1
|
Xu Y, Huang J, Fan X, Wang Z, Lou J, Liu X, Weng G. Clinical experience of bench surgery combined with autotransplantation after three-dimensional laparoscopic nephrectomy for the treatment of highly complex renal tumor. World J Surg Oncol 2023; 21:373. [PMID: 38031058 PMCID: PMC10687882 DOI: 10.1186/s12957-023-03246-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE To assess the feasibility and safety of three-dimensional (3D) laparoscopic nephrectomy in combination with bench surgery and autotransplantation for treating highly complex renal tumors. MATERIALS AND METHODS The clinical data of six patients with highly complex renal cell carcinoma were collected. All patients underwent 3D laparoscopic nephrectomy in combination with bench surgery and autotransplantation by the same surgeons, two of them had previously undergone laparoscopic partial nephrectomy for contralateral renal cancer. RESULTS The total operative time was 366 ± 65 min, the warm ischemia time (WIT) was 1.3 ± 0.4 min, and the cold ischemia time was 121 ± 26 min. While one patient received a diluted autologous blood transfusion, the intraoperative blood loss was 217 ± 194 ml. No increase in the serum creatinine (SCr) level was observed at postoperative day 30 compared with the preoperative time, and none of the patients received dialysis either during the hospital stay or to date. Although one patient underwent nephrectomy due to tumor recurrence in the transplanted kidney, the others reported no tumor recurrence or distant metastases on imaging to date. CONCLUSION 3D laparoscopic nephrectomy, when combined with bench surgery and autotransplantation, can become a feasible option for treating highly complex renal cell carcinoma cases when expecting to preserve renal function maximally.
Collapse
Affiliation(s)
- Yangkai Xu
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo, 315100, Zhejiang, China
| | - Jiawen Huang
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo, 315100, Zhejiang, China
| | - Xiaodong Fan
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo, 315100, Zhejiang, China
| | - Zhichao Wang
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo, 315100, Zhejiang, China
| | - Jiangyong Lou
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo, 315100, Zhejiang, China
| | - Xiaoming Liu
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo, 315100, Zhejiang, China
| | - Guobin Weng
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo, 315100, Zhejiang, China.
| |
Collapse
|
2
|
García-Perdomo HA, Caparrós MJR, Asensio AA, Cabo AV. Effect of positive surgical margins in patients who undergo a partial nephrectomy regarding recurrence, overall survival, recurrence/progression-free survival, and metastasis-free survival. A systematic review and meta-analysis. Clin Genitourin Cancer 2022; 20:459-472. [DOI: 10.1016/j.clgc.2022.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/29/2022] [Indexed: 11/03/2022]
|
3
|
Zhang X, Su Z, Lv P, Liu Z, Bai S. Functional, oncological outcomes and safety of nephron-sparing surgery versus radical nephrectomy in patients with localised renal cell carcinoma with high anatomical complexity: a retrospective cohort study with propensity score matching method. BMJ Open 2021; 11:e051622. [PMID: 34952876 PMCID: PMC8712983 DOI: 10.1136/bmjopen-2021-051622] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nephron-sparing surgery (NSS) is widely applied for small renal masses. However, the indication of NSS in patients with localised renal cell carcinoma (RCC) with high anatomical complexity is controversial. Thus, we compare functional and oncological outcomes, and safety of NSS versus radical nephrectomy (RN) in patients with localised RCC with high anatomical complexity Radius, Exophytic/endophytic, Nearness, Anterior/posterior, Location. (R.E.N.A.L.) score ≥10. METHODS We evaluated 575 patients with localised RCC that underwent NSS or RN at our centre between January 2013 and December 2018. Demographic characteristics, comorbidities, tumour data, surgery procedure, perioperative data and survival data were recorded. After propensity score matching, the variables were compared by binary paired logistic regression. The change in estimated glomerular filtration rate (eGFR) was compared with covariance analysis adjusted for baseline value. Recurrence and survival were calculated using Kaplan-Meier curves with log-rank tests. P<0.05 was considered to be statistically significant. RESULTS In the matched group, NSS showed lower eGFR loss compared with the RN group (17.81 mL/min/1.73 m2 vs 28.28 mL/min/1.73 m2, p<0.001). Moreover, the recurrence-free survival (p=0.002), cardiocerebrovascular disease-specific survival (p=0.015) and overall survival (p=0.017) of patients with NSS were better than those that underwent RN. Cancer-specific survival in both groups showed no difference (p=0.323). The incidence of minor and major complications in the two groups showed no difference (p=0.144, p=0.108). CONCLUSION NSS resulted in better preservation of renal function and oncological outcomes compared with RN, with acceptable complications. These findings could help improve clinical decision making for patients with localised RCC with high anatomical complexity. TRIAL REGISTRATION NUMBER ChiCTR2000040652.
Collapse
Affiliation(s)
- Xuanyu Zhang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhonghua Su
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Lv
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zeqi Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
4
|
Abu-Ghanem Y, Challacombe B. How to Deal with Renal Cell Carcinoma Tumours >7 cm: Referee. EUR UROL SUPPL 2021; 33:45-47. [PMID: 34632422 PMCID: PMC8488232 DOI: 10.1016/j.euros.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Ben Challacombe
- Urology Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
5
|
Huang R, Zhang C, Wang X, Hu H. Partial Nephrectomy Versus Radical Nephrectomy for Clinical T2 or Higher Stage Renal Tumors: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:680842. [PMID: 34178668 PMCID: PMC8222682 DOI: 10.3389/fonc.2021.680842] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/21/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The choice of surgical method for clinically diagnosed T2 or higher stage kidney cancer remains controversial. Here, we systematically reviewed and collected published comparative studies on renal function, oncologic outcomes, and perioperative results of partial nephrectomy (PN) versus radical nephrectomy (RN) for larger renal tumors (T2 and above), and performed a meta-analysis. EVIDENCE ACQUISITION Following searches of PubMed, Web of Science, and Embase, the original studies on PN vs. RN in the treatment of T2 renal cancer were screened through strict inclusion and exclusion criteria. RevMan 5.4 was used for data analysis of the perioperative results, renal function, and oncologic outcomes of the two surgical methods for T2 renal tumor therapy. The weighted mean difference was used as the combined effect size for continuous variables, while the odds ratio (OR) or risk ratio (RR) was used as the combined effect size for binary variables. Both variables used a 95% confidence interval (CI) to estimate statistical accuracy. In cases with low heterogeneity, the fixed-effects model was used to pool the estimated value; otherwise, the random-effects model was used when significant heterogeneity was detected. RESULTS Fifteen retrospective studies including 5,056 patients who underwent nephrectomy (PN: 1975, RN: 3081) were included. The decline in estimated GFR (eGFR) after PN was lower than RN [(MD: -11.74 ml/min/1.73 m2; 95% CI: -13.15, -10.32; p < 0.00001)]. The postoperative complication rate of PN was higher than that of PN (OR: 2.09; 95% CI: 1.56, 2.80; p < 0.00001)], and the postoperative overall survival (OS) of PN was higher than that of RN (HR: 0.77; 95% CI: 0.65, 0.90; p = 0.002), and tumor recurrence (RR, 0.69; 95% CI: 0.53, 0.90; p = 0.007). No obvious publication bias was found in the funnel chart of the OS rates of the two groups of patients. CONCLUSIONS PN is beneficial for patients with T2 renal tumors in terms of OS and renal function protection. However, it is also associated with a higher risk of surgical complications.
Collapse
Affiliation(s)
| | | | | | - Honglin Hu
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
6
|
Mühlbauer J, Kowalewski KF, Walach MT, Porubsky S, Wessels F, Nuhn P, Wagener N, Kriegmair MC. Partial nephrectomy preserves renal function without increasing the risk of complications compared with radical nephrectomy for renal cell carcinomas of stages pT2-3a. Int J Urol 2020; 27:906-913. [PMID: 32783245 DOI: 10.1111/iju.14326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/19/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To compare the operative and functional result of partial and radical nephrectomy in renal cell carcinomas of stages pT2-3a. METHODS Consecutive patients with renal cell carcinoma of stages pT2-3a, cN0 and cM0, who underwent partial or radical nephrectomy between January 2005 and October 2019 at a tertiary care center were included. Data were collected retrospectively. End-points included severe postoperative complications (Clavien-Dindo classification ≥3), acute and chronic renal function impairment, and overall survival. Uni- and multivariable outcome analyses were based on logistic regression. RESULTS A total of 158 patients were included (110 radical nephrectomy and 48 partial nephrectomy). Over time, partial nephrectomy was increasingly used. A RENAL score ≥10 was the only independent predictor influencing the surgical approach (radical nephrectomy vs partial nephrectomy, odds ratio 8.62, 95% confidence interval 3.32-22.37, P < 0.001). No significant differences in complications for radical nephrectomy versus partial nephrectomy were found (12.7% vs 8.3%, P = 0.424). Renal function was better preserved in the partial nephrectomy group (the latest chronic kidney disease stage ≥3: radical nephrectomy 73% vs partial nephrectomy 41%, P = 0.005). The surgical approach was a significant factor for chronic kidney disease (odds ratio 51.07, 95% confidence interval 3.57-730.59, P = 0.004). Overall survival did not significantly differ between radical nephrectomy and partial nephrectomy (mean overall survival 85.86 months, 95% confidence interval 3.83-78.36 vs 81.28 months, 95% confidence interval 4.59-72.29, P = 0.702). CONCLUSIONS In selected patients, partial nephrectomy can be used in large or locally advanced renal cell carcinoma. Compared with radical nephrectomy, it allows better preservation of renal function without harboring an increased risk of severe postoperative complications.
Collapse
Affiliation(s)
- Julia Mühlbauer
- Departments of, Department of, Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Karl-Friedrich Kowalewski
- Departments of, Department of, Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Margarete T Walach
- Departments of, Department of, Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan Porubsky
- Department of, Pathology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Frederik Wessels
- Departments of, Department of, Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Philipp Nuhn
- Departments of, Department of, Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Nina Wagener
- Departments of, Department of, Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Maximilian C Kriegmair
- Departments of, Department of, Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
7
|
Zhang L, Wu B, Zha Z, Qu W, Zhao H, Yuan J. The Clinicopathological Risk Factors in Renal Cell Cancer for the Oncological Outcomes Following Nephron-Sparing Surgery: A PRISMA Systematic Review and Meta-Analysis. Front Oncol 2020; 10:286. [PMID: 32211325 PMCID: PMC7067827 DOI: 10.3389/fonc.2020.00286] [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] [Received: 05/29/2019] [Accepted: 02/18/2020] [Indexed: 12/26/2022] Open
Abstract
Background and Objectives: Published data from individual studies present conflicting evidence about the relationship between clinicopathological risk factors and oncological outcomes in renal cell cancer (RCC) following nephron-sparing surgery (NSS). This study was conducted to explore the potential risk factors for RCC progress after NSS. Methods: Studies published in PubMed, Web of Science, and EMBASE were systematically reviewed from inception to March 2019 to determine risk factors for RCC following NSS. The predictive ability of identified predictors was assessed by hazard ratios (HRs) with 95% confidence intervals (CIs). A fixed-effect or random-effect was used to pool the estimates. Subgroup analyses were performed to explore the source of heterogeneity. Results: Seventeen studies including 38,522 patients with RCC were analyzed. The meta-analysis indicated that positive surgical margin (pooled HR = 1.47; 95% CI:1.24-1.73; P < 0.001), higher Fuhrman grade (pooled HR = 1.58; 95% CI:1.10-2.28; P = 0.013), higher pathological stage (pooled HR = 1.72; 95% CI:1.40-2.12; P < 0.001) and large tumor size (pooled HR = 1.09; 95% CI:1.03-1.16; P = 0.003) were significantly associated with recurrence risk. However, age (pooled HR = 1.00; 95% CI: 1.00-1.01; P = 0.257), sex (male vs. female) (pooled HR = 1.04; 95% CI: 0.89-1.21; P = 0.605) and surgical approach (laparoscope vs. open) (pooled HR = 0.80; 95% CI: 0.59-1.07; P = 0.129) had no effect on recurrence after NSS. In addition, we found that positive surgical margin was significantly associated with recurrence-free survival (pooled HR = 1.87; 95% CI: 1.32-2.66; P < 0.001) and overall mortality (pooled HR = 1.15; 95% CI: 1.07-1.23; P < 0.001), as well as large tumor size for recurrence-free survival (pooled HR = 1.18; 95% CI: 1.06-1.30; P = 0.002)and overall mortality (pooled HR = 1.01; 95% CI: 1.00-1.02; P = 0.004). Conclusions: Unfavorable pathological characteristics were distinctly related to worse oncological outcomes in RCC patients following NSS. These results may contribute to proposed prediction models for RCC patients to aid in counseling and risk stratification.
Collapse
Affiliation(s)
- Lijin Zhang
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiangyin, China
| | - Bin Wu
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiangyin, China
| | - Zhenlei Zha
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiangyin, China
| | - Wei Qu
- Department of Pharmacy, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiangyin, China
| | - Hu Zhao
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiangyin, China
| | - Jun Yuan
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiangyin, China
| |
Collapse
|
8
|
Li J, Zhang Y, Teng Z, Han Z. Partial nephrectomy versus radical nephrectomy for cT2 or greater renal tumors: a systematic review and meta-analysis. MINERVA UROL NEFROL 2019; 71:435-444. [DOI: 10.23736/s0393-2249.19.03470-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
9
|
Tang Q, Lin RC, Yao L, Zhang Z, Hao H, Zhang CJ, Cai L, Li XS, He ZS, Zhou LQ. [Clinicopathologic features and prognostic analyses of locally recurrent renal cell carcinoma patients after initial surgery]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:628-631. [PMID: 31420612 DOI: 10.19723/j.issn.1671-167x.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the clinicopathologic features and potential prognostic predictors of locally recurrent renal cell carcinoma patients after initial surgery. METHODS Authors retrospectively analyzed data extracted from 81 patients who were treated for postoperative locally recurrence of renal cell carcinoma from January 2006 to June 2016 in the Department of Urology, Peking University First Hospital. Postoperative locally recurrence of renal cell carcinoma was defined as disease recurring in the remnant kidney, renal fossa, adjacent abdomen, ipsilateral adrenal and retroperitoneal lymph nodes. RESULTS In the study, 81 patients were finally included, of whom 43 were initially treated in our hospital and 38 were initially treat in other centers. Partial nephrectomy (PN) was performed for 38 cases (26 in our hospital and 12 in other hospitals) as initial treatment and radical nephrectomy (RN) was conducted for the remnant 43 cases (17 in our hospital and 26 in other hospitals). Overall median recurrence time was 26 months (range: 3-164 months), in which 26 months (range: 3-55 months) for PN cases and 30 months (range: 4-164 months) for RN cases (P=0.009). Sixty-nine patients had single site recurrence, including remnant kidney (n=29), renal fossa (n=20), abdomen (n=4), ipsilateral lymph nodes (n=5), ipsilateral adrenal (n=11), while 12 patients had multiple sites recurrence. Seventy-eight patients were managed by complete surgical resection, while three patients were managed by radiofrequency ablation. Postoperative pathological diagnoses included clear cell carcinoma (n=72), papillary renal cell carcinoma (n=8, 7 cases with type 1, 1 case with type 2) and Xp11 translocation/TFE3 gene fusion renal cell carcinoma (n=1). Complete pathologic information of the initial surgery could be extracted from 43 patients who were initially treated in our hospital. Seventeen patients with initial radical nephrectomy were staged as T1a (n=4), T1b (n=2), T2a (n=1), T3a (n=8), and T3b (n=2). Twenty-six patients with initial partial nephrectomy were staged as T1a (n=18), T1b (n=7), and T3a (n=1). For PN cohort, the patients with T1a stage disease had longer median recurrence time than those with beyond T1a stage disease, and the difference was significant (29 months vs. 18 months, P=0.041). At the end of the follow-up, 58 patients were alive, 4 died and 19 lost the follow-up. Overall, 3-year and 5-year disease free survival rates were 81.9%, and 53.6%, respectively. CONCLUSION The present research reported a large-scale single central experience of locally recurrent renal cell carcinoma. The recurrence time of the PN group is shorter than that of the RN group. For patients after PN surgery, median recurrence time is longer for patients with T1a stage tumor when compared with those with stage beyond T1a. Patients can obtain relative long-term survival after complete secondary surgery resection.
Collapse
Affiliation(s)
- Q Tang
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - R C Lin
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - L Yao
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - Z Zhang
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - H Hao
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - C J Zhang
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - L Cai
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - X S Li
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - Z S He
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| | - L Q Zhou
- Department of Urology, Peking University First Hospital; Institute of Urology, Peking University, Beijing 100034, China
| |
Collapse
|
10
|
Autorino R, Mayer Grob B, Guruli G, Hampton LJ. Partial Versus Total Nephrectomy: Indications, Limitations, and Advantages. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
11
|
Rouffilange J, Gobet A, Capon G, Comat V, Lagabrielle S, Guillaume A, Robert G, Bensadoun H, Ferrière JM, Bernhard JC. [Partial nephrectomy for renal masses >7cm: Morbidity, oncological and functional outcomes (UroCCR-7 study)]. Prog Urol 2018; 28:588-595. [PMID: 30017703 DOI: 10.1016/j.purol.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/03/2018] [Accepted: 06/07/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To describe the morbidity, mortality, oncological and functional results of Partial nephrectomy (PN) for the treatment of renal tumors of more than 7cm. MATERIAL AND METHODS Thirty-seven partial nephrectomies for tumors larger than 7cm operated in a single center between 1987 and 2016 were analyzed retrospectively. The pre, per and postoperative clinico-biological data were collected within the UroCCR database. The GFR was assessed at day 5, 1 month and last follow-up. Intraoperative and postoperative surgical complications, the recurrence rate and the overall and specific mortality were collected. RESULTS The mean age of the patients was 57 years (44-68). The preoperative GFR and the median tumor size were 80mL/min and 8cm, respectively. The indication for surgery was elective in 21 cases (60%) and 19 tumors (54%) were malignant. Postoperative complications occurred in 24,3 cases (24.3%). The median post-operative GFR was respectively 77mL/min, 80mL/min and 77mL/min at day 5, 1month and at last follow-up. With a median follow up of 31 months [1-168], 5 patients (26,3%) had metastatic progression of whom 1 (5.3%) had a concomitant local recurrence and 3 (15.8%) had died from cancer. CONCLUSION This study confirms the feasibility of PN for large tumors with acceptable morbidity, limited risk of local recurrence and excellent functional results. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- J Rouffilange
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - A Gobet
- Institut de santé publique, d'épidémiologie et de développement, université Victor-Segalen Bordeaux 2, 33000 Bordeaux, France
| | - G Capon
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - V Comat
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - S Lagabrielle
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - A Guillaume
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - G Robert
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - H Bensadoun
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - J-M Ferrière
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - J-C Bernhard
- Service de chirurgie urologique, andrologie et transplantation rénale, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; Réseau français de recherche sur le cancer du rein UroCCR, 33000 Bordeaux, France
| |
Collapse
|
12
|
de Saint Aubert N, Audenet F, Mccaig F, Delavaud C, Verkarre V, Le Guilchet T, Dariane C, Pettenati C, Slaoui H, Mejean A, Timsit MO. Nephron sparing surgery in tumours greater than 7cm. Prog Urol 2018; 28:336-343. [PMID: 29699856 DOI: 10.1016/j.purol.2018.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 01/17/2018] [Accepted: 03/19/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Partial nephrectomy (PN) is the gold standard treatment for renal cell carcinomas under 4cm. No robust data exists to recommend PN for tumours>7cm (cT2). The objective of this work is to evaluate the results of PN for cT2 tumours. PATIENTS AND METHODS All patients who underwent PN or radical nephrectomy (RN) for cT2 tumours between 2000 and 2013 at our institution have been included. Patient demographics, postoperative data including renal function, morbidity, mortality and oncologic outcomes were reviewed retrospectively and compared using χ2 test, Mann-Whitney test, Kaplan-Meier method and log rank test. RESULTS We included 130 patients, 49 (38%) in the PN group and 81 (62%) in the RN group, with a median follow-up of 42 months [19-69]. Variation of postoperative renal function at day 5 and last recorded value was significantly different between the groups (P=0.03 and P<0.001). The PN group had a significantly higher complication rate as compared with RN group (37% versus 14%, P=0.002). There were no significant differences between the two groups for overall, recurrence free and specific survival (P=0.55, P=0.55, P=0.24, respectively). In univariate analysis, the type of surgery (PN versus RN) was not associated with a significant difference of oncologic outcome (margins, survival). CONCLUSION PN can be offered for cT2 tumours with oncological outcomes similar to RN. Despite an increased morbidity, it remains acceptable with the demonstrated advantage of preservation of renal function. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- N de Saint Aubert
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - F Audenet
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - F Mccaig
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - C Delavaud
- Hôpital Necker-Enfants-Malades, 245, rue de Sèvres, 75015 Paris, France
| | - V Verkarre
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - T Le Guilchet
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - C Dariane
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - C Pettenati
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - H Slaoui
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Mejean
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M O Timsit
- Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| |
Collapse
|
13
|
Delto JC, Paulucci D, Helbig MW, Badani KK, Eun D, Porter J, Abaza R, Hemal AK, Bhandari A. Robot-assisted partial nephrectomy for large renal masses: a multi-institutional series. BJU Int 2018; 121:908-915. [DOI: 10.1111/bju.14139] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
| | | | - Michael W. Helbig
- Florida International University Herbert Wertheim College of Medicine; Miami FL USA
| | | | - Daniel Eun
- Lewis Katz School of Medicine at Temple University; Philadelphia PA USA
| | | | | | | | | |
Collapse
|
14
|
Reix B, Bernhard JC, Patard JJ, Bigot P, Villers A, Suer E, Vuong N, Verhoest G, Alimi Q, Beauval JB, Benoit T, Nouhaud FX, Lenormand C, Hamidi N, Cai J, Eto M, Larre S, El Bakhri A, Ploussard G, Hung A, Koutlidis N, Schneider A, Carrouget J, Droupy S, Marchal S, Doerfler A, Seddik S, Matsugasumi T, Orsoni X, Descazeaud A, Pfister C, Bensalah K, Soulie M, Gill I, Flamand V. Overall survival and oncological outcomes after partial nephrectomy and radical nephrectomy for cT2a renal tumors: A collaborative international study from the French kidney cancer research network UroCCR. Prog Urol 2018; 28:146-155. [DOI: 10.1016/j.purol.2017.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/12/2017] [Accepted: 12/07/2017] [Indexed: 01/20/2023]
|
15
|
[Comparison of operative and oncologic results between partial nephrectomy and radiofrequency ablation for treatment of renal tumors in patients older than 75]. Prog Urol 2017; 28:55-61. [PMID: 29174691 DOI: 10.1016/j.purol.2017.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 09/14/2017] [Accepted: 10/19/2017] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Elderly patients represent a growing part of our society for who treatment strategy for localized renal tumors has to be chosen knowing iatrogen effects and renal function morbidity. The aim was to analyze oncological and functional results of nephron sparing surgery (PN) versus radiofrequency ablation (RFA). MATERIALS AND METHODS All patients aged more than 75 treated by partial nephrectomy or radiofrequency ablation between 2007 and 2014 in our centre were included. Patient and tumors data were compared and these criteria were analyzed: survival (overall and without recurrence) and loss of renal function (pre- and postoperative MDRD). RESULTS In total, 100 patients were included (26 partial nephrectomies, group 1 and 74 radiofrequency ablation, group 2) with a 32-months medium follow-up. Medium age and tumor size were significantly different (respectively, 78 versus 81 years old, P=0.001, 38mm versus 29mm, P=0.003). Perioperative results showed no differences in complications. Transfusion rate and duration of hospital stay were significantly higher in the PN group. Median overall survival were 45 vs. 27 months (P=0.23) for PN and RFA and median recurrence-free survival were 28 vs. 10 months (P=0.34). On a multivariate analysis, operative technique (PN or RFA) were not significantly linked to survival (HR 2.37 [95% CI: 0.66-8.5]), P=0.19. Loss of renal function were 1.5±14mL/min/1.73m2 for PN and 3±14mL/min/1.73m2 for RFA (P=0.69). CONCLUSION Our study showed better perioperative results for RFA than for PN, without significant different survival. Loss of renal function were little and similar. LEVEL OF EVIDENCE 4.
Collapse
|
16
|
Abstract
The incidence of the small renal mass continues to increase owing to the aging population and the ubiquity imaging. Most of these tumors are stage I tumors. Management strategies include surveillance, ablation, and extirpation. There is a wide body of literature favoring nephron-sparing approaches. Although nephron-sparing surgery may yield decreased long-term morbidity, it is not without its drawbacks, including a higher rate of complications. Urologists must be attuned to the complications of surgery and develop strategies to minimize risk. This article reviews expected complications of surgery on renal masses and risk stratification schema.
Collapse
Affiliation(s)
- William T Berg
- Department of Urology, Stony Brook University Hospital, Nicolls Road, Stony Brook, NY 11794, USA.
| | - Jeffrey J Tomaszewski
- Department of Urology, Cooper Medical School of Rowan University, Broadway, Camden, NJ 08103, USA
| | - Hailiu Yang
- Department of Urology, Cooper Medical School of Rowan University, Broadway, Camden, NJ 08103, USA
| | - Anthony Corcoran
- Department of Urology, Winthrop University Hospital, 1st Street, Mineola, NY 11501, USA
| |
Collapse
|
17
|
[Partial nephrectomy vs. radical nephrectomy for tumor>7cm]. Prog Urol 2017; 27:80-86. [PMID: 28161366 DOI: 10.1016/j.purol.2016.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 10/20/2016] [Accepted: 12/08/2016] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The usefulness of partial nephrectomy (PN) has been demonstrated for the treatment of renal tumor<7cm and it is now the standard treatment for such lesions. However, few studies are available regarding tumors≥T2. The objective of this study was to assess PN results for the treatment of renal tumors>7cm. MATERIALS AND METHODS A retrospective two-center study was performed, including 170 patients treated. Thirty-two patients underwent PN and 138 radical nephrectomy (RN) for renal cT2 tumors between 2004 and 2014. The biological and clinical characteristics including perioperative morbidity as well as the survival rate were compared between these 2 groups. RESULTS The median age was 59.5 years and the median follow-up was 47 months. More cT2b tumors were treated through RN (34.1% vs. 12.5%, P=0.01). The postoperative decrease in creatinine clearance was higher for the RN group (-24.3mL/min vs. -16.8; P=0.04). This difference was no longer significant at last follow-up. Perioperative complications were more frequent in the PN group (50.0% vs. 18.1%; P=0.008), and more severe (Clavien≥3 18.7% vs. 5.1%, P=0.01). No difference was found regarding the overall survival. Surgical margins were more frequent in the PN group (9.1% vs. 0.85%; P=0.01). CONCLUSION Our results suggested the feasibility of PN for renal tumors>7cm, involving however a higher perioperative complication risk. Cautious patient selection appeared to be required for the indication of PN for large tumors. LEVEL OF EVIDENCE 4.
Collapse
|
18
|
Partial Versus Total Nephrectomy: Indications, Limitations, and Advantages. Urol Oncol 2017. [DOI: 10.1007/978-3-319-42603-7_62-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
19
|
Mir MC, Derweesh I, Porpiglia F, Zargar H, Mottrie A, Autorino R. Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1b and T2 Renal Tumors: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol 2016; 71:606-617. [PMID: 27614693 DOI: 10.1016/j.eururo.2016.08.060] [Citation(s) in RCA: 283] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/25/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Partial nephrectomy (PN) is the reference standard of management for a cT1a renal mass. However, its role in the management of larger tumors (cT1b and cT2) is still under scrutiny. OBJECTIVE To conduct a meta-analysis assessing functional, oncologic, and perioperative outcomes of PN and radical nephrectomy (RN) in the specific case of larger renal tumors (≥cT1b). The primary endpoint was an overall analysis of cT1b and cT2 masses. The secondary endpoint was a sensitivity analysis for cT2 only. EVIDENCE ACQUISITION A systematic literature review was performed up to December 2015 using multiple search engines to identify eligible comparative studies. A formal meta-analysis was performed for studies comparing PN to RN for both cT1b and cT2 tumors. In addition, a sensitivity analysis including the subgroup of studies comparing PN to RN for cT2 only was conducted. Pooled estimates were calculated using a fixed-effects model if no significant heterogeneity was identified; alternatively, a random-effects model was used when significant heterogeneity was detected. For continuous outcomes, the weighted mean difference (WMD) was used as summary measure. For binary variables, the odds ratio (OR) or risk ratio (RR) was calculated with 95% confidence interval (CI). Statistical analyses were performed using Review Manager 5 (Cochrane Collaboration, Oxford, UK). EVIDENCE SYNTHESIS Overall, 21 case-control studies including 11204 patients (RN 8620; PN 2584) were deemed eligible and included in the analysis. Patients undergoing PN were younger (WMD -2.3 yr; p<0.001) and had smaller masses (WMD -0.65cm; p<0.001). Lower estimated blood loss was found for RN (WMD 102.6ml; p<0.001). There was a higher likelihood of postoperative complications for PN (RR 1.74, 95% CI 1.34-2.2; p<0.001). Pathology revealed a higher rate of malignant histology for the RN group (RR 0.97; p=0.02). PN was associated with better postoperative renal function, as shown by higher postoperative estimated glomerular filtration rate (eGFR; WMD 12.4ml/min; p<0.001), lower likelihood of postoperative onset of chronic kidney disease (RR 0.36; p<0.001), and lower decline in eGFR (WMD -8.6ml/min; p<0.001). The PN group had a lower likelihood of tumor recurrence (OR 0.6; p<0.001), cancer-specific mortality (OR 0.58; p=0.001), and all-cause mortality (OR 0.67; p=0.005). Four studies compared PN (n=212) to RN (n=1792) in the specific case of T2 tumors (>7cm). In this subset of patients, the estimated blood loss was higher for PN (WMD 107.6ml; p<0.001), as was the likelihood of complications (RR 2.0; p<0.001). Both the recurrence rate (RR 0.61; p=0.004) and cancer-specific mortality (RR 0.65; p=0.03) were lower for PN. CONCLUSIONS PN is a viable treatment option for larger renal tumors, as it offers acceptable surgical morbidity, equivalent cancer control, and better preservation of renal function, with potential for better long-term survival. For T2 tumors, PN use should be more selective, and specific patient and tumor factors should be considered. Further investigation, ideally in a prospective randomized fashion, is warranted to better define the role of PN in this challenging clinical scenario. PATIENT SUMMARY We performed a cumulative analysis of the literature to determine the best treatment option in cases of localized kidney tumor of higher clinical stage (T1b and T2, as based on preoperative imaging). Our findings suggest that removing only the tumor and saving the kidney might be an effective treatment modality in terms of cancer control, with the advantage of preserving the kidney function. However, a higher risk of perioperative complications should be taken into account when facing larger tumors (clinical stage T2) with kidney-sparing surgery.
Collapse
Affiliation(s)
- Maria Carmen Mir
- Department of Urology, Hospital del Mar-Parc de Salut Mar-IMIM, Barcelona, Spain
| | - Ithaar Derweesh
- Department of Urology, UC San Diego Health System, La Jolla, CA, USA
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, University of Turin San Luigi Hospital, Orbassano, Italy
| | - Homayoun Zargar
- Urology Department, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | | | - Riccardo Autorino
- Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
| |
Collapse
|
20
|
Lee BH, Feifer A, Feuerstein MA, Benfante NE, Kou L, Yu C, Kattan MW, Russo P. Validation of a Postoperative Nomogram Predicting Recurrence in Patients with Conventional Clear Cell Renal Cell Carcinoma. Eur Urol Focus 2016; 4:100-105. [PMID: 28753780 DOI: 10.1016/j.euf.2016.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/20/2016] [Accepted: 07/13/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Clear cell renal cell carcinoma (RCC) continues to be the most commonly diagnosed subtype and is associated with more aggressive behavior than papillary and chromophobe RCC. Predicting disease recurrence after surgical extirpation is important for counseling and targeting those at high risk for adjuvant therapy clinical trials. OBJECTIVE To validate a postoperative nomogram predicting 5-yr recurrence-free probability (RFP) for clinically localized clear cell RCC. DESIGN, SETTING, AND PARTICIPANTS We identified all patients who underwent nephrectomy for clinically localized clear cell RCC from 1990 to 2009 at Memorial Sloan Kettering Cancer Center. After excluding patients with bilateral renal masses, familial RCC syndromes, and T3c or T4 tumors due to the limited number, 1642 participants were available for analysis. INTERVENTIONS Partial or radical nephrectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Disease recurrence was defined as any new tumor after nephrectomy or kidney cancer-specific mortality, whichever occurred first. A postoperative nomogram was used to calculate the predicted 5-yr RFP, and these values were compared with the actual 5-yr RFP. Nomogram performance was evaluated by concordance index and calibration plot. RESULTS AND LIMITATIONS Median follow-up was 39 mo (interquartile range: 14-79 mo), and disease recurrence was observed in 50 patients. The nomogram concordance index was 0.81. The calibration curve showed that the nomogram underestimated the actual 5-yr RFP. We updated the nomogram by including the entire patient population, which maintained performance and significantly improved calibration. CONCLUSIONS The updated clear cell RCC postoperative nomogram performed well in the combined cohort. Underestimation of actual 5-yr RFP by the original nomogram may be due to increased surgeon experience and other unknown variables. PATIENT SUMMARY We updated a valuable prediction tool used for assessing the disease recurrence probability after nephrectomy for clear cell renal cell carcinoma.
Collapse
Affiliation(s)
- Byron H Lee
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Feifer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael A Feuerstein
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicole E Benfante
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lei Kou
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Changhong Yu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
21
|
Zonal NephRo Score: external validation for predicting complications after open partial nephrectomy. World J Urol 2015; 34:545-51. [DOI: 10.1007/s00345-015-1648-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022] Open
|
22
|
Une taille tumorale supérieure à 7cm influence-t-elle les résultats de la néphrectomie partielle pour tumeur du rein ? Prog Urol 2015; 25:138-44. [DOI: 10.1016/j.purol.2014.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 10/26/2014] [Accepted: 11/22/2014] [Indexed: 01/20/2023]
|