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Kamel AI, Badawy MH, Elganzoury H, Elkhouly A, Elesaily K, Eldahshan S, Ismail MAA, Elshafie MF, Abdel Aziz EM, El Baz AG, Roshdy MA, El Leithy TR, Ghobashy S, Kamal AM. Clinical versus Pathologic staging of Renal Tumors: Role of Multi-Detector CT Urography. Electron Physician 2016; 8:1791-5. [PMID: 26955451 PMCID: PMC4768930 DOI: 10.19082/1791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 11/20/2015] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Our ability to diagnose renal cell carcinoma (RCC) has increased in the past 30 years as a result of the extensive application of imaging techniques, such as ultrasonography, computed tomography, and magnetic resonance imaging. Multi-detector computed tomography (MDCT) remains the most appropriate imaging modality for the diagnosis and staging of RCC. The aim of this work was to compare the findings of MDCT with surgical pathology to determine the accuracy of delineating tumor size, localization, organ confinement, lymph node metastases, and the extent of tumor thrombus in the renal vein and inferior vena cava. METHODS The clinical, surgical, and anatomo-pathologic records of 99 patients treated by nephrectomy (radical or partial) for solid renal tumors at Theodor Bilharz Research Institute and Nasser Institute from 2005 to 2011 were reviewed retrospectively. All cases were staged pre-operatively with abdominal MDCT (pre- and post-contrast enhancement) in addition to the routine biochemical, hematological, and radiological work-up. The tumors' histologic types were determined according to the WHO classification of renal tumors in adults in 2004, and staging was updated to the TNM 2010 system. Data were analyzed using the t-test. RESULTS The mean age was 52 (range 21-73). Seventy-eight patients were males, and 21 patients were females (Male/Female ratio: 3.7:1). There were no significant differences in the mean tumor size between radiographic and pathologic assessments in different tumor stages. The overall incidence of lymph node invasion in surgical specimens was 76%, whereas MDCT showed a positive incidence in 68.4% of cases (false negative result in 7 cases, 7.6%). CONCLUSION Our findings indicated that MDCT urography is an accurate method to estimate renal tumor size, lymph node, vascular and visceral metastases preoperatively. Also, preoperative staging of renal tumors with MDCT represents a valuable and accurate tool.
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Affiliation(s)
- Ahmed I Kamel
- Urology department, Theodor Bilharz Research Institute, Giza, Egypt
| | | | | | - Amr Elkhouly
- Urology department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Khalid Elesaily
- Urology department, Theodor Bilharz Research Institute, Giza, Egypt
| | - S Eldahshan
- Urology department, Theodor Bilharz Research Institute, Giza, Egypt
| | | | | | | | - Ahmed G El Baz
- Urology department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Mamdouh A Roshdy
- Urology department, Theodor Bilharz Research Institute, Giza, Egypt
| | | | - Samir Ghobashy
- Urology department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Ahmed M Kamal
- Urology department, Theodor Bilharz Research Institute, Giza, Egypt
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152
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Kwon O, Byun SS, Hong SK, Ku JH, Kwak C, Kim HH, Lee SE. Efficacy of Partial Nephrectomy for Renal Tumors >4 cm: Comparison With Renal Tumors ≤4 cm. Int Surg 2016; 101:7-13. [DOI: 10.9738/intsurg-d-15-00226.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Partial nephrectomy has become a treatment of choice for clinical T1a renal masses. Some international guidelines suggest that partial nephrectomy can be applied also in clinical T1b tumors. The aim of this study was to evaluate the feasibility of partial nephrectomy for tumors larger than 4 cm. We reviewed the medical records of 1280 patients who underwent partial nephrectomy and had pathologically confirmed malignancy. Patients were categorized into two groups by the size of tumors on computed tomography image, with a cutoff value of 4 cm. The oncologic and functional outcomes were compared between the two groups. Recurrence-free survival after surgery was estimated using the Kaplan-Meier method. Of the 1280 patients, 203 patients (15.9%) had renal tumors larger than 4 cm. There were significantly more exophytic tumors (P < 0.001) and the R.E.N.A.L. scores were significantly higher (P < 0.001) in partial nephrectomy >4 cm. Mean ischemic times were significantly different (P < 0.001). After 24 months, mean creatinine level between partial nephrectomy >4 cm and partial nephrectomy ≤4 cm was not different significantly (P = 0.554). And the percent changes of glomerular filtration rate after partial nephrectomy were not different at last follow-up (P = 0.082). The 5-year recurrence-free survival rates were 96.6% in partial nephrectomy ≤4 cm, and 94.5% in partial nephrectomy >4 cm (P = 0.416). Based on the present findings, partial nephrectomy for tumors larger than 4 cm showed comparable feasibility and safety to partial nephrectomy for tumors ≤4 cm considering oncologic and functional outcomes, despite longer operative and ischemic time.
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Affiliation(s)
- Ohseong Kwon
- Department of Urology, The Catholic University, Seoul St. Mary Hospital, Seoul, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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153
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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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154
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Yang Y, Zhai C, Chang Y, Zhou L, Shi T, Tan C, Xu L, Xu J. High expression of chemokine CCL2 is associated with recurrence after surgery in clear-cell renal cell carcinoma. Urol Oncol 2015; 34:238.e19-26. [PMID: 26749463 DOI: 10.1016/j.urolonc.2015.11.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 11/21/2015] [Accepted: 11/29/2015] [Indexed: 01/07/2023]
Abstract
PURPOSE Chemokine (C-C motif) ligand 2 (CCL2) is known to recruit monocytes and macrophages to sites of inflammation. Recent studies suggest CCL2 is overexpressed in multiple cancer types and may play a role in the tumor progression. The aim of this study was to assess the association between CCL2 expression and the risk of recurrence after surgery in patients with clear-cell renal cell carcinoma (ccRCC). METHODS This study included 268 ccRCC patients who underwent nephrectomy at a single institute between 2001 and 2004. Clinicopathologic variables and recurrence-free survival (RFS) were recorded. CCL2 expression levels were evaluated by immunohistochemical staining in tumor tissues. Kaplan-Meier method was applied to compare survival curves. Cox regression models were fitted to analyze the effect of prognostic factors on recurrence-free survival (RFS). Harrell's concordance index was calculated to assess predictive accuracy. RESULTS High CCL2 expression was associated with a greater risk of recurrence in ccRCC patients (P<0.001). Multivariate analysis confirmed that CCL2 expression was an independent prognostic factor for RFS (P = 0.045). The predictive accuracy of the Leibovich prognostic score was improved when CCL2 expression was added (0.76 vs. 0.71, P<0.001). Notably, the improvement in prediction was more pronounced in patients with low-risk disease. A nomogram integrating CCL2 expression and pathologic factors was then constructed, which predicted 5- and 10-year RFS well for ccRCC patients. CONCLUSIONS High chemokine CCL2 expression is an independent predictor of recurrence in ccRCC patients. Evaluation of CCL2 could help guide postsurgical management for ccRCC patients.
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Affiliation(s)
- Yuanfeng Yang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Changwen Zhai
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuan Chang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lin Zhou
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianming Shi
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Cheng Tan
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Le Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Jiejie Xu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China.
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155
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Fernando A, Fowler S, O'Brien T. Nephron-sparing surgery across a nation - outcomes from the British Association of Urological Surgeons 2012 national partial nephrectomy audit. BJU Int 2015; 117:874-82. [PMID: 26469291 DOI: 10.1111/bju.13353] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine the scope and outcomes of nephron-sparing surgery (NSS), i.e. partial nephrectomy, across the UK and in so doing set a realistic benchmark and identify fresh contemporary challenges in NSS. PATIENTS AND METHODS In 2012 reporting of outcomes of all types of nephrectomy became mandatory in the UK. In all, 148 surgeons in 86 centres prospectively entered data on 6 042 nephrectomies undertaken in 2012. This study is a retrospective analysis of the NSS procedures in the dataset. RESULTS A total of 1 044 NSS procedures were recorded and the median (range) surgical volume was 4 (1-39) per consultant and 8 (1-59) per centre. In all, 36 surgeons and 10 centres reported on only one NSS. The indications for NSS were: elective with a tumour of ≤4.5 cm in 59%, elective with a tumour of >4.5 cm in 10%, relative in 7%, imperative in 12%, Von Hippel-Lindau in 1%, and unknown in 11%. The median (range) tumour size was 3.4 (0.8-30) cm. The technique used was minimally invasive surgery in 42%, open in 58%, with conversions in 4%. The histology results were: malignant in 80%, benign in 18%, and unknown in 2%. In patients aged <40 years 36% (36/101) had benign histology vs 17% (151/874) of those aged ≥40 years (P < 0.01). In patients with tumours of <2.5 cm 29% (69/238) had benign histology vs 14% (57/410) with tumours of 2.5-4 cm vs 8% (16/194) with tumours of ≥4 cm (P = 0.02). In patients aged <40 years with of tumours of <2.5 cm 44% (15/34) were benign. The 30-day mortality was 0.1% (1/1 044). There were major complications (Clavien-Dindo grade of ≥IIIa) in 5% (53/1 044). There was an increased risk of complications after extended elective NSS of 19% (19/101) vs elective at 12% (76/621) (relative risk [RR] 1.54; P < 0.01). Margins were recorded in 68% (709/1 044) of the patients, with positive margins identified in 7% (51/709). Positive surgical margins after NSS for pathological T3 (pT3) tumours were found in 47.8% (11/23) vs 6.1% (32/523) for pT1a, tumours (RR 5.61; P < 0.01). In all, 14% (894/6 042) of the patients underwent surgery for T1a tumours: 55% (488/894) by NSS, 42% (377/894) by radical nephrectomy (RN), and in 3% (29/894) the procedure used was unknown. Major complications after occurred in 4.9% (24/488) of NSS vs 1.3% (5/377) of RN (P < 0.01). Limitations included poor reporting of renal function data and no data on tumour complexity. CONCLUSIONS In its first year, mandatory national reporting has provided several challenging contemporary insights into NSS.
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Affiliation(s)
- Archie Fernando
- BAUS, The Royal College of Surgeons of England, London, UK.,The Urology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sarah Fowler
- BAUS, The Royal College of Surgeons of England, London, UK
| | - Tim O'Brien
- BAUS, The Royal College of Surgeons of England, London, UK.,The Urology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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156
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Yang L, Liu Y, An H, Chang Y, Zhang W, Zhu Y, Xu L, Xu J. High Expression of Colony-Stimulating Factor 1 Receptor Associates with Unfavorable Cancer-Specific Survival of Patients with Clear Cell Renal Cell Carcinoma. Ann Surg Oncol 2015; 23:1044-52. [PMID: 26467457 DOI: 10.1245/s10434-015-4911-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Colony-stimulating factor 1 receptor (CSF-1R), a single-pass type III transmembrane tyrosine-protein kinase, is mainly involved in inflammation and immune regulation to facilitate the progression of solid tumors. This study aimed to evaluate the impact of CSF-1R expression on clinical outcome of patients with clear cell renal cell carcinoma (ccRCC) after surgery. METHODS We retrospectively enrolled 268 patients with ccRCC undergoing nephrectomy between 2001 and 2004. Clinicopathologic features and cancer-specific survival (CSS) were collected. Western blot analysis was performed in the pairwise comparisons of CSF-1R expression in peritumor and tumor tissues of patients with ccRCC. Immunohistochemistry was conducted to determine CSF-1R expression level in tumor specimens. Survival analysis was performed by the Kaplan-Meier method. Cox regression models were used to evaluate the impact of prognostic factors on CSS. A concordance index was calculated to measure prognostic accuracy. A prognostic nomogram was constructed on the basis of the identified independent prognostic factors. RESULTS CSF-1R expression in tumor tissues was higher than in peritumor tissues in 71.4% (5 of 7) patients. CSF-1R expression of tumor tissues was positively associated with metastasis, tumor, node, metastasis classification system (TNM) stage, Eastern Cooperative Oncology Group performance status score and poor CSS. CSF-1R expression was determined as an independent prognostic factor for CSS in patients with ccRCC. Furthermore, extension of the well-established prognostic models with CSF-1R expression presented significantly improved prognostic accuracy. An efficient prognostic nomogram was constructed on the basis of the independent prognostic factors. CONCLUSIONS High CSF-1R expression is a potential independent adverse prognostic factor for CSS in patients with ccRCC.
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Affiliation(s)
- Liu Yang
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Yidong Liu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Huimin An
- Department of Urology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Yuan Chang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weijuan Zhang
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai, China.
| | - Yu Zhu
- Department of Urology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Le Xu
- Department of Urology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiejie Xu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China.
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157
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Weight CJ, Mulders PF, Pantuck AJ, Thompson RH. The Role of Adrenalectomy in Renal Cancer. Eur Urol Focus 2015; 1:251-257. [PMID: 28723393 DOI: 10.1016/j.euf.2015.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 08/25/2015] [Accepted: 09/08/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT Since the 1960s, routine ipsilateral adrenalectomy (IA) has been considered an integral step in the removal of renal tumors as a part of a radical nephrectomy. However, recent data from the past decade have narrowed the indications for adrenalectomy and called into question the need for adrenalectomy at all in the treatment of renal cell carcinoma (RCC). OBJECTIVE We sought to identify the role of adrenalectomy in the treatment of RCC. Specifically, we wanted to answer the following questions: What is the incidence of ipsilateral adrenal involvement by cancer? How reliable is preoperative imaging? What is the rate of ipsilateral and contralateral metachronous recurrence? And finally, what are the potential noncancer sequelae from unnecessary removal of the adrenal gland? EVIDENCE ACQUISITION A systematic literature search of Embase, PubMed, Cochrane, and Ovid Medline was performed to identify studies evaluating the role of adrenalectomy during RCC surgery. Only articles published in English from the years 2000-2015 were included. Case reports, articles about primary adrenal tumors, letters to the editor, and surgical technique papers were excluded. EVIDENCE SYNTHESIS We found little evidence to suggest that routine IA is associated with a higher risk of short-term surgical or medical complications. We did not find evidence that IA is associated with improved cancer control. Tomographic preoperative imaging of the adrenal gland demonstrating no cancer involvement is rarely wrong (<1% of the time), and the few adrenal lesions missed on imaging can often be identified intraoperatively. Some evidence indicates that IA may be associated with worse long-term survival. Adrenalectomy rates have been decreasing in recent years, reflecting a changing practice pattern. CONCLUSIONS IA at the time of kidney surgery for a renal mass should be performed only if radiographic or intraoperative evidence indicates adrenal gland involvement. PATIENT SUMMARY We sought to define the role of adrenalectomy in patients with kidney cancer. Although there are not high-quality studies to answer this question definitively, we conclude that the adrenal gland should be spared unless there is clinical evidence of adrenal involvement.
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Affiliation(s)
| | - Peter F Mulders
- Radbount University, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Allan J Pantuck
- University of California at Los Angles, Los Angeles, CA, USA
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Effectiveness and safety of computed tomography-guided radiofrequency ablation of renal cancer: a 14-year single institution experience in 203 patients. Eur Radiol 2015; 26:1656-64. [PMID: 26373755 DOI: 10.1007/s00330-015-4006-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 08/07/2015] [Accepted: 09/03/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To define effectiveness and safety of CT-guided radiofrequency ablation (RFA) of renal tumours and prognostic indicators for treatment success. METHODS Patients with a single treatment of a solitary, biopsy-proven renal tumour with intent to cure over a 14-year period were included (n = 203). Probability of residual disease over time, complication rates and all-cause mortality were assessed in relation to multiple variables. RESULTS Mean tumour size was 2.5 cm (range 1.0-6.0). Mean follow-up was 34.1 months (range 1-131). There was an increase in likelihood of residual disease for tumours ≥3.5 cm (P < 0.05), clear cell subtype of renal cell carcinoma (P ≤ 0.005) and maximum treatment temperature ≤70 °C (P < 0.05). There was a decrease in likelihood of residual disease for exophytic tumours (P = 0.01) and no difference based on age, gender, tumour location or type of radio freqency (RF) electrode used. Major complications occurred in 3.9 %. Median post-treatment survival was 7 years for patients with tumours <4 cm, and 5-year overall survival was 80 %. Probability of minor complication increased with tumour size (P = 0.03), as did all-cause mortality (P = 0.005). CONCLUSIONS CT-guided RFA is safe and effective for early-stage renal cancer, particularly for exophytic tumours measuring <3.5 cm. Overall 5-year survival with tumours <4 cm is comparable to partial nephrectomy. KEY POINTS • Prognostic indicators for success of CT-guided RFA of renal tumours are reported. • Tumour size ≥3.5 cm confers an increased risk for residual tumour. • Clear cell renal cell carcinoma subtype confers increased risk for residual tumour. • Tmax <70 °C within the ablation zone confers increased risk for residual tumour. • Exophytic tumours have a lower probability of residual disease.
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159
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Vanden Berg RNW, Bierman EN, Noord MV, Rice HE, Routh JC. Nephron-sparing surgery for Wilms tumor: A systematic review. Urol Oncol 2015; 34:24-32. [PMID: 26254695 DOI: 10.1016/j.urolonc.2015.07.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/30/2015] [Accepted: 07/06/2015] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Radical nephrectomy (RN, or total nephrectomy) is the current gold-standard surgical treatment for children with Wilms tumors (WT). However, nephron-sparing surgery (NSS, or partial nephrectomy) has recently been gaining increasing attention. The objective of this systematic review is to compare the effectiveness of NSS as compared with RN for the treatment of children with WT. METHODS We searched the Cochrane Controlled Trials Register, clinicaltrials.gov, MEDLINE, EMBASE, Google Scholar, and recently presented meeting abstracts for reports in English. The bibliographies of included studies were then hand-searched for any missed articles. The protocol was prospectively registered. Manuscripts were assessed and data abstracted in duplicate with differences resolved by the senior author. Owing to high heterogeneity among the final included studies, only a qualitative systematic review was performed; no formal meta-analysis was undertaken. RESULTS We identified 694 articles, 118 of which were selected for full-text review and 66 of which were included in the final analysis. Most studies were single- or multi-institution retrospective case series (60, 91%), with a small number of prospective cohort studies (6, 9%) and 1 administrative database analysis. Most studies were from Europe (27, 41%) or North America (21, 32%). Nearly half (32, 48%) of studies those were included were dated from 2010 or later. In total, data on 4,002 patients were included, of whom 1,040 (26%) underwent NSS and 2,962 (74%) underwent NSS. Reported rupture rates were similar between RN and NSS (13% vs. 7%), as were recurrence rates (12% vs. 11%) and survival rates (85% vs. 88%). However, these comparisons are limited by inherent biases in the design and reporting of most included studies. CONCLUSIONS Most contemporary studies reporting the use of NSS in children with WT report similar long-term outcomes to RN. However, most existing studies are limited by their small numbers, inconsistent reporting, and methodological biases. There are significant opportunities for future research on the use of NSS in children with WT, including issues related to surgical quality, optimal technique, timing and duration of chemotherapy, and variation in the use of NSS among centers.
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Affiliation(s)
| | | | | | - Henry E Rice
- Duke University School of Medicine, Durham, NC; Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Jonathan C Routh
- Duke University School of Medicine, Durham, NC; Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
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Zekri J, Dreosti LM, Ghosn M, Hamada E, Jaloudi M, Khorshid O, Larbaoui B. Multidisciplinary management of clear-cell renal cell carcinoma in Africa and the Middle East: current practice and recommendations for improvement. J Multidiscip Healthc 2015; 8:335-44. [PMID: 26251610 PMCID: PMC4524587 DOI: 10.2147/jmdh.s85538] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The management of renal cell carcinoma (RCC) has evolved considerably in recent years. This report represents the consensus of 22 relevant medical specialists from Africa and the Middle East region engaged in the management of RCC. Partial or radical nephrectomy is the standard of care for most patients with localized RCC. It is essential that patients are followed up appropriately after surgery to enable local and distant relapses to be identified and treated promptly. The treatment of advanced/metastatic disease has changed dramatically with the introduction of targeted therapies. Follow-up of these patients enables therapy optimization and assessment of response to treatment. There was universal agreement on the importance of management of RCC by a multidisciplinary team supported by a multidisciplinary tumor board. Barriers hindering this approach were identified. These included lack of awareness of the benefits of multidisciplinary team role, poor communication among relevant disciplines, time constraints, and specifics of private practice. Other challenges include shortage of expert specialists as urologists and oncologists and lack of local management guidelines in some countries. Solutions were proposed and discussed. Medical educational initiatives and awareness activities were highlighted as keys to encouraging cooperation between specialties to improve patients’ outcome. Establishing combined genitourinary cancer clinics and formal referral systems should encourage a culture of effective communication. Joining forces with professionals in peripheral areas and the private sector is likely to help standardize care. Sustained action will be required to ensure that all patients with RCC in the region benefit from up-to-date care.
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Affiliation(s)
- Jamal Zekri
- College of Medicine, King Faisal Specialist Hospital and Research Centre, Alfaisal University, Jeddah, Saudi Arabia
| | - Lydia M Dreosti
- Department of Medical Oncology, University of Pretoria, Pretoria, South Africa
| | - Marwan Ghosn
- Faculty of Medicine Hematology, Oncology Department, Saint Joseph University, Beirut, Lebanon
| | - Emad Hamada
- Faculty of Medicine, Cairo University, Kasr Alainy, Cairo, Egypt
| | - Mohamed Jaloudi
- Oncology Hematology Department, Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates
| | - Ola Khorshid
- National Cancer Institute, Cairo University, Kasr El Ainy, Cairo, Egypt
| | - Blaha Larbaoui
- Oncology Service, Université Djillali Liabés, Sidi Bel Abbés, Algeria
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161
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Li M, Gao Y, Cheng J, Qu L, Chen J, Cai C, Xu B, Li P, Bao Y, Xu Z, Xu Y, Wu D, Wu Z, Wang L, Sun Y. Diameter-Axial-Polar Nephrometry is Predictive of Surgical Outcomes Following Partial Nephrectomy. Medicine (Baltimore) 2015. [PMID: 26222856 PMCID: PMC4554132 DOI: 10.1097/md.0000000000001228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
This study sought to evaluate the predictive value of the DAP (diameter-axial-polar) nephrometry system on surgical outcomes following partial nephrectomy (PN).This was a retrospective study of 237 patients who underwent open or minimally invasive PN for renal tumors at a single tertiary care center between 2009 and 2013. The primary outcomes included ischemia time >20 minutes and percentage of estimated glomerular filtration rate (eGFR) decline >10%. Statistical analysis was performed to study associations and predictions.The DAP sum score exhibited a statistically significant correlation with ischemia time, operative time (OT), estimated blood loss (EBL), length of hospital stay (LOS), and percent change in eGFR. The DAP sum score (odds ratio [OR]: 1.749; 95% confidence interval [CI] 1.379-2.220; P < 0.001) and conventional laparoscopy and laparo-endoscopic single-site (CL&LESS) surgery versus the open surgical approach (OR: 5.736; 95% CI: 2.529-13.011; P < 0.001) independently predicted an ischemia time >20 minutes. Similarly, the DAP sum score (OR: 1.297; 95% CI 1.051-1.602; P = 0.016), age-weighted Charlson comorbidity index (CCI) (OR: 4.730; 95% CI 1.463-15.291; P = 0.009), EBL (OR 2.433; 95% CI 1.095-5.407; P = 0.029), and ischemia time (OR 3.332; 95% CI 1.777-6.249; P < 0.001) were identified as independent predictors of eGFR decline >10%. Furthermore, the DAP score × ischemia time interactions were statistically significant (P < 0.001).We confirmed the predictive value of the DAP nephrometry score with respect to ischemia time and renal functional decline in an independent external cohort of patients undergoing PN. The effect of the DAP score on renal functional decline partially depends on that of ischemia time, and the individual component DAP scores may have different effects on clinical outcomes.
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Affiliation(s)
- Mingmin Li
- From the Department of Radiology, Changhai Hospital (ML, BX); Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai (YG, LQ, JC, PL, YB, ZX, YX, DW, ZW, LW); Department of Urology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning (JC); Department of Special Clinics, Changhai Hospital (CC); Kidney Cancer Center (ZW, LW, YS); and Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China (YS)
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Tsili AC, Argyropoulou MI. Advances of multidetector computed tomography in the characterization and staging of renal cell carcinoma. World J Radiol 2015; 7:110-127. [PMID: 26120380 PMCID: PMC4473304 DOI: 10.4329/wjr.v7.i6.110] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/18/2015] [Accepted: 04/29/2015] [Indexed: 02/06/2023] Open
Abstract
Renal cell carcinoma (RCC) accounts for approximately 90%-95% of kidney tumors. With the widespread use of cross-sectional imaging modalities, more than half of RCCs are detected incidentally, often diagnosed at an early stage. This may allow the planning of more conservative treatment strategies. Computed tomography (CT) is considered the examination of choice for the detection and staging of RCC. Multidetector CT (MDCT) with the improvement of spatial resolution and the ability to obtain multiphase imaging, multiplanar and three-dimensional reconstructions in any desired plane brought about further improvement in the evaluation of RCC. Differentiation of RCC from benign renal tumors based on MDCT features is improved. Tumor enhancement characteristics on MDCT have been found closely to correlate with the histologic subtype of RCC, the nuclear grade and the cytogenetic characteristics of clear cell RCC. Important information, including tumor size, localization, and organ involvement, presence and extent of venous thrombus, possible invasion of adjacent organs or lymph nodes, and presence of distant metastases are provided by MDCT examination. The preoperative evaluation of patients with RCC was improved by depicting the presence or absence of renal pseudocapsule and by assessing the possible neoplastic infiltration of the perirenal fat tissue and/or renal sinus fat compartment.
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163
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Xu L, Chang Y, An H, Zhu Y, Yang Y, Xu J. High APOBEC3B expression is a predictor of recurrence in patients with low-risk clear cell renal cell carcinoma. Urol Oncol 2015; 33:340.e1-8. [PMID: 26051357 DOI: 10.1016/j.urolonc.2015.05.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 04/28/2015] [Accepted: 05/07/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE APOBEC3B is a member of the cytosine deaminase family, which converts cytosine to uracil during RNA editing and retrovirus or retrotransposon restriction. Recent evidence has revealed that APOBEC3B-catalyzed genomic DNA deamination could provide genetic fuel for cancer development, metastasis, and even treatment resistance. The aim of this study was to assess the association between APOBEC3B expression and the risk of recurrence after surgery in patients with renal cell carcinoma (RCC). METHODS We retrospectively enrolled 299 consecutive patients with RCC who underwent nephrectomy at a single center in 2008. Clinicopathologic variables and recurrence-free survival (RFS) were recorded. APOBEC3B expression levels were determined by immunohistochemistry in tumor tissues. Kaplan-Meier method was applied to compare survival curves. Cox regression models were fitted to analyze the effect of prognostic factors on RFS. The Harrell concordance index was calculated to assess predictive accuracy. RESULTS High APOBEC3B expression was associated with an increased risk of recurrence in patients with clear cell RCC (ccRCC) (P<0.001) rather than in patients with non-ccRCC (P = 0.247). After backward elimination, APOBEC3B expression was identified as an independent prognostic factor for RFS in patients with clear cell histology (P = 0.016). The predictive accuracy of the Leibovich prognostic score was improved when APOBEC3B expression was incorporated. Notably, the improvement in prediction mainly took place in patients with low-risk disease defined by the Leibovich score. CONCLUSIONS High APOBEC3B expression is an independent predictor of recurrence in patients with ccRCC, and the prognostic value is most prominent in those with low-risk disease.
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Affiliation(s)
- Le Xu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuan Chang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huimin An
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yu Zhu
- Department of Urology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Yuanfeng Yang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiejie Xu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China.
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164
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Tang K, Xu H. Prognostic value of meta-signature miRNAs in renal cell carcinoma: an integrated miRNA expression profiling analysis. Sci Rep 2015; 5:10272. [PMID: 25974855 PMCID: PMC4431463 DOI: 10.1038/srep10272] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 04/07/2015] [Indexed: 12/29/2022] Open
Abstract
To identify a robust panel of microRNA (miRNA) signatures that can distinguish renal cell carcinoma (RCC) from normal kidney using miRNA expression levels. We performed a comprehensive meta-analysis of 29 published studies that compared the miRNA expression profiles of RCC tissues and adjacent normal tissues (NT) to determine candidate miRNAs as prognostic biomarkers for RCC. Using vote-counting strategy and robust rank aggregation method, we identified a statistically significant miRNA meta-signature of two upregulated (miR-21, miR-210) and three downregulated (miR-141, miR-200c and miR-429) miRNAs. X-tile plot was used to generate the optimum cut-off point for the 15 different deregulated miRNAs and Kaplan-Meier method was used to calculate CSS. In a cohort of 45 patients, the high expression of miR-21 (HR: 5.46, 95%CI: 2.02-53.39) and miR-210 (HR: 6.85, 95%CI: 2.13-43.36), the low expression of miR-141 (HR: 0.16, 95%CI: 0.004-0.18), miR-200c (HR: 0.08, 95%CI: 0.01-0.43) and miR-429 (HR: 0.18, 95%CI: 0.02-0.50) were associated with poor cancer-specific survival (CSS) following RCC resection. We also constructed a five-miRNAs-based classifier as a reliable prognostic and predictive tool for CSS in patients with RCC, especially in clear cell RCC (ccRCC) (HR: 5.46, 95% CI: 1.51-19.66). This method might facilitate patient counselling and individualise management of RCC.
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Affiliation(s)
- Kun Tang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Hadjipavlou M, Khan F, Fowler S, Joyce A, Keeley FX, Sriprasad S. Partial vs radical nephrectomy for T1 renal tumours: an analysis from the British Association of Urological Surgeons Nephrectomy Audit. BJU Int 2015; 117:62-71. [DOI: 10.1111/bju.13114] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Fahd Khan
- Department of Urology; Darent Valley Hospital; Dartford Kent UK
| | - Sarah Fowler
- British Association of Urological Surgeons; London UK
| | - Adrian Joyce
- Department of Urology; St James's University Hospital; Leeds UK
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166
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Choi JE, You JH, Kim DK, Rha KH, Lee SH. Comparison of Perioperative Outcomes Between Robotic and Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-analysis. Eur Urol 2015; 67:891-901. [DOI: 10.1016/j.eururo.2014.12.028] [Citation(s) in RCA: 239] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/12/2014] [Indexed: 11/15/2022]
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167
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Application of long-acting VLHL PAI-1 during sutureless partial nephrectomy in mice reduces bleeding. BIOMED RESEARCH INTERNATIONAL 2015; 2015:392862. [PMID: 25883959 PMCID: PMC4391615 DOI: 10.1155/2015/392862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/10/2015] [Indexed: 11/17/2022]
Abstract
PAI-1 prevents lysis of blood clot by inhibiting the urokinase and tPA induced conversion of plasminogen to plasmin. VLHL PAI-1 protein mutant was created to extend half-life over 700 hours. The objective of this paper was to test VLHL PAI-1 effects on bleeding during partial nephrectomy in mice. All animals had a left partial nephrectomy after intravenous infusion of saline or tPA. The animals were divided into four groups. Group 1 was infused with saline and kidney was exposed to saline too; Group 2 was infused with saline and kidney was exposed to PAI-1. Group 3 was infused with tPA and kidney was exposed to saline, while Group 4 was infused with tPA and kidney was exposed to PAI-1. Preweighed gauze containing PAI-1 or saline was then applied to the kidney for 30 minutes. The gauze was afterward weighed and blood loss was measured by subtracting the preweight of gauze from the final weight. We have observed a statistically significant (P ≤ 0.05) reduction of bleeding in PAI-1-treated group in comparison to saline and tPA-treated groups. Based on these results we propose that VLHL PAI-1 can be used therapeutically in limiting the flow of blood from renal wounds.
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168
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Semerjian A, Zettervall SL, Amdur R, Jarrett TW, Vaziri K. 30-Day Morbidity and Mortality Outcomes of Prolonged Minimally Invasive Kidney Procedures Compared with Shorter Open Procedures: National Surgical Quality Improvement Program Analysis. J Endourol 2015; 29:830-7. [PMID: 25646859 DOI: 10.1089/end.2014.0795] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Prolonged operative time (ORT) is often considered a drawback to minimally invasive surgery (MIS) because of increased morbidity. Limited data exist comparing long laparoscopic ORT with similar or shorter open ORT. This study aims to identify ORT when a minimally invasive procedure becomes inferior to its open counterpart. METHODS Minimally invasive and open total and partial nephrectomies and nephroureterectomies were identified in the National Surgical Quality Improvement Program (NSQIP) from 2005 to 2012. Procedures were split into open and minimally invasive nephrectomy and then stratified into four ORT groups: 0 to 90 minutes, 91 minutes to 3 hours, 3 to 6 hours, and ≥ 6 hours. Thirty-day mortality and morbidity were analyzed. Univariate analysis was performed using chi-square and Fisher exact tests. Significant univariate results were then tested using stepwise logistic regression, controlling for demographics, comorbidities, and preoperative treatments. RESULTS There were 14,813 patients identified. Both partial and total minimally invasive kidney procedures had significantly improved outcomes compared with open counterparts of similar ORT. In the total nephrectomy group, a minimally invasive approach had a lower rate of surgical site infections, sepsis, pneumonia, return to operating room, and overall length of stay when compared with open procedures of the same duration. Length of hospital stay decreased in MIS regardless of operative time, except when comparing minimally invasive cases longer than 6 hours with open cases less than 90 minutes. Transfusion rates also significantly decreased in minimally invasive total nephrectomy cases. In the partial nephrectomy group, similar outcomes were seen in terms of length of stay and infectious outcomes. Interestingly, transfusion risk was decreased in the open partial nephrectomy group when comparing cases less than 90 minutes with minimally invasive partial nephrectomies lasting 3 to 6 hours; otherwise there was no significant correlation with transfusion risk. CONCLUSIONS Minimally invasive operations are less morbid than open operations of similar ORT. Longer and likely more complex laparoscopic procedures continue to provide a benefit to patients when compared with shorter and possibly less complex open procedures. These data should be considered during a surgeon's preoperative and operative decision-making.
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Affiliation(s)
- Alice Semerjian
- 1 Department of Urology, George Washington University School of Medicine & Health Sciences , Washington, D.C
| | - Sara L Zettervall
- 2 Department of Surgery, George Washington University School of Medicine & Health Sciences , Washington, D.C
| | - Richard Amdur
- 2 Department of Surgery, George Washington University School of Medicine & Health Sciences , Washington, D.C
| | - Thomas W Jarrett
- 1 Department of Urology, George Washington University School of Medicine & Health Sciences , Washington, D.C
| | - Khashayar Vaziri
- 2 Department of Surgery, George Washington University School of Medicine & Health Sciences , Washington, D.C
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169
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Serum and urine biomarkers for human renal cell carcinoma. DISEASE MARKERS 2015; 2015:251403. [PMID: 25922552 PMCID: PMC4398943 DOI: 10.1155/2015/251403] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/26/2015] [Indexed: 12/16/2022]
Abstract
Renal cell carcinoma (RCC) diagnosis is mostly achieved incidentally by imaging provided for unrelated clinical reasons. The surgical management of localized tumors has reported excellent results. The therapy of advanced RCC has evolved considerably over recent years with the widespread use of the so-called “targeted therapies.” The identification of molecular markers in body fluids (e.g., sera and urine), which can be used for screening, diagnosis, follow-up, and monitoring of drug-based therapy in RCC patients, is one of the most ambitious challenges in oncologic research. Although there are some promising reports about potential biomarkers in sera, there is limited available data regarding urine markers for RCC. The following review reports some of the most promising biomarkers identified in the biological fluids of RCC patients.
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170
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Schiavina R, Serni S, Mari A, Antonelli A, Bertolo R, Bianchi G, Brunocilla E, Borghesi M, Carini M, Longo N, Martorana G, Mirone V, Morgia G, Porpiglia F, Rocco B, Rovereto B, Simeone C, Sodano M, Terrone C, Ficarra V, Minervini A. A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project. Clin Genitourin Cancer 2015; 13:165-70. [DOI: 10.1016/j.clgc.2014.08.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 08/12/2014] [Accepted: 08/25/2014] [Indexed: 01/12/2023]
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Borghesi M, Brunocilla E, Volpe A, Dababneh H, Pultrone CV, Vagnoni V, La Manna G, Porreca A, Martorana G, Schiavina R. Active surveillance for clinically localized renal tumors: An updated review of current indications and clinical outcomes. Int J Urol 2015; 22:432-8. [DOI: 10.1111/iju.12734] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 12/30/2014] [Accepted: 01/16/2015] [Indexed: 01/14/2023]
Affiliation(s)
- Marco Borghesi
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
- Department of Medical and Surgical Sciences; University of Bologna; Bologna Italy
| | - Eugenio Brunocilla
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
| | - Alessandro Volpe
- Department of Urology; University of Eastern Piedmont, Maggiore della Carità Hospital; Novara Italy
| | - Hussam Dababneh
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
| | - Cristian Vincenzo Pultrone
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
- Department of Medical and Surgical Sciences; University of Bologna; Bologna Italy
| | - Valerio Vagnoni
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
| | - Gaetano La Manna
- Department of Medical and Surgical Sciences; University of Bologna; Bologna Italy
- Department of Nephrology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
| | - Angelo Porreca
- Department of Urology; Abano Terme Hospital; Abano Terme Italy
| | - Giuseppe Martorana
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
- Department of Medical and Surgical Sciences; University of Bologna; Bologna Italy
| | - Riccardo Schiavina
- Department of Urology; University of Bologna, S. Orsola-Malpighi Hospital; Bologna Italy
- Department of Medical and Surgical Sciences; University of Bologna; Bologna Italy
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172
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Komninos C, Tuliao P, Koo KC, Chang CH, Han WK, Rha KH. Obesity is not associated with increased operative complications in single-site robotic partial nephrectomy. Yonsei Med J 2015; 56:382-7. [PMID: 25683985 PMCID: PMC4329348 DOI: 10.3349/ymj.2015.56.2.382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/09/2014] [Accepted: 05/21/2014] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To evaluate the impact of high body mass index (BMI) on outcomes following robotic laparoendoscopic single-site surgery (R-LESS) robotic-assisted laparoscopic partial nephrectomy (RPN). MATERIALS AND METHODS Data from 83 Korean patients who had undergone robotic partial nephrectomy from 2006 to 2014 were retrospectively analyzed. The subjects were stratified into two groups according to WHO definitions for the Asian population, consisting of 56 normal range (BMI=18.5-24.99 kg/m²) and 27 obese (≥25 kg/m²) patients. Outcome measurements included Trifecta achievement and the perioperative and postoperative comparison between high and normal BMI series. The measurements were estimated and analyzed with SPSS version 17. RESULTS Tumor's complexity characteristics (R.E.N.A.L. score, tumor size) of both groups were similar. No significant differences existed between the two groups with regard to operative time (p=0.27), warm ischemia time (p=0.35) estimated blood loss (p=0.42), transfusion rate (p=0.48) renal function following up for 1 year, positive margins (p=0.24) and postoperative complication rate (p=0.34). Trifecta was achieved in 5 (18.5%) obese and 19 (33.9%) normal weight patients, respectively (p=0.14). In multivariable analysis, only tumor size was significantly correlated with the possibility of Trifecta accomplishment. CONCLUSION Our findings suggest that R-LESS RPN can be effectively and safely performed in patients with increased BMI, since Trifecta rate, and perioperative and postoperative outcomes are not significantly different in comparison to normal weight subjects.
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Affiliation(s)
- Christos Komninos
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Patrick Tuliao
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyo Chul Koo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chien-Hsiang Chang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
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173
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Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, Kuczyk MA, Lam T, Marconi L, Merseburger AS, Mulders P, Powles T, Staehler M, Volpe A, Bex A. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 2015; 67:913-24. [PMID: 25616710 DOI: 10.1016/j.eururo.2015.01.005] [Citation(s) in RCA: 1761] [Impact Index Per Article: 195.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/02/2015] [Indexed: 02/09/2023]
Abstract
CONTEXT The European Association of Urology Guideline Panel for Renal Cell Carcinoma (RCC) has prepared evidence-based guidelines and recommendations for RCC management. OBJECTIVES To provide an update of the 2010 RCC guideline based on a standardised methodology that is robust, transparent, reproducible, and reliable. EVIDENCE ACQUISITION For the 2014 update, the panel prioritised the following topics: percutaneous biopsy of renal masses, treatment of localised RCC (including surgical and nonsurgical management), lymph node dissection, management of venous thrombus, systemic therapy, and local treatment of metastases, for which evidence synthesis was undertaken based on systematic reviews adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant databases (Medline, Cochrane Library, trial registries, conference proceedings) were searched (January 2000 to November 2013) including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm. Risk of bias (RoB) assessment and qualitative and quantitative synthesis of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment. EVIDENCE SYNTHESIS All chapters of the RCC guideline were updated. For the various systematic reviews, the search identified a total of 10,862 articles. A total of 151 studies reporting on 78,792 patients were eligible for inclusion; where applicable, data from RCTs were included and meta-analyses were performed. For RCTs, there was low RoB across studies; however, clinical and methodological heterogeneity prevented data pooling for most studies. The majority of studies included were retrospective with matched or unmatched cohorts based on single or multi-institutional data or national registries. The exception was for systemic treatment of metastatic RCC, in which several RCTs have been performed, resulting in recommendations based on higher levels of evidence. CONCLUSIONS The 2014 guideline has been updated by a multidisciplinary panel using the highest methodological standards, and provides the best and most reliable contemporary evidence base for RCC management. PATIENT SUMMARY The European Association of Urology Guideline Panel for Renal Cell Carcinoma has thoroughly evaluated available research data on kidney cancer to establish international standards for the care of kidney cancer patients.
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Affiliation(s)
- Borje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | - Steven Canfield
- Division of Urology, University of Texas Medical School at Houston, Houston, TX, USA
| | - Saeed Dabestani
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Fabian Hofmann
- Department of Urology, Sunderby Hospital, Sunderby, Sweden
| | - Milan Hora
- Department of Urology, Faculty Hospital and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Markus A Kuczyk
- Department of Urology and Urologic Oncology, Hanover University Medical School, Hanover, Germany
| | - Thomas Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Axel S Merseburger
- Department of Urology and Urologic Oncology, Hanover University Medical School, Hanover, Germany
| | - Peter Mulders
- Department of Urology, Radboud University, Nijmegen, The Netherlands
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, St. Bartholomew's Hospital, London, UK
| | - Michael Staehler
- Urologische Klinik, Klinikum der Ludwig-Maximilians Universität, Munich, Germany
| | - Alessandro Volpe
- Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Axel Bex
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Abstract
Owing to improvements in catheters and embolic agents, renal artery embolization (RAE) is increasingly used to treat nephrological and urological disease. RAE has become a useful adjunct to medical resuscitation in severe penetrating, iatrogenic or blunt renal traumatisms with active bleeding, and might avoid surgical intervention, particularly among patients that are haemodynamically stable. The role of RAE in pre-operative or palliative management of advanced malignant renal tumours remains debated; however, RAE is recommended as a first-line therapy for bleeding angiomyolipomas and can be used as a preventative treatment for angiomyolipomas at risk of bleeding. RAE represents an alternative to nephrectomy in various medical conditions, including severe uncontrolled hypertension among patients with end-stage renal disease, renal graft intolerance syndrome or autosomal dominant polycystic kidney disease. RAE is increasingly used to treat renal artery aneurysms or symptomatic renal arteriovenous malformations, with a low complication rate as compared with surgical alternatives. This Review highlights the potential use of RAE as an adjunct in the management of renal disease. We first compare and contrast the technical approaches of RAE associated with the various available embolization agents and then discuss the complications associated with RAE and alternative procedures.
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175
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Gorin MA, Ball MW, Pierorazio PM, Argani P, Allaf ME. Partial nephrectomy for the treatment of translocation renal cell carcinoma. Clin Genitourin Cancer 2014; 13:e199-201. [PMID: 25592300 DOI: 10.1016/j.clgc.2014.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/04/2014] [Accepted: 12/15/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the outcome of patients with translocation renal cell carcinoma (RCC) treated with partial nephrectomy. PATIENTS AND METHODS Our institutional review board-approved renal mass registry was queried for patients who underwent partial nephrectomy for a pathologically confirmed translocation RCC. We describe the demographic, clinical, pathological, and follow-up data for this series of patients. RESULTS Between 2003 and 2013, 1897 patients with RCC were treated at our institution with a radical or partial nephrectomy. In total, 10 (0.5%) patients were diagnosed with a translocation RCC. Of these patients, 4 (40%) underwent treatment with partial nephrectomy for an incidentally detected small renal mass (mean imaging diameter, 2.6 cm [range, 1.0-4.2 cm]). During a mean follow-up of 37 months (range, 8-81 months), all patients were alive without evidence of disease. CONCLUSION At short-term follow-up, partial nephrectomy appears to be an effective treatment option for patients with small translocation RCCs. Larger studies are required to more extensively investigate the optimal treatment of these potentially aggressive tumors.
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Affiliation(s)
- Michael A Gorin
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Mark W Ball
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pedram Argani
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
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176
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Liss MA, Wang S, Palazzi K, Jabaji R, Patel N, Lee HJ, Parsons JK, Derweesh IH. Evaluation of national trends in the utilization of partial nephrectomy in relation to the publication of the American Urologic Association guidelines for the management of clinical T1 renal masses. BMC Urol 2014; 14:101. [PMID: 25519922 PMCID: PMC4289557 DOI: 10.1186/1471-2490-14-101] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 11/10/2014] [Indexed: 11/24/2022] Open
Abstract
Background Partial nephrectomy has been underutilized in the United States. We investigated national trends in partial nephrectomy (PN) utilization before and after publication of the American Urological Association (AUA) Practice Guideline for management of the clinical T1 renal mass. Methods We identified adult patients who underwent radical (RN) or PN from November 2007 to October 2011 in the Nationwide Inpatient Sample (NIS). PN prevalence was calculated prior to (11/2007-10/2009) and after Guidelines publication (11/2009-10/2011) and compared the rate of change by linear regression. We also examined the nephrectomy trends in patients with chronic kidney disease (CKD). Statistical analysis included linear regression to determine point-prevalence of PN rates in CKD patients and logistic regression to identify variables associated with PN. Results During the study period, 30,944 patients underwent PN and 64,767 RN. The prevalence PN increased from 28.9% in the years prior to guideline release to 35.3% in the years following guideline release with an adjusted odds ratio (OR) of 1.24 (CI 1.01–1.54; p = 0.049). The rate of PN significantly increased throughout the study period (R2 0.15, p = 0.006): however, the rate of change was not increased after the guidelines. (p = 0.46). Overall rate of PN in patients with CKD did not increase over time (R2 0.0007, p = 0.99). Conclusion We noted a 6.4% absolute increase in PN after release of the AUA guidelines on clinical T1 renal mass was published; however, the rate of increase was not likely associated with guideline release. The rate of PN performed is increasing; however, further investigation regarding medical decision-making surrounding PN is needed.
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Affiliation(s)
| | | | | | | | | | | | | | - Ithaar H Derweesh
- Department of Urology, University of California San Diego Health System, La Jolla, CA, USA.
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177
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Park YH, Kim KT, Bae JB, Kim HH. Transvaginal and transrectal natural orifice translumenal endoscopic surgery nephrectomy in a porcine survival model: comparison with conventional laparoscopic nephrectomy. J Endourol 2014; 29:351-6. [PMID: 25350081 DOI: 10.1089/end.2014.0309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE We analyzed the technical feasibility, physiological influence, and safety of transvaginal (TV) and transrectal (TR) natural orifice translumenal endoscopic surgery (NOTES) nephrectomy compared with conventional laparoscopic surgery in a porcine survival model. METHODS Fifteen female pigs (32.8-37.2 kg) were randomly assigned to undergo TV NOTES (n=5), TR NOTES (n=5), or conventional laparoscopic nephrectomy (n=5). Postoperatively, all animals were observed for global health status during the recovery from anesthesia. Variable laboratory parameters and inflammatory cytokines were compared among the groups during the entire experimental period. Postmortem examination was performed 1 week after operation for assessment of abdominal complications and cultures for microorganisms. RESULTS All experiments were completed successfully without insertion of an extra port or conversion to laparoscopic or open surgery. Although mean operative times were longer in TV and TR NOTES groups than in the conventional laparoscopy group (61 vs 84 vs 24 min, P<0.001), there were no signs of visceral injury or peritonitis on postmortem examination. None of the laboratory parameters, including white blood cell count, tumor necrosis factor-α, interleukin (IL)-1, and IL-6 differed among the groups during the entire experimental period. CONCLUSIONS TV and TR NOTES nephrectomy could be completed successfully with similar physiologic influence to those of conventional laparoscopic nephrectomy in a porcine survival model.
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Affiliation(s)
- Yong Hyun Park
- 1 Department of Urology, The Catholic University of Korea , Seoul St. Mary's Hospital, Seoul, Korea
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178
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Han KS, Song GH, You D, Song C, Jeong IG, Hong JH, Ahn H, Kim CS, Hong B. Comparison of Hand-Assisted Laparoscopic vs Robot-Assisted Laparoscopic vs Open Partial Nephrectomy in Patients with T1 Renal Masses. J Endourol 2014; 31:374-379. [PMID: 25353326 DOI: 10.1089/end.2014.0517] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the validity of hand-assisted laparoscopic partial nephrectomy (HALPN) for small renal masses, patients who underwent HALPN, robot-assisted laparoscopic partial nephrectomy (RALPN), or open partial nephrectomy (OPN) at a single medical institution were compared in terms of perioperative outcomes. PATIENTS AND METHODS In this retrospective cohort study, all 590 consecutive patients who underwent HALPN (n=89), RALPN (n=147), or OPN (n=354) between July 2011 and April 2014 in a single institute were compared in terms of perioperative outcomes, including the mean operative time, warm ischemia time (WIT), length of the hospital stay, change in the estimated glomerulofiltration rate (eGFR), duration of analgesic use, surgical margins, and adverse events. The patient groups were compared by a multivariate regression model, in which adjustments were made for differences in baseline demographic and tumor characteristics. RESULTS OPN associated with a significantly longer mean operative time (187 minutes) than RALPN (162 minutes; p<0.001) or HALPN (172 minutes; p=0.013), a longer hospital stay (7.3, 5.3, and 5.9 days, respectively; p<0.001 and <0.001, respectively), and a longer duration of analgesic use (6.6, 4.6, and 5.4 days, respectively; p<0.001 and <0.001, respectively). HALPN and RALPN were equivalent in terms of operative time. RALPN had a significantly longer WIT than HALPN and OPN (p<0.001 and <0.001, respectively). HALPN had a significantly longer hospital stay than RALPN (p=0.026). The three methods differed in terms of eGFR change (p=0.028), but multivariate analysis found that the surgical method was not a significant factor for eGFR. The three methods did not differ in terms of complication rates. CONCLUSIONS HALPN associated with shorter operative and convalescence times compared with OPN. HALPN was generally not inferior to RALPN in terms of perioperative outcomes, although it associated with a longer convalescence.
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Affiliation(s)
- Kyung-Sik Han
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Gee Hyun Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
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Menko FH, Maher ER, Schmidt LS, Middelton LA, Aittomäki K, Tomlinson I, Richard S, Linehan WM. Hereditary leiomyomatosis and renal cell cancer (HLRCC): renal cancer risk, surveillance and treatment. Fam Cancer 2014; 13:637-44. [PMID: 25012257 PMCID: PMC4574691 DOI: 10.1007/s10689-014-9735-2] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Hereditary leiomyomatosis and renal cell cancer (HLRCC) is an autosomal dominant condition in which susceptible individuals are at risk for the development of cutaneous leiomyomas, early onset multiple uterine leiomyomas and an aggressive form of type 2 papillary renal cell cancer. HLRCC is caused by germline mutations in the fumarate hydratase (FH) gene which inactivate the enzyme and alters the function of the tricarboxylic acid (Krebs) cycle. Issues surrounding surveillance and treatment for HLRCC-associated renal cell cancer were considered as part of a recent international symposium on HLRCC. The management protocol proposed in this article is based on a literature review and a consensus meeting. The lifetime renal cancer risk for FH mutation carriers is estimated to be 15 %. In view of the potential for early onset of RCC in HLRCC, periodic renal imaging and, when available, predictive testing for a FH mutation is recommended from 8 to 10 years of age. However, the small risk of renal cell cancer in the 10-20 years age range and the potential drawbacks of screening should be carefully discussed on an individual basis. Surveillance preferably consists of annual abdominal MRI. Treatment of renal tumours should be prompt and generally consist of wide-margin surgical excision and consideration of retroperitoneal lymph node dissection. The choice for systemic treatment in metastatic disease should, if possible, be part of a clinical trial. Screening procedures in HLRCC families should preferably be evaluated in large cohorts of families.
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Affiliation(s)
- Fred H Menko
- Netherlands Cancer Institute, Amsterdam, The Netherlands,
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180
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Castellucci R, Cindolo L, Alvaréz-Maestro M, Giusti G, Berardinelli F, Pellegrini F, Schips L. Single-site laparoscopic partial nephrectomy: Where are we going? World J Clin Urol 2014; 3:358-363. [DOI: 10.5410/wjcu.v3.i3.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/23/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To review an evolution of laparoscopic surgery, there has been a growing interest in laparoendoscopic single-site surgery (LESS).
METHODS: A comprehensive electronic literature search was conducted using PubMed database to identify all publications relating to LESS-partial nephrectomy (PN). The research includes articles published from April 2008 to January 2014. We focused our attention only on articles in which were cited the single-site surgical technique (laparoscopic and robotic), tumour stage and grade, mean tumour size, intraoperative variables, blood loss and transfusion rate, length of post-operative stay and complication rates, Clavien classification, positive of surgical margins, pain assessment at discharge.
RESULTS: A total of 9 studies were collected with 221 patients included. The mean patients age was 62 years. The mean tumor size was 2.35 cm with a mean operative time of 181 min (range 111-270 min) and 58.3% were done by robot. The mean ischemia time was 23.6 min. The 25.8% of patients underwent an unclamp LESS-PN. Mean estimated blood loss was 296 mL and median length of hospital stay was 4 d. The rate of severe post-operative complications (≥ Clavien grade III) was 5.4%. Not all surgical series of LESS-PN or Robotic-LESS-PN shows conversion in Multiport Laparoscopic or Open Surgery. Regarding oncologic outcomes, surgical margins were positive 4% of patients (9/221), no distant or port-site metastases were recorded.
CONCLUSION: LESS-PN and RLESS-PN are feasible and associated with reduced postoperative pain, shorter median hospital stay, shorter recovery time, and better cosmetic satisfaction without compromising surgical and oncological safety.
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181
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Laparoscopic nephrectomy, ex vivo partial nephrectomy, and autotransplantation for the treatment of complex renal masses. Case Rep Urol 2014; 2014:354104. [PMID: 25506461 PMCID: PMC4260371 DOI: 10.1155/2014/354104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/15/2014] [Indexed: 11/17/2022] Open
Abstract
In the contemporary era of minimally invasive surgery, very few T1/T2 renal lesions are not amenable to nephron-sparing surgery. However, centrally located lesions continue to pose a clinical dilemma. We sought to describe our local experience with three cases of laparoscopic nephrectomy, ex vivo partial nephrectomy, and autotransplantation. Laparoscopic donor nephrectomy was performed followed by immediate renal cooling and perfusion with isotonic solution. Back-table partial nephrectomy, renorrhaphy, and autotransplantation were then performed. Mean warm ischemia (WIT) and cold ischemic times (CIT) were 2 and 39 minutes, respectively. Average blood loss was 267 mL. All patients preserved their renal function postoperatively. Final pathology confirmed pT1, clear cell renal cell carcinoma with negative margins in all. All are disease free at up to 39 months follow-up with stable renal function. In conclusion, the described approach remains a viable option for the treatment of complex renal masses preserving oncological control and renal function.
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182
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Giannarini G, Gandaglia G, Montorsi F, Briganti A. Reply to M. Valerio et al. J Clin Oncol 2014; 32:3681-2. [PMID: 25135993 DOI: 10.1200/jco.2014.57.7353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Giorgio Gandaglia
- Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Urological Research Institute, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
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Abstract
Local treatment of metastases such as metastasectomy or radiotherapy remains controversial in the treatment of metastatic renal cell carcinoma. To investigate the benefits and harms of various local treatments, we did a systematic review of all types of comparative studies on local treatment of metastases from renal cell carcinoma in any organ. Interventions included metastasectomy, radiotherapy modalities, and no local treatment. The results suggest that patients treated with complete metastasectomy have better survival and symptom control (including pain relief in bone metastases) than those treated with either incomplete or no metastasectomy. Nevertheless, the available evidence was marred by high risks of bias and confounding across all studies. Although the findings presented here should be interpreted with caution, they and the identified gaps in knowledge should provide guidance for clinicians and researchers, and directions for further research.
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184
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Porpiglia F, Bertolo R, Amparore D, Cattaneo G, Fiori C. Mini–Retroperitoneoscopic Clampless Partial Nephrectomy for “Low-complexity” Renal Tumours (PADUA Score ≤8). Eur Urol 2014; 66:778-83. [DOI: 10.1016/j.eururo.2014.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/02/2014] [Indexed: 11/27/2022]
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185
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Haddad AQ, Kapur P, Singla N, Raman JD, Then MT, Nuhn P, Buchner A, Bastian P, Seitz C, Shariat SF, Bensalah K, Rioux-Leclercq N, Sagalowsky A, Lotan Y, Margulis V. Validation of mammalian target of rapamycin biomarker panel in patients with clear cell renal cell carcinoma. Cancer 2014; 121:43-50. [PMID: 25186283 DOI: 10.1002/cncr.28976] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/11/2014] [Accepted: 06/12/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND This was an external validation of the prognostic benefit of mammalian target of rapamycin (mTOR) marker panel in patients with clear cell renal cell carcinoma (ccRCC). METHODS Immunohistochemistry for 5 mTOR pathway markers was performed on tissue microarrays of patients with nonmetastatic ccRCC treated surgically at 4 centers. The markers employed were phosphatase and tensin homolog (PTEN), phosphoinositide 3-kinase (PI3K), phosphorylated-mTOR (p-mTOR), phosphorylated-S6 (p-S6), and phosphorylated 4E-binding protein-1 (p-4EBP1). Cox regression was used to correlate marker status and oncologic outcomes. Discrimination of the models was determined using area under the curve and net reclassification improvement. RESULTS Five hundred twenty-eight patients with a median follow-up of 56.5 months were included. Expression of PI3K, PTEN, p-mTOR, p-4EBP1, and p-S6 was altered in 52%, 78%, 25%, 86%, and 30% of patients, respectively. The number of altered biomarkers predicted recurrence-free survival (RFS) in multivariate analysis adjusted for stage, grade, and lymph node status (HR, 3.20; P = .02 for patients with 4-5 altered biomarkers compared with 0-1 altered markers). A biomarker panel consisting of only 2 markers (p-S6 and p-4EBP1) independently predicted for worse RFS (HR, 4.38; P = .003 for patients with 2 altered markers compared to patients with 0 altered markers). The biomarker score increased predictive accuracy when added to the clinical Cox regression model. CONCLUSIONS m-TOR pathway biomarkers add prognostic information in addition to standard clinicopathologic variables in ccRCC patients and may identify patients who could benefit from additional treatments or closer postoperative surveillance.
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Affiliation(s)
- Ahmed Q Haddad
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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186
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Mayo adhesive probability score: an accurate image-based scoring system to predict adherent perinephric fat in partial nephrectomy. Eur Urol 2014; 66:1165-71. [PMID: 25192968 DOI: 10.1016/j.eururo.2014.08.054] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 08/21/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND Image-based renal morphometry scoring systems are used to predict the potential difficulty of partial nephrectomy (PN), but they are centered entirely on tumor-specific factors and neglect other patient-specific factors that may complicate the technical aspects of PN. Adherent perinephric fat (APF) is one such factor known to make PN difficult. OBJECTIVE To develop an accurate image-based nephrometry scoring system to predict the presence of APF encountered during robot-assisted partial nephrectomy (RAPN). DESIGN, SETTING, AND PARTICIPANTS We prospectively analyzed 100 consecutive RAPNs performed by one surgeon and defined APF as the need for subcapsular renal dissection to isolate the renal tumor for RAPN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The scoring algorithm to predict the presence of APF was developed with a multivariable logistic regression model using a forward selection approach with a focus on improvement in the area under the receiver operating characteristic curve. RESULTS AND LIMITATIONS Thirty patients (30%; 95% confidence interval, 21-40) had APF. Single-variable analysis noted an increased likelihood of APF in male patients (p<0.001), higher body mass index (p=0.003), greater posterior perinephric fat thickness (p<0.001), greater lateral perinephric fat thickness (p<0.001), and those with perirenal fat stranding (p<0.001). Two of these variables, posterior perinephric fat thickness and stranding, were most highly predictive of APF in multivariable analysis and were therefore used to create a risk score, termed Mayo Adhesive Probability (MAP) and ranging from 0 to 5, to predict the presence of APF. We observed APF in 6% of patients with a MAP score of 0, 16% with a score of 1, 31% with a score of 2, 73% with a score of 3-4, and 100% of patients with a score of 5. CONCLUSIONS MAP score accurately predicts the presence of APF in patients undergoing RAPN. Prospective validation of the MAP score is required. PATIENT SUMMARY The Mayo Adhesive Probability score that we we developed is an accurate system that predicts whether or not adherent perinephric, or "sticky," fat is present around the kidney that would make partial nephrectomy difficult.
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187
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Escudier B, Porta C, Schmidinger M, Algaba F, Patard J, Khoo V, Eisen T, Horwich A. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014; 25 Suppl 3:iii49-56. [DOI: 10.1093/annonc/mdu259] [Citation(s) in RCA: 284] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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188
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Malone JK, Blake C, Caulfield BM. Neuromuscular Electrical Stimulation During Recovery From Exercise. J Strength Cond Res 2014; 28:2478-506. [DOI: 10.1519/jsc.0000000000000426] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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189
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[Clinical outcomes after non-ischemic partial nephrectomy for clinical T1 renal tumors using soft coagulation versus microwave tissue coagulation]. Nihon Hinyokika Gakkai Zasshi 2014; 105:85-90. [PMID: 25158549 DOI: 10.5980/jpnjurol.105.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE We have performed non-ischemic partial nephrectomy for clinical T1 renal tumors using microwave tissue coagulation (MTC group) or soft coagulation (soft coagulation group). The clinical outcomes were retrospectively compared between the two groups. MATERIALS AND METHODS A total of 36 patients were analyzed in this study (22 in the MTC group and 14 in the soft coagulation group). The anatomical characteristics of the renal tumors were assessed using the R.E.N.A.L Nephrometry Score. Renal function was assessed by the estimated glomerular filtration rate. RESULTS The preoperative estimated glomerular filtration rate was 72.1 ml/min in the MTC group and 65.6 ml/min in the soft coagulation group (p = 0.05). The R.E.N.A.L Nephrometry Score was not significantly different between the two groups. Clavian grade > or = 2 postoperative complications occurred in one patient (4.5%) in the MTC group and one patient (7.1%) in the soft coagulation group. Postoperative local recurrence and distant metastasis occurred in one patient (8.3%) in the soft coagulation group and no patients in the MTC group, which was not a significant difference between the two groups. The median postoperative decrease in estimated glomerular filtration rate was 11.5% in the MTC group and 3.6% in the soft coagulation group. Postoperative renal preservation tended to be better in the soft coagulation group than in the MTC group, but this difference was not significant. CONCLUSION The use of soft coagulation in non-ischemic partial nephrectomy for the treatment of clinical T1 renal tumors is as effective as that of MTC.
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190
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Antonelli A, Minervini A, Mari A, Bertolo R, Bianchi G, Lapini A, Longo N, Martorana G, Mirone V, Morgia G, Novara G, Porpiglia F, Rocco B, Rovereto B, Schiavina R, Simeone C, Sodano M, Terrone C, Ficarra V, Carini M, Serni S. TriMatch comparison of the efficacy of FloSeal versus TachoSil versus no hemostatic agents for partial nephrectomy: Results from a large multicenter dataset. Int J Urol 2014; 22:47-52. [DOI: 10.1111/iju.12603] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Andrea Minervini
- 1st Department of Urology; University of Florence; Florence Italy
| | - Andrea Mari
- 1st Department of Urology; University of Florence; Florence Italy
| | - Riccardo Bertolo
- Department of Urology; University of Turin; San Luigi Gonzaga Hospital; Turin Italy
| | - Giampaolo Bianchi
- Department of Urology; University of Modena-Reggio Emilia; Modena Italy
| | - Alberto Lapini
- 1st Department of Urology; University of Florence; Florence Italy
| | - Nicola Longo
- Department of Urology; University Federico II; Naples Italy
| | | | | | | | | | - Francesco Porpiglia
- Department of Urology; University of Turin; San Luigi Gonzaga Hospital; Turin Italy
| | | | - Bruno Rovereto
- Department of Urology; Policlinico San Matteo; Pavia Italy
| | | | | | - Mario Sodano
- Department of Urology; University of Brescia; Brescia Italy
| | - Carlo Terrone
- Department of Urology; “Maggiore della Carità” Hospital; Novara Italy
| | | | - Marco Carini
- 1st Department of Urology; University of Florence; Florence Italy
| | - Sergio Serni
- 1st Department of Urology; University of Florence; Florence Italy
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191
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Wu Z, Li M, Song S, Ye H, Yang Q, Liu B, Cai C, Yang B, Xiao L, Chen Q, Lü C, Gao X, Xu C, Gao X, Hou J, Wang L, Sun Y. Propensity-score matched analysis comparing robot-assisted with laparoscopic partial nephrectomy. BJU Int 2014; 115:437-45. [PMID: 24731125 DOI: 10.1111/bju.12774] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Zhenjie Wu
- Department of Urology; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Mingmin Li
- Department of Radiology; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Shangqing Song
- Department of Urology; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Huamao Ye
- Department of Urology; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Qing Yang
- Department of Urology; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Bing Liu
- Department of Urology; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Chen Cai
- Department of Special Clinics; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Bo Yang
- Department of Urology; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Liang Xiao
- Department of Urology; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Qi Chen
- Department of Health Statistics; Second Military Medical University; Shanghai China
| | - Chen Lü
- Department of Urology; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Xu Gao
- Department of Urology; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Chuanliang Xu
- Department of Urology; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Xiaofeng Gao
- Department of Urology; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Jianguo Hou
- Department of Urology; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Linhui Wang
- Department of Urology; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Yinghao Sun
- Department of Urology; Changhai Hospital; Second Military Medical University; Shanghai China
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192
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Steinestel J, Steffens S, Steinestel K, Schrader AJ. Positive surgical margins in nephron-sparing surgery: risk factors and therapeutic consequences. World J Surg Oncol 2014; 12:252. [PMID: 25103683 PMCID: PMC4249770 DOI: 10.1186/1477-7819-12-252] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/20/2014] [Indexed: 01/21/2023] Open
Abstract
The increased use of nephron-sparing surgery to treat localized renal cell carcinoma (RCC) lends weight to the question of the value of microscopically positive surgical margins (PSM) in cases with a tumor bed macroscopically free of residual tumor. The aim of this article is to highlight the data available on risk factors for PSM, their clinical relevance, and possible therapeutic consequences. For this purpose, publications on the incidence and relevance of PSM after partial nephrectomy from the last 15 years were examined and evaluated. We summarize that PSM are generally rare, regardless of the surgical procedure, and are seen more often in connection with an imperative indication for nephron-sparing surgery as well as a central tumor location. Most studies describe that PSM lead to a moderate increase in the rate of local relapses, but no study has thus far been able to demonstrate an association with shorter tumor-specific overall survival. Intraoperative frozen section analysis had no positive influence on the risk of definite PSM in most trials. Therefore, we conclude that PSM should definitely be avoided. However, in cases with a macroscopically tumor-free intraoperative resection bed, they should lead to close surveillance of the affected kidney and not to immediate (re)intervention.
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Affiliation(s)
- Julie Steinestel
- />Department of Urology, Münster University Medical Center, Albert-Schweitzer-Campus 1, Building A1, 48149 Münster, Germany
| | - Sandra Steffens
- />Department of Urology, Hannover University Medical School, Carl-Neubergstr. 1, 30625 Hannover, Germany
| | - Konrad Steinestel
- />Department of Pathology, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - Andres Jan Schrader
- />Department of Urology, Münster University Medical Center, Albert-Schweitzer-Campus 1, Building A1, 48149 Münster, Germany
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193
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Komninos C, Tuliao P, Rha KH. Current status of robotic laparoendoscopic single-site partial nephrectomy. Int J Urol 2014; 21:954-9. [PMID: 25047133 DOI: 10.1111/iju.12558] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 06/10/2014] [Indexed: 12/23/2022]
Abstract
Robotic laparoendoscopic single-site partial nephrectomy is increasingly carried out in an attempt to improve the cosmetic outcome of minimally-invasive procedures. However, the actual role of this novel technique remains to be determined. The present article reviews evidence and examines updates of robotic laparoendoscopic single-site partial nephrectomy outcomes reported in more contemporary studies. A comprehensive online systematic search of PubMed, Scopus and Web of Science databases according to Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria recommendations was carried out in January 2014, identifying data from 2008 to 2014 regarding robotic laparoendoscopic single-site partial nephrectomy. The majority of medical evidence to date is based on case reports or retrospective studies. Current studies show that robotic laparoendoscopic single-site partial nephrectomy is a feasible procedure carried out in an acceptable length of operative time, and resulting in a desirable cosmetic outcome and less postoperative pain. However, comparable studies show that robotic laparoendoscopic single-site partial nephrectomy is inferior to the conventional approach, especially with regard to warm ischemia time. Furthermore, the numerous limitations that exist with the utilization of the current commercial single-site devices make robotic laparoendoscopic single-site PN more challenging and more complicated for surgeons compared with conventional procedures. Further significant improvements, along with more studies, are required in order to develop the ideal robotic laparoendoscopic single-site robotic platform and overcome the current limitations. For the time being, robotic laparoendoscopic single-site partial nephrectomy procedures could be applicable in patients with low tumor size and complexity, and should not be routinely applied in all cases.
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Affiliation(s)
- Christos Komninos
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea; Department of Urology, General Hospital of Nikaia "St. Panteleimon", Athens, Greece
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194
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Kaouk JH, Haber GP, Autorino R, Crouzet S, Ouzzane A, Flamand V, Villers A. A novel robotic system for single-port urologic surgery: first clinical investigation. Eur Urol 2014; 66:1033-43. [PMID: 25041850 DOI: 10.1016/j.eururo.2014.06.039] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 06/23/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The idea of performing a laparoscopic procedure through a single abdominal incision was conceived with the aim of expediting postoperative recovery. OBJECTIVE To determine the clinical feasibility and safety of single-port urologic procedures by using a novel robotic surgical system. DESIGN, SETTING, AND PARTICIPANTS This was a prospective institutional review board-approved, Innovation, Development, Exploration, Assessment, Long-term Study (IDEAL) phase 1 study. After enrollment, patients underwent a major urologic robotic single-port procedure over a 3-wk period in July 2010. The patients were followed for 3 yr postoperatively. INTERVENTION Different types of urologic surgeries were performed using the da Vinci SP Surgical System. This system is intended to provide the same core clinical capabilities as the existing multiport da Vinci system, except that three articulating endoscopic instruments and an articulating endoscopic camera are inserted into the patient through a single robotic port. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The main outcomes were the technical feasibility of the procedures (as measured by the rate of conversions) and the safety of the procedures (as measured by the incidence of perioperative complications). Secondary end points consisted of evaluating other key surgical perioperative outcomes as well as midterm functional and oncologic outcomes. RESULTS AND LIMITATIONS A total of 19 patients were enrolled in the study. Eleven of them underwent radical prostatectomy; eight subjects underwent nephrectomy procedures (partial nephrectomy, four; radical nephrectomy, two; and simple nephrectomy, two). There were no conversions to alternative surgical approaches. Overall, two major (Clavien grade 3b) postoperative complications were observed in the radical prostatectomy group and none in the nephrectomy group. At 1-yr follow-up, one radical prostatectomy patient experienced biochemical recurrence, which was successfully treated with salvage radiation therapy. The median warm ischemia time for three of the partial nephrectomies was 38 min. At 3-yr follow-up all patients presented a preserved renal function; none had tumor recurrence. Study limitations include the small sample and the lack of a control group. CONCLUSIONS We describe the first clinical application of a novel robotic platform specifically designed for single-port urologic surgery. Major urologic procedures were successfully completed without conversions. Further assessment is warranted to corroborate these promising findings. PATIENT SUMMARY A novel purpose-built robotic system enables surgeons to perform safely and effectively a variety of major urologic procedures through a single small abdominal incision. TRIAL REGISTRATION The study was registered on www.ClinicalTrials.gov (NCT02136121).
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Affiliation(s)
- Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| | | | - Riccardo Autorino
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sebastien Crouzet
- Department of Urology and Transplantation, Edouard Herriot Hospital, Lyon, France
| | - Adil Ouzzane
- Department of Urology, CHU Lille, University Lille Nord de France, Lille, France
| | - Vincent Flamand
- Department of Urology, CHU Lille, University Lille Nord de France, Lille, France
| | - Arnauld Villers
- Department of Urology, CHU Lille, University Lille Nord de France, Lille, France
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195
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Fukushima H, Saito K, Ishioka J, Matsuoka Y, Numao N, Koga F, Masuda H, Fujii Y, Sakai Y, Arisawa C, Okuno T, Yonese J, Kamata S, Nagahama K, Noro A, Morimoto S, Tsujii T, Kitahara S, Gotoh S, Higashi Y, Kihara K. Equivalent survival and improved preservation of renal function after distal ureterectomy compared with nephroureterectomy in patients with urothelial carcinoma of the distal ureter: A propensity score-matched multicenter study. Int J Urol 2014; 21:1098-104. [DOI: 10.1111/iju.12554] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 06/05/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Hiroshi Fukushima
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Kazutaka Saito
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Junichiro Ishioka
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Yoh Matsuoka
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Noboru Numao
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Fumitaka Koga
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Hitoshi Masuda
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Yasuhisa Fujii
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Yasuyuki Sakai
- Department of Urology; National Cancer Center Hospital East; Chiba Japan
| | | | - Tetsuo Okuno
- Department of Urology; JA Toride Medical Center; Ibaraki Japan
| | - Junji Yonese
- Department of Urology; Cancer Institute Hospital; Tokyo Japan
| | | | - Katsushi Nagahama
- Department of Urology; Kohnodai Hospital; National Center for Global Health and Medicine; Chiba Japan
| | - Akira Noro
- Department of Urology; Saitama Red Cross Hospital; Saitama Japan
| | - Shinji Morimoto
- Department of Urology; Tsuchiura Kyodo General Hospital; Ibaraki Japan
| | - Toshihiko Tsujii
- Department of Urology; Tokyo Metropolitan Ohtsuka Hospital; Tokyo Japan
| | | | - Shuichi Gotoh
- Department of Urology; Hamamatsu Medical Center; Shizuoka Japan
| | - Yotsuo Higashi
- Department of Urology; Saitama Prefectural Cancer Center; Saitama Japan
| | - Kazunori Kihara
- Department of Urology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
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196
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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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Ficarra V, Minervini A, Antonelli A, Bhayani S, Guazzoni G, Longo N, Martorana G, Morgia G, Mottrie A, Porter J, Simeone C, Vittori G, Zattoni F, Carini M. A multicentre matched-pair analysis comparing robot-assisted versus open partial nephrectomy. BJU Int 2014; 113:936-41. [PMID: 24219227 DOI: 10.1111/bju.12570] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To compare the perioperative, pathological and functional outcomes in two contemporary, large series of patients in different institutions and who underwent open partial nephrectomy (OPN) or robot-assisted PN (RAPN) for suspected renal tumours. PATIENTS AND METHODS This was a retrospective, multicentre, international, matched-pair analysis comparing patients who underwent RAPN or OPN for suspected renal cell carcinoma. Data on patients who underwent OPN were extracted by an Italian observational registry collecting data from 19 different centres. Data on patients who received RAPN were extracted from a multicentre, international database collecting cases treated in four high-volume referral centres of robotic surgery. The matching was in a 1:1 ratio for the surgical approach and included 200 patients in each arm. RESULTS The mean warm ischaemia time was shorter in the OPN group than in the RAPN group, at a mean (SD) of 15.4 (5.9) vs 19.2 (7.3) min (P < 0.001). Conversely, the median (interquartile range) estimated blood loss was 150 (100-300) mL in the OPN group and 100 (50-150) mL in the RAPN group (P < 0.001). There were no differences in operating time (P = 0.18) and the intraoperative complication rate (P = 0.31) between the approaches. Postoperative complications were recorded in 43 (21.5%) patients who underwent OPN and in 28 (14%) who received RAPN (P = 0.02). Moreover, major complications (grade 3-4) were reported in nine (4.5%) patients after OPN and in nine (4.5%) after RAPN. Positive margins were detected in nine (5.5%) patients after OPN and in nine (5.7%) after RAPN (P = 0.98). The mean (SD) 3-month estimated glomerular filtration rate declined by 16.6 (18.1) mL/min from the preoperative value in the OPN group and by 16.4 (22.9) mL/min in the RAPN group (P = 0.28). CONCLUSION RAPN can achieve equivalent perioperative, early oncological and functional outcomes as OPN. Moreover, RAPN is a less invasive approach, offering a lower risk of bleeding and postoperative complications than OPN.
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198
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Capitanio U, Suardi N, Matloob R, Roscigno M, Abdollah F, Di Trapani E, Moschini M, Gallina A, Salonia A, Briganti A, Montorsi F, Bertini R. Extent of lymph node dissection at nephrectomy affects cancer-specific survival and metastatic progression in specific sub-categories of patients with renal cell carcinoma (RCC). BJU Int 2014; 114:210-5. [PMID: 24854206 DOI: 10.1111/bju.12508] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To test whether the number of lymph nodes removed affects cancer-specific survival (CSS) or metastatic progression-free survival (MPFS) in different renal cell carcinoma (RCC) scenarios. METHODS We used Cox regression analyses to analyse the effect of the number of lymph nodes removed on CSS and MPFS in 1983 patients with RCC treated with nephrectomy. To adjust for possible clinical and surgical selection bias, analyses were further adjusted for number of positive nodes, presence of metastases, age, performance status, T stage, tumour size and grade. RESULTS The prevalence of lymph node invasion was 6.1%. The mean follow-up period was 83.3 months. Multivariable analyses showed that the number of nodes removed had an independent, protective effect on CSS in patients with pT2a-pT2b or pT3c-pT4 RCC (hazard ratio [HR] 0.91, P = 0.008 and HR 0.89, P < 0.001, respectively), in patients with bulky tumours (tumour size >10 cm, HR 0.97, P = 0.03) or when sarcomatoid features were found (HR 0.81, P = 0.006). The removal of each additional lymph node was associated with a 3-19% increase in CSS. When considering MPFS as an endpoint, the number of nodes removed had an independent, protective effect in the same patient categories. CONCLUSIONS When clinically indicated, the number of nodes removed affects CSS and MPFS in specific sub-categories of patients with RCC.
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Affiliation(s)
- Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy
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199
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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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Robotic versus open partial nephrectomy: a systematic review and meta-analysis. PLoS One 2014; 9:e94878. [PMID: 24740259 PMCID: PMC3989253 DOI: 10.1371/journal.pone.0094878] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/18/2014] [Indexed: 01/30/2023] Open
Abstract
Objectives To critically review the currently available evidence of studies comparing robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN). Materials and Methods A comprehensive review of the literature from Pubmed, Web of Science and Scopus was performed in October 2013. All relevant studies comparing RPN with OPN were included for further screening. A cumulative meta-analysis of all comparative studies was performed and publication bias was assessed by a funnel plot. Results Eight studies were included for the analysis, including a total of 3418 patients (757 patients in the robotic group and 2661 patients in the open group). Although RPN procedures had a longer operative time (weighted mean difference [WMD]: 40.89; 95% confidence interval [CI], 14.39–67.40; p = 0.002), patients in this group benefited from a lower perioperative complication rate (19.3% for RPN and 29.5% for OPN; odds ratio [OR]: 0.53; 95%CI, 0.42–0.67; p<0.00001), shorter hospital stay (WMD: −2.78; 95%CI, −3.36 to −1.92; p<0.00001), less estimated blood loss(WMD: −106.83; 95%CI, −176.4 to −37.27; p = 0.003). Transfusions, conversion to radical nephrectomy, ischemia time and estimated GFR change, margin status, and overall cost were comparable between the two techniques. The main limitation of the present meta-analysis is the non-randomization of all included studies. Conclusions RPN appears to be an efficient alternative to OPN with the advantages of a lower rate of perioperative complications, shorter length of hospital stay and less blood loss. Nevertheless, high quality prospective randomized studies with longer follow-up period are needed to confirm these findings.
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