1
|
Ito H, Uemura K, Ikeda M, Jikuya R, Kondo T, Tatenuma T, Kawahara T, Komeya M, Ito Y, Muraoka K, Hasumi H, Makiyama K. Impacts of Complete Endophytic Renal Tumors on Surgical, Functional, and Oncological Outcomes of Robot-Assisted Partial Nephrectomy. J Endourol 2024; 38:347-352. [PMID: 38243789 DOI: 10.1089/end.2023.0608] [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] [Indexed: 01/22/2024] Open
Abstract
Objective: Complete endophytic renal tumors (CERTs) are the most challenging for robot-assisted partial nephrectomy (RAPN). This study aimed to determine the impact of CERT on outcomes of RAPN. Methods: All RAPN cases for localized renal tumor undertaken at Yokohama City University Hospital between 2016 and 2023 were enrolled. Tumor characteristics and surgical, functional, and oncologic outcomes of RAPN were compared between CERT and non-CERT groups. Results: Consecutive 666 patients were enrolled, and 76 (11.4%) were identified as CERT (3 points of "E" score). CERT showed smaller tumor diameters (p < 0.001), more predominant hilar tumor (p = 0.029), higher "N" scores (p < 0.001) and "L" scores (p = 0.006) than non-CERT. The CERT group showed longer warm ischemia times (p < 0.001), more frequent positive surgical margins (p = 0.028), and relatively lower trifecta achievement rates (p = 0.101) than the non-CERT group. In multivariable analysis, the CERT was an independent predictor for trifecta achievement but not for pentafecta achievement. Conclusions: CERT was associated with longer warm ischemia time, positive surgical margin, and lower trifecta achievement, but not with surgical complication and pentafecta achievement in RAPN. This study suggested that CERT had limited influence on long-term renal functional preservation; however, it had strong impacts on short-term surgical outcome.
Collapse
Affiliation(s)
- Hiroki Ito
- Department of Urology, Yokohama City University Hospital, Yokohama, Japan
| | - Koichi Uemura
- Department of Urology, Yokohama City University Hospital, Yokohama, Japan
| | - Maiko Ikeda
- Department of Urology, Yokohama City University Hospital, Yokohama, Japan
| | - Ryosuke Jikuya
- Department of Urology, Yokohama City University Hospital, Yokohama, Japan
| | - Takuya Kondo
- Department of Urology, Yokohama City University Hospital, Yokohama, Japan
| | - Tomoyuki Tatenuma
- Department of Urology, Yokohama City University Hospital, Yokohama, Japan
| | - Takashi Kawahara
- Department of Urology, Yokohama City University Hospital, Yokohama, Japan
| | - Mitsuru Komeya
- Department of Urology, Yokohama City University Hospital, Yokohama, Japan
| | - Yusuke Ito
- Department of Urology, Yokohama City University Hospital, Yokohama, Japan
| | - Kentaro Muraoka
- Department of Urology, Yokohama City University Hospital, Yokohama, Japan
| | - Hisashi Hasumi
- Department of Urology, Yokohama City University Hospital, Yokohama, Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Hospital, Yokohama, Japan
| |
Collapse
|
2
|
Butaney M, Wilder S, Wang Y, Bhayani S, Qi J, Van Till M, Mirza M, Johnson A, Perkins S, Noyes S, Weizer A, Johnson L, Patel A, Semerjian A, Lane BR, Rogers C. Positive surgical margins in partial nephrectomy: a collaborative effort to maintain surgical quality. BJU Int 2024; 133:273-275. [PMID: 37953479 DOI: 10.1111/bju.16223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Affiliation(s)
- Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | - Samantha Wilder
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | - Yuzhi Wang
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | - Sonia Bhayani
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | - Ji Qi
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Monica Van Till
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mahin Mirza
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anna Johnson
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sara Perkins
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | - Sabrina Noyes
- Corewell Health Hospital System, Grand Rapids, MI, USA
| | - Alon Weizer
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lewis Johnson
- Bronson Urology and Continence Specialists, Kalamazoo, MI, USA
| | - Amit Patel
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | | | - Brian R Lane
- Corewell Health Hospital System, Grand Rapids, MI, USA
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Craig Rogers
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| |
Collapse
|
3
|
Semko SL, Voylenko OA, Pikul MV, Stakhovskyi OE, Kononenko OA, Vitruk IV, Stakhovsky EO, Hrechko B. Comparison of aggressiveness in central versus peripheral T1a clear-cell renal cell carcinoma. Urol Oncol 2024; 42:31.e9-31.e15. [PMID: 38151425 DOI: 10.1016/j.urolonc.2023.11.014] [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: 05/15/2023] [Revised: 09/21/2023] [Accepted: 11/19/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE This study aimed to estimate the difference between peripheral and central small renal lesions in terms of their oncologic potential. METHODS Cross-sectional retrospective analysis of patients with small renal masses (T1a) who underwent surgical treatment between January 2008 and July 2019 at the affiliated hospital. Only patients with ccRCC pathology were included. Cases were divided into 2 groups depending on tumor location (central or peripheral) based on the R.E.N.A.L and local nephrometry scoring. Presence of nodal involvement, distant metastases, ISUP grade and endophytic growth were defined as aggressiveness predictors. Statistical analyses was performed using a standard statistical software (IBM SPPS Statistics Ver. 22), with P < 0.05 considered statistically significant. Associations between tumor location and Fuhrman grade, exo-/endophytic growth, TNM classification, and type of operation were tested using the Pearson χ² test and 1-way ANOVA test. RESULTS Patients with centrally located tumors had a higher incidence of clinical and pathological lymph node involvement (P = 0.02, χ2 = 5.1). Patients in both groups had an equal number of distant metastases at the time of diagnosis (P = 0.3, χ2 = 0.8). The operation time was significantly longer in patients with central lesions, which obviously showed higher tumor complexity in this group (P < 0.005). Pathological evaluation revealed differences between ISUP grades in both groups (P < 0.005, χ2 = 29.9). Central masses were characterized by higher aggressiveness, indicating a worse prognosis. Furthermore, the cases in the first group were more often endophytic (P = 0.03, χ2 = 0.9). Nevertheless, this did not affect the surgical strategy in most cases with a tendency toward partial nephrectomy. Eventually, organ-sparing treatment was preferable in both groups (P = 0.13, χ2 = 2.29). CONCLUSION Centrally located kidney cancer has showed in present study a higher incidence of high ISUP grade, regional nodal involvement and endophytic growth type. Endophytic growth type was associated with worse ISUP grading. Distribution of ISUP grade was not age depended, thus showing no difference by this criterion, when comparing different age groups. Higher ISUP grade was strongly associated with presence of distant metastases in T1a kidney tumors. Further analysis is needed to investigate aggressiveness of centrally located T1a RCC, as it may influence current conservative management options.
Collapse
Affiliation(s)
- Sofiya L Semko
- Department of Plastic and Reconstructive Oncological Urology, National Cancer Institute, Kyiv, Ukraine.
| | - Oleg A Voylenko
- Department of Plastic and Reconstructive Oncological Urology, National Cancer Institute, Kyiv, Ukraine
| | - Maksym V Pikul
- Department of Plastic and Reconstructive Oncological Urology, National Cancer Institute, Kyiv, Ukraine
| | - Oleksandr E Stakhovskyi
- Department of Plastic and Reconstructive Oncological Urology, National Cancer Institute, Kyiv, Ukraine
| | - Oleksii A Kononenko
- Department of Plastic and Reconstructive Oncological Urology, National Cancer Institute, Kyiv, Ukraine
| | - Iurii V Vitruk
- Department of Plastic and Reconstructive Oncological Urology, National Cancer Institute, Kyiv, Ukraine
| | - Eduard O Stakhovsky
- Department of Plastic and Reconstructive Oncological Urology, National Cancer Institute, Kyiv, Ukraine
| | - Bohdan Hrechko
- Department of Plastic and Reconstructive Oncological Urology, National Cancer Institute, Kyiv, Ukraine
| |
Collapse
|
4
|
Gülşen M, Özden E, Çamlıdağ İ, Öner S, Bostancı Y, Yakupoğlu YK, Yılmaz AF, Sarıkaya Ş. Intraoperative Ultrasound Can Facilitate Laparoscopic Partial Nephrectomy in Adherent Perinephric Fat. J Laparoendosc Adv Surg Tech A 2023; 33:480-486. [PMID: 36689198 DOI: 10.1089/lap.2022.0535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background: Adherent perinephric fat (APF) is one of the challenging factors of laparoscopic partial nephrectomy (LPN). The aim of this study was to investigate the effect of intraoperative laparoscopic ultrasound (ILUS) on determining renal tumor localization and dissection in patients with APF who underwent LPN. Methods: Prospectively collected data from 517 patients who underwent LPN from October 2010 to September 2020 in tertiary university hospital were evaluated retrospectively. The cohort was divided into two main groups according to the Mayo Adhesive Probability (MAP) score: Group 1 (MAP score ≤3) and Group 2 (MAP score ≥4). After implementing propensity score-matched analysis including the complexity of tumor, age, and body mass index, Group 1 consisted of 202 patients with ≤3 MAP score and Group 2 included 46 patients. Then, both groups were allocated into two subgroups according to whether ILUS was used. Demographics, perioperative features such as perirenal fatty tissue dissection, tumor excision, operation time, and perioperative outcomes accepted as trifecta, considering warm ischemia time, negative surgical margin, and complications were compared. Results: In Group 1, ILUS use did not seem to affect perioperative outcomes in both subgroups. However, ILUS has a positive effect on perirenal fatty tissue dissection (10 versus 19 minutes, P = .011), tumor excision (4 versus 7 minutes, P = .005), and operation time (78 versus 90 minutes, P = .046) in Group 2. Trifecta outcomes were also better in higher MAP scores and ultrasound-used subgroups (P = .019). Conclusions: ILUS should be considered a helpful and effective instrument in overcoming APF in LPN. It might also have a positive effect on trifecta outcomes.
Collapse
Affiliation(s)
- Murat Gülşen
- Department of Urology, Samsun Gazi State Hospital, İlkadım, Samsun, Turkey.,Department of Urology and Faculty of Medicine, Ondokuz Mayıs University, Atakum, Samsun, Turkey
| | - Ender Özden
- Department of Urology and Faculty of Medicine, Ondokuz Mayıs University, Atakum, Samsun, Turkey
| | - İlkay Çamlıdağ
- Department of Radiology, Faculty of Medicine, Ondokuz Mayıs University, Atakum, Samsun, Turkey
| | - Süleyman Öner
- Department of Urology and Faculty of Medicine, Ondokuz Mayıs University, Atakum, Samsun, Turkey.,Department of Urology, Eskişehir Yunus Emre State Hospital, Eskişehir, Turkey
| | - Yakup Bostancı
- Department of Urology and Faculty of Medicine, Ondokuz Mayıs University, Atakum, Samsun, Turkey
| | - Yarkın Kamil Yakupoğlu
- Department of Urology and Faculty of Medicine, Ondokuz Mayıs University, Atakum, Samsun, Turkey
| | - Ali Faik Yılmaz
- Department of Urology and Faculty of Medicine, Ondokuz Mayıs University, Atakum, Samsun, Turkey
| | - Şaban Sarıkaya
- Department of Urology and Faculty of Medicine, Ondokuz Mayıs University, Atakum, Samsun, Turkey
| |
Collapse
|
5
|
Batista LT, Oliveira JGRD, Gouvea VP, Souza LAD, Tourinho-Barbosa R. Alternative use of endocavitary probe to guide minimally invasive partial nephrectomy: is it reasonable? Acta Cir Bras 2022; 37:e370607. [PMID: 36134853 PMCID: PMC9488510 DOI: 10.1590/acb370607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/20/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose: To describe the use of endocavitary ultrasound probe as an auxiliary tool when performing partial nephrectomy in cases of endophytic renal tumors, to standardize the method, and to report the preliminary results achieved with this technique. Methods: Fifteen patients diagnosed with completely endophytic underwent partial nephrectomy with the use of an endocavitary ultrasound probe. This article describes the technique involved in partial nephrectomy and details the preparation of the endocavitary ultrasound probe to ensure its safe use. Results: All the patients had a RENAL score between 8 and 11. The median time of warm ischemia was 26 and 18 minutes for laparoscopic or robot-assisted surgery, respectively. The median duration of surgery was 150 minutes, and the median console time was 145 minutes for the laparoscopic and robot-assisted surgery groups, respectively. The median estimate of blood loss was 200 mL. Only three patients in the laparoscopic group had focal positive surgical margins. There were no cases of infection at the site of probe entry. Conclusions: Intraoperative use of an endocavitary ultrasound probe for partial nephrectomy is possible and a safe alternative to the excision of endophytic tumors when neither robotic probes nor laparoscopic probes are available.
Collapse
Affiliation(s)
- Lucas Teixeira Batista
- PhD. Universidade Federal da Bahia - Department of Urology - Salvador (BA), Brazil.,PhD. Hospital Cardiopulmonar - Department of Urology - Salvador (BA), Brazil
| | | | - Vitor Parente Gouvea
- Graduate student. Escola Bahiana de Medicina e Saúde Pública - Salvador (BA), Brazil
| | | | - Rafael Tourinho-Barbosa
- PhD. Hospital Cardiopulmonar - Department of Urology - Salvador (BA), Brazil.,PhD. Faculdade de Medicina do ABC - Department of Urology - Santo André (SP), Brazil
| |
Collapse
|
6
|
Deng X, Liu X, Hu B, Jiang M, Zhu K, Nie J, Liu T, Chen L, Deng W, Fu B, Xiong S. Pathological diagnostic nomograms for predicting malignant histology and unfavorable pathology in patients with endophytic renal tumor. Front Oncol 2022; 12:964048. [PMID: 36212405 PMCID: PMC9532530 DOI: 10.3389/fonc.2022.964048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo develop and validate nomograms for pre-treatment prediction of malignant histology (MH) and unfavorable pathology (UP) in patients with endophytic renal tumors (ERTs).MethodsWe retrospectively reviewed the clinical information of 3245 patients with ERTs accepted surgical treatment in our center. Eventually, 333 eligible patients were included and randomly enrolled into training and testing sets in a ratio of 7:3. We performed univariable and multivariable logistic regression analyses to determine the independent risk factors of MH and UP in the training set and developed the pathological diagnostic models of MH and UP. The optimal model was used to construct a nomogram for MH and UP. The area under the receiver operating characteristics (ROC) curves (AUC), calibration curves and decision curve analyses (DCA) were used to evaluate the predictive performance of models.ResultsOverall, 172 patients with MH and 50 patients with UP were enrolled in the training set; and 74 patients with MH and 21 patients with UP were enrolled in the validation set. Sex, neutrophil-to-lymphocyte ratio (NLR), R score, N score and R.E.N.A.L. score were the independent predictors of MH; and BMI, NLR, tumor size and R score were the independent predictors of UP. Single-variable and multiple-variable models were constructed based on these independent predictors. Among these predictive models, the malignant histology-risk nomogram consisted of sex, NLR, R score and N score and the unfavorable pathology-risk nomogram consisted of BMI, NLR and R score performed an optimal predictive performance, which reflected in the highest AUC (0.842 and 0.808, respectively), the favorable calibration curves and the best clinical net benefit. In addition, if demographic characteristics and laboratory tests were excluded from the nomograms, only the components of the R.E.N.A.L. Nephrometry Score system were included to predict MH and UP, the AUC decreased to 0.781 and 0.660, respectively (P=0.001 and 0.013, respectively).ConclusionIn our study, the pathological diagnostic models for predicting malignant and aggressive histological features for patients with ERTs showed outstanding predictive performance and convenience. The use of the models can greatly assist urologists in individualizing the management of their patients.
Collapse
Affiliation(s)
- Xinxi Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Urology, Jiu Jiang NO.1 People’s Hospital, Jiujiang, China
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Bing Hu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Ming Jiang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Ke Zhu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Jianqiang Nie
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Taobin Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
- *Correspondence: Situ Xiong, ; Bin Fu,
| | - Situ Xiong
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
- *Correspondence: Situ Xiong, ; Bin Fu,
| |
Collapse
|
7
|
Xiong S, Jiang M, Jiang Y, Hu B, Chen R, Yao Z, Deng W, Wan X, Liu X, Chen L, Fu B. Partial Nephrectomy Versus Radical Nephrectomy for Endophytic Renal Tumors: Comparison of Operative, Functional, and Oncological Outcomes by Propensity Score Matching Analysis. Front Oncol 2022; 12:916018. [PMID: 35957884 PMCID: PMC9360524 DOI: 10.3389/fonc.2022.916018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/22/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose The study aimed to compare operative, functional, and oncological outcomes between partial nephrectomy (PN) and radical nephrectomy (RN) for entophytic renal tumors (ERTs) by propensity score matching (PSM) analysis. Methods A total of 228 patients with ERTs who underwent PN or RN between August 2014 and December 2021 were assessed. A PSM in a 1:1 ratio was conducted to balance the differences between groups. Perioperative characteristics, renal functional, and oncological outcomes were compared between groups. Univariate and multivariate logistic and Cox proportional hazard regression analyses were used to determine the predictors of functional and survival outcomes. Results After PSM, 136 cases were matched to the PN group (n = 68) and the RN group (n = 68). Patients who underwent RN had shorter OT, less EBL, and lower high-grade complications (all p <0.05) relative to those who underwent PN. However, better perseveration of renal function was observed in the PN group, which was reflected in 48-h postoperative AKI (44.1% vs. 70.6%, p = 0.002), 1-year postoperative 90% eGFR preservation (45.6% vs. 22.1%, p = 0.004), and new-onset CKD Stage ≥III at last follow-up (2.9% vs. 29.4%, p <0.001). RN was the independent factor of short-term (OR, 2.812; 95% CI, 1.369–5.778; p = 0.005) and long-term renal function decline (OR, 10.242; 95% CI, 2.175–48.240; p = 0.003). Furthermore, PN resulted in a better OS and similar PFS and CSS as compared to RN (p = 0.042, 0.15, and 0.21, respectively). RN (OR, 7.361; 95% CI, 1.143–47.423; p = 0.036) and pT3 stage (OR, 4.241; 95% CI, 1.079–16.664; p = 0.039) were independent predictors of overall mortality. Conclusion Among patients with ERTs, although the PN group showed a higher incidence of high-grade complications than RN, when technically feasible and with experienced surgeons, PN is recommended for better preservation of renal function, longer OS, and similar oncological outcomes.
Collapse
Affiliation(s)
- Situ Xiong
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Ming Jiang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Yi Jiang
- Jiangxi Institute of Urology, Nanchang, China
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bing Hu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Ru Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Zhijun Yao
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Xianwen Wan
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Bin Fu, ; Xiaoqiang Liu, ; Luyao Chen, ; Xianwen Wan,
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Bin Fu, ; Xiaoqiang Liu, ; Luyao Chen, ; Xianwen Wan,
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Bin Fu, ; Xiaoqiang Liu, ; Luyao Chen, ; Xianwen Wan,
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
- *Correspondence: Bin Fu, ; Xiaoqiang Liu, ; Luyao Chen, ; Xianwen Wan,
| |
Collapse
|
8
|
Gonzalez‐Montoro A, Vera‐Donoso CD, Konstantinou G, Sopena P, Martinez M, Ortiz JB, Carles M, Benlloch JM, Gonzalez AJ. Nuclear-medicine probes: Where we are and where we are going. Med Phys 2022; 49:4372-4390. [PMID: 35526220 PMCID: PMC9545507 DOI: 10.1002/mp.15690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/08/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
Nuclear medicine probes turned into the key for the identification and precise location of sentinel lymph nodes and other occult lesions (i.e., tumors) by using the systemic administration of radiotracers. Intraoperative nuclear probes are key in the surgical management of some malignancies as well as in the determination of positive surgical margins, thus reducing the extent and potential surgery morbidity. Depending on their application, nuclear probes are classified into two main categories, namely, counting and imaging. Although counting probes present a simple design, are handheld (to be moved rapidly), and provide only acoustic signals when detecting radiation, imaging probes, also known as cameras, are more hardware-complex and also able to provide images but at the cost of an increased intervention time as displacing the camera has to be done slowly. This review article begins with an introductory section to highlight the relevance of nuclear-based probes and their components as well as the main differences between ionization- (semiconductor) and scintillation-based probes. Then, the most significant performance parameters of the probe are reviewed (i.e., sensitivity, contrast, count rate capabilities, shielding, energy, and spatial resolution), as well as the different types of probes based on the target radiation nature, namely: gamma (γ), beta (β) (positron and electron), and Cherenkov. Various available intraoperative nuclear probes are finally compared in terms of performance to discuss the state-of-the-art of nuclear medicine probes. The manuscript concludes by discussing the ideal probe design and the aspects to be considered when selecting nuclear-medicine probes.
Collapse
Affiliation(s)
- Andrea Gonzalez‐Montoro
- Instituto de Instrumentación para Imagen Molecular (I3M)Centro Mixto CSIC Universitat Politècnica de ValènciaValenciaSpain
| | | | | | - Pablo Sopena
- Servicio de Medicina NuclearÁrea clínica de Imagen Médica, La Fe HospitalValenciaSpain
| | | | | | | | - Jose Maria Benlloch
- Instituto de Instrumentación para Imagen Molecular (I3M)Centro Mixto CSIC Universitat Politècnica de ValènciaValenciaSpain
| | - Antonio Javier Gonzalez
- Instituto de Instrumentación para Imagen Molecular (I3M)Centro Mixto CSIC Universitat Politècnica de ValènciaValenciaSpain
| |
Collapse
|
9
|
Motoyama D, Ito T, Sugiyama T, Otsuka A, Miyake H. Comparison of perioperative outcomes among patients with exophytic, mesophytic, and endophytic renal tumors undergoing robot-assisted partial nephrectomy. Int J Urol 2022; 29:1026-1030. [PMID: 35669994 DOI: 10.1111/iju.14946] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/12/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES It has been well documented that partial nephrectomy for completely endophytic renal tumors is a highly challenging procedure accompanied by several technical difficulties even with the assistance of a robotic surgical system. This study aimed to compare perioperative variables among patients with exophytic, mesophytic, and endophytic renal tumors undergoing robot-assisted partial nephrectomy. METHODS This study retrospectively included 265 consecutive patients with localized small renal masses undergoing robot-assisted partial nephrectomy at our institution. In this study, completely endophytic tumor was defined as the mass totally covered by renal healthy parenchyma, and according to the points for the 'E' domain of RENAL nephrometry score based on preoperative computed tomography, subjects were classified into three groups as follows: exophytic, mesophytic, and endophytic tumor groups, and perioperative outcomes among these groups were compared. RESULTS Of 265 patients, 127, 112, and 26 were classified into the exophytic, mesophytic, and endophytic tumor groups, respectively. A significantly smaller tumor diameter was observed in the endophytic group than in the other groups (P < 0.001), whereas the RENAL nephrometry score was significantly higher (P < 0.001). In addition, the warm ischemia time in the endophytic tumor group was significantly longer than that in other groups (P = 0.009); however, no significant difference in the trifecta achievement was noted among the three groups. CONCLUSIONS This study suggests that robot-assisted partial nephrectomy for patients with completely endophytic tumors can be regarded as a feasible approach without marked impairment of perioperative outcomes; however, further investigation of the long-term functional and oncological outcomes in these patients is required.
Collapse
Affiliation(s)
- Daisuke Motoyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiki Ito
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takayuki Sugiyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsushi Otsuka
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|
10
|
Tuderti G, Brassetti A, Mastroianni R, Misuraca L, Bove A, Anceschi U, Ferriero M, Guaglianone S, Gallucci M, Simone G. Expanding the limits of nephron-sparing surgery: Surgical technique and mid-term outcomes of purely off-clamp robotic partial nephrectomy for totally endophytic renal tumors. Int J Urol 2022; 29:282-288. [PMID: 34973156 DOI: 10.1111/iju.14763] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/25/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To report surgical technique, perioperative, oncological, and mid-term functional outcomes in a single-center purely off-clamp robotic partial nephrectomy series for totally endophytic masses. METHODS A retrospective analysis of a prospectively collected, institutional review board-approved renal cancer database was carried out to include patients with a totally endophytic renal tumor treated with off-clamp robotic partial nephrectomy between January 2013 and December 2020 at our center. Our database was queried to identify cases that had been assigned 3 points for the "E" domain of the R.E.N.A.L. nephrometry score and 3 points for the "exophytic rate" domain of the PADUA (Preoperative Aspects and Dimensions Used for an Anatomical) nephrometry score. Preoperative indocyanine green renal mass marking was performed in 33 patients, in whom the tumor was vascularized by a specific feeding artery. Surgical steps, perioperative, oncological and functional data were reported. RESULTS Fifty-six consecutive patients with totally endophytic renal masses were treated. The median tumor diameter was 3 cm, and median PADUA and R.E.N.A.L. scores were both 10. The median operative time was 82 min. Low-grade Clavien complications occurred in two patients (3.6%) and high-grade Clavien complications were observed in four patients (7.1%). Positive surgical margins were detected in one patient; 2-year recurrence-free, cancer-specific, and overall survival rates were 100%, 100%, and 98.2%, respectively. At a median follow-up of 24 months, new onset of chronic kidney disease stage 3b occurred in one patient. At last follow-up, the median estimated glomerular filtration rate was 77 mL/min, with a median estimated glomerular filtration rate percent decrease of 5.5%. Trifecta was achieved in 91% of patients. CONCLUSIONS Purely off-clamp robotic partial nephrectomy is a feasible and safe surgical approach, even in totally endophytic renal tumors, providing a favorable perioperative complications rate, excellent oncological outcomes, and negligible impact on renal function at mid-term follow-up. Indocyanine green preoperative marking of endophytic renal tumors represents a useful tool for rapid intraoperative identification of the mass, real-time control of resection margins, and a more precise dissection.
Collapse
Affiliation(s)
- Gabriele Tuderti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Alfredo Bove
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | | | | | - Michele Gallucci
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| |
Collapse
|
11
|
Zeuschner P, Siemer S. [Robot-assisted surgery for renal cell carcinoma - today a standard?]. Aktuelle Urol 2021; 52:464-473. [PMID: 34107546 DOI: 10.1055/a-1493-1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Twenty years have passed since the first reports on robot-assisted kidney tumor surgery in 2001. However, robotic surgery has not spread to all German urologic departments yet. Hence, one has to question whether robot-assisted kidney tumor surgery can be considered a standard today. Until now, no prospective randomized controlled trials have compared robot-assisted radical nephrectomy with the open or laparoscopic approach. Regardless, laparoscopy and robotics both have proven better perioperative and comparable oncological outcomes than with open nephrectomy. In direct comparison, robot-assisted nephrectomy has no additional benefits over the laparoscopic approach and is less cost-effective. However, reports on robot-assisted level III or IV vena cava tumor thrombectomies illustrate that robotic surgery can be superior to the laparoscopic approach in highly complex interventions. Likewise, no prospective randomized controlled trials have analyzed robot-assisted partial nephrectomy yet. When conducted by experienced surgeons, robotic and laparoscopic partial nephrectomies can also have lower morbidity compared to the open approach. No consensus has been reached when directly comparing robotic and laparoscopic partial nephrectomy. However, evidence is increasing that robot-assisted partial nephrectomy can offer additional benefits, especially for the treatment of highly complex endophytic renal tumors. Thereof, head-to-head comparisons are often impacted by patient- and tumor-related factors, as well as the learning curve of the surgeon, bed-side assistant and the annual caseload of the department. Hence, one has to conclude that robot-assisted kidney tumor surgery has evolved into a standard procedure with good results. The perioperative outcomes of robot-assisted surgery are superior to the open technique at a comparable oncological follow-up. Even if robot-assisted interventions are often more expensive than laparoscopic surgery due to higher costs of acquisition, robotics have the potential to gain superior results especially in very complex tumor surgery. Due to expiring patent protections, new manufacturers and the development of new technologies, the market of robotic surgery will most likely undergo significant changes and its costs will probably decrease within the next years.
Collapse
Affiliation(s)
- Philip Zeuschner
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Stefan Siemer
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| |
Collapse
|
12
|
Yu F, Xu Q, Liu XG. Impact of Laparoscopic Partial Nephrectomy and Open Partial Nephrectomy on Outcomes of Clear Cell Renal Cell Carcinoma. Front Surg 2021; 8:681835. [PMID: 34395509 PMCID: PMC8358068 DOI: 10.3389/fsurg.2021.681835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/25/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: To analyze the impact of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) on outcomes of complex clear cell renal cell carcinoma (ccRCC). Methods: A total of 132 high-complex ccRCC patients with a Radius Exophytic Nearness Anterior Location (R.E.N.A.L) score ≥7 enrolled in our hospital between January 2018 and June 2020 were matched and assigned to an LPN group (given LPN treatment) and an OPN group (given OPN treatment), with 66 cases in each group. Two weeks and 3 months after the operation, the renal indexes, inflammatory factors, basic perioperative conditions, and incidence of complications were compared. Results: Two weeks after the operation, the levels of SCr and CysC were elevated, with higher levels observed in the LPN group (all P < 0.05), and the eGFR levels were reduced, with a lower result in the LPN group. Three months after the operation, the two groups observed decreased levels of SCr and CysC, and an increased level of eGFR; moreover, the decreased SCr and CysC levels were still higher, and the increased eGFR was lower than those before the operation (P < 0.05). The levels of CRP and TNF-α in the two groups increased after the operation, with a lower outcome in the LPN group (P < 0.05). Moreover, the LPN group had less intraoperative blood loss and shorter postoperative length of hospital stay but longer blocking time compared to the OPN group (P < 0.05). Patients in the LPN group were recorded with a lower complication incidence compared with the OPN group (3.03 vs. 15.15%, P < 0.05). Conclusion: Both LPN and OPN enjoy significant efficacy in the treatment of complex ccRCC and effectively protect renal function. Moreover, LPN is a more acceptable option for complex ccRCC due to its numerous benefits in postoperative stress response, complications, recovery. which is worthy of promotion with safety and feasibility.
Collapse
Affiliation(s)
- Feng Yu
- Department of Urology, Nantong Third People's Hospital, Nantong, China
| | - Qian Xu
- Department of Urology, Nantong Third People's Hospital, Nantong, China
| | - Xian-Gen Liu
- Department of Urology, Nantong Third People's Hospital, Nantong, China
| |
Collapse
|
13
|
Motoyama D, Sato R, Watanabe K, Matsushita Y, Watanabe H, Matsumoto R, Ito T, Sugiyama T, Otsuka A, Miyake H. Perioperative outcomes in patients undergoing robot-assisted partial nephrectomy: Comparative assessments between complex and non-complex renal tumors. Asian J Endosc Surg 2021; 14:379-385. [PMID: 33006270 DOI: 10.1111/ases.12872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The aim of this study was to investigate the effects of renal tumor complexity on perioperative outcomes in patients receiving robot-assisted partial nephrectomy (RAPN). METHODS This study included 153 consecutive patients with cT1 renal masses undergoing RAPN and analyzed their perioperative outcomes, particularly tumor complexity. In this series, cT1b, completely endophytic, hilar, and cystic tumors were considered complex tumors. Patients with tumors that met at least one of the complex criterion were placed in the complex tumor group; patients with tumors that did not meet any of the complex criteria were placed in the non-complex tumor group. RESULTS Of the 153 patients, 54 (35.3%) had complex tumors; specifically, 18 (11.8%) had cT1b tumors, 15 (9.8%) had completely endophytic tumors, 28 (18.3%) had hilar tumors, and 8 (5.2%) had cystic tumors. The non-complex group included 99 patients (64.7%). The complex tumor group had significantly longer warm ischemia and console times than the non-complex tumor group, but there was no significant difference between them in the achievement of the trifecta. Both warm ischemia and console times were significantly correlated with the number of complex factors. Multivariate analyses of complex factors demonstrated that completely endophytic and cT1b tumors were independently associated with warm ischemia time and console time, respectively. CONCLUSIONS For patients with complex tumors, RAPN may be a feasible procedure with acceptable perioperative outcomes. However, special attention should be paid to long warm ischemia and console times, particularly in those with completely endophytic and/or cT1b tumors.
Collapse
Affiliation(s)
- Daisuke Motoyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Ryo Sato
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kyohei Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiromitsu Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Rikiya Matsumoto
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiki Ito
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takayuki Sugiyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsushi Otsuka
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|
14
|
Abstract
BACKGROUND Localized renal cell carcinoma is increasingly relevant in daily urological practice due to earlier diagnosis and higher life expectancy. OBJECTIVES To analyze and compare current treatment evidence for localized renal cell carcinoma regarding new aspects of nephron-sparing surgery, the different surgical approaches and focal therapy. METHODS A systematic search was performed to identify relevant publications from 2018 and 2019. RESULTS Prospective randomized trials comparing nephrectomy with partial nephrectomy, the three different surgical approaches with each other, and focal therapy with surgery are still lacking. Positive effects on survival by partial nephrectomy could be demonstrated, even though partial nephrectomy has a higher morbidity than radical nephrectomy. Older patients (>75 years) with advanced localized renal cell carcinoma did not appear to benefit from partial nephrectomy so far, but minimally invasive surgical approaches are underrepresented in such studies. Minimally invasive partial nephrectomy is superior to the open approach, and robot-assisted partial nephrectomy has better results than laparoscopy. Focal therapy of kidney tumors is technically safe and feasible, but relevant comparisons with partial nephrectomy are still lacking. CONCLUSIONS Partial nephrectomy is still the gold standard treatment for localized renal cell carcinoma, it should be preferably performed by a robot-assisted approach. Focal therapy can serve as an alternative in highly selected cases.
Collapse
|
15
|
Chen DX, Hou YH, Jiang YN, Shao LW, Wang SJ, Wang XQ. Removal of pediatric stage IV neuroblastoma by robot-assisted laparoscopy: A case report and literature review. World J Clin Cases 2019; 7:1499-1507. [PMID: 31363479 PMCID: PMC6656671 DOI: 10.12998/wjcc.v7.i12.1499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/29/2019] [Accepted: 05/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Neuroblastoma (NB) is the most common extracranial solid tumor in children, with an incidence of approximately 1/10000. Surgical resection is an effective treatment for children with NB. Robot-assisted laparoscopic surgery is a new method and is superior to conventional laparoscopic surgery, since it has been preliminarily applied in clinical practice with a significant curative effect. This paper discusses significance and feasibility of complete resection of stage IV NB using robot-assisted laparoscopic surgery, while comparing its safety and effectiveness with conventional laparoscopic surgery.
CASE SUMMARY In June 2018, a girl with stage IV retroperitoneal NB, aged 3 years and 5 mo, was admitted. Her weight was 15 kg, and her height was 100 cm. Robot-assisted, five-port laparoscopic resection of NB was performed. Starting from the middle point between the navel and the anterior superior iliac spine to the left lower abdomen, the pneumoperitoneum and observation hole (10 mm) were established using the Hasson technique. Operation arm #1 was located between the left anterior axillary line, the navel, and the costal margin (8 mm); operation arm #2 was located at the intersection of the right anterior axillary line and Pfannenstiel line (8 mm); one auxiliary hole was located between arm #2 (on the Pfannenstiel line) and the observation hole (12 mm); and another auxiliary hole (5 mm) was located slightly below the left side of the xiphoid. Along the right line of Toldt and the hepatic flexure of the transverse colon, the colon was turned to the left and below with a hook electrode. Through Kocher's incision, the duodenum and the pancreatic head were turned to the left to expose the inferior vena cava and the abdominal aorta. The vein was separated along the right external iliac, and the inferior vena cava was then lifted to expose the right renal vein from the bottom to the top. The tumor was transected horizontally below the renal vein, and it was first cut into pieces and then resected. The right renal artery and the left renal vein were also exposed, and the retrohepatic inferior vena cava was isolated. The tumor was resected along the surface of the psoas muscle, the back of the inferior vena cava, and the right side of the abdominal aorta. Finally, the lymph node metas-tases in front of the abdominal aorta and left renal vein were completely removed. The specimens were loaded into a disposable specimen retrieval bag and removed from the enlarged auxiliary hole. T-tube drainage was placed and brought out through a hole in the right lower quadrant of the abdomen. The operative time was 389 min, the time of pneumoperitoneum was 360 min, the intraoperative blood loss was approximately 200 mL, and the postoperative recovery was smooth. There were no complications, such as lymphatic fistula, diarrhea, bleeding, and paralytic ileus. Two months after discharge, there were no other complications. The literature on the application of robot-assisted laparoscopic surgery in the treatment of NB in children was reviewed
CONCLUSION The robot has the advantages of a three-dimensional view and flexible operation, and it can operate finely along blood vessels. The successful experience of this case confirmed that robot-assisted laparoscopic surgery can skeletonize the abdominal blood vessels in the tumor and cut the tumor into pieces, indicating that robot-assisted laparoscopic surgery is feasible.
Collapse
Affiliation(s)
- Di-Xiang Chen
- Department of Pediatrics, PLA General Hospital, Beijing 100853, China
| | - Yi-Han Hou
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Ya-Nan Jiang
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Li-Wei Shao
- Department of Pathology, PLA General Hospital, Beijing 100853, China
| | - Shan-Jie Wang
- Department of Hepatobiliary Disease, Sixth People’s Hospital of Jinan Affiliated to Jining Medical School, Jinan 250200, Shandong Province, China
| | - Xian-Qiang Wang
- Department of Pediatrics, PLA General Hospital, Beijing 100853, China
| |
Collapse
|