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Ohsugi H, Ikeda J, Takayasu K, Takizawa N, Taniguchi H, Yanishi M, Kinoshita H. Trifecta outcomes of robotic partial nephrectomy in obese patients: A comparison of body mass index <25, 25 to <30, and ≥30. Int J Urol 2024. [PMID: 39073237 DOI: 10.1111/iju.15529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/19/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE We analyzed robotic partial nephrectomy (RPN) outcomes in obese patients based on body mass index (BMI) and trifecta achievement. METHODS We retrospectively reviewed 296 patients who underwent RPN at Kansai Medical University Hospital between 2014 and 2022. The preoperative clinical data and perioperative outcomes were evaluated. Trifecta achievement (negative surgical margin, no major complications, and no acute kidney injury on postoperative day three) and its relationship to three BMI groups (<25, 25 to <30, and ≥30) were the primary outcome. The correlation between factors in achieving trifecta and BMI was evaluated. Univariate and multivariate analyses assessed variables for achieving the trifecta with logistic regression analysis. C-statistics quantitatively evaluated the prediction accuracy. RESULTS Among 296 patients, 264 (89.2%) achieved trifecta (BMI categories were <25 [89.9%], 25 to <30 [89.4%], and ≥30 [82.6%]). There was no significant BMI-related difference (p = 0.566). Intraoperative blood loss increased with the BMI (p = 0.034). Multivariate analyses showed preoperative aspects and dimensions used for anatomic (PADUA) score independently predicted trifecta failure (odds ratio 1.71; 95% confidence interval 1.32-2.20; p < 0.001). The C-statistics of the PADUA score increased with increasing BMI. CONCLUSIONS Higher BMI patients had more intraoperative blood loss during RPN. However, RPN remains safe and has acceptable quality and functional outcomes. Since patients with high PADUA scores combined with a high BMI may be at risk of trifecta failure, this should be explained before RPN.
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Affiliation(s)
- Haruyuki Ohsugi
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Junichi Ikeda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Kenta Takayasu
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Nae Takizawa
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Hisanori Taniguchi
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Masaaki Yanishi
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
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Franco A, Riolo S, Tema G, Guidotti A, Brassetti A, Anceschi U, Bove AM, D’Annunzio S, Ferriero M, Mastroianni R, Misuraca L, Guaglianone S, Tuderti G, Leonardo C, Cicione A, Licari LC, Bologna E, Flammia RS, Nacchia A, Trucchi A, Lombardo R, Franco G, Tubaro A, Simone G, De Nunzio C. Renal Function Preservation in Purely Off-Clamp Sutureless Robotic Partial Nephrectomy: Initial Experience and Technique. Diagnostics (Basel) 2024; 14:1579. [PMID: 39125455 PMCID: PMC11311424 DOI: 10.3390/diagnostics14151579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 08/12/2024] Open
Abstract
The aim of our study is to evaluate the effectiveness and safety of a sutureless off-clamp robot-assisted partial nephrectomy (sl-oc RAPN), particularly its impact on renal function. A multicenter study was conducted from April 2021 to June 2022. Patients diagnosed with a renal mass of >2 cm and a PADUA score of ≤6 consecutively underwent an sl-oc RAPN procedure. Tumor features, patients characteristics, and intraoperative outcomes were assessed. An evaluation of renal function was performed preoperatively, and again at 1 and 3 months after surgery by measuring the creatinine and blood urea nitrogen levels. The renal function of the two separate kidneys was assessed by a sequential renal scintigraphy performed before and at least 30 days after surgery. A total of 21 patients underwent an sl-oc RAPN. The median age was 64 years (IQR 52/70), the median tumor diameter was 40 mm (IQR 29/45), and the median PADUA score was 4 (3.5/5). The intraoperative outcomes included operative time (OT), 90 (IQR 74/100) min; estimated blood loss (EBL), 150 (IQR 50/300) mL; and perioperative complications, CD > 3 1(5%); only two patients presented positive surgical margins in their final histology (2/21, 10%). Compared to the preoperative value, a decrease in renal function was highlighted with a statistically significant median decrease of 10 mL/min (p < 0.01). The renal scintigraphy showed an overall decrease in renal function compared to the preoperative value, with a range in the operated kidney that varied from 0 to 15 mL/s and from 0% to 40%, with a median value of 4 mL/s and 12%. sl-oc RAPN is a safe procedure, with a minimal impact on kidney function alteration. This technique has proven effective in preserving renal function and maintaining optimal oncological outcomes with limited complications.
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Affiliation(s)
- Antonio Franco
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Sara Riolo
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Giorgia Tema
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Alessio Guidotti
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Aldo Brassetti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Alfredo Maria Bove
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Simone D’Annunzio
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Mariaconsiglia Ferriero
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Riccardo Mastroianni
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Leonardo Misuraca
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Salvatore Guaglianone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Gabriele Tuderti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Costantino Leonardo
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Antonio Cicione
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Leslie Claire Licari
- Urology Unit, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00185 Rome, Italy; (L.C.L.); (E.B.); (G.F.)
| | - Eugenio Bologna
- Urology Unit, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00185 Rome, Italy; (L.C.L.); (E.B.); (G.F.)
| | - Rocco Simone Flammia
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Antonio Nacchia
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Alberto Trucchi
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Riccardo Lombardo
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Giorgio Franco
- Urology Unit, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00185 Rome, Italy; (L.C.L.); (E.B.); (G.F.)
| | - Andrea Tubaro
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
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Suppanuntaroek S, Garcia K, Combates C, Deal C, Paster IC, Morrill CC, Batai K, Lee B. Best predictive single nephrometry score component to correlate with achievement of trifecta outcome in laparoscopic and robotic surgery. BMC Urol 2024; 24:134. [PMID: 38943111 PMCID: PMC11212392 DOI: 10.1186/s12894-024-01518-4] [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: 01/17/2024] [Accepted: 06/14/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND To evaluate the predictive value of individual components of the R.E.N.A.L scoring system for Laparoscopic (LPN) and Robotic Partial Nephrectomy (RPN). METHODS Patients that had undergone a Laparoscopic (LPN) or Robotic Partial Nephrectomy (RPN) between 2018 and 2023 were reviewed. Our data collection included Race, Ethnicity, Age, BMI, R.E.N.A.L nephrometry score, and complications. Cases that achieved trifecta outcomes were designated as "Group A" and cases that did not achieve trifecta were "Group B". All the data were collected using REDCap database. RESULTS A total of 111 cases were included, Group A consisted of 82% of all cases, whereas Group B 18%. Radius score demonstrated significant distinction concerning trifecta attainment and was the most predictive component of the 5 scoring metrics of the nephrometry system. In a subgroup analysis, R-score of 3 or a renal mass measuring ≥ 7 cm, was a significant independent negative predictor for trifecta outcomes, as well as tumor size at presentation. CONCLUSION Renal nephrometry score is predictive of trifecta outcomes for patients undergoing laparoscopic or robotic partial nephrectomy. Radius of mass was the most effective predictive component of the nephrometry score for trifecta prediction.
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Affiliation(s)
- Sappaya Suppanuntaroek
- Department of Urology, University of Arizona, Tucson, AZ, USA
- Urology, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
| | - Kyle Garcia
- Department of Urology, University of Arizona, Tucson, AZ, USA
| | | | - Carly Deal
- Department of Urology, University of Arizona, Tucson, AZ, USA.
| | | | | | - Ken Batai
- Roswell Park Cancer Institute, Cancer Prevention and Control, Buffalo, NY, USA
| | - Benjamin Lee
- Department of Urology, University of Arizona, Tucson, AZ, USA
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4
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Sarkis J, Champy CM, Doumerc N, Bruyere F, Rouprêt M, Branger N, Surlemont L, Michel C, Waeckel T, Parier B, Beauval JB, Bigot P, Lang H, Vallee M, Guillotreau J, Patard JJ, Sarrazin C, de Vergie S, Belas O, Boissier R, Mallet R, Panthier F, Taha F, Le Clerc QC, Hoquetis L, Audenet F, Vignot L, Paparel P, Fontenil A, Bernhard JC, Ingels A. Robot-assisted Partial Nephrectomy for Hilar and Nonhilar Renal Masses: Comparison of Perioperative, Oncological, and Functional Results in a Multicentre Prospective Cohort (NEPRAH Study, UroCCR 175). Eur Urol Oncol 2024:S2588-9311(24)00150-0. [PMID: 38937207 DOI: 10.1016/j.euo.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/04/2024] [Accepted: 06/07/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND AND OBJECTIVE A hilar location for a renal tumour is sometimes viewed as a limiting factor for safe partial nephrectomy. Our aim was to evaluate perioperative, oncological, and functional outcomes of robot-assisted partial nephrectomy (RAPN) for hilar tumours (RAPN-H) in comparison to RAPN for nonhilar tumours (RAPN-NH). METHODS We conducted an observational, multicentre cohort study using prospectively collected data from the French Research Network on Kidney Cancer (UroCCR). The registry includes data for 3551 patients who underwent RAPN for localised or locally advanced renal masses between 2010 and 2023 in 29 hospitals in France. We studied the impact of a hilar location on surgery, postoperative renal function, tumour characteristics, and survival. We also compared rates of trifecta achievement (warm ischaemia time [WIT] <25 min, negative surgical margins, and no perioperative complications) between the groups. Finally, we performed a subgroup analysis of RAPN without vascular clamping. Variables were compared in univariable analysis and using multivariable linear, logistic, and Cox proportional-hazards models adjusted for relevant patient and tumour covariates. KEY FINDINGS AND LIMITATIONS The analytical population included 3451 patients, of whom 2773 underwent RAPN-NH and 678 underwent RAPN-H. Longer WIT (β = 2.4 min; p < 0.01), longer operative time (β = 11.4 min; p < 0.01) and a higher risk of postoperative complications (odds ratio 1.33; p = 0.05) were observed in the hilar group. Blood loss, the perioperative transfusion rate, postoperative changes in the estimated glomerular filtration rate, and trifecta achievement rates were comparable between the groups (p > 0.05). At mean follow-up of 31.9 mo, there was no significant difference in recurrence-free survival (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.58-1.2; p = 0.3), cancer-specific survival (HR 1.1, 95% CI 0.48-2.6; p = 0.79), or overall survival (HR 0.89, 95% CI 0.52-1.53; p = 0.69). CONCLUSIONS AND CLINICAL IMPLICATIONS Patient and tumour characteristics rather than just hilar location should be the main determinants of the optimal surgical strategy for hilar tumours. PATIENT SUMMARY We found that kidney tumours located close to major kidney blood vessels led to a longer operation and a higher risk of complications during robot-assisted surgery to remove the tumour. However, tumours in these locations were not related to a higher risk of kidney function loss, cancer recurrence, or death.
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Affiliation(s)
- Julien Sarkis
- Urology Department, Grand Hôpital de l'Est Francilien, Meaux, France.
| | - Cecile M Champy
- Urology Department, Henri Mondor University Hospital, AP-HP, Creteil, France; Inserm Clinical Investigation Centre 1430, Henri Mondor University Hospital, AP-HP, Creteil, France
| | | | | | - Morgan Rouprêt
- Urology Department, CHU La Pitié Salpêtrière, AP-HP Paris, France
| | - Nicolas Branger
- Urology Department, Institut Paoli Calmettes, Marseille, France
| | | | | | | | - Bastien Parier
- Urology Department, Hôpital Bicêtre, AP-HP Paris, France
| | | | | | - Hervé Lang
- Urology Department, CHRU Strasbourg, Strasbourg, France
| | | | | | | | | | | | | | - Romain Boissier
- Aix Marseille Université, Service de Chirurgie urologique et de Transplantation rénale, CHU Conception, AP-HM, Marseille, France
| | - Richard Mallet
- Urology Department, Polyclinique Francheville, Périgueux, France
| | | | - Fayek Taha
- Urology Department, CHU Reims, Reims, France
| | | | | | - François Audenet
- Urology Department, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Philippe Paparel
- Urology Department, Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | | | | | - Alexandre Ingels
- Urology Department, Henri Mondor University Hospital, AP-HP, Creteil, France; Inserm Clinical Investigation Centre 1430, Henri Mondor University Hospital, AP-HP, Creteil, France
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5
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De Nunzio C, Tema G, Brassetti A, Anceschi U, Bove AM, D’Annunzio S, Ferriero M, Mastroianni R, Misuraca L, Guaglianone S, Tuderti G, Leonardo C, Lombardo R, Cicione A, Franco A, Bologna E, Licari LC, Riolo S, Flammia RS, Nacchia A, Trucchi A, Franco G, Tubaro A, Simone G. Purely Off-Clamp Sutureless Robotic Partial Nephrectomy for Novice Robotic Surgeons: A Multi-Institutional Propensity Score-Matched Analysis. J Clin Med 2024; 13:3553. [PMID: 38930082 PMCID: PMC11204664 DOI: 10.3390/jcm13123553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Objectives: To compare perioperative outcomes of patients treated with sutureless off-clamp robotic partial nephrectomy (sl-oc RAPN) by either a novice or an expert robotic surgeon at two different institutions. Methods: Data concerning two continuous series of patients with cT1-2N0M0 renal tumors treated with sl-oc RAPN either by a novice or an expert surgeon were extracted from prospectively populated institutional databases over the last 4 years. Perioperative outcomes as well as the baseline characteristics of patients and tumors were compared by using χ2 and Mann-Whitney tests for categorical and continuous variables, respectively. A 1:1 propensity match score analysis (PMSa) generated two homogeneous cohorts. Logistic regression analysis was performed to assess predictors of trifecta outcomes, defined as negative surgical margins, no Clavien-Dindo ≧ 3 grade complications, and no ≧ 30% postoperative eGFR reduction. Results: Overall, 328 patients were treated by an expert surgeon, while 40 were treated by a novice surgeon. After PMSa analysis, two cohorts of 23 patients each were generated, homogeneous for all baseline variables (p ≥ 0.07). Hospital stay was the only significantly different outcome observed between the two groups (5 days vs. 2 days; p < 0.001). No statistically significant differences were recorded when comparing trifecta outcomes (expert: 100% vs. novice: 87%; p = 0.07). In the logistic regression analysis, no statistically significant predictors of trifecta outcomes were recorded. Conclusions: sl-oc RAPN is a feasible and safe nephron sparing technique, even when performed by a novice robotic surgeon.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Ospedale Sant’Andrea, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (G.T.); (R.L.); (A.C.); (A.F.); (S.R.); (A.N.); (A.T.); (A.T.)
| | - Giorgia Tema
- Department of Urology, Ospedale Sant’Andrea, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (G.T.); (R.L.); (A.C.); (A.F.); (S.R.); (A.N.); (A.T.); (A.T.)
| | - Aldo Brassetti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Alfredo Maria Bove
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Simone D’Annunzio
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Mariaconsiglia Ferriero
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Riccardo Mastroianni
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Leonardo Misuraca
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Salvatore Guaglianone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Gabriele Tuderti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Costantino Leonardo
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Riccardo Lombardo
- Department of Urology, Ospedale Sant’Andrea, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (G.T.); (R.L.); (A.C.); (A.F.); (S.R.); (A.N.); (A.T.); (A.T.)
| | - Antonio Cicione
- Department of Urology, Ospedale Sant’Andrea, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (G.T.); (R.L.); (A.C.); (A.F.); (S.R.); (A.N.); (A.T.); (A.T.)
| | - Antonio Franco
- Department of Urology, Ospedale Sant’Andrea, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (G.T.); (R.L.); (A.C.); (A.F.); (S.R.); (A.N.); (A.T.); (A.T.)
| | - Eugenio Bologna
- Urology Unit, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00185 Rome, Italy; (E.B.); (L.C.L.); (G.F.)
| | - Leslie Claire Licari
- Urology Unit, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00185 Rome, Italy; (E.B.); (L.C.L.); (G.F.)
| | - Sara Riolo
- Department of Urology, Ospedale Sant’Andrea, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (G.T.); (R.L.); (A.C.); (A.F.); (S.R.); (A.N.); (A.T.); (A.T.)
| | - Rocco Simone Flammia
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Antonio Nacchia
- Department of Urology, Ospedale Sant’Andrea, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (G.T.); (R.L.); (A.C.); (A.F.); (S.R.); (A.N.); (A.T.); (A.T.)
| | - Alberto Trucchi
- Department of Urology, Ospedale Sant’Andrea, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (G.T.); (R.L.); (A.C.); (A.F.); (S.R.); (A.N.); (A.T.); (A.T.)
| | - Giorgio Franco
- Urology Unit, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00185 Rome, Italy; (E.B.); (L.C.L.); (G.F.)
| | - Andrea Tubaro
- Department of Urology, Ospedale Sant’Andrea, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (G.T.); (R.L.); (A.C.); (A.F.); (S.R.); (A.N.); (A.T.); (A.T.)
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
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6
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Soputro NA, Ferguson EL, Ramos-Carpinteyro R, Chavali JS, Geskin A, Fareed K, Berglund R, Fergany AF, Stein RJ, Haber GP, Campbell SC, Weight CJ, Kaouk JH. Long-Term Functional and Oncologic Outcomes Following Robotic Partial and Radical Nephrectomy: A Report from a Single Institution with up to 15 Years of Follow-Up. J Endourol 2024; 38:573-583. [PMID: 38568897 DOI: 10.1089/end.2023.0543] [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: 04/05/2024] Open
Abstract
Objective: To evaluate the long-term functional and oncologic outcomes after robotic partial nephrectomy (RAPN) and radical nephrectomy (RARN). Materials and Methods: A retrospective review was performed on 1816 patients who underwent RAPN and RARN at our institution between January 2006 and January 2018. Patients with long-term follow-ups of at least 5 years were selected. Exclusion criteria included patients with a previous history of partial or radical nephrectomy, known genetic mutations, and whose procedures were performed for benign indications. Statistical analysis was performed with results as presented. Results: A total of 769 and 142 patients who underwent RAPN and RARN, respectively, met our inclusion criteria. The duration of follow-up was similar after the two procedures with a median of ∼100 months. The 5- and 10-year chronic kidney disease (CKD) upstaging-free survivals were 74.5% and 65.9% after RAPN and 53% and 46.4% after RARN, respectively. Older age was identified as a potential predictor for CKD progression after RARN, whereas older age, higher body mass index, baseline renal function, and ischemia time were shown to predict CKD progression after RAPN. Renal cell carcinoma-related mortality rates for RAPN and RARN were equally 1.1%. No statistically significant differences were identified in the local recurrence, metastatic, and disease-specific survival between the two procedures. Conclusion: Compared with RARN, RAPN conferred a better CKD progression-free survival. Several factors were identified as potential predictors for clinically significant CKD progression both in the early and late postoperative phase. Long-term oncologic outcomes between the two procedures remained similarly favorable.
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Affiliation(s)
- Nicolas A Soputro
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ethan L Ferguson
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Jaya S Chavali
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Albert Geskin
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaled Fareed
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ryan Berglund
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amr F Fergany
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert J Stein
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Georges P Haber
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven C Campbell
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Jihad H Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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7
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Okada A, Ohashi K, Hashimoto H, Ota Y, Sugino T, Unno R, Iwatsuki S, Etani T, Taguchi K, Naiki T, Kurokawa S, Hamamoto S, Ando R, Nakane A, Kawai N, Tozawa K, Yasui T. Three-dimensional computed tomography-based resection process map for robot-assisted partial nephrectomy: propensity score matching of a single-center retrospective study. J Surg Oncol 2024; 129:1311-1324. [PMID: 38470556 DOI: 10.1002/jso.27615] [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: 10/07/2023] [Revised: 01/22/2024] [Accepted: 02/11/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND AND OBJECTIVES We aimed to examine the effect of preoperative three-dimensional (3D) computed tomography (CT)-based resection process map (RPM) imaging on the outcomes of robot-assisted partial nephrectomy (RAPN). METHODS We retrospectively analyzed 177 patients (RPM group, n = 92; non-RPM group, n = 85) who underwent this surgery between November 2012 and April 2022. Patient-specific contrast-enhanced CT images were used to construct an RPM, a 3D representation of the kidney showing the planned tumor resection and a 5 mm safety margin. Outcome analyses were performed using propensity score matching. The primary endpoint was the trifecta achievement rate. RESULTS We extracted 90 cases. The trifecta achievement rate showed no significant differences between the RPM (73.3%) and non-RPM groups (73.3%). However, the RPM group had fewer Grade 3 and higher complications (0.0% vs. 13.3%, p = 0.026). The da Vinci Xi (OR 3.38, p = 0.016) and tumor diameter (OR 0.95, p = 0.013) were independent factors affecting trifecta achievement in multivariate analysis. Using RPM imaging was associated with the absence of Grade 3 and higher perioperative complications (OR 5.33, p = 0.036) in univariate analysis. CONCLUSIONS Using preoperative 3D CT-based RPM images before RAPN may not affect trifecta achievement, but may reduce serious complication occurrence by providing detailed information on tumor resection.
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Affiliation(s)
- Atsushi Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuya Ohashi
- Department of Radiology, Nagoya City University Hospital, Nagoya, Japan
- Department of Radiology, Nagoya City University Midori Municipal Hospital, Nagoya, Japan
| | - Hiroya Hashimoto
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yuya Ota
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Teruaki Sugino
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Rei Unno
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shoichiro Iwatsuki
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toshiki Etani
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Taku Naiki
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Kurokawa
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryosuke Ando
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akihiro Nakane
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Noriyasu Kawai
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keiichi Tozawa
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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8
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Prata F, Basile S, Tedesco F, Ragusa A, Pira M, Iannuzzi A, Fantozzi M, Civitella A, Scarpa RM, Papalia R. Skill Transfer from Laparoscopic Partial Nephrectomy to the Hugo™ RAS System: A Novel Proficiency Score to Assess Surgical Quality during the Learning Curve. J Clin Med 2024; 13:2226. [PMID: 38673499 PMCID: PMC11050920 DOI: 10.3390/jcm13082226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objectives: The absence of validated tools to assess the skill transfer from laparoscopy to robotic surgery remains an unsolved issue in the context of robot-assisted partial nephrectomy (RAPN). We aimed to describe and validate a novel proficiency score to critically evaluate the surgical quality of RAPN with the Hugo™ RAS System (Medtronic, Minneapolis, MN, USA). Methods: Between October 2022 and September 2023, 27 consecutive patients underwent off-clamp RAPN for localized renal tumors at our institution. To analyze the learning curve (LC), the cohort was chronologically divided into two phases of 6 months each. Proficiency was defined as the achievement of trifecta while maintaining a comparable intraoperative time in the interquartile range of laparoscopic partial nephrectomy performed by the same surgeon. A logistic binary regression model was built to identify predictors of proficiency achievement. Results: A proficiency score was achieved in 14 patients (74.1%). At univariable analysis, number of consecutive procedures > 12 (OR 13.7; 95%CI 2.05-21.1, p = 0.007), pathological tumor size (OR 0.92; 95%CI 0.89-0.99, p = 0.04) and essential blood hypertension (OR 0.16; 95%CI 0.03-0.82, p = 0.02) were found to be predictors of proficiency score. At multivariable analysis, after adjusting for potential confounding factors, number of consecutive procedures > 12 (OR 8.1; 95%CI 1.44-14.6, p = 0.03) was the only independent predictor of proficiency score achievement. Conclusions: Our results showed that the skills of an experienced laparoscopic surgeon are transferrable to the novel Hugo™ RAS System in the context of nephron-sparing surgery. Improved surgical quality may be expected after completing the first 12 consecutive procedures.
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Affiliation(s)
- Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (S.B.); (F.T.); (A.R.); (M.P.); (A.I.); (M.F.); (A.C.); (R.M.S.); (R.P.)
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9
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Prata F, Ragusa A, Tedesco F, Pira M, Iannuzzi A, Fantozzi M, Civitella A, Scarpa RM, Papalia R. Trifecta Outcomes of Robot-Assisted Partial Nephrectomy Using the New Hugo™ RAS System Versus Laparoscopic Partial Nephrectomy. J Clin Med 2024; 13:2138. [PMID: 38610903 PMCID: PMC11012303 DOI: 10.3390/jcm13072138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Laparoscopic partial nephrectomy (LPN) is still performed in many referred urological institutions, representing a valid alternative to robot-assisted partial nephrectomy (RAPN). We aimed to compare trifecta outcomes of LPN and RAPN with the Hugo™ RAS System. (2) Methods: Between October 2022 and September 2023, eighty-nine patients underwent minimally invasive partial nephrectomy (group A, RAPN = 27; group B, Laparoscopic PN = 62) for localized renal tumors at our Institution. Continuous variables were presented as median and IQR and compared by means of the Mann-Whitney U test, while categorical variables were presented as frequencies (%) and compared by means of the χ2 test. (3) Results: Group A showed a higher rate of male patients (81.5% vs. 59.7%, p = 0.04) and a higher trend towards larger clinical tumor size (34 vs. 29 mm, p = 0.14). All the other baseline variables were comparable between the two groups (all p > 0.05). Regarding post-operative data, group A displayed a lower operative time (92 vs. 149.5 min, p = 0.005) and a shorter hospital stay (3 vs. 5, p = 0.002). A higher rate of malignant pathology was evidenced in group A (77.8% vs. 58.1%, p = 0.07) as well as a lower trend towards positive surgical margins (3.7% vs. 4.8%, p = 0.82), even if not statistically significant. (4) Conclusions: The rate of trifecta achievement was 92.6% and 82.3% for group A and B (p = 0.10), respectively. In terms of trifecta outcomes, RAPN using the Hugo™ RAS System showed comparable results to LPN performed by the same experienced surgeon.
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Affiliation(s)
- Francesco Prata
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (F.T.); (M.P.); (A.I.); (M.F.); (A.C.); (R.M.S.); (R.P.)
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10
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Fong KY, Gan VHL, Lim BJH, Chan YH, Castellani D, Chen K, Tay KJ, Ho HSS, Yuen JSP, Aslim E, Teoh J, Lim EJ. Off-clamp vs on-clamp robot-assisted partial nephrectomy: a systematic review and meta-analysis. BJU Int 2024; 133:375-386. [PMID: 38069544 DOI: 10.1111/bju.16250] [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: 12/31/2023]
Abstract
OBJECTIVE To compare intra- and postoperative outcomes between off-clamp and on-clamp robot-assisted partial nephrectomy (RAPN), using data from randomised controlled trials (RCTs) or covariate-matched studies (propensity score-matched or matched-pair analysis). METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant literature review was conducted on PubMed, EMBASE, Scopus and CENTRAL for relevant studies comparing off-clamp to on-clamp RAPN. Primary outcomes were estimated blood loss, postoperative percentage decrease in estimated glomerular filtration rate (eGFR), and margin positive rate. Secondary outcomes were operative time, postoperative eGFR, length of stay, all postoperative complications, major complications, and need for transfusion. Random-effects meta-analyses were performed to generate mean differences (MDs) or odds ratios (ORs). RESULTS A total of 10 studies (2307 patients) were shortlisted for analysis. There was no significant difference in estimated operative blood loss between off-clamp and on-clamp RAPN (MD 21.9 mL, 95% confidence interval [CI] -0.9 to 44.7 mL; P = 0.06, I2 = 58%). Off-clamp RAPN yielded a smaller postoperative eGFR deterioration (MD 3.10%, 95% CI 1.05-5.16%; P = 0.008, I2 = 13%) and lower odds of margin positivity (OR 0.62, 95% CI 0.40-0.94; P = 0.03, I2 = 0%). No significant differences were found for all secondary outcomes. CONCLUSIONS Off-clamp and on-clamp RAPN are similarly effective approaches for selected renal masses. Within the classic trifecta of PN outcomes, off-clamp RAPN yields similar rates of perioperative complications and may possibly offer better preservation of renal function and reduced margin-positive rates.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Valerie Huei Li Gan
- Department of Urology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
| | | | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Kenneth Chen
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Henry Sun Sien Ho
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | | | - Edwin Aslim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Jeremy Teoh
- S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
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11
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Mazzoleni F, Perri D, Pacchetti A, Morini E, Berti L, Besana U, Faiella E, Moramarco L, Santucci D, Fior D, Bozzini G. Indocyanine green-marked fluorescence-guided off-clamp versus intraoperative ultrasound-guided on-clamp robotic partial nephrectomy: Outcomes on surgical procedure. BJUI COMPASS 2024; 5:466-472. [PMID: 38633831 PMCID: PMC11019242 DOI: 10.1002/bco2.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/09/2023] [Accepted: 09/26/2023] [Indexed: 04/19/2024] Open
Abstract
Objectives To compare surgical and functional outcomes between off-clamp robot-assisted partial nephrectomy with indocyanine-green tumour marking through preliminary superselective embolization and on-clamp robot-assisted partial nephrectomy with intraoperative ultrasound identification of the renal mass. Material and methods One hundred and forty patients with a single renal mass underwent indocyanine-green fluorescence-guided off-clamp robot-assisted partial nephrectomy with preoperative superselective embolization (Group A, 70 patients) versus intraoperative ultrasound-guided on-clamp robot-assisted partial nephrectomy without embolization (Group B, 70 patients). We assessed operative time, intraoperative blood loss, complications, length of stay, renal function, need for ancillary procedures and blood transfusions. Results Mean tumour size was 24 versus 25 mm in Group A versus Group B (p = 0.19). Mean operative time was 86.5 versus 121.8 min (p = 0.02), mean blood loss was 72.8 versus 214.2 mL (p = 0.02), and mean haemoglobin drop on postoperative day 1 was 1.1 versus 2.6 g/dL (p = 0.04) in Group A versus Group B. One-month creatinine, hospital stay and enucleated tumour volume were comparable. Ten postoperative complications occurred in Group A (13.3%) and 11 in Group B (15.3%). Following superselective embolization, no patients required blood transfusions versus two patients in Group B. Postoperative selective renal embolization was needed in one case per group. Conclusions Preoperative superselective embolization of a renal mass with indocyanine-green before off-clamp robot-assisted partial nephrectomy significantly reduces operative time and intraoperative blood loss compared to on-clamp intraoperative ultrasound-guided robot-assisted partial nephrectomy. A longer follow-up is needed to establish the effect on renal function.
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Affiliation(s)
| | - Davide Perri
- Division of UrologySant'Anna HospitalSan Fermo della BattagliaItaly
| | - Andrea Pacchetti
- Division of UrologySant'Anna HospitalSan Fermo della BattagliaItaly
| | - Elena Morini
- Division of UrologySant'Anna HospitalSan Fermo della BattagliaItaly
| | - Lorenzo Berti
- Division of UrologyBusto Arsizio HospitalBusto ArsizioItaly
| | - Umberto Besana
- Division of UrologySant'Anna HospitalSan Fermo della BattagliaItaly
| | - Eliodoro Faiella
- Division of RadiologySant'Anna HospitalSan Fermo della BattagliaItaly
| | - Lorenzo Moramarco
- Division of RadiologySant'Anna HospitalSan Fermo della BattagliaItaly
| | | | - Davide Fior
- Division of RadiologySant'Anna HospitalSan Fermo della BattagliaItaly
| | - Giorgio Bozzini
- Division of UrologySant'Anna HospitalSan Fermo della BattagliaItaly
- Division of UrologyBusto Arsizio HospitalBusto ArsizioItaly
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12
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Sun ZJ, Liu F, Wei HB, Zhang DH. Laparoscopic partial versus radical nephrectomy for localized renal cell carcinoma over 4 cm. J Cancer Res Clin Oncol 2023; 149:17837-17848. [PMID: 37943356 PMCID: PMC10725398 DOI: 10.1007/s00432-023-05487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE To compare the long-term clinical and oncologic outcomes of laparoscopic partial nephrectomy (LPN) and laparoscopic radical nephrectomy (LRN) in patients with renal cell carcinoma (RCC) > 4 cm. METHODS We retrospectively reviewed the records of all patients who underwent LPN or LRN in our department from January 2012 to December 2017. Of the 151 patients who met the study selection criteria, 54 received LPN, and 97 received LRN. After propensity-score matching, 51 matched pairs were further analyzed. Data on patients' surgical data, complications, histologic data, renal function, and survival outcomes were collected and analyzed. RESULTS Compared with the LRN group, the LPN group had a longer operative time (135 min vs. 102.5 min, p = 0.001), larger intraoperative bleeding (150 ml vs. 50 ml, p < 0.001), and required longer stays in hospital (8 days vs. 6 days, p < 0.001); however, the level of ECT-GFR was superior at 3, 6, and 12 months (all p < 0.001). Similarly, a greater number of LRN patients developed CKD compared with LPN until postoperative 12 months (58.8% vs. 19.6%, p < 0.001). In patients with preoperative CKD, LPN may delay the progression of the CKD stage and even improve it when compared to LRN treatment. There were no significant differences between the two groups for OS, CSS, MFS, and PFS (p = 0.06, p = 0.30, p = 0.90, p = 0.31, respectively). The surgical method may not be a risk factor for long-term survival prognosis. CONCLUSION LPN preserves renal function better than LRN and has the potential value of significantly reducing the risk of postoperative CKD, but the long-term survival prognosis of patients is comparable.
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Affiliation(s)
- Zi-Jun Sun
- Department of Urology, Zhejiang Provincial People's Hospital, Qingdao University, Qingdao, Shandong, China
| | - Feng Liu
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang, China
| | - Hai-Bin Wei
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang, China
| | - Da-Hong Zhang
- Department of Urology, Zhejiang Provincial People's Hospital, Qingdao University, Qingdao, Shandong, China.
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang, China.
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13
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Cheng Q, Ren A, Xu X, Meng Z, Feng X, Pylypenko D, Dou W, Yu D. Application of DKI and IVIM imaging in evaluating histologic grades and clinical stages of clear cell renal cell carcinoma. Front Oncol 2023; 13:1203922. [PMID: 37954085 PMCID: PMC10637387 DOI: 10.3389/fonc.2023.1203922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
Purpose To evaluate the value of quantitative parameters derived from diffusion kurtosis imaging (DKI) and intravoxel incoherent motion (IVIM) in differentiating histologic grades and clinical stages of clear cell renal cell carcinoma (ccRCC). Materials and methods A total of 65 patients who were surgically and pathologically diagnosed as ccRCC were recruited in this study. In addition to routine renal magnetic resonance imaging examination, all patients underwent preoperative IVIM and DKI. The corresponding diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), mean diffusivity (MD), kurtosis anisotropy (KA), and mean kurtosis (MK) values were obtained. Independent-samples t-test or Mann-Whitney U test was used for comparing the differences in IVIM and DKI parameters among different histologic grades and clinical stages. The diagnostic efficacy of IVIM and DKI parameters was evaluated using the receiver operating characteristic (ROC) curve. Spearman's correlation analysis was used to separately analyze the correlation of each parameter with histologic grades and stages of ccRCC. Results The D and MD values were significantly higher in low-grade ccRCC than high-grade ccRCC (all p < 0.001) and in low-stage than high-stage ccRCC (all p < 0.05), and the f value of high-stage ccRCC was lower than that of low-stage ccRCC (p = 0.007). The KA and MK values were significantly higher in low-grade than high-grade ccRCC (p = 0.000 and 0.000, respectively) and in low-stage than high-stage ccRCC (p = 0.000 and 0.000, respectively). The area under the curve (AUC) values of D, D*, f, MD, KA, MK, DKI, and IVIM+DKI values were 0.825, 0.598, 0.626, 0.792, 0.750, 0.754, 0.803, and 0.857, respectively, in grading ccRCC and 0.837, 0.719, 0.710, 0.787, 0.796, 0.784, 0.864, 0.823, and 0.916, respectively, in staging ccRCC. The AUC of IVIM was 0.913 in staging ccRCC. The D, D*, and MD values were negatively correlated with the histologic grades and clinical stages (all p < 0.05), and the KA and MK values showed a positive correlation with histologic grades and clinical stages (all p < 0.05). The f value was also negatively correlated with the ccRCC clinical stage (p = 0.008). Conclusion Both the IVIM and DKI values can be used preoperatively to predict the degree of histologic grades and stages in ccRCC, and the D and MD values have better diagnostic performance in the grading and staging. Also, further slightly enhanced diagnostic efficacy was observed in the model with combined IVIM and DKI parameters.
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Affiliation(s)
- QiChao Cheng
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - AnLi Ren
- Department of Radiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - XingHua Xu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhao Meng
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Xue Feng
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | | | | | - DeXin Yu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
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Bic A, Mazeaud C, Salleron J, Bannay A, Balkau B, Larose C, Hubert J, Eschwège P. Complications after partial nephrectomy: robotics overcomes open surgery and laparoscopy: the PMSI French national database. BMC Urol 2023; 23:146. [PMID: 37715175 PMCID: PMC10502976 DOI: 10.1186/s12894-023-01322-6] [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: 03/25/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE To evaluate three partial nephrectomies (PN) procedures: open (OPN), standard laparoscopy (LPN), and robot-assisted laparoscopy (RAPN), for the risk of initial complications and rehospitalization for two years after the surgery. MATERIALS AND METHODS From the French national hospital database (PMSI-MCO), every hospitalization in French hospitals for renal tumor PN in 2016-2017 were extracted. Complications were documented from the initial hospitalization and any rehospitalization over two years. Chi-square and ANOVA tests compared the frequency of complications and length of initial hospitalization between the three surgical procedures. Relative risks (RR) and 95% confidence intervals were computed. RESULTS The 9119 initial hospitalizations included 4035 OPN, 1709 LPN, and 1900 RAPN; 1475 were excluded as the laparoscopic procedure performed was not determined. The average length of hospitalization was 8.1, 6.2, and 4.5 days for OPN, LPN, and RAPN, respectively. Compared to OPN, there were fewer complications at the time of initial hospitalization for the mini-invasive procedures: 29% for OPN vs. 20% for LPN (0.70 [0.63;0.78]) and 12% for RAPN (RR=0.43, 95%CI [0.38;0.49]). For RAPN compared to LPN, there were fewer haemorrhages (RR=0.55 [0.43;0.72]), anemia (0.69 {0.48;0.98]), and sepsis (0.51 [0.36;0.71]); during follow up, there were fewer urinary tract infections (0.64 [0.45;0.91]) but more infectious lung diseases (1.69 [1.03;2.76]). Over the two-year postoperative period, RAPN was associated with fewer acute renal failures (RR=0.73 [0.55;0.98]), renal abscesses (0.41 [0.23;0.74]), parietal complications (0.69 [0.52;0.92]) and urinary tract infections (0.54 [0.40;0.73]) than for OPN. CONCLUSIONS Conservative renal surgery is associated with postoperative morbidity related to the surgical procedure fashion. Mini-invasive procedures, especially robot-assisted surgery, had fewer complications and shorter hospital lengths of stay.
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Affiliation(s)
- Antoine Bic
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France.
- Department of Urology, Nancy University Hospital, Avenue de Bourgogne, Vandoeuvre Cedex, 54511, France.
| | - Charles Mazeaud
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France
| | - Julia Salleron
- Département de Biostatistiques, Institut de Cancérologie de Lorraine, 6 avenue de Bourgogne CS 30519, Vandoeuvre-lès-Nancy Cedex, 54519, France
| | - Aurélie Bannay
- Service d'Évaluation et Information Médicales, CHRU Nancy, Nancy, France
| | - Beverley Balkau
- Épidémiologie Clinique, Centre de Recherche en Épidémiologie et Santé des Populations, Institut National de la Santé et de la Recherche Médicale U1018, Université Paris-Saclay, USVQ, Université Paris-Sud, Villejuif, F-94807, France
| | - Clément Larose
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France
| | - Jacques Hubert
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France
| | - Pascal Eschwège
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France
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