Centre Hospitalier de l’Université de Montréal, 1058 rue St-Denis, Montreal, Quebec H2X 3J4. E-mail:
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Parma P, Samuelli A, Guatelli S, Luciano M, Dall'Oglio B, Bondavalli C. Transperitoneal Laparoscopic Radical Nephrectomy for a 12 cm Renal Mass. Urologia 2009. [DOI: 10.1177/039156030907600224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laparoscopic radical nephrectomy is now considered a standard of care for patients with T1 renal carcinoma not suitable for nephron-sparing surgery. In the hands of experienced laparoscopic urological surgeons also T2 renal cell carcinoma can be approached through the laparoscopic technique. We present the video of a radical laparoscopic nephrectomy in a patient with a 12cm renal mass of the right kidney. We chose the transperitoneal approach; the operative time was 240 minutes. There were neither intra- nor post-operative complications. The patient was discharged at day 4 postoperatively.
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Affiliation(s)
- P. Parma
- Divisione di Urologia, Azienda Ospedaliera Carlo Poma, Mantova
| | - A. Samuelli
- Divisione di Urologia, Azienda Ospedaliera Carlo Poma, Mantova
| | - S. Guatelli
- Divisione di Urologia, Azienda Ospedaliera Carlo Poma, Mantova
| | - M. Luciano
- Divisione di Urologia, Azienda Ospedaliera Carlo Poma, Mantova
| | - B. Dall'Oglio
- Divisione di Urologia, Azienda Ospedaliera Carlo Poma, Mantova
| | - C. Bondavalli
- Divisione di Urologia, Azienda Ospedaliera Carlo Poma, Mantova
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Gamboa AJ, Young JL, Dash A, Abraham JB, Box GN, Ornstein DK. Pelvic lymph node dissection and outcome of robot-assisted radical cystectomy for bladder carcinoma. J Robot Surg 2009; 3:7-12. [PMID: 25484987 PMCID: PMC4247420 DOI: 10.1007/s11701-009-0124-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 01/08/2009] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Pelvic lymph node dissection (PLND) at the time of radical cystectomy for urothelial carcinoma of the bladder is critical for accurate staging and may improve oncologic outcomes. Minimally invasive approaches have been criticized for limiting the extent of the PLND. We reviewed our experience with PLND and its perioperative outcomes with robot-assisted laparoscopic radical cystectomy (RARC). METHODS Data were collected prospectively from 50 patients scheduled for RARC. Included in the analysis were patients who had RARC and a standard PLND. The entire extirpative portion of the procedure was performed using the da Vinci Robot (Intuitive Surgical, Sunnyvale, CA, USA). RESULTS A total of 41 patients were included in the study: 30 men and 11 women with a mean age of 69.7 years (range 49-85) and a mean body mass index of 26.9 (range 19.5-43.7). The median total operative time was 497.77 min (320-805). The mean estimated blood loss was 253.66 ml (range 50-700). The transfusion rate was 44% (18 out of 41) ranging from 0 to 4 units (median 0 units of blood). The mean total number of lymph nodes retrieved was 25.07 (range 4-68). Nodal metastases were seen in 14.63% (6/41). Rate of positive surgical margin was 4.87% (2/41). The median length of hospital stay was 8 days (5-37). The median duration of nasogastric tube, time to ambulation, first clear liquid intake, passage of colonic gas, time to bowel movement, and start of solid food intake were 1 (0-5), 2 (1-7), 3 (2-10), 4 (1-6), 5 (2-11) and 6 days (3-24), respectively. CONCLUSION An adequate PLND, comparable with that recommended for open surgery, can be performed safely with robot assistance. The perioperative outcomes were likewise comparable with that of the gold standard, open cystectomy.
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Affiliation(s)
- Aldrin J. Gamboa
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868 USA
| | - Jennifer L. Young
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868 USA
| | - Atreya Dash
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868 USA
| | - Jose Benito Abraham
- Department of Urology, University of California, Irvine, 333 City Boulevard West, Suite 2100, Orange, CA 92868 USA
| | - Geoffrey N. Box
- Ohio State University, 540 Doan Hall, 410 W. 10th Ave Columbus, Columbus, OH 43210 USA
| | - David K. Ornstein
- Vanguard Urologic Institute, 6400 Fannin St., Suite 2300, Houston, TX 77030 USA
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The Eastbourne Extraction: Forceps Removal of Large Laparoscopic Nephrectomy Specimens Without Morcellation. Surg Laparosc Endosc Percutan Tech 2009; 19:82-3. [DOI: 10.1097/sle.0b013e31818a6d76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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134
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Conley SP, Humphreys MR, Desai PJ, Castle EP, Dueck AC, Ferrigni RG, Andrews PE. Laparoscopic Radical Nephrectomy for Very Large Renal Tumors (≥10 cm): Is There a Size Limit? J Endourol 2009; 23:57-61. [DOI: 10.1089/end.2008.0263] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Garg S, Batura D, Biyani CS, Gill IS. Laparoscopic surgery for cancers of the kidney: long-term oncological efficacy. BJU Int 2008; 102:1498-501. [DOI: 10.1111/j.1464-410x.2008.08019.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gjertson CK, Sundaram CP. Testicular Pain Following Laparoscopic Renal Surgery. J Urol 2008; 180:2037-40; discussion 2040-1. [DOI: 10.1016/j.juro.2008.07.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Carl K. Gjertson
- Division of Urology, University of Connecticut Health Center, Farmington, Connecticut
| | - Chandru P. Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
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A prospective comparison of laparoscopic and robotic radical nephrectomy for T1-2N0M0 renal cell carcinoma. World J Urol 2008; 27:89-94. [PMID: 18704439 DOI: 10.1007/s00345-008-0321-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 07/28/2008] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES We prospectively evaluated the safety, feasibility, and efficiency of robotic radical nephrectomy (RRN) for localized renal tumors (T1-2N0M0) and compared this with laparoscopic radical nephrectomy (LRN). MATERIALS AND METHODS Between October 2006 to August 2007, a prospective data analysis of 15 cases of renal cell carcinoma (RCC) stage T1-2N0M0, undergoing RRN was done. These patients were compared with a contemporary cohort of 15 patients of RCC with clinical stage T1-2N0M0, undergoing LRN. To keep comparison robust, all cases were performed by a single surgeon. Demographic, intra-operative, post-operative outcomes, pathological characteristics and follow-up data of the two groups were recorded and analyzed statistically. RESULTS Patients in group A (RRN) experienced significantly (P = 0.001) long operating time than group B (LRN). However, mean estimated blood loss, intra-operative and post-operative complications, blood transfusion rate, analgesic requirement, hospital stay and convalescence were comparable in two groups (P < 0.05). There was one conversion to open surgery in group A, and none in group B. The mean follow-up was comparable in two groups (8.3 and 9.1 months, respectively, in group A and B, P = 0.09). There were no local, port-site or distal recurrences in either group. CONCLUSIONS Robotic radical nephrectomy is a safe, feasible and effective for performing radical nephrectomy for localized RCC. Both groups (RRN and LRN) had comparable intra-operative, peri-operative, post-operative and oncological outcomes except for longer operating time with increased cost for RRN. In this comparative study, there were no outstanding benefits of RRN observed over LRN for localized RCC.
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Abstract
PURPOSE OF REVIEW The recent contributions to renal cell carcinoma in the fields of molecular biology and the expanded use of molecularly targeted agents will be reviewed. This study is intended to update prognostic and therapeutic decision-making data and provide perspective on advances in understanding the molecular biology of this disease. RECENT FINDINGS Updates to the currently used prognostic algorithms for renal cell carcinoma are needed, and recently verified prognostic nomograms will be discussed. This comes in the wake of numerous advances in the use of molecularly targeted drugs, which will be reviewed. Finally, advancements in understanding the biology of renal cell carcinoma include the discovery of von Hippel-Lindau associated mechanisms involved in renal cyst formation and renewed appreciation for the influence of this pathway on the tumor cell glucose utilization profile. SUMMARY Renal cell carcinoma continues to evolve swiftly with the approval of new agents and the maturation of clinical trials to provide relevant structure to treatment decisions. This study will give an overview of the latest concepts in the epidemiology and biology of renal cell carcinoma and provide current surgical and systemic updates for managing renal cell carcinoma.
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141
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Palit V, Joyce AD. Updates in endourology. Curr Urol Rep 2008; 9:122-7. [PMID: 18419996 DOI: 10.1007/s11934-008-0023-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Rapid urologic innovations in minimally invasive treatment are creating exciting new horizons in endourology. However, these new concepts are blurring the traditional boundary between endourology and oncology. Organ-sparing surgery, laparoscopy, robotics systems, and image-guided ablation techniques enable surgeons to develop specifically tailored treatments for patients. We examine recent developments and future prospects for how new technology will continue to advance the field of endourology.
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Affiliation(s)
- Victor Palit
- St. James's University Hospital, Beckett Steet, Leeds, LS9 7TF, UK
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144
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Merseburger AS, Kuczyk MA. Changing concepts in the surgery of renal cell carcinoma. World J Urol 2008; 26:127-33. [PMID: 18265990 DOI: 10.1007/s00345-008-0238-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 01/13/2008] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Herein, current developments in open and minimally invasive renal surgery are presented. MATERIALS AND METHODS This also includes considerations on the appropriate indication for the two surgical procedures in small renal tumours, locally advanced disease (>pT2), complicated renal tumours as well as cytoreductive surgical situations. In small renal tumours, similar survival rates have been described for laparoscopic radical and partial nephrectomy. However, even experienced high volume laparoscopic centres report a high learning curve, increased complications and initial technical problems to achieve parenchymal haemostasis and renal ischaemia during nephron-sparing surgery. Surgical management of large (>T2) or complicated tumours is feasible, but long-term oncological outcome is not yet available. CONCLUSION Promising new developments such as natural orifice translumenal endoscopic surgery (NOTES) might add to our surgical armamentarium for minimally invasive surgery.
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Affiliation(s)
- Axel S Merseburger
- Department of Urology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
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Surgical management of large renal tumors. ACTA ACUST UNITED AC 2008; 5:35-46. [PMID: 18185512 DOI: 10.1038/ncpuro0963] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 09/13/2007] [Indexed: 12/18/2022]
Abstract
In addition to an increased occurrence of small, localized, incidentally discovered renal cell carcinomas (RCCs), there has been an upward trend in the incidence of advanced renal tumors per unit of population and in disease mortality worldwide. As radical nephrectomy remains the standard of care in treating localized RCC, this manuscript focuses on surgical approaches. We defined 'large renal tumors' as those greater than 7 cm or those with venous involvement. We discuss operative strategies in both open and laparoscopic surgery as well as approaches to special circumstances, including patients with tumor thrombus and the indications for nephron-sparing surgery in patients with greater than T2 RCC. The literature pertaining to controversial areas such as preoperative renal artery embolization and the clinical utility of metastectomy and cytoreductive therapy are also reviewed. The theoretical basis and potential applications of neoadjuvant therapy for larger renal tumors is examined as well.
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Mejean A, Correas JM, Escudier B, de Fromont M, Lang H, Long JA, Neuzillet Y, Patard JJ, Piechaud T. [Kidney tumors]. Prog Urol 2007; 17:1101-44. [PMID: 18153989 DOI: 10.1016/s1166-7087(07)74782-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Hemal AK, Kolla SB, Wadhwa P. Evaluation of laparoscopic radical cystectomy for loco-regionally advanced bladder cancer. World J Urol 2007; 26:161-6. [PMID: 18030474 DOI: 10.1007/s00345-007-0221-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Accepted: 10/09/2007] [Indexed: 10/22/2022] Open
Abstract
We studied the safety and feasibility of laparoscopic radical cystectomy (LRC) in patients with loco-regionally advanced bladder cancer and report the short-term oncological outcome. This study comprised a total of 13 patients (10 males, 3 females), who presented with myriad of symptoms and on imaging they were found to have radiologically evident advanced disease (6 pelvic lymphadenopathies, 10 extravesical tumor extensions, three prostate/seminal vesical invasions). In view of recalcitrant symptoms (hematuria, frequency and irritative voiding) all patients underwent LRC and bilateral modified pelvic lymphadenectomy with ileal conduit urinary diversion. Mean age of the patients was 56.3 years. Mean operative time was 310 min with an average blood loss of 556 ml. No major intra-operative complications were noted. One patient died in the post-operative period due to sepsis. Histopathology report revealed pT3b N0 in two patients; pT3b N1 in four; pT3b N2 in three; pT4a N0 in one, and pT4aN1 in three patients. Adjuvant chemotherapy was administered in nine patients. At mean follow up of 18 months (range 6-28), seven patients are alive and cancer-free, while two patients are alive with metastases. LRC provides an alternative approach for treatment of patients with loco-regionally advanced bladder cancer, who suffer from recurrent hematuria and severe irritative voiding symptoms, in whom open surgery was the standard approach hitherto. However, it should be considered experimental and should be attempted only by surgeons who have significant experience of laparoscopic pelvic surgery and advanced skills, and after discussing the potential risks and benefits with the patient.
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Affiliation(s)
- Ashok K Hemal
- Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029 India.
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Bandi G, Christian MW, Hedican SP, Moon TD, Nakada SY. Oncological outcomes of hand-assisted laparoscopic radical nephrectomy for clinically localized renal cell carcinoma: a single-institution study with >or=3 years of follow-up. BJU Int 2007; 101:459-62. [PMID: 17941924 DOI: 10.1111/j.1464-410x.2007.07235.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the intermediate-term outcomes of hand-assisted laparoscopic radical nephrectomy (HALRN) for clinically organ-confined renal cell carcinoma (RCC). PATIENTS AND METHODS We retrospectively reviewed patients who had HALRN for clinically organ-confined RCC at the University of Wisconsin from 1996 to 2003. All patients with pathologically confirmed RCC and with >or=3 years of follow-up were included in a retrospective chart review of variables before, during and after HALRN, as well as the clinical outcomes. RESULTS In all, 75 patients had HALRN in the study period; their mean age was 59 years, body mass index 29 kg/m(2), operative duration 227 min, estimated blood loss 130 mL, and none required conversion to open nephrectomy. The median time to first oral intake was 2.5 days and the median hospital stay 4 days. On pathological examination the mean tumour size was 5.8 cm; 70% were pT1, 26% pT2 and 4% pT3; 82% were clear cell, 9% papillary, 8% chromophobe and 1% collecting duct carcinoma. Of the 65 patients who had a follow-up of >or=36 months (mean 46, range 36-117), the 3- and 5-year disease-free survival rate was 93.4% and 90.2%, respectively; the 3- and 5-year cancer-specific survival rate was 96.5% and 94.4%, respectively. CONCLUSION Our study suggests that HALRN is a safe and minimally invasive treatment for managing clinically organ-confined RCC, with good intermediate-term oncological outcomes.
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Affiliation(s)
- Gaurav Bandi
- Division of Urology, Department of Surgery, University of Wisconsin Medical School, Madison, WI 53792, USA
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Hemal AK, Kumar A, Gupta NP, Kumar R. Oncologic outcome of 132 cases of laparoscopic radical nephrectomy with intact specimen removal for T1-2N0M0 renal cell carcinoma. World J Urol 2007; 25:619-26. [PMID: 17786453 DOI: 10.1007/s00345-007-0210-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Accepted: 08/04/2007] [Indexed: 10/22/2022] Open
Abstract
We present the short and long-term oncologic outcome of 132 patients with pathologically confirmed T1-T2, N0M0 renal cell carcinoma (RCC), who underwent laparoscopic radical nephrectomy with intact specimen removal at our institution. Beginning January 1998, we prospectively collected data of 132 patients undergoing laparoscopic radical nephrectomy, whose final pathologic stage was T1 or T2, N0M0, RCC. The clinical data of three groups categorized as group (pT1a)--36 patients, group (pT1b)--51 patients and group (pT2)--45 patients were analyzed statistically to assess oncological outcome. The specimens were removed intact without morcellation in all patients in a homemade plastic bag. The total median follow-up was 56 months (range 3-80 months) and there were no local or port-site recurrences or hernia. Patients with pT2 tumors had significantly greater operating time, blood loss and analgesic requirements than pT1a/pT1b tumor patients. The distant metastases were found in 1, 4 and 5 patients in group pT1a, pT1b and pT2, respectively. The 5-year cancer-specific survival was 97.2, 86.3 and 82.2%, respectively, in pT1a, pT1b and pT2 tumor patients (significantly lower in pT2 than pT1a, P = 0.008). The 5-year recurrence-free survival was 97.2, 84.3 and 82.2%, respectively, in pT1a, pT1b and pT2 tumor patients (significantly lower in pT2 than pT1a, P = 0.02). Laparoscopic radical nephrectomy (retroperitoneal and transperitoneal route) with intact specimen removal for localized renal cell carcinoma (T1-2N0M0) provides satisfactory short and long-term oncologic efficacy.
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Affiliation(s)
- Ashok K Hemal
- Department of Urology, All India Institute of Medical Sciences, New Delhi 110029, India.
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