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Nguyen HH, Do TT, Hoang L, Do NS, Van TC, Nguyen DM. Retroperitoneal Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma: Indications and Long-term Outcome of a Cohort Study in Vietnam. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE: Laparoscopic radical nephrectomy (LRN) has been suggested as the standard care for cancer patients in the T1-2 stage. However, whether this advanced technique is most indicated suitable for renal tumors higher than T3a and N1 is unclear, especially in different regions and countries, such as the difference between European and Asia.
METHODS: From 2013 to 2021, the data of pathologically diagnosed renal cell carcinoma (RCC) patients who received laparoscopic retroperitoneal radical nephrectomy was subjected to the present study.
RESULTS: Overall, all the registered Vietnamese patients were eligible for the study. The average operative time was 86.8 ± 21.2 min and the percentage number of patients in stages 1, 2, and 3 were 134 (70.2%), 30 (15.7%), and 27 (14.1%), respectively. Patients in the 3rd stage had a significantly longer operative time than stages 1–2 (p = 0.0001). No Lymph-node dissection (LND) was recorded in 10 patients (5.2%), limited LND in 163 patients (85.3%), regional LND in 13 patients (6.8%), extended LND (eLND) in 5 patients (2.6%). eLND showed only prolongation of operative time (p = 0.000), however, did not increase intraoperative complications as well as prolonged the duration of analgesia and hospital stay when compared with the other 2 groups (p = 0.82, 0.85, 0.91). Mean follow-up time: 42.3 ± 24.7 months. The 5-year recurrent free survival and 5-year overall survival of the stage 1, 2, 3 were: 98.3%, 100%, 87.8%, and 98.9%, 100%, and 91.3%, respectively. (p = 0.0011, p = 0.0082).
CONCLUSION: Retroperitoneal LRN could be an important technique in improving long-term oncological outcomes for Vietnamese patients, especially in the stage of T1-3N0-1M0 tumors. Radical retroperitoneal nephrectomy is safe and technically feasible as well as providing favorable long-term oncological outcomes for stage T1-2-3aN1M0 RCC.
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You D, Choi SY, Ryu J, Kim CS. Surgical Consideration in Renal Tumors. KIDNEY CANCER 2020. [DOI: 10.1007/978-3-030-28333-9_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Serur E, Zambrano N, Brown K, Clemetson E, Lakhi N. Extracorporeal Manual Morcellation of Very Large Uteri Within an Enclosed Endoscopic Bag: Our 5-Year Experience. J Minim Invasive Gynecol 2016; 23:903-8. [PMID: 27058770 DOI: 10.1016/j.jmig.2016.03.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVES To describe a technique to manually morcellate large uteri within a polyurethane endoscopic bag at the time of laparoscopic hysterectomy, and report perioperative outcomes from our 5 years of experience. STUDY DESIGN Retrospective review of all consecutive hysterectomies with uterine weight >500 g performed between January 2010 and December 2014 in which the uterus was manually morcellated within an endoscopic bag by either an abdominal or vaginal approach (Canadian Task Force Classification Level III). SETTING Tertiary care academic medical center. PATIENTS A total of 104 women with a uterine weight >500 g who underwent laparoscopic hysterectomy using a manual morcellation technique. INTERVENTION Manual morcellation was done extracorporeally, within a partially exteriorized specimen bag, using a scalpel under direct visualization by the operating surgeon. MEASUREMENTS AND MAIN RESULTS A total of 104 laparoscopic hysterectomies were performed in women with a uterus weighing >500 g using a manual morcellation technique for specimen extraction. The median patient age was 48.1 years (range, 34-69 years), and the median body mass index was 31.0 kg/m(2) (range, 19.1-56.7 kg/m(2)). The median blood loss and specimen weight were 200 mL (range, 20-1200 mL) and 741.5 g (range, 500-1930 g), respectively. Morcellation was performed through an abdominal approach in 58.7% of the patients and through a vaginal approach in 41.3%. The median duration of morcellation was 14.8 minutes (range, 4.5-21.6 minutes) for the abdominal route and 11.7 minutes (range, 5.2-16.8 minutes) for the vaginal route. Occult malignancy was identified in 2 patients. There were no complications related to the morcellation technique or gross bag rupture. CONCLUSION Manual morcellation within an endoscopic bag allows for the extraction of large uteri without the use of a power morcellator. In our 5 years of experience, we have not experienced any incidence of gross spillage, visually noted bag rupture, or complications associated with our morcellation technique.
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Affiliation(s)
- Eli Serur
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY
| | - Nabila Zambrano
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY
| | - Kevin Brown
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY
| | - Emily Clemetson
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY
| | - Nisha Lakhi
- Department of Obstetrics and Gynecology, Richmond University Medical Center, Staten Island, NY.
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Outcomes of curative nephrectomy against renal cell carcinoma based on a central pathological review of 914 specimens from the era of cytokine treatment. Int J Clin Oncol 2015; 20:1161-70. [DOI: 10.1007/s10147-015-0840-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
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Krabbe LM, Bagrodia A, Margulis V, Wood CG. Surgical management of renal cell carcinoma. Semin Intervent Radiol 2014; 31:27-32. [PMID: 24596437 DOI: 10.1055/s-0033-1363840] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Surgical resection of renal cell carcinoma (RCC) is the benchmark for long-term cure of the disease. Although open or laparoscopic radical nephrectomy is considered the gold standard for stage T1b-T4 tumors, nephron-sparing surgery is the preferred operative modality for small renal masses demonstrating equivalent oncologic efficacy and improved renal function outcomes compared with complete nephrectomy. With the advance of minimally invasive surgery, nephron-sparing procedures can safely be conducted laparoscopically with or without robotic assistance. RCC with intravenous tumor thrombus presents a surgical challenge, but multidisciplinary surgical approaches can provide long-term benefit in these patients. The role of cytoreductive nephrectomy and metastasectomy in patients with metastatic RCC (mRCC) is controversial, but seems to be beneficial for patients in the era of targeted therapy.
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Affiliation(s)
- Laura-Maria Krabbe
- Department of Urology, the University of Muenster Medical Center, Muenster, Germany ; Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | - Aditya Bagrodia
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | - Vitaly Margulis
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
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Yang L, Fan T, Wei Q, Cui X, Bu S, Han P. Transient variations in the serum concentrations of cell adhesion molecules following retroperitoneal laparoscopic and open radical nephrectomy for localized renal-cell carcinoma. J Endourol 2012; 26:1323-8. [PMID: 22698005 DOI: 10.1089/end.2011.0673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate differences in the serum concentrations of cell adhesion molecules (CAMs) after retroperitoneal laparoscopic and conventional open radical nephrectomies for localized renal-cell carcinoma (RCC). PATIENTS AND METHODS A total of 62 patients with stage T(1)N(0)M(0) RCC were randomized to either a retroperitoneal laparoscopic radical nephrectomy group (n=31) or an open group (n=31). Serum levels of soluble cluster of differentiation 44 splice variant 6 (sCD44v6), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), and soluble epithelial cadherin (sE-cadherin) were determined independently by enzyme linked immunosorbent assay (ELISA) preoperatively, and on postoperative days 1 and 5. In addition, follow-up results were compared. RESULTS On postoperative day 1, sCD44v6, sICAM-1, and sVCAM-1 levels increased significantly compared with preoperative levels in both groups (P<0.05). sE-cadherin levels decreased compared with preoperative levels in both groups without statistically significant differences (P>0.05). sCD44v6 levels in the retro-laparoscopy group were significantly higher than in the open group (P<0.05), while sICAM-1, sVCAM-1, and sE-cadherin levels showed no statistically significant differences between both groups (P>0.05). On postoperative day 5, all parameters in both groups were similar to preoperative values (P>0.05). Follow-up ranged from 7 to 18 months postoperatively in all 62 patients, with a 100% cancer-specific survival rate in each group. CONCLUSION Although postoperatively higher serum concentrations of CAMs in both groups and significantly elevated sCD44v6 in the retro-laparoscopy group may be facilitated, the differences in CAMs between both groups are small and transient. Together with the similar follow-up results, this further supports previous studies that failed to show a difference in the oncologic outcomes between open and laparoscopic radical nephrectomy and provides a probable molecular mechanism.
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Affiliation(s)
- Lu Yang
- Department of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
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Wang L, Liu B, Wu Z, Yang Q, Chen W, Xu Z, Wang C, Xiao L, Wang F, Sun Y. A Matched-Pair Comparison of Laparoendoscopic Single-Site Surgery and Standard Laparoscopic Radical Nephrectomy by a Single Urologist. J Endourol 2012; 26:676-81. [PMID: 22017261 DOI: 10.1089/end.2011.0161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Linhui Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Bing Liu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qing Yang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wei Chen
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zunli Xu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Cheng Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Liang Xiao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fubo 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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Lu Y, Tianyong F, Qiang W, Xiaobo C, Siyuan B, Ping H. Early immune outcome of retroperitoneal laparoscopic radical nephrectomy for localized renal cell carcinoma: a prospective, randomized study. Can Urol Assoc J 2011; 6:E242-8. [PMID: 22060731 DOI: 10.5489/cuaj.11003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We evaluated differences in cytokine responses and T-lymphocyte subsets following retroperitoneal laparoscopic and conventional open radical nephrectomies for localized renal cell carcinoma (RCC). METHODS A total of 62 patients with T(1)N(0)M(0) staged RCC were randomized to either retro-laparoscopic (n = 31) or open (n = 31) radical nephrectomy. Plasma levels of interleukin-1β (IL-1β), IL-6, and tumour necrosis factor-alpha (TNF-α) were measured separately by enzyme linked immunosorbent assay (ELISA) preoperatively and on postoperative days 1 and 5. Levels of CD3(+), CD4(+) and CD8(+) as well as the CD4(+):CD8(+) ratio were acquired by flow cytometry at the same time points. RESULTS Levels of IL-1β, IL-6 and TNF-α increased significantly compared to preoperative values in both groups (p < 0.05) on postoperative day 1, and all the parameters in the open group were significantly higher than those in the retro-laparoscopy group (p < 0.05). On postoperative day 1, the levels of CD3(+) and CD4(+) and the CD4(+):CD8(+) ratio decreased markedly compared to preoperative values for both groups (p < 0.05). Elevations of the CD4(+):CD8(+) ratio in the retro-laparoscopy group (p < 0.05) and the CD8(+) level in the open group (p < 0.05) were observed when compared with the other group. On postoperative day 5, the levels of CD3(+) and CD4(+) and the CD4(+):CD8(+) ratio in the retro-laparoscopy group, as well as the level of CD8(+) in the open group, returned to about preoperative levels (p < 0.05). Follow-up ranged from 4 to 14 months postoperatively in all 62 patients with a 100% cancer-specific survival rate in both groups. CONCLUSIONS Retroperitoneal laparoscopic radical nephrectomy is associated with the milder cytokine responses caused by trauma and inflammation and the better preserved distribution of T-lymphocytes.
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Affiliation(s)
- Yang Lu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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A Novel Bovine Model for Training Urological Surgeons in Laparoscopic Radical Nephrectomy. J Endourol 2011; 25:1377-83. [DOI: 10.1089/end.2011.0060] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Long-term oncologic outcomes of laparoscopic radical nephrectomy for kidney cancer resection: Dundee cohort and metaanalysis of observational studies. Surg Endosc 2011; 25:3154-61. [PMID: 21594741 DOI: 10.1007/s00464-011-1736-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The long-term oncologic outcome of laparoscopic radical nephrectomy compared with that of open radical nephrectomy remains unclear. A few case series with follow-up periods longer than 5 years are reported in the literature. The existing literature is focused primarily on early and intermediate outcomes of laparoscopic radical nephrectomy. This study aimed to assess the outcome of laparoscopic radical nephrectomy for localized disease compared with open surgery. METHODS The search strategy was designed to identify observational and experimental studies conducted in any country that investigated the long-term oncologic outcomes of laparoscopic radical nephrectomy compared with open surgical resection, published in any language. We searched the MEDLINE (1996 to May 2010), EMBASE (1996 to May 2010), and Cochrane databases using the OVID interrogation software. The study included 77 men from the Dundee cohort referred for clinically localized renal cell carcinoma who underwent open or laparoscopic radical nephrectomy between January 1998 and 2004, with at least 5 years of follow-up evaluation for each. These men were included in a metaanalysis of observational studies reporting on 438 patients with a mean or median follow-up period of 5 years. The data was analyzed using Minitab statistical software and Cochrane RevMan 5.4 using the random model. RESULTS The five studies (including the Dundee cohort) investigating the effects of the laparoscopic approach on renal cancer management showed no significant differences in 5 years survival between laparoscopic and open surgical approaches for the resection of kidney cancer. The resulting pooled odds ratio (OR) did not differ markedly between the two groups (pooled OR, 0.82; 95% confidence interval [CI], 0.48-1.39). Similar to overall survival, the laparoscopic and open surgical approaches for renal cancer surgery did not differ significantly (Figs. 4, 5). The pooled ORs for the two outcomes were 0.76 (955 CI, 0.36-1.56) for laparoscopic surgery and 0.73 (95% CI, 0.32-1.69) for open surgery. The quality of the studies was poor. The reported designs of the studies were prone to selection, confounding, and reporting biases. CONCLUSIONS The current retrospective data (observational studies) comparing long-term oncologic outcomes between laparoscopic and open radical nephrectomy did not demonstrate any significant differences during a follow-up period of 5 years.
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Jeong W, Rha KH, Kim HH, Byun SS, Kwon TG, Seo IY, Sung GT, Jeon SH, Jeong YB, Hong SH. Comparison of Laparoscopic Radical Nephrectomy and Open Radical Nephrectomy for Pathologic Stage T1 and T2 Renal Cell Carcinoma With Clear Cell Histologic Features: A Multi-institutional Study. Urology 2011; 77:819-24. [DOI: 10.1016/j.urology.2010.06.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 05/13/2010] [Accepted: 06/06/2010] [Indexed: 11/26/2022]
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12
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Jeon SH, Kwon TG, Rha KH, Sung GT, Lee W, Lim JS, Jeong YB, Hong SH, Kim HH, Byun SS. Comparison of laparoscopic versus open radical nephrectomy for large renal tumors: a retrospective analysis of multi-center results. BJU Int 2010; 107:817-821. [DOI: 10.1111/j.1464-410x.2010.09688.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Ha US, Hwang TK, Kim YJ, Oh TH, Jeon YS, Lee W, Lim JS, Lee TY, Choi Y, Park SK, Byun SS. Comparison of oncological outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy for the management of clear-cell renal cell carcinoma: a multi-institutional study. BJU Int 2010; 107:1467-72. [DOI: 10.1111/j.1464-410x.2010.09636.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Luo JH, Zhou FJ, Xie D, Zhang ZL, Liao B, Zhao HW, Dai YP, Chen LW, Chen W. Analysis of long-term survival in patients with localized renal cell carcinoma: laparoscopic versus open radical nephrectomy. World J Urol 2009; 28:289-93. [DOI: 10.1007/s00345-009-0487-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 10/22/2009] [Indexed: 11/29/2022] Open
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Abstract
INTRODUCTION The retroperitoneal surgery is the clearer indication for the laparoscopic approach. Still there are indications for open surgery because of the complexity of the patient and the surgeon experience. OBJECTIVES The main objective is to report our experience of laparoscopic radical nephrectomies in patient with tumors greater than 7 cm. or surgical specimens with more than 700 g of weight. We analyze their characteristics, complications rate, surgical time, postoperative outcome and hospital stay. MATERIALS AND METHODS Since July 2004 to July 2008 we have performed 104 laparoscopic radical nephrectomies. We have selected 41 patients with characteristics of big surgical specimens. RESULTS The average surgical time has been of 184,3 min. Only 1 case has been converted into open surgery and only 1 intraoperative death because of cardiologic arrhythmia. The average hospital stay has been of 3,51 days. The complications rate and postoperative outcome are similar to the whole series. DISCUSSION Laparoscopic nephrectomy is technically less complex than radical prostatectomy. However, their possible complication implies a much bigger severity. The more complex cases must be approach laparoscopically only after a wide experience. Actually, in our department we usually indicate an open approach when surgical specimen crossover the abdominal middle line and in those cases where the tumoral thrombus affect the main renal vein and/or the vena cava.
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Berger A, Brandina R, Atalla MA, Herati AS, Kamoi K, Aron M, Haber GP, Stein RJ, Desai MM, Kavoussi LR, Gill IS. Laparoscopic radical nephrectomy for renal cell carcinoma: oncological outcomes at 10 years or more. J Urol 2009; 182:2172-6. [PMID: 19758651 DOI: 10.1016/j.juro.2009.07.047] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE We present oncological outcomes at a followup of 10 years or greater after laparoscopic radical nephrectomy for cancer. MATERIALS AND METHODS Between February 1994 and March 1999 a total of 73 laparoscopic radical nephrectomies were performed by 2 surgeons for pathologically confirmed renal cell carcinoma. Data were obtained from patient charts, radiographic reports, telephone followup and a check of the Social Security Death Index. RESULTS Mean followup was 11.2 years (range 10 to 15). Each patient completed a minimum 10-year followup. Mean patient age at surgery was 60 years. Mean tumor size on computerized tomography was 5 cm (range 1.7 to 13). Pathological stage was pT1a in 41% of cases, pT1b in 30%, pT2 in 15%, pT3a in 10%, pT3b in 3% and pT4 in 1%. High grade tumors (Fuhrman 3 or greater) were present in 18 cases (28%). A positive surgical margin occurred in 1 case. Actual 10-year overall, cancer specific and recurrence-free survival rates were 65%, 92% and 86%, respectively. Overall, cancer specific and recurrence-free survival rates at 12 years were 35%, 78% and 77%, respectively. At a mean of 67 months 10 patients (14%) had metastatic disease, of whom 8 (11%) died. CONCLUSIONS Long-term oncological outcomes after laparoscopic radical nephrectomy for renal cell carcinoma are excellent and appear comparable to those of open surgery.
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Affiliation(s)
- Andre Berger
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California 90080, USA
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Bird VG, Shields JM, Aziz M, Ayyathurai R, De Los Santos R, Roeter DH. Laparoscopic Radical Nephrectomy for Patients with T2 and T3 Renal-Cell Carcinoma: Evaluation of Perioperative Outcomes. J Endourol 2009; 23:1527-33. [DOI: 10.1089/end.2009.0399] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Vincent G. Bird
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - John M. Shields
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Mohammed Aziz
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rajnikanth Ayyathurai
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rosely De Los Santos
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Daniel H. Roeter
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
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Gabr AH, Gdor Y, Strope SA, Roberts WW, Wolf JS. Patient and pathologic correlates with perioperative and long-term outcomes of laparoscopic radical nephrectomy. Urology 2009; 74:635-40. [PMID: 19616826 DOI: 10.1016/j.urology.2009.01.091] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 11/29/2008] [Accepted: 01/14/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To comprehensively analyze and compare patient and pathologic correlates with perioperative events and with the long-term results of laparoscopic radical nephrectomy. METHODS Laparoscopic radical nephrectomy was performed in 255 patients with renal cell carcinoma. Mean follow-up time was 35.2 months; for 39 patients, it was 5 or more years. RESULTS Multivariate analysis revealed that major intraoperative complications were associated with increased body mass index and that major postoperative complications were associated with a higher American Society of Anesthesiologists (ASA) score. Older age and higher ASA score were associated with longer hospitalization. Patients were classified using a risk group stratification that incorporated grade and stage; 118 patients were low risk, 93 were intermediate risk, and 44 patients were high risk. No pathologic features were associated with perioperative outcomes. Kaplan-Meier recurrence-free, cancer-specific, and overall survival at 5 years were 79.2%, 88%, and 76.2%, respectively. Multivariate analysis revealed that pathologic risk group, mass size, and high-risk histologic subtype were associated with recurrence-free survival, and cancer-specific survival was associated with pathologic risk group and mass size. Age, high-risk pathologic risk group, and a high-risk histologic subtype were associated with overall survival. CONCLUSIONS Our results indicate that perioperative outcomes of laparoscopic radical nephrectomy are associated with body mass index, ASA score, and age, but not with tumor characteristics. Recurrence-free and cancer-specific survival rates were associated with the expected pathologic parameters, confirming the oncologic efficacy of the procedure. Overall survival is associated not only with tumor pathology but also with age, suggesting that competing-cause mortality is important in this setting.
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Affiliation(s)
- Ahmed H Gabr
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan 48109-0330, USA
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Abstract
The diagnosis and treatment of renal cell carcinoma (RCC) has been the subject of major changes since the late 1980s. Initially, surgery was the only treatment available, but more recently, systemic therapies have been developed, and their introduction has modified some of the surgical indications for rcc. In addition, refinements in surgical technique and the introduction of minimally invasive approaches have revolutionized patient care and bear the promise of even more improvements to come. This paper provides an up-to-date overview of recent developments in the surgical treatment of RCC.
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Affiliation(s)
- J.B. Lattouf
- Correspondence to: Jean-Baptiste Lattouf, Department of Surgery–Urology, Centre Hospitalier de l’Université de Montréal, 1058 rue St-Denis, Montreal, Quebec H2X 3J4. E-mail:
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Bird VG, Au JK, Sandman Y, Santos RDL, Ayyathurai R, Shields JM. Comparison of Different Extraction Sites Used During Laparoscopic Radical Nephrectomy. J Urol 2009; 181:1565-70. [DOI: 10.1016/j.juro.2008.11.113] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Vincent G. Bird
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Jason K. Au
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Yekutiel Sandman
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rosely De Los Santos
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rajnikanth Ayyathurai
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
| | - John M. Shields
- Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida
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Garg S, Batura D, Biyani CS, Gill IS. Laparoscopic surgery for cancers of the kidney: long-term oncological efficacy. BJU Int 2008; 102:1498-501. [DOI: 10.1111/j.1464-410x.2008.08019.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Box GN, Lehman DS, Landman J, Clayman RV. Minimally Invasive Management of Upper Tract Malignancies: Renal Cell and Transitional Cell Carcinoma. Urol Clin North Am 2008; 35:365-83, vii. [DOI: 10.1016/j.ucl.2008.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Merseburger AS, Kuczyk MA. Changing concepts in the surgery of renal cell carcinoma. World J Urol 2008; 26:127-33. [PMID: 18265990 DOI: 10.1007/s00345-008-0238-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 01/13/2008] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Herein, current developments in open and minimally invasive renal surgery are presented. MATERIALS AND METHODS This also includes considerations on the appropriate indication for the two surgical procedures in small renal tumours, locally advanced disease (>pT2), complicated renal tumours as well as cytoreductive surgical situations. In small renal tumours, similar survival rates have been described for laparoscopic radical and partial nephrectomy. However, even experienced high volume laparoscopic centres report a high learning curve, increased complications and initial technical problems to achieve parenchymal haemostasis and renal ischaemia during nephron-sparing surgery. Surgical management of large (>T2) or complicated tumours is feasible, but long-term oncological outcome is not yet available. CONCLUSION Promising new developments such as natural orifice translumenal endoscopic surgery (NOTES) might add to our surgical armamentarium for minimally invasive surgery.
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Affiliation(s)
- Axel S Merseburger
- Department of Urology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
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