1
|
Wang K, Guo B, Niu Y, Li G. Development and validation of a nomogram to predict recurrence for clinical T1/2 clear cell renal cell carcinoma patients after nephrectomy. BMC Surg 2024; 24:196. [PMID: 38926690 PMCID: PMC11201317 DOI: 10.1186/s12893-024-02487-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE To develop and validate a nomogram for predicting recurrence-free survival (RFS) for clinical T1/2 (cT1/2) clear cell renal cell carcinoma (ccRCC) patients after nephrectomy. METHODS Clinicopathological and survival data from 1289 cT1/2 ccRCC patients treated at the Second Hospital of Tianjin Medical University between 2017 and 2020 were included. Cox regression analysis was used to identify independent risk factors in 902 and 387 ccRCC patients in the training and validation cohorts, respectively, and construct the nomogram. The performance of the nomogram was assessed through calibration plots, time-dependent receiver operating characteristic (ROC) curves, C-index (concordance-index), and decision curve analysis (DCA). Kaplan-Meier curves were used to evaluate the probability of RFS in patients with different recurrence risks. RESULTS Age, tumor size, surgical approach, Fuhrman grade, and pT3a upstage were identified as independent predictors of RFS. The area under the curve (AUC) for the 3-year and 5-year RFS ROC curves were 0.791 and 0.835 in the training cohort, and 0.860 and 0.880 in the validation cohort. The DCA and calibration plots demonstrated the optimal application and excellent accuracy of the nomogram for predicting 3-year and 5-year RFS. Kaplan-Meier curves revealed significant differences in RFS among the three risk groups in both the training and validation cohorts. Clinically, the developed nomogram provides a more precise tool for risk stratification, enabling tailored postoperative management and surveillance strategies, ultimately aiming to improve patient outcomes. CONCLUSIONS We developed a nomogram for predicting RFS in cT1/2 ccRCC patients after nephrectomy with high accuracy. The clinical implementation of this nomogram can significantly enhance clinical decision-making, leading to improved patient outcomes and optimized resource utilization in the management of ccRCC.
Collapse
Affiliation(s)
- Keruo Wang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University Tianjin, Tianjin, 300211, China
| | - Baoyin Guo
- Department of Urology, Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, 301800, China
| | - Yuanjie Niu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University Tianjin, Tianjin, 300211, China
| | - Gang Li
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University Tianjin, Tianjin, 300211, China.
| |
Collapse
|
2
|
Wang L, Li KP, Yin S, Yang L, Zhu PY. Oncologic and perioperative outcomes of laparoscopic versus open radical nephrectomy for the treatment of renal tumor (> 7 cm): a systematic review and pooled analysis of comparative outcomes. World J Surg Oncol 2023; 21:35. [PMID: 36747217 PMCID: PMC9901136 DOI: 10.1186/s12957-023-02916-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Systematic evaluation of the effectiveness and safety of laparoscopic radical nephrectomy (LRN) for renal tumor (>7 cm). METHODS The databases PubMed, Scopus, SinoMed, ScienceDirect, and Google Scholar were systematically searched for trials up to November 2022. The pooled results were evaluated by weighted mean difference (WMD), odds ratio (OR), and hazard ratio (HR). RESULTS This meta-analysis (18 trials) demonstrated that compared to open radical nephrectomy (ORN), LRN had a longer operative time (OT) (WMD=15.99, 95% CI: 6.74 to 25.24, p = 0.0007), lower estimated blood loss (EBL) (WMD = -237.07, 95% CI: -300.02 to -174.12, p < 0.00001), lower transfusion rates (OR = 0.37, 95% CI: 0.24 to 0.55, p < 0.00001), and shorter length of stay (LOS) (WMD = -2.95, 95% CI: -3.86 to -2.03, p < 0.00001). No statistically relevant differences were found in overall survival (OS) (HR = 1.04, 95% CI: 0.81 to 1.35, p = 0.76), cancer-specific survival (CSS) (HR = 1.28, 95% CI: 0.97 to 1.68, p = 0.08), progression-free survival (PFS) (HR = 1.20, 95% CI 0.97 to 1.48, p = 0.1), recurrence-free survival (RFS) (OR = 1.27, 95% CI: 0.89 to 1.81, p = 0.56), local recurrence rate (OR = 0.85, 95% CI: 0.42 to 1.71, p = 0.65), and intraoperative and postoperative complications. CONCLUSION For patients with renal tumors (> 7 cm), LRN has specific perioperative advantages over ORN (LOS, EBL, and transfusion rates). However, the OT was prolonged in the LRN group. In addition, no differences in complication or oncological outcomes (OS, CSS, PFS, RFS, and local recurrence rate) were reported. TRIAL REGISTRATION PROSPERO CRD42022367114.
Collapse
Affiliation(s)
- Li Wang
- grid.413387.a0000 0004 1758 177XDepartment of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000 China
| | - Kun-peng Li
- grid.411294.b0000 0004 1798 9345Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, 730030 China
| | - Shan Yin
- grid.413387.a0000 0004 1758 177XDepartment of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000 China
| | - Lin Yang
- grid.413387.a0000 0004 1758 177XDepartment of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000 China
| | - Ping-yu Zhu
- grid.413387.a0000 0004 1758 177XDepartment of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000 China
| |
Collapse
|
3
|
Elevated Plasma Interleukin-35 as a Prognostic Indicator in Localized Clear Cell Renal Cell Carcinoma. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6886590. [PMID: 36124013 PMCID: PMC9482474 DOI: 10.1155/2022/6886590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/10/2022] [Accepted: 08/20/2022] [Indexed: 11/17/2022]
Abstract
Purpose The aim of the study is to investigate the prognostic value of plasma interleukin-35 in the surgical treatment of patients with clear cell renal cell carcinoma (ccRCC). Material and Methods. Plasma IL-35 levels were measured in patients with ccRCC. The cut-off value of IL-35 was determined by the receiver operating characteristic (ROC) analysis and the area under the curve (AUC). The effects of the IL-35 and other clinicopathological characteristics on overall survival (OS) and progression-free survival (PFS) were evaluated using the univariate and multivariate logistic regression analysis. Result Sixty-four ccRCC patients admitted to the urology department at the First Affiliated Hospital of Soochow University were selected, of whom 50 were diagnosed with localized ccRCC. Plasma interleukin-35 levels were significantly higher in patients with ccRCC than that in healthy controls. The cut-off value of IL-35 was 99.7 pg/mL. Multivariate analysis selected by univariate analyses demonstrated that the preoperative IL-35 was an independent prognostic factor for 5-year OS (OR: 1.02, 95% CI: 1.01 to 1.04, p < 0.0001) and 5-year PFS (OR: 1.02, 95% CI: 1.00 to 1.03, p=0.011) in all patients with localized ccRCC. Conclusion Current results indicate that preoperative IL-35 is an independent prognostic marker for OS and RFS in patients with localized ccRCC after surgery.
Collapse
|
4
|
Survival after minimally invasive vs. open radical nephrectomy for stage I and II renal cell carcinoma. Int J Clin Oncol 2022; 27:1068-1076. [PMID: 35319076 DOI: 10.1007/s10147-022-02153-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/06/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND A recently reported phase III randomized trial comparing open and minimally invasive hysterectomy showed significantly higher rates of local recurrence after minimally invasive surgery (MIS) for cervical cancer. This raised concerns regarding patterns of recurrences and survival after MIS in general. This study aims to determine the effect of MIS on all-cause mortality among patients undergoing radical nephrectomy for Stage I and II renal cell carcinoma (RCC). METHODS We utilized the National Cancer Database to identify patients diagnosed with clinical stage I-II RCCs between 2010 and 2013. Patients for whom a laparoscopic or robotic radical nephrectomy was attempted were compared to patients who underwent open radical nephrectomy (ORN). Adjusted regression models with inverse probability propensity score weighting (IPW) were utilized to identify independent predictors of receiving MIS. All-cause mortality rates were compared using IPW survival functions and log-rank tests. Adjusted Cox proportional hazard models were fitted to determine independent predictors of OS. RESULTS 27,642 patients were identified; 11,524 (41.7%) had MIS, while 16,118 (58.3%) had ORN. Kaplan-Meier survival curves in the IPW cohort showed significant OS advantage for patients who underwent MIS (p < 0.001). Furthermore, length of hospital stays (3 vs. 4 days), 30 day readmission rates (2.4 vs. 2.87%), 30 day (0.53 vs. 0.96%) and 90 day mortality rates (1.04 vs. 1.77%) were significantly higher in the ORN group (p < 0.001). CONCLUSIONS MIS was associated with better OS outcomes compared to ORN for stage I and II RCC. In addition, MIS had lower post-operative readmission, 30- and 90 day mortality rates.
Collapse
|
5
|
Jenkins J, Foy C, Davenport K. A comparison of surgical practice and operative outcomes between retroperitoneal and transperitoneal laparoscopic nephrectomies – 6 years of data from the BAUS Nephrectomy database. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211050008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: While the choice of surgical approach for laparoscopic nephrectomy is broadly split between transperitoneal and retroperitoneal options, the evidence for the impact of this decision on perioperative outcomes is built on relatively small volume data, with often inconsistent findings and conclusions. We aimed to assess the impact of operative approach on perioperative outcomes for laparoscopic radical, partial and simple nephrectomy and nephroureterectomy through analysis of the British Association of Urological Surgeons (BAUS) Nephrectomy database. Patients and methods: All patients added to the BAUS Nephrectomy database with laparoscopic surgery between 2012 and 2017 inclusively were included and subdivided by operation and surgical approach. Preoperative patient and tumour characteristics, as well as intraoperative and post-operative short-term outcomes, were assessed. Results: Overall, 26,682 operations were documented over the review window (81.6% transperitoneal). Small increases in blood loss ( p = 0.001), transfusion rate ( p = 0.02) and operative length ( p = 0.01) were seen for transperitoneal radical nephrectomies and longer hospital stays seen for retroperitoneal procedures (radical nephrectomy p = 0.00l; partial nephrectomy p = 0.04). Retroperitoneal procedures were associated with increased rates of conversion for simple nephrectomy ( p = 0.02), nephroureterectomy ( p = 0.03) and most notably partial nephrectomy (10.5% versus 4.4%; p = 0.001). No further variation in intraoperative complications, post-operative complications, tumour margin positivity rates, unintended ITU admission, or likelihood of death was identified related to surgical approach. Conclusion: Observed variations in perioperative outcomes were generally modest in nature, and little ground is seen to support a change in operative technique for those committed to one approach. A caveat to this exists with open conversion for retroperitoneal partial nephrectomies and requires careful consideration of patient selection by the individual surgeon. Level of evidence: 4
Collapse
Affiliation(s)
- James Jenkins
- Urology Department, Royal Devon and Exeter Hospital, Royal Devon and Exeter NHS Foundation Trust, UK
| | | | | |
Collapse
|
6
|
Wang Z, Zhang P, Chong Y, Xue Y, Yang X, Li H, Wang L, Zhang Y, Chen Q, Li Z, Xue L, Li H, Chong T. Perioperative Circulating Tumor Cells (CTCs), MCTCs, and CTC-White Blood Cells Detected by a Size-Based Platform Predict Prognosis in Renal Cell Carcinoma. DISEASE MARKERS 2021; 2021:9956142. [PMID: 34733376 PMCID: PMC8560287 DOI: 10.1155/2021/9956142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 07/16/2021] [Accepted: 09/17/2021] [Indexed: 12/15/2022]
Abstract
To explore the clinical significance of the perioperative counts of circulating tumor cells (CTCs), mesenchymal CTCs (MCTCs), and CTC- white blood cells (WBCs) in renal cell carcinoma patients. A total of 131 patients with renal cancer who underwent operation excision from our hospital were enrolled. In addition, 20 patients with benign renal diseases were recruited as a control. Blood samples were collected from the 131 patients, before operation and 3 months after surgery. Samples were also obtained simultaneously from the control group. CanPatrol CTC detection technique was used to enrich and identify CTCs, MCTCs, and CTC-WBCs. All enrolled patients were T1-3N0M0. From these, 52 patients with renal cancer underwent radical resection, while other 79 patients underwent nephron-sparing surgery. The positive rate of CTC, MCTC, and CTC-WBC before surgery were 95.4% (125/131), 61.1% (80/131), and 11.5% (15/131), respectively. Preoperative total CTCs, MCTCs, or CTC-WBCs were poorly correlated with patients' parameters. Preoperative CTC, MCTC, or CTC-WBC showed no association with progression-free survival (PFS). In contrast, postoperative total CTCs (≥6), positive MCTCs, and positive CTC-WBCs significantly correlated with recurrence and metastasis. These results remained independent indicators for worse PFS. In addition, the increased CTC and MCTC count after surgery also correlated with unfavorable PFS. The detection of six or more total CTCs, MCTC, or CTC-WBCs in peripheral blood after surgery might help to identify a subset of patients that have higher recurrent risk than the overall population of patients with at different stages of renal cancer.
Collapse
Affiliation(s)
- Zhenlong Wang
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, Shanxi 710004, China
| | - Peng Zhang
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, Shanxi 710004, China
| | - Yue Chong
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shanxi 710061, China
| | - Yuquan Xue
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, Shanxi 710004, China
| | - Xiaojie Yang
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, Shanxi 710004, China
| | - Hecheng Li
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, Shanxi 710004, China
| | - Li Wang
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, Shanxi 710004, China
| | - Yaping Zhang
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, Shanxi 710004, China
| | - Qi Chen
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, Shanxi 710004, China
| | - Zhaolun Li
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, Shanxi 710004, China
| | - Li Xue
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, Shanxi 710004, China
| | - HongLiang Li
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, Shanxi 710004, China
| | - Tie Chong
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 Xiwu Road, Xi'an, Shanxi 710004, China
| |
Collapse
|
7
|
Marko J, Craig R, Nguyen A, Udager AM, Wolfman DJ. Chromophobe Renal Cell Carcinoma with Radiologic-Pathologic Correlation. Radiographics 2021; 41:1408-1419. [PMID: 34388049 DOI: 10.1148/rg.2021200206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Renal cell carcinoma (RCC) is a heterogeneous group of neoplasms derived from the renal tubular epithelial cells. Chromophobe RCC (chRCC) is the third most common subtype of RCC, accounting for 5% of cases. chRCC may be detected as an incidental finding or less commonly may manifest with clinical symptoms. The mainstay of therapy for chRCC is surgical resection. chRCC has a better prognosis compared with the more common clear cell RCC. At gross pathologic analysis, chRCC is a solid well-defined mass with lobulated borders. Histologic findings vary by subtype but include large pale polygonal cells with abundant transparent cytoplasm, crinkled "raisinoid" nuclei with perinuclear halos, and prominent cell membranes. Pathologic analysis reveals only moderate vascularity. The most common imaging pattern is a predominantly solid renal mass with circumscribed margins and enhancement less than that of the renal cortex. The authors discuss chRCC with emphasis on correlative pathologic findings and illustrate the multimodality imaging appearances of chRCC by using cases from the Radiologic Pathology Archives of the American Institute for Radiologic Pathology. ©RSNA, 2021.
Collapse
Affiliation(s)
- Jamie Marko
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md, and American Institute for Radiologic Pathology, Silver Spring, Md (J.M.); F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (R.C.); George Washington University School of Medicine and Health Sciences, Washington, DC (A.N.); Department of Pathology, University of Michigan Medical School, Ann Arbor, Mich (A.M.U.); and Department of Radiology, Johns Hopkins Hospital and Health System, 5255 Loughboro Rd NW, Washington, DC 20016 (D.J.W.)
| | - Ryan Craig
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md, and American Institute for Radiologic Pathology, Silver Spring, Md (J.M.); F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (R.C.); George Washington University School of Medicine and Health Sciences, Washington, DC (A.N.); Department of Pathology, University of Michigan Medical School, Ann Arbor, Mich (A.M.U.); and Department of Radiology, Johns Hopkins Hospital and Health System, 5255 Loughboro Rd NW, Washington, DC 20016 (D.J.W.)
| | - Andrew Nguyen
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md, and American Institute for Radiologic Pathology, Silver Spring, Md (J.M.); F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (R.C.); George Washington University School of Medicine and Health Sciences, Washington, DC (A.N.); Department of Pathology, University of Michigan Medical School, Ann Arbor, Mich (A.M.U.); and Department of Radiology, Johns Hopkins Hospital and Health System, 5255 Loughboro Rd NW, Washington, DC 20016 (D.J.W.)
| | - Aaron M Udager
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md, and American Institute for Radiologic Pathology, Silver Spring, Md (J.M.); F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (R.C.); George Washington University School of Medicine and Health Sciences, Washington, DC (A.N.); Department of Pathology, University of Michigan Medical School, Ann Arbor, Mich (A.M.U.); and Department of Radiology, Johns Hopkins Hospital and Health System, 5255 Loughboro Rd NW, Washington, DC 20016 (D.J.W.)
| | - Darcy J Wolfman
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md, and American Institute for Radiologic Pathology, Silver Spring, Md (J.M.); F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (R.C.); George Washington University School of Medicine and Health Sciences, Washington, DC (A.N.); Department of Pathology, University of Michigan Medical School, Ann Arbor, Mich (A.M.U.); and Department of Radiology, Johns Hopkins Hospital and Health System, 5255 Loughboro Rd NW, Washington, DC 20016 (D.J.W.)
| |
Collapse
|
8
|
Abstract
Minimally invasive renal surgery has revolutionized the surgical management of renal cancer since the initial report of laparoscopic nephrectomy in 1991. Laparoscopic nephrectomy became the mainstay of management in surgically resectable renal masses since the 1990s. The growing body of literature supporting nephron-sparing surgery over the last two decades has meant that minimally invasive radical nephrectomy (MI-RN) is now the preferred treatment for renal tumors not amenable to partial nephrectomy. While there is a well-described experience with complex radical nephrectomy using standard laparoscopy, robot-assisted surgery has shortened the learning curve and facilitated greater uptake of minimally invasive surgery in difficult surgical scenarios traditionally performed open surgically. Increased experience and expertise with robot-assisted renal surgery has led to expansion of the indications for MI-RN to include larger masses, locally advanced renal masses invading adjacent tissues or regional hilar/retroperitoneal lymph nodes, cytoreductive nephrectomy (CN) in metastatic disease, and concurrent venous tumor thrombectomy for renal vein or inferior vena cava (IVC) involvement. In this article, we review the various surgical techniques and adjunctive procedures associated with MI-RN.
Collapse
Affiliation(s)
- Akbar N Ashrafi
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Division of Surgery, North Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Inderbir S Gill
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
9
|
Ucar G, Acikgoz Y, Ergun Y, Bal O, Yilmaz M, Karakaya S, Akdeniz N, Kostek O, Aydin Isak O, Yazici Sener G, Dirikoc M, Aktürk Esen S, Dogan M, Uncu D. Sunitinib or Pazopanib: Is There Any Difference Between Tyrosine Kinase Inhibitors in the Pre-Nivolumab Setting in Metastatic Renal Cell Carcinoma? Cureus 2020; 12:e10525. [PMID: 33094066 PMCID: PMC7574822 DOI: 10.7759/cureus.10525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction Treatment options for metastatic renal cell carcinoma disease have been improved in recent years. However, there is still no optimal treatment sequence or combination for metastatic disease. We aimed to investigate whether patients differed in terms of disease outcomes regarding pre-nivolumab tyrosine kinase inhibitors (TKIs). Material and methods The analysis of patients was performed after all cohorts were sub-grouped into two groups according to pre-nivolumab TKIs as following the sunitinib arm and the pazopanib arm. Result A total of 75 patients were included in this study. The median follow-up time was eight months for all cohorts. The objective response rate was statistically significantly higher in the pazopanib arm as compared to the sunitinib arm (56% vs 30%, p=0.02). Progression-free survival was significantly higher in pazopanib than sunitinib (10.3 months vs 5.3 months, p=0.02). Multivariate analysis revealed that pazopanib treatment was associated with better progression-free survival (HR: 0.44, 95 CI; 0.22-0.91, p=0.02). While the median overall survival for patients who had received sunitinib was 11.0 months, it has not been reached the median in the pazopanib arm (11.0 months vs NR, p=0.051). Discussion We demonstrated significantly better progression-free survival and a higher objective response rate with nivolumab treatment in patients who had received pazopanib as compared with patients who received sunitinib in the pre-nivolumab period.
Collapse
Affiliation(s)
- Gokhan Ucar
- Medical Oncology, Health of Science Ankara City Hospital, Ankara, TUR
| | - Yusuf Acikgoz
- Medical Oncology, Health of Science Ankara City Hospital, Ankara, TUR
| | - Yakup Ergun
- Medical Oncology, Health of Science Ankara City Hospital, Ankara, TUR
| | - Oznur Bal
- Medical Oncology, Health of Science Ankara City Hospital, Ankara, TUR
| | - Mesut Yilmaz
- Medical Oncology, Bakırkoy Sadi Konuk Training and Research Hospital, Istanbul, TUR
| | - Serdar Karakaya
- Medical Oncology, Health of Science Abdurrahman Yurtaslan Training and Research Hospital, Ankara, TUR
| | - Nadiye Akdeniz
- Medical Oncology, Dicle University Medical Faculty, Diyarbakır, TUR
| | - Osman Kostek
- Medical Oncology, Trakya University Medical Faculty, Edirne, TUR
| | - Ozlem Aydin Isak
- Medical Oncology, Health of Science Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, TUR
| | | | - Merve Dirikoc
- Medical Oncology, Health of Science Ankara City Hospital, Ankara, TUR
| | - Selin Aktürk Esen
- Medical Oncology, Health of Science Ankara City Hospital, Ankara, TUR
| | - Mutlu Dogan
- Medical Oncology, Health of Science Abdurrahman Yurtaslan Training and Research Hospital, Ankara, TUR
| | - Dogan Uncu
- Medical Oncology, Health of Science Ankara City Hospital, Ankara, TUR
| |
Collapse
|
10
|
Metastatic Renal Cell Carcinoma with Level IV Thrombus: Contemporary Management with Complete Response to Neoadjuvant Targeted Therapy. Case Rep Urol 2019; 2019:7102504. [PMID: 31001447 PMCID: PMC6437729 DOI: 10.1155/2019/7102504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 03/04/2019] [Indexed: 01/02/2023] Open
Abstract
Renal cell carcinoma, particularly the most common clear cell type, is one of the most aggressive of urological cancers with significant risk of metastatic spread. It also has a propensity for venotropism with a proportion of tumors developing thrombi up to the right atrium. The response with newly adopted targeted therapy has been considered to be in the evolutionary stage with no clear role with respect to debulking or reducing the size of the inferior vena cava (IVC) thrombus. We describe a case of a right-sided metastatic RCC with Level IV thrombus initially managed with Pazopanib followed by Nivolumab and Adalimumab followed by cytoreductive nephrectomy and IVC thrombectomy in the post-targeted therapy setting with complete curative response.
Collapse
|
11
|
Alsharm A, Bazarbashi S, Alghamdi A, Alkhateeb S, Aljubran A, Abusamra A, Alharbi H, Alotaibi M, Almansour M, Alkushi H, Ahmed I, Murshid E, Eltijani A, Rabah D. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for renal cell carcinoma 2017. Urol Ann 2018; 10:123-132. [PMID: 29719321 PMCID: PMC5907318 DOI: 10.4103/ua.ua_175_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In this report, we update the previously published Saudi guidelines for the evaluation and medical and surgical management of renal cell carcinoma. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The recommendations are presented with supporting evidence level.
Collapse
Affiliation(s)
- Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ali Aljubran
- Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ashraf Abusamra
- Department of Surgery, Urology Section, King Khalid Hospital, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Hulayel Alharbi
- Department of Medical Oncology, King Fahed Specialist Hospital, Dammam, Saudi Arabia
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mubarak Almansour
- Department of Oncology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hussein Alkushi
- Department of Pathology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Imran Ahmed
- Department of Oncology, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Oncology Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Amin Eltijani
- Department of Oncology, Division of Medical Oncology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, College of Medicine and Uro-Oncology Research Chair, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
12
|
Alsharm A, Bazarbashi S, Alghamdi A, Alkhateeb S, Aljubran A, Abusamra A, Alharbi H, Alotaibi M, Almansour M, Alkushi H, Ahmed I, Murshid E, Eltijani A, Rabah D. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for renal cell carcinoma 2017. Urol Ann 2018. [PMID: 29719321 DOI: 10.4103/ua.ua-175-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In this report, we update the previously published Saudi guidelines for the evaluation and medical and surgical management of renal cell carcinoma. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The recommendations are presented with supporting evidence level.
Collapse
Affiliation(s)
- Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ali Aljubran
- Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ashraf Abusamra
- Department of Surgery, Urology Section, King Khalid Hospital, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Hulayel Alharbi
- Department of Medical Oncology, King Fahed Specialist Hospital, Dammam, Saudi Arabia
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mubarak Almansour
- Department of Oncology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hussein Alkushi
- Department of Pathology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Imran Ahmed
- Department of Oncology, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Oncology Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Amin Eltijani
- Department of Oncology, Division of Medical Oncology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, College of Medicine and Uro-Oncology Research Chair, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
13
|
Yuan B, Wang Y, Gao J, Zhang Y, Fu Y, An W. Lower pole approach in retroperitoneal laparoscopic radical nephrectomy: a new approach for the management of renal vascular pedicle. World J Surg Oncol 2018; 16:31. [PMID: 29454352 PMCID: PMC5816350 DOI: 10.1186/s12957-018-1324-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/29/2018] [Indexed: 12/25/2022] Open
Abstract
Background The objective of this study was to examine the effectiveness and safety of lower pole (LP) approach in retroperitoneal laparoscopic radical nephrectomy (LRN). Methods One hundred thirty-two renal cancer patients were scheduled for selective retroperitoneal LRN. The surgery parameters and outcomes were compared. Out of 132 patients, 78 (59.1%) patients underwent LRN via LP approach, while 54 (40.9%) patients underwent LRN via lateroposterior space (LPS) approach. Results Compared to LPS group, the LP group had a higher body mass index (27.0 ± 1.7 kg/m2 vs. 24.5 ± 1.8 kg/m2, P < 0.0001) and a larger tumor size (6.9 ± 3.5 cm vs. 4.1 ± 3.3 cm, P < 0.0001). The LP approach reduced the volumes of blood loss and transfusion significantly (135.3 ± 17.2 mL vs. 219.6 ± 30.9 mL, P < 0.0001; 55.6 ± 28.3 vs. 141.1 ± 50.4 mL, P < 0.0001) as compared to the LPS approach. The LP approach also decreased the risk of conversion to open procedure (1.3 vs. 7.4%, P < 0.05). Conclusions The LP approach is an effective and safe alternative to the LPS approach for retroperitoneal LRN and might be more suitable for patients with obesity, large tumors, tumors located at the medial part of the kidney, or renal pedicular adhesion.
Collapse
Affiliation(s)
- Bo Yuan
- Department of Urology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, China
| | - Yuantao Wang
- Department of Urology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, China
| | - Jialin Gao
- Department of Urology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, China
| | - Yongrui Zhang
- Department of Urology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, China
| | - Yaowen Fu
- Department of Urology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, China.
| | - Wei An
- Department of Urology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, China.
| |
Collapse
|
14
|
|
15
|
Tsujino T, Komura K, Ichihashi A, Tsutsumi T, Matsunaga T, Yoshikawa Y, Maenosono R, Okita K, Takai T, Oide R, Minami K, Uehara H, Taniguchi K, Hirano H, Nomi H, Ibuki N, Takahara K, Inamoto T, Azuma H. The combination of preoperative platelet count and neutrophil lymphocyte ratio as a prognostic indicator in localized renal cell carcinoma. Oncotarget 2017; 8:110311-110325. [PMID: 29299149 PMCID: PMC5746384 DOI: 10.18632/oncotarget.22688] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/28/2017] [Indexed: 01/06/2023] Open
Abstract
Introduction The combination of platelet count and neutrophil to lymphocyte ratio (COP-NLR) has been shown to provide prognostic information in several cancers, whereas its prognostic value in renal cell carcinoma (RCC) has not been reported. The objective of the present study was to examine the preoperative prognostic value of the COP-NLR in patients with localized RCC undergoing nephrectomy. Material and Methods The record of 268 patients, who underwent nephrectomy due to a diagnosis of RCC at our institute was analyzed in the study. The cut-off value of platelet count and NLR were defined by receive operating characteristic (ROC) analysis and the areas under the curve (AUC). Patients with both an increased platelet count (> 310×109/l) and an elevated NLR (> 3.85) were assigned to the score 2, and patients with one or neither of these indicators were assigned to the score 1 or 0, respectively. The impact of the COP-NLR and other clinicopathological characteristics on overall survival (OS) and recurrence-free survival (RFS) were evaluated using the univariate and multivariate Cox regression analysis. Result The median follow-up duration after surgical resection was 60 months. Multivariate analysis using the 10 clinicopathological findings selected by univariate analyses demonstrated that the preoperative COP-NLR was an independent prognostic factor for OS (HR: 2.32, 95%CI: 1.22 to 4.26, p=0.011) and RFS (HR: 1.91, 95%CI: 1.02 to 3.53, p=0.044). Conclusion The findings of the current study suggested that the preoperative COP-NLR is an independent prognostic indicator of OS and RFS for patients with localized RCC.
Collapse
Affiliation(s)
- Takuya Tsujino
- Department of Urology, Osaka Medical College, Osaka 569-8686, Japan
| | - Kazumasa Komura
- Department of Urology, Osaka Medical College, Osaka 569-8686, Japan.,Translational Research Program, Osaka Medical College, Osaka 569-8686, Japan
| | | | - Takeshi Tsutsumi
- Department of Urology, Osaka Medical College, Osaka 569-8686, Japan
| | | | - Yuki Yoshikawa
- Department of Urology, Osaka Medical College, Osaka 569-8686, Japan
| | | | - Kyohei Okita
- Department of Urology, Osaka Medical College, Osaka 569-8686, Japan
| | - Tomoaki Takai
- Department of Urology, Osaka Medical College, Osaka 569-8686, Japan
| | - Rintaro Oide
- Department of Biological Fundamental Research, Osaka Medical College, Osaka 569-8686, Japan
| | - Koichiro Minami
- Department of Urology, Osaka Medical College, Osaka 569-8686, Japan
| | - Hirofumi Uehara
- Department of Urology, Osaka Medical College, Osaka 569-8686, Japan
| | - Kohei Taniguchi
- Translational Research Program, Osaka Medical College, Osaka 569-8686, Japan.,Department of General and Gastroenterological Surgery, Osaka Medical College, Osaka 569-8686, Japan
| | - Hajime Hirano
- Department of Urology, Osaka Medical College, Osaka 569-8686, Japan
| | - Hayahito Nomi
- Department of Urology, Osaka Medical College, Osaka 569-8686, Japan
| | - Naokazu Ibuki
- Department of Urology, Osaka Medical College, Osaka 569-8686, Japan
| | - Kiyoshi Takahara
- Department of Urology, Osaka Medical College, Osaka 569-8686, Japan
| | - Teruo Inamoto
- Department of Urology, Osaka Medical College, Osaka 569-8686, Japan
| | - Haruhito Azuma
- Department of Urology, Osaka Medical College, Osaka 569-8686, Japan
| |
Collapse
|
16
|
Liu G, Ma Y, Wang S, Han X, Gao D. Laparoscopic Versus Open Radical Nephrectomy for Renal Cell Carcinoma: a Systematic Review and Meta-Analysis. Transl Oncol 2017; 10:501-510. [PMID: 28550770 PMCID: PMC5447386 DOI: 10.1016/j.tranon.2017.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The aim of this study is to summarize and quantify the current evidence on the therapeutic efficacy of laparoscopic radical nephrectomy (LRN) compared with open radical nephrectomy (ORN) in patients with renal cell carcinoma (RCC) in a meta-analysis. METHODS Data were collected by searching Pubmed, Embase, Web of Science, and ScienceDirect for reports published up to September 26, 2016. Studies that reported data on comparisons of therapeutic efficacy of LRN and ORN were included. The fixed-effects model was used in this meta-analysis if there was no evidence of heterogeneity; otherwise, the random-effects model was used. RESULTS Thirty-seven articles were included in the meta-analysis. The meta-analysis showed that the overall mortality was significantly lower in the LRN group than that in the ORN group (odds ratio [OR] =0.77, 95% confidence interval [CI]: 0.62-0.95). However, there was no statistically significant difference in cancer-specific mortality (OR=0.77, 95% CI: 0.55-1.07), local tumor recurrence (OR=0.86, 95% CI: 0.65-1.14), and intraoperative complications (OR=1.27, 95% CI: 0.83-1.94). The risk of postoperative complications was significantly lower in the LRN group (OR=0.71, 95% CI: 0.65-0.78). In addition, LRN has been shown to offer superior perioperative results to ORN, including shorter hospital stay days, time to start oral intake, and convalescence time, and less estimated blood loss, blood transfusion rate, and anesthetic consumption. CONCLUSION LRN was associated with better surgical outcomes as assessed by overall mortality and postoperative complications compared with ORN. LRN has also been shown to offer superior perioperative results to ORN.
Collapse
Affiliation(s)
- Gang Liu
- Department of Urology, Affiliated Hospital of Weifang Medical University
| | - Yulei Ma
- Department of Urology, Affiliated Hospital of Weifang Medical University
| | - Shouhua Wang
- Department of Urology, Affiliated Hospital of Weifang Medical University.
| | - Xiancheng Han
- Department of Urology, Affiliated Hospital of Weifang Medical University
| | - Dianjun Gao
- Department of Urology, Affiliated Hospital of Weifang Medical University
| |
Collapse
|
17
|
Alghamdi A, Alkhateeb S, Alghamdi K, Bazarbashi S, Murshid E, Alotaibi M, Abusamra A, Rabah D, Ahmad I, Al-Mansour M, Saadeddin A, Alsharm A. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for renal cell carcinoma. Urol Ann 2016; 8:136-40. [PMID: 27141180 PMCID: PMC4839227 DOI: 10.4103/0974-7796.179239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with renal cell carcinoma (RCC). It is categorized according to the stage of the disease using the tumor node metastasis staging system 7(th) edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and healthcare policy makers in the management of patients diagnosed with RCC.
Collapse
Affiliation(s)
- Abdullah Alghamdi
- Department of Urology, Prince Sultan Military Medical City, Jeddah, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Address for correspondence: Dr. Sultan Alkhateeb, Department of Surgery, Division of Urology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, P.O. Box: 22490 (1446), Riyadh 11426, Saudi Arabia. E-mail:
| | - Khalid Alghamdi
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Department of Oncology, Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Oncology Center, Prince Sultan Military Medical City, Jeddah, Saudi Arabia
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, RIyadh, Saudi Arabia
| | - Ashraf Abusamra
- Department of Surgery, Urology Section, King Khalid Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, College of Medicine and Uro-Oncology Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Imran Ahmad
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mubarak Al-Mansour
- Department of Oncology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ahmad Saadeddin
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
18
|
Abstract
Renal cell carcinoma is a common malignancy with increasing incidence due to the incidental detection of non-symptomatic small renal masses on imaging. Management of these small tumors has evolved toward minimally invasive nephron-sparing techniques which include partial nephrectomy and image-guided ablation. Cryoablation and radiofrequency ablation are the most utilized ablation modalities with the former more suited for larger and central renal masses due to intra-procedural visualization of the ablation zone and reduced pelvicalyceal injury. In this article, we review the epidemiology and natural history of renal cell carcinoma, the role of biopsy, and the management options available-surgery, image-guided ablation, and active surveillance-with a focus on cryoablation. The clinical outcomes of the longer term maturing cryoablation data are discussed with reference to partial nephrectomy and radiofrequency ablation. Image-guided ablation has often been the management choice in patients deemed unfit for surgery; however, growing evidence from published series demonstrates image-guided ablation as a sound alternative treatment with equivalent oncological outcomes and minimal patient impact.
Collapse
Affiliation(s)
- Nirav Patel
- Department of Radiology, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom.
| | - Alexander J King
- Department of Radiology, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
| | - David J Breen
- Department of Radiology, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
| |
Collapse
|
19
|
Nayak JG, Patel P, Bjazevic J, Liu Z, Saarela O, Kapoor A, Rendon R, Kawakami J, Tanguay S, Breau RH, Black PC, Drachenberg DE. Clinical outcomes following laparoscopic management of pT3 renal masses: A large, multi-institutional cohort. Can Urol Assoc J 2015; 9:397-402. [PMID: 26788228 DOI: 10.5489/cuaj.2848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION We described the clinical and oncological outcomes of patients treated by laparoscopic surgery for non-metastatic pT3 renal cell carcinoma (RCC). METHODS We queried a multi-institutional database for patients diagnosed with non-metastatic pathological T3 RCC from 13 Canadian centres treated laparoscopically (radical or partial nephrectomy) between 2008 and 2014. Clinical and pathological outcomes were evaluated. Progression was defined as the development of recurrence or metastatic disease. Log-rank testing and Kaplan-Meier statistical methods assessed for differences and estimated progression-free survival (PFS). RESULTS In total, 176 patients were identified with a median age of 64 years. The median tumour size was 7.0 cm. Pre-clinical stage was cT1 to cT4 in 39%, 28%, 30% and 3%, respectively. The median blood loss was 150 mL (range: 0-6000) and the median operative time was 124 minutes (range: 60-360). Most lesions were clear cell RCC (80%). After a median follow-up of 17.6 months (range: 0.2-75.0), disease progression occurred in 26% (46/176) of patients, consisting of local recurrence in 7% (3/46), and metastatic disease in 93% (43/46). The 3-year PFS was 67%, with a median PFS of 49 months. Of those who progressed, the median time to progression was 10.3 months. CONCLUSIONS This study is the largest cohort of pT3 RCC patients treated laparoscopically in the literature and suggests that for properly selected patients, laparoscopic management of locally advanced renal masses yields acceptable short-term oncological outcomes.
Collapse
Affiliation(s)
- Jasmir G Nayak
- Section of Urology, University of Manitoba, Winnipeg, MB;; Department of Urology, University of Washington, Seattle, WA
| | - Premal Patel
- Department of Urology, University of Washington, Seattle, WA
| | | | | | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, NS
| | - Jun Kawakami
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, QC
| | - Rodney H Breau
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | | |
Collapse
|
20
|
|
21
|
Psutka SP, Stewart SB, Boorjian SA, Lohse CM, Tollefson MK, Cheville JC, Leibovich BC, Thompson RH. Diabetes Mellitus is Independently Associated with an Increased Risk of Mortality in Patients with Clear Cell Renal Cell Carcinoma. J Urol 2014; 192:1620-7. [DOI: 10.1016/j.juro.2014.06.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2014] [Indexed: 12/31/2022]
Affiliation(s)
| | | | | | - Christine M. Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | |
Collapse
|
22
|
Bazarbashi S, Alkhateeb S, Abusamra A, Rabah D, Alotaibi M, Almansour M, Murshid E, Alsharm A, Alolayan A, Ahmad I, Alghamdi K, Alghamdi A. Saudi oncology society and Saudi urology association combined clinical management guidelines for renal cell carcinoma. Urol Ann 2014; 6:286-9. [PMID: 25371602 PMCID: PMC4216531 DOI: 10.4103/0974-7796.140974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 04/15/2014] [Indexed: 02/05/2023] Open
Abstract
In this report, updated guidelines for the evaluation, medical and surgical management of renal cell carcinoma are presented. They are categorized according the stage of the disease using the tumor node metastasis staging system 7(th) edition. The recommendations are presented with supporting evidence level.
Collapse
Affiliation(s)
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, Riyadh, Saudi Arabia
| | - Ashraf Abusamra
- Section of Urology, Department of Surgery, King Khaled Hospital, Riyadh, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, Division of Urology, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
- Princess Al-Johora Al-Ibrahim Centre for Cancer Research (Uro-Oncology Research Chair), King Saud University, Riyadh, Saudi Arabia
- Address for correspondence: Dr. Danny Rabah, Department of Surgery, Division of Urology, College of Medicine, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, Princess Al-Johora Al-Ibrahim Centre for Cancer Research (Uro-Oncology Research Chair), King Saud University, Riyadh, Saudi Arabia. E-mail:
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mubarak Almansour
- Oncology Department, Princess Noura Oncology Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alsharm
- Department of Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ashwaq Alolayan
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Imran Ahmad
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Khalid Alghamdi
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
23
|
Golebiewski A. Editorial Comment from Dr Golebiewski to Long-term outcome of hand-assisted laparoscopic radical nephrectomy for T1 renal cell carcinoma. Int J Urol 2014; 21:1096-7. [PMID: 25039370 DOI: 10.1111/iju.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Andrzej Golebiewski
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland.
| |
Collapse
|
24
|
Krebs R, Andreoni C, Ortiz V. Impact of Radical and Partial Nephrectomy on Renal Function in Patients with Renal Cancer. Urol Int 2014; 92:449-54. [DOI: 10.1159/000355609] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 09/11/2013] [Indexed: 11/19/2022]
|
25
|
Ren T, Liu Y, Zhao X, Ni S, Zhang C, Guo C, Ren M. Transperitoneal approach versus retroperitoneal approach: a meta-analysis of laparoscopic partial nephrectomy for renal cell carcinoma. PLoS One 2014; 9:e91978. [PMID: 24658032 PMCID: PMC3962363 DOI: 10.1371/journal.pone.0091978] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 02/16/2014] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To compare the efficiency and safety of the transperitoneal approaches with retroperitoneal approaches in laparoscopic partial nephrectomy for renal cell carcinoma and provide evidence-based medicine support for clinical treatment. METHODS A systematic computer search of PUBMED, EMBASE, and the Cochrane Library was executed to identify retrospective observational and prospective randomized controlled trials studies that compared the outcomes of the two approaches in laparoscopic partial nephrectomy. Two reviewers independently screened, extracted, and evaluated the included studies and executed statistical analysis by using software STATA 12.0. Outcomes of interest included perioperative and postoperative variables, surgical complications and oncological variables. RESULTS There were 8 studies assessed transperitoneal laparoscopic partial nephrectomy (TLPN) versus retroperitoneal laparoscopic partial nephrectomy (RLPN) were included. RLPN had a shorter operating time (SMD = 1.001,95%confidence interval[CI] 0.609-1.393,P<0.001), a lower estimated blood loss (SMD = 0.403,95%CI 0.015-0.791,P = 0.042) and a shorter length of hospital stay (WMD = 0.936 DAYS,95%CI 0.609-1.263,P<0.001) than TLPN. There were no significant differences between the transperitoneal and retroperitoneal approaches in other outcomes of interest. CONCLUSIONS This meta-analysis indicates that, in appropriately selected patients, especially patients with intraperitoneal procedures history or posteriorly located renal tumors, the RLPN can shorten the operation time, reduce the estimated blood loss and shorten the length of hospital stay. RLPN may be equally safe and be faster compared with the TLPN.
Collapse
Affiliation(s)
- Tong Ren
- Department of Urinary Surgery, First Affiliated Hospital, Harbin Medical University, NanGang District, Harbin, Heilongjiang Province China
| | - Yan Liu
- Department of Biostatistics, School of Public Health, Harbin Medical University, Nangang District, Harbin, China
| | - Xiaowen Zhao
- Department of Health Economics, School of Public Health, Harbin Medical University, Nangang District, Harbin, China
| | - Shaobin Ni
- Department of Urinary Surgery, First Affiliated Hospital, Harbin Medical University, NanGang District, Harbin, Heilongjiang Province China
| | - Cheng Zhang
- Department of Urinary Surgery, First Affiliated Hospital, Harbin Medical University, NanGang District, Harbin, Heilongjiang Province China
| | - Changgang Guo
- Department of Urinary Surgery, First Affiliated Hospital, Harbin Medical University, NanGang District, Harbin, Heilongjiang Province China
| | - Minghua Ren
- Department of Urinary Surgery, First Affiliated Hospital, Harbin Medical University, NanGang District, Harbin, Heilongjiang Province China
- * E-mail:
| |
Collapse
|
26
|
Buethe DD, Spiess PE. Current management considerations for the incidentally detected small renal mass. Cancer Control 2014; 20:211-21. [PMID: 23811705 DOI: 10.1177/107327481302000309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Nephron-sparing treatments remain underutilized for the management of small renal masses despite a rise in incidentally detected renal cell carcinoma and a downward stage migration. METHODS Historical publications representative of currently accepted paradigms were reviewed, and the results of a contemporary scientific literature search conducted in PubMed focusing on studies involving humans, published in English, and inclusive of clinical trials, meta-analyses, randomized controlled trials, and practice guidelines are included. Results from contemporary retrospective trials augment the data when level I or II evidence is absent. RESULTS Phase III clinical trial results substantiate the long-held tenet that partial nephrectomy is equivalent to radical nephrectomy with respect to safety and oncologic efficacy. Further, minimally invasive techniques using laparoscopy and robotic assistance to achieve partial nephrectomy appear equally effective to traditional open techniques. Although no prospective randomized studies are available, large retrospective studies support the notion that active surveillance and thermal ablative techniques are viable options for carefully selected patients. CONCLUSIONS The management of small renal masses encompasses a host of therapeutic options, all of which must be considered and discussed with the individual patient.
Collapse
Affiliation(s)
- David D Buethe
- Genitourinary Oncology Program, Moffitt Cancer Center, Tampa, FL 33612, USA
| | | |
Collapse
|
27
|
Fan X, Xu K, Lin T, Liu H, Yin Z, Dong W, Huang H, Huang J. Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma: a systematic review and meta-analysis. BJU Int 2012; 111:611-21. [PMID: 23106964 DOI: 10.1111/j.1464-410x.2012.11598.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Laparoscopic nephrectomy is now considered to be the reference procedure for kidney cancer. It can be performed via a transperitoneal or retroperitoneal approach. Each approach has its advantages and disadvantages. No definitive conclusions regarding objective difference between the two approaches have been reached to date. This meta-analysis indicates that in appropriately selected patients, especially patients with posteriorly located renal tumors, the retroperitoneal approach may be faster and equally safe compared with the transperitoneal approach. OBJECTIVE To evaluate the efficiency and safety of the retroperitoneal and transperitoneal approaches in laparoscopic radical/partial nephrectomy (RN/PN) for renal cell carcinoma. METHODS A systematic search of PUBMED, EMBASE, and the Cochrane Library was performed to identify prospective randomized controlled trials and retrospective observational studies that compared the outcomes of the two approaches. Outcomes of interest included perioperative and postoperative variables, surgical complications and oncological variables. RESULTS Twelve studies assessing transperitoneal laparoscopic RN (TLRN) vs retroperitoneal laparoscopic RN (RLRN) and six studies assessing transperitoneal laparoscopic PN (TLPN) vs retroperitoneal laparoscopic PN (RLPN) were included. The RLRN approach had a shorter time to renal artery control (weighted mean difference [WMD] 68.65 min; 95% confidence interval [CI] 40.80-96.50; P < 0.001) and a lower overall complication rate (odds ratio 2.12; 95% CI 1.30-3.47; P = 0.003) than TLRN. RLPN had a shorter operating time (WMD 48.85 min; 95% CI 29.33-68.37; P < 0.001) and a shorter length of hospital stay (WMD 1.01 days; 95% CI 0.39-1.63; P = 0.001) than TLPN. There were no significant differences between the retroperitoneal and transperitoneal approaches in other outcomes of interest. CONCLUSIONS This meta-analysis indicates that, in appropriately selected patients, especially patients with posteriorly located renal tumours, the retroperitoneal approach may be faster and equally safe compared with the transperitoneal approach. Despite our rigorous methodology, conclusions drawn from our pooled results should be interpreted with caution because of the inherent limitations of the included studies.
Collapse
Affiliation(s)
- Xinxiang Fan
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | | | | | | | | | | | | | | |
Collapse
|
28
|
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.
Collapse
Affiliation(s)
- Lu Yang
- Department of Urology, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
| | | | | | | | | | | |
Collapse
|
29
|
Choi Y, Park B, Jeong BC, Seo SI, Jeon SS, Choi HY, Adami HO, Lee JE, Lee HM. Body mass index and survival in patients with renal cell carcinoma: a clinical-based cohort and meta-analysis. Int J Cancer 2012; 132:625-34. [PMID: 22610826 DOI: 10.1002/ijc.27639] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 05/03/2012] [Indexed: 11/08/2022]
Abstract
Growing evidence suggests that obesity, an established cause of renal cell cancer (RCC), may also be associated with a better prognosis. To evaluate the association between RCC survival and obesity, we analyzed a large cohort of patients with RCC and undertook a meta-analysis of the published evidence. We collected clinical and pathologic data from 1,543 patients who underwent nephrectomy for RCC between 1994 and 2008 with complete follow-up through 2008. Patients were grouped according to BMI (kg/m(2) ): underweight <18.5, normal weight 18.5 to <23, overweight 23 to <25 and obese ≥25. We estimated survival using the Kaplan-Meier method and Cox proportional hazard models to examine the impact of BMI on overall survival (OS) and cancer-specific survival (CSS) with adjustment for covariates. We performed a meta-analysis of BMI and OS, CSS and recurrence-free survival (RFS) from all relevant studies using a random-effects model. The 5-year CSS increased from 76.1% in the lowest to 92.7% in the highest BMI category. A multivariate analysis showed higher OS [hazard ratio (HR) = 0.45; 95% CI: 0.29-0.68) and CSS (HR = 0.47; 95% CI: 0.29-0.77] in obese patients than in normal weight patients. The meta-analysis further corroborated that high BMI significantly improved OS (HR = 0.57; 95% CI: 0.43-0.76), CSS (HR = 0.59; 95% CI: 0.48-0.74) and RFS (HR = 0.49; 95% CI: 0.30-0.81). Our study shows that preoperative BMI is an independent prognostic indicator for survival among patients with RCC.
Collapse
Affiliation(s)
- Yuni Choi
- Women's Health Research Institute, Sookmyung Women's University, Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Harper JD, Spencer ES, Porter MP, Gore JL. Adoption of laparoscopic radical nephrectomy in the state of Washington. Urology 2012; 79:326-31. [PMID: 22310748 DOI: 10.1016/j.urology.2011.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/12/2011] [Accepted: 10/18/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine state-wide trends in adoption of laparoscopic radical nephrectomy (LRN). Open radical nephrectomy and LRN confer equivalent long-term oncological outcomes, yet LRN usage has not increased analogous to diffusion of laparoscopy in other fields. MATERIAL AND METHODS From the Washington State Comprehensive Hospital Abstract Reporting System, we identified patients who underwent ORN and LRN from 1998 to 2007. Number of LRNs was examined for each hospital state-wide. Length of stay outcomes were examined, and multivariate models were created to examine characteristics of LRN patients and of patients who received care at high-volume LRN hospitals (HiLap). RESULTS The proportion of nephrectomies performed laparoscopically increased 27%. In 1998, 7 hospitals (12%) performed≥1 LRN compared with 36 hospitals (61%) in 2007. Four HiLap hospitals accounted for 61% of the increase in LRN from 1998-2002, and 36% of the increase overall. Women (OR 1.15, 95% CI 1.00-1.33) and healthier patients (OR 1.52, 95% CI 1.28-1.82 for patients with Charlson 0 vs ≥2) were more likely to undergo LRN. Mean length of stay for nephrectomies was shorter at HiLap hospitals (P=.04 for 1998-2002, P<.001 for 2003-2007). CONCLUSIONS Uptake of LRN in Washington state parallels national trends; however, the proportion of LRN is lower than expected. A handful of hospitals account for the majority of the increase in LRN. The quality of nephrectomy care may be better at these centers. Barriers exist that prevent LRN adoption even after a trial case. Dissemination of the processes or personnel associated with use of LRN may increase the proportion of patients undergoing LRN.
Collapse
Affiliation(s)
- Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, WA 98195, USA.
| | | | | | | |
Collapse
|
31
|
Stroup SP, Palazzi KL, Chang DC, Ward NT, Parsons JK. Inpatient safety trends in laparoscopic and open nephrectomy for renal tumours. BJU Int 2012; 110:1808-13. [PMID: 22471427 DOI: 10.1111/j.1464-410x.2012.11071.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
UNLABELLED Study Type--Cohort study Level of Evidence 2b. What's known on the subject? and What does the study add? Laparoscopic radical nephrectomy for renal cancer provides equivalent long-term cancer control with shorter hospital stays, less postoperative pain, and faster resumption of normal activities, but it has diffused slowly into clinical practice, perhaps as a result of perceptions about safety. Patient safety outcomes for laparoscopic and open radical nephrectomy using validated measures remain incompletely characterized. This is the first study to investigate peri-operative outcomes of radical nephrectomy using validated patient safety measures. We found a 32% decreased probability of adverse patient safety events occurring in laparoscopic compared with open radical nephrectomy. The safety benefits of laparoscopy were attained only after 10% of cases were completed laparoscopically--a proportion some have proposed as the 'tipping point' for the adoption of surgical innovations. This observation could have implications for patient safety in the setting of diffusion of new surgical techniques. OBJECTIVE • To compare peri-operative adverse patient safety events occurring in laparoscopic radical nephrectomy (LRN) with those occurring in open radical nephrectomy (ORN). METHODS • We used the US Nationwide Inpatient Sample to identify patients undergoing kidney surgery for renal tumours from 1998 to 2008. • We used patient safety indicators (PSIs), which are validated measures of preventable adverse outcomes, and multivariate regression to analyse associations of surgery type with patient safety. RESULTS • Open radical nephrectomy accounted for 235,098 (89%) cases while 28,609 (11%) cases were LRN. • Compared with ORN, LRN patients were more likely to be male (P= 0.048), have lower Charlson comorbidity scores (P < 0.001), and to undergo surgery at urban (P < 0.001) and teaching (P < 0.001) hospitals. • PSIs occurred in 18,714 (8%) of ORN and 1434 (5%) of LRN cases (P < 0.001). • On multivariate analysis, LRN was associated with a 32% decreased probability of any PSI (adjusted odds ratio 0.68, 95% confidence interval: 0.6 to 0.77, P < 0.001). Stratification by year showed that this difference was initially manifested in 2003, when the proportion of LRN cases first exceeded 10%. CONCLUSIONS • We found that LRN was associated with substantially superior peri-operative patient safety outcomes compared with ORN, but only after the national prevalence of LRN exceeded 10%. • Further study is needed to explain these patterns and promote the safe diffusion of novel surgical therapies into broad practice.
Collapse
Affiliation(s)
- Sean P Stroup
- UC San Diego Medical Center, Division of Urology VA San Diego Medical Center Moores UCSD Cancer Center, San Diego, CA 92103, USA
| | | | | | | | | |
Collapse
|
32
|
Liatsikos E, Kallidonis P, Do M, Dietel A, Al-Aown A, Constantinidis C, Stolzenburg JU. Laparoscopic radical and partial nephrectomy: technical issues and outcome. World J Urol 2011; 31:785-91. [PMID: 22120179 DOI: 10.1007/s00345-011-0754-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 08/16/2011] [Indexed: 10/15/2022] Open
Abstract
The laparoscopic approach has been established as a treatment modality for the performance of radical nephrectomy during the recent years, while laparoscopic partial nephrectomy represents an alternative under investigation in several centers of laparoscopic excellence around the world. Significant advantages of laparoscopic surgery when compared to the classical open approach have extensively documented for over 2 decades. Nevertheless, laparoscopy is an evolving surgical field, which is characterized by the rapid adaptation of technical innovations. Laparoscopic renal surgery includes approaches for radical and partial nephrectomy with oncological outcome similar to open surgery and decreased postoperative morbidity and therefore can be considered for the same indications as open surgery. Several issues regarding the technical feasibility and refinement as well as the oncological efficacy of these procedures are presented.
Collapse
|
33
|
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.
Collapse
Affiliation(s)
- Yang Lu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | | | | | | | | | | |
Collapse
|
34
|
Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, Patard JJ, Mulders PF, Sinescu IC. EAU Guidelines on Renal Cell Carcinoma: The 2010 Update. Eur Urol 2010; 58:398-406. [PMID: 20633979 DOI: 10.1016/j.eururo.2010.06.032] [Citation(s) in RCA: 1123] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 06/21/2010] [Indexed: 12/22/2022]
|