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Mastroianni R, Chiacchio G, Perpepaj L, Tuderti G, Brassetti A, Anceschi U, Ferriero M, Misuraca L, D’Annunzio S, Bove AM, Guaglianone S, Flammia RS, Proietti F, Pula M, Milanese G, Leonardo C, Galosi AB, Simone G. Comparison of Perioperative, Functional, and Oncologic Outcomes of Open vs. Robot-Assisted Off-Clamp Partial Nephrectomy: A Propensity Scored Match Analysis. SENSORS (BASEL, SWITZERLAND) 2024; 24:2822. [PMID: 38732928 PMCID: PMC11086121 DOI: 10.3390/s24092822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/15/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024]
Abstract
Off-clamp partial nephrectomy represents one of the latest developments in nephron-sparing surgery, with the goal of preserving renal function and reducing ischemia time. The aim of this study was to evaluate and compare the functional, oncologic, and perioperative outcomes between off-clamp robot-assisted partial nephrectomy (off-C RAPN) and off-clamp open partial nephrectomy (off-C OPN) through a propensity score-matched (PSM) analysis. A 1:1 PSM analysis was used to balance variables potentially affecting postoperative outcomes. To report surgical quality, 1 year trifecta was used. Univariable Cox regression analysis was performed to identify predictors of trifecta achievement. The Kaplan-Meier method was used to compare cancer-specific survival (CSS), overall survival (OS), disease-free survival (DFS), and metastasis-free survival (MFS) probabilities between groups. Overall, 542 patients were included. After PSM analysis, two homogeneous cohorts of 147 patients were obtained. The off-C RAPN cohort experienced shorter length of stay (LoS) (3.4 days vs. 5.4 days; p < 0.001), increased likelihoods of achieving 1 year trifecta (89.8% vs. 80.3%; p = 0.03), lower postoperative Clavien-Dindo ≤ 2 complications (1.3% vs. 18.3%, p < 0.001), and lower postoperative transfusion rates (3.4% vs. 12.2%, p = 0.008). At univariable analysis, the surgical approach (off-C RAPN vs. off-C OPN, OR 2.22, 95% CI 1.09-4.46, p = 0.02) was the only predictor of 1 year trifecta achievement. At Kaplan-Meier analysis, no differences were observed between the two groups in terms of OS (log-rank p = 0.451), CSS (log-rank p = 0.476), DFS (log-rank p = 0.678), and MFS (log-rank p = 0.226). Comparing RAPN and OPN in a purely off-clamp scenario, the minimally invasive approach proved to be a feasible and safe surgical approach, with a significantly lower LoS and minor rate of postoperative complications and transfusions as a result of improved surgical quality expressed by higher 1 year trifecta achievement.
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Affiliation(s)
- Riccardo Mastroianni
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Giuseppe Chiacchio
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
- Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, 60126 Ancona, Italy; (L.P.); (G.M.); (A.B.G.)
| | - Leonard Perpepaj
- Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, 60126 Ancona, Italy; (L.P.); (G.M.); (A.B.G.)
| | - Gabriele Tuderti
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Aldo Brassetti
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Umberto Anceschi
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Mariaconsiglia Ferriero
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Leonardo Misuraca
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Simone D’Annunzio
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Alfredo Maria Bove
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Salvatore Guaglianone
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Rocco Simone Flammia
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Flavia Proietti
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Marco Pula
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Giulio Milanese
- Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, 60126 Ancona, Italy; (L.P.); (G.M.); (A.B.G.)
| | - Costantino Leonardo
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
| | - Andrea Benedetto Galosi
- Urology Division, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, 60126 Ancona, Italy; (L.P.); (G.M.); (A.B.G.)
| | - Giuseppe Simone
- Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.M.); (G.T.); (A.B.); (U.A.); (M.F.); (L.M.); (S.D.); (A.M.B.); (S.G.); (R.S.F.); (F.P.); (M.P.); (C.L.); (G.S.)
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Bertolo R, Amparore D, Muselaers S, Marchioni M, Wu Z, Campi R, Antonelli A. Thermal ablation for T1b renal cancer: an "I wish I could, but I cannot?". Minerva Urol Nephrol 2024; 76:254-259. [PMID: 38742559 DOI: 10.23736/s2724-6051.24.05842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Riccardo Bertolo
- Unit of Urology, Confortini Surgical Center, Civile Maggiore Hospital, University Hospital of Verona, University of Verona, Verona, Italy -
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands -
| | - Daniele Amparore
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Stijn Muselaers
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michele Marchioni
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- Department of Urology, SS Annunziata Hospital, G. D'Annunzio Chieti-Pescara University, Chieti, Italy
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, G. D'Annunzio Chieti-Pescara University, Chieti, Italy
| | - Zhenjie Wu
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- Department of Urology, Shanghai Hospital, Naval Medical University, Shanghai, China
| | - Riccardo Campi
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Antonelli
- Unit of Urology, Confortini Surgical Center, Civile Maggiore Hospital, University Hospital of Verona, University of Verona, Verona, Italy
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Aveta A, Iossa V, Spena G, Conforti P, Pagano G, Dinacci F, Verze P, Manfredi C, Ferro M, Lasorsa F, Spirito L, Napolitano L, Tufano A, Fiorenza A, Russo P, Crocerossa F, Lucarelli G, Perdonà S, Sanseverino R, Siracusano S, Cilio S, Pandolfo SD. Ablative Treatments for Small Renal Masses and Management of Recurrences: A Comprehensive Review. Life (Basel) 2024; 14:450. [PMID: 38672721 PMCID: PMC11050889 DOI: 10.3390/life14040450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
This review focuses on ablative techniques for small renal masses (SRMs), including radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), and irreversible electroporation (IRE), and discusses recurrence management. Through an extensive literature review, we outline the procedures, outcomes, and follow-up strategies associated with each ablative method. The review provides a detailed examination of these techniques-RFA, CA, MWA, and IRE-elucidating their respective outcomes. Recurrence rates vary among them, with RFA and CA showing comparable rates, MWA demonstrating favorable short-term results, and IRE exhibiting promise in experimental stages. For managing recurrences, various strategies are considered, including active surveillance, re-ablation, or salvage surgery. Surveillance is preferred post-RFA and post-CA, due to slow SRM growth, while re-ablation, particularly with RFA and CA, is deemed feasible without additional complications. Salvage surgery emerges as a viable option for larger or resistant tumors. While ablative techniques offer short-term results comparable to surgery, further research is essential to understand their long-term effects fully. Decisions concerning recurrence management should consider individual and tumor-specific factors. Imaging, notably contrast-enhanced ultrasounds, plays a pivotal role in assessing treatment success, emphasizing the necessity of a multidisciplinary approach for optimal outcomes. The lack of randomized trials highlights the need for further research.
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Affiliation(s)
- Achille Aveta
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
- Department of Urology, Umberto I Hospital, ASL Salerno, 84014 Nocera Inferiore, Italy; (V.I.); (R.S.)
| | - Vincenzo Iossa
- Department of Urology, Umberto I Hospital, ASL Salerno, 84014 Nocera Inferiore, Italy; (V.I.); (R.S.)
- Department of Urology, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Gianluca Spena
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (A.T.); (S.P.)
| | - Paolo Conforti
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Giovanni Pagano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Fabrizio Dinacci
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy;
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.M.); (L.S.)
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, IRCCS, 71013 Milan, Italy;
| | - Francesco Lasorsa
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.L.); (G.L.)
| | - Lorenzo Spirito
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.M.); (L.S.)
| | - Luigi Napolitano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Antonio Tufano
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (A.T.); (S.P.)
| | - Alessandra Fiorenza
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Pierluigi Russo
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy;
| | - Fabio Crocerossa
- Division of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Giuseppe Lucarelli
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.L.); (G.L.)
| | - Sisto Perdonà
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (A.T.); (S.P.)
| | - Roberto Sanseverino
- Department of Urology, Umberto I Hospital, ASL Salerno, 84014 Nocera Inferiore, Italy; (V.I.); (R.S.)
| | | | - Simone Cilio
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Savio Domenico Pandolfo
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
- Department of Urology, University of L’Aquila, 67100 L’Aquila, Italy;
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy;
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Attawettayanon W, Kazama A, Yasuda Y, Zhang JJH, Shah S, Rathi N, Munoz-Lopez C, Lewis K, Li J, Beksac AT, Campbell RA, Kaouk J, Haber GP, Weight C, Martin C, Campbell SC. Thermal Ablation Versus Partial Nephrectomy for cT1 Renal Mass in a Solitary Kidney: A Matched Cohort Comparative Analysis. Ann Surg Oncol 2024; 31:2133-2143. [PMID: 38071719 DOI: 10.1245/s10434-023-14646-2] [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: 08/07/2023] [Accepted: 11/09/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Nephron-sparing approaches are preferred for renal mass in a solitary kidney (RMSK), with partial nephrectomy (PN) generally prioritized. Thermal ablation (TA) also is an option for small renal masses in this setting; however, comparative functional/survival outcomes are not well-defined. METHODS A retrospective study of 504 patients (1975-2022) with cT1 RMSK managed with PN (n = 409)/TA (n = 95) with necessary data for analysis was performed. Propensity score was used for matching patients, including age, preoperative glomerular filtration rate (GFR), tumor diameter, R.E.N.A.L. ((R)adius (tumor size as maximal diameter), (E)xophytic/endophytic properties of tumor, (N)earness of tumor deepest portion to collecting system or sinus, (A)nterior (a)/posterior (p) descriptor, and (L)ocation relative to polar lines), and comorbidities. Functional outcomes were compared, and Kaplan-Meier was used to analyze survival. RESULTS The matched cohort included 132 patients (TA = 66/PN = 66), with median tumor diameter of 2.4 cm, R.E.N.A.L. of 6, and preoperative GFR of 52 ml/min/1.73 m2. Acute kidney injury occurred in 11%/61% in the TA/PN cohorts, respectively (p < 0.01). After recovery, median GFR preserved was 89%/83% for TA/PN, respectively (p = 0.02), and 5-year dialysis-free survival was 96% in both cohorts. Median follow-up was 53 months. Five-year recurrence-free survival (RFS) was 62%/86% in the TA/PN cohorts, respectively (p < 0.01). Five-year local recurrence (LR)-free survival was 74%/95% in the TA/PN cohorts, respectively (p < 0.01). Five-year cancer-specific survival (CSS) was 96%/98% in the TA/PN cohorts, respectively (p = 0.7). Local recurrence was observed in nine of 36 (25%) and five of 30 (17%) patients managed with laparoscopic versus percutaneous TA, respectively. For TA with LR (n = 14), nine patients presented with multifocality and/or cT1b tumors. Twelve LR were managed with salvage TA, and seven remained cancer-free, while five developed systemic recurrence, three with concomitant LR. CONCLUSIONS Functional outcomes for TA for RMSK were improved compared with PN. Local recurrence was more common after TA and often was associated with the laparoscopic approach, multifocality, and large tumor size. Improved patient selection and greater experience with TA should improve outcomes. Salvage of LR was not always possible. Partial nephrectomy remains the reference standard for RMSK.
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Affiliation(s)
- Worapat Attawettayanon
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Akira Kazama
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yosuke Yasuda
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - J J H Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Snehi Shah
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nityam Rathi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Carlos Munoz-Lopez
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kieran Lewis
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jianbo Li
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, OH, USA
| | - Alp T Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca A Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Christopher Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Charles Martin
- Department of Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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Abdelsalam ME, Hudspeth TN, Leonards L, Kusin SB, Buckley JR, Bassett R, Awad A, Karam JA, Matin SF, Lu T, Ahrar K. Effectiveness of Thermal Ablation for Renal Cell Carcinoma after Prior Partial Nephrectomy. EUR UROL SUPPL 2023; 57:45-50. [PMID: 38020520 PMCID: PMC10658406 DOI: 10.1016/j.euros.2023.08.005] [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] [Accepted: 08/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Repeat partial nephrectomy (PN) for tumors recurring in the ipsilateral kidney is associated with surgical complexity and a higher rate of complications. Objective To evaluate the local oncologic efficacy of thermal ablation (TA) for renal cell carcinoma (RCC) in the ipsilateral kidney following PN. Design setting participation We included patients who underwent ablation for renal tumors in the ipsilateral kidney after PN between January 2005 and December 2019. Demographics, tumor size, procedural details, complications, pathology, local oncologic outcomes, and survival outcomes are described. Outcome measurements and statistical analysis The procedural, pathologic, and oncologic outcomes are described. Survival rates were estimated using the Kaplan-Meier method. Results and limitations A total of 66 patients (46 male and 20 female) with a median age of 62 yr (interquartile range [IQR] 52-69) met our inclusion criteria. In these patients, 74 TA procedures were performed for 86 lesions (median tumor size 1.9 cm, IQR 1.6-2.5). Radiofrequency ablation and cryoablation accounted for 60 (81%) and 14 (19%) procedures, respectively. Three patients (3.7%) had Clavien-Dindo grade III complications. Of 65 lesion biopsies, 62 (95.5%) were diagnostic. The most common subtype was clear cell RCC (n = 37). The median imaging follow-up duration was 60 mo (IQR 43-88). Recurrence in the ablation zone occurred for four lesions (4.6%) at a median of 6.9 mo (IQR 6.4-10.7). The rates of overall, recurrence-free, and disease-free survival were 93.1%, 94.4%, and 65.6% at 5 yr, and 71.6%, 94.4%, and 60.1% at 10 yr, respectively. Limitations include the retrospective design and the lack of a control group. Conclusions TA is effective for the treatment of RCC in the ipsilateral kidney following PN. Patient summary Heat treatment to remove tumor tissue is an effective option for small kidney masses recurring after partial kidney removal for cancer. Long-term follow-up data revealed that this treatment resulted in low recurrence and complication rates.
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Affiliation(s)
- Mohamed E. Abdelsalam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tessa N. Hudspeth
- Department of Radiology, Texas Radiology Associates, LLP, Plano, TX, USA
| | - Laura Leonards
- Department of Radiology, North Oaks Medical Center, Hammond, LA, USA
| | - Samuel B. Kusin
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Roland Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahmed Awad
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jose A. Karam
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Surena F. Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas Lu
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kamran Ahrar
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Di Maida F, Grosso AA, Campi R, Lambertini L, Gallo ML, Cadenar A, Salamone V, Coco S, Paganelli D, Tuccio A, Masieri L, Minervini A. Redo Partial Nephrectomy for Local Recurrence After Previous Nephron-sparing Surgery. Surgical Insights and Oncologic Results from a High-volume Robotic Center. EUR UROL SUPPL 2023; 57:84-90. [PMID: 37810278 PMCID: PMC10551832 DOI: 10.1016/j.euros.2023.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Background The role of redo partial nephrectomy (PN) for recurrent renal cell carcinoma (RCC) is still overlooked. Objective To report our experience of salvage PN for local recurrence after previous nephron-sparing surgery (NSS). Design setting and participants We prospectively gathered data from patients treated with robotic redo PN for locally recurrent RCC after previous NSS from January 2017 to January 2023. The type of surgical resection technique was assigned to the pathologic specimen according to the surface-intermediate-base (SIB) score. Surgical procedure Redo PN was performed by using the Si Da Vinci robotic platform. Measurements Operative time, warm ischemia time, and intra- and postoperative complications were recorded. The severity of postoperative complications and tumor stage were evaluated. Results and limitations Overall, 26 patients entered the study. The median clinical diameter was 3.5 (interquartile range [IQR] 2.2-4.9) cm and the median Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score was 8 (IQR 7-9). In 14 (53.8%) cases, recurrence was at the level of previous tumor resection bed. The median operative time was 177 (IQR 148-200) min, and hilar clamping was performed in 14 (53.8%) cases with a median warm ischemia time of 16 (14.5-22) min. Pure enucleation (SIB score 0-1), hybrid enucleation (SIB score 2), and pure enucleoresection (SIB score 3) were recorded in 13 (50%), eight (30.8%), and five (19.2%) cases, respectively. The totality of recurrent RCC far from previous tumor resection bed received a SIB score of 0-1, while in 57.1% and 35.8% of recurrent RCC on previous tumor resection a hybrid enucleation and a pure enucleoresection were performed, respectively. At a median follow-up of 37 (IQR 16-45) mo, five (19%) patients experienced disease recurrence, being local and systemic in three (11.5%) and two (7.7%) patients, respectively. Conclusions Our study highlights the feasibility and safety of redo PN for the treatment of locally recurrent RCCs after NSS, either on previous tumor resection bed or elsewhere in the kidney. Patient summary Robotic redo partial nephrectomy is a challenging procedure. The surgeon needs to tailor the surgical strategy and tumor resection technique case by case, given the heterogeneity of clinical scenarios and the need to achieve maximal functional preservation while ensuring oncologic efficacy.
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Affiliation(s)
- Fabrizio Di Maida
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio Andrea Grosso
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Luca Lambertini
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Maria Lucia Gallo
- Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Anna Cadenar
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Vincenzo Salamone
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Simone Coco
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Daniele Paganelli
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Agostino Tuccio
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Masieri
- Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
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Huang J, Su R, Zhang C, Bao Y, Hu X, Ye X, Chen M, Wang P, Wu J, Wang Y, Tang Q, Huang Z, Zheng B, Li C, Guo J, Huang Y, Wei Q, He Z, Xue W. Comparative analysis of salvage partial nephrectomy versus radical nephrectomy after the failure of initial partial nephrectomy. Urol Oncol 2023; 41:434.e17-434.e25. [PMID: 37563078 DOI: 10.1016/j.urolonc.2023.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/07/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES To compare the oncologic outcomes and renal function discrepancy of salvage partial nephrectomy (sPN) and salvage radical nephrectomy (sRN) after an initial failed PN. MATERIALS AND METHODS Retrospective data from multiple centers between 2008 and 2022 were analyzed in this study. Patients who received sPN or sRN after an initial failed PN were identified. Comparative analysis and propensity score matching (PSM) was performed and the RENAL score, tumor size, and pathological T stage at salvage surgery were used to match the 2 groups. Local recurrence-free survival (LRFS) and recurrence-free survival (RFS) were assessed using the Cox proportional hazards model and log-rank tests. Renal function after salvage surgery was assessed using the Wilcoxon rank sum test. RESULTS A total of 140 patients who underwent salvage surgery were evaluated, of whom 60 were considered for PSM analysis after matching. At a median follow-up of 27.0 months, LRFS and RFS showed no significant difference between sPN and sRN, either before (LRFS, HR = 0.673 [95% CI: 0.171-2.644], P = 0.610; RFS, HR = 0.744 [95% CI: 0.271-1.344], P = 0.595) or after matching (LRFS, HR = 1.080 [95% CI: 0.067-17.30], P = 0.957; RFS, HR = 1.199 [95% CI: 0.241-5.983], P = 0.822). During long-term follow-up, sPN preserved renal function (after matching, eGFR, 71.4 vs. 54.0, P < 0.001) and prevented eGFR loss (after matching: 6.6% vs. 25.6%, P < 0.001). CONCLUSION Salvage partial nephrectomy offers a better alternative than sRN for recurrence after initial PN, as sPN preserves renal function better while maintaining parallel tumor control and acceptable complication rates.
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Affiliation(s)
- Jiwei Huang
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ruopeng Su
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cuijian Zhang
- Department of Urology, First Hospital of Peking University, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, P. R. China
| | - Yige Bao
- Department of Urology and Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyi Hu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiongjun Ye
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minfeng Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Ping Wang
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jitao Wu
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Yueming Wang
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Tang
- Department of Urology, First Hospital of Peking University, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, P. R. China
| | - Zhiyang Huang
- Department of Urology, Quanzhou First Hospital affiliated to Fujian Medical University, Quanzhou, China
| | - Bing Zheng
- The Department of Urology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Chancan Li
- The Department of Urology, AnHui NO.2 Provincial People Hospital, Hefei, China
| | - Jianming Guo
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yiran Huang
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Wei
- Department of Urology and Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhisong He
- Department of Urology, First Hospital of Peking University, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, P. R. China.
| | - Wei Xue
- Department of Urology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Aurilio G, Mauri G, Rossi D, Della Vigna P, Bonomo G, Varano GM, Maiettini D, Rocca MC, Verri E, Cullurà D, Nolé F, Orsi F. Image-Guided Ablations in Patients with Recurrent Renal Cell Carcinoma. J Clin Med 2023; 12:4902. [PMID: 37568303 PMCID: PMC10420241 DOI: 10.3390/jcm12154902] [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: 05/29/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Renal cell carcinoma (RCC) is one of the most frequently diagnosed tumors and a leading cause of death. The high risk of local recurrence and distant metastases represent a significant clinical issue. Different image-guided ablation techniques can be applied for their treatment as an alternative to surgery, radiotherapy or systemic treatments. A retrospective analysis was conducted at our institution, including a total number of 34 RCC patients and 44 recurrent RCC tumors in different locations (kidney, lung, adrenal gland, liver, pancreas, pararenal and other) using microwave ablation, radiofrequency ablation, cryoablation and laser ablation. The estimated time to local and distant tumor progression after treatment were 22.53 ± 5.61 months and 24.23 ± 4.47 months, respectively. Systemic treatment was initiated in 10/34 (29%) treated patients with a mean time-to-systemic-therapy of 40.92 ± 23.98 months. Primary technical success was achieved in all cases and patients while the primary efficacy rate was achieved in 43/44 (98%) cases and 33/34 (97%) patients, respectively, with a secondary technical success and efficacy rate of 100%. At a mean follow-up of 57.52 months ± 27.86 months, local tumor progression occurred in 3/44 (7%) cases and distant progression in 25/34 (74%) patients. No significant complications occurred. Image-guided ablations can play a role in helping to better control recurrent disease, avoiding or delaying the administration of systemic therapies and their significant adverse effects.
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Affiliation(s)
- Gaetano Aurilio
- Division of Cancer Prevention and Genetics, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy;
| | - Giovanni Mauri
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Duccio Rossi
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Paolo Della Vigna
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Guido Bonomo
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Gianluca Maria Varano
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Daniele Maiettini
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Maria Cossu Rocca
- Department of Oncology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.C.R.); (E.V.); (D.C.); (F.N.)
| | - Elena Verri
- Department of Oncology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.C.R.); (E.V.); (D.C.); (F.N.)
| | - Daniela Cullurà
- Department of Oncology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.C.R.); (E.V.); (D.C.); (F.N.)
| | - Franco Nolé
- Department of Oncology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.C.R.); (E.V.); (D.C.); (F.N.)
| | - Franco Orsi
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
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Okhawere KE, Grauer R, Zuluaga L, Meilika KN, Ucpinar B, Beksac AT, Razdan S, Saini I, Abramowitz C, Abaza R, Eun DD, Bhandari A, Hemal AK, Porter J, Stifelman MD, Menon M, Badani KK. Operative and oncological outcomes of salvage robotic radical and partial nephrectomy: a multicenter experience. J Robot Surg 2023:10.1007/s11701-023-01538-6. [PMID: 36928751 DOI: 10.1007/s11701-023-01538-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/08/2023] [Indexed: 03/18/2023]
Abstract
We aim to describe the perioperative and oncological outcomes for salvage robotic partial nephrectomy (sRPN) and salvage robotic radical nephrectomy (sRRN). Using a prospectively maintained multi-institutional database, we compared baseline clinical characteristics and perioperative and postoperative outcomes, including pathological stage, tumor histology, operative time, ischemia time, estimated blood loss (EBL), length of stay (LOS), postoperative complication rate, recurrence rate, and mortality. We identified a total of 58 patients who had undergone robotic salvage surgery for a recurrent renal mass, of which 22 (38%) had sRRN and 36 (62%) had sRPN. Ischemia time for sRPN was 14 min. The median EBL was 100 mL in both groups (p = 0.581). One intraoperative complication occurred during sRRN, while three occurred during sRPN cases (p = 1.000). The median LOS was 2 days for sRRN and 1 day for sRPN (p = 0.039). Postoperatively, one major complication occurred after sRRN and two after sRPN (p = 1.000). The recurrence reported after sRRN was 5% and 3% after sRPN. Among the patients who underwent sRRN, the two most prevalent stages were pT1a (27%) and pT3a (27%). Similarly, the two most prevalent stages in sRPN patients were pT1a (69%) and pT3a (6%). sRRN and sRPN have similar operative and perioperative outcomes. sRPN is a safe and feasible procedure when performed by experienced surgeons. Future studies on large cohorts are essential to better characterize the importance and benefit of salvage partial nephrectomies.
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Affiliation(s)
- Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Laura Zuluaga
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Kirolos N Meilika
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Burak Ucpinar
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Indu Saini
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Chiya Abramowitz
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Ronney Abaza
- Department of Urology, OhioHealth Dublin Methodist Hospital, Dublin, OH, USA
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine Temple University, Philadelphia, PA, USA
| | - Akshay Bhandari
- Division of Urology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - James Porter
- Department of Urology, Swedish Urology, Seattle, WA, USA
| | - Michael D Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Mani Menon
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA.
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Gaas MY, Kaprin AD, Vorobyev NV, Rapoport LM, Korolev DO, Kalpinsky AS. Markers of local kidney cancer recurrence: A surgeon's mistake or a pattern? Review. Urologia 2022:3915603221140964. [PMID: 36515572 DOI: 10.1177/03915603221140964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The influence of various morphological, anatomical, genetic and other factors on the local recurrence-free survival of patients who have undergone different renal cell cancer (RCC) treatment is still a rather complex, ambiguous and controversial issue for practicing oncourologists. This review evaluates the effect of several factors on both recurrence-free survival and local recurrence-free survival. The review includes articles, clinical cases, literature reviews, and meta-analyses highlighting the analysis of independent and interrelated predisposing factors for developing local recurrence of RCC from 1984 to 2020. The PubMed, Web of Science, and Scopus databases were searched in English, Spanish, and German. A review of the literature showed the role of the following indices in the local recurrence RCC: microvascular invasion (p = 0.001), tumor necrosis (p = 0.0001), high malignancy (Fuhrman III or IV) (HR = 38.3, 95% CI 3.1-467, p = 0.004) as histological factors, tumor size as an anatomical factor. Thus, the authors state that every centimeter of the tumor increases the risk of local recurrence (p < 0.05). A group from the Mayo Clinic showed the equivalence of different treatment methods in local RCC recurrence. Thus, in the group of patients with cT1a stage kidney cancer, the 5-year local recurrence-free survival rates were 97.7% (96.7-98.6), 95.9% (92.3-99.6), and 95.9% (92.3-99.6) for renal resection, RFA, and cryoablation, respectively. Surgical margin status is the most studied and controversial marker of local renal cell carcinoma recurrence. Researchers found a direct effect of PSM on the risk of local RCC recurrence (p < 0.01). The personalized approach with the search and evaluation of predisposing factors for the local recurrence, as well as further selection of the most optimal treatment, will allow oncourologists to improve both the effectiveness of primary treatment and the recurrence-free survival of patients.
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Affiliation(s)
- Margarita Y Gaas
- Department Urology and Operative Nephrology with the Course of Oncourology of Medical Institute of Peoples' Friendship University of Russia, Moscow, Russian Federation
| | - Andrey D Kaprin
- Department Urology and Operative Nephrology with the Course of Oncourology of Medical Institute of Peoples' Friendship University of Russia, Moscow, Russian Federation
| | - Nikolay V Vorobyev
- Department of Oncology, Radiotherapy and Plastic Surgery of I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.,P.A. Hertsen Moscow Oncology Research Center, A Branch of FSBI NMRRC of the Ministry of Health of Russia, Moscow, Russian Federation
| | - Leonid M Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Dmitry O Korolev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Alexey S Kalpinsky
- Department of Tumors of the Reproductive and Urinary Organs, Moscow Research Oncological Institute, P. A. Herzen, Branch of the Federal State Budgetary Institution "National Research Center of Radiology," Moscow, Russian Federation
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Huang J, Wang Y, Zhang C, Hu X, Wang P, Shi G, Dong L, Zhang J, Kong W, Chen Y, Xia D, Guo J, Xue W, Huang Y, He Z. Surgical Management and oncologic outcomes for Local Retroperitoneal Recurrence Of Renal Cell Carcinoma After Radical Nephrectomy. Clin Genitourin Cancer 2022; 21:315.e1-315.e7. [PMID: 36396584 DOI: 10.1016/j.clgc.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Local retroperitoneal recurrence (RPR) after racial nephrectomy (RN) of renal cell carcinoma (RCC) remains a therapeutic challenge and has a poor prognosis. We aimed to compare the oncological outcomes of patients with RPR treated with RPR surgery or targeted therapy alone and assess the prognostic factors of these patients. PATIENTS AND METHODS This is a retrospective multi-center study of patients with RPR after prior RN treated with or without surgical treatment from 2008 to 2020. RPR of RCC is defined as an ipsilateral recurrence confined to the renal fossa, adrenal gland or retroperitoneal lymph nodes after prior nephrectomy, which was diagnosed by cross-sectional imaging. Clinical and pathological features, perioperative complications were reported using descriptive statistics. Cancer-specific survival (CSS) was evaluated by Kaplan-Meier method and studied using Cox proportional hazards model. RESULTS Median follow-up period was 35 months (IQR 20-61) for the RPR surgery group and 23 months (IQR 9-40.5) for the targeted therapy group. No patients had distant metastatic disease at the time of RPR diagnosis. Treatment with RPR surgery resulted in significantly longer CSS than targeted therapy alone (P < .001). In multivariable analysis, high Fuhrman grade, size of RPR tumor, mixed type of RPR, multiple recurrence lesions and the absence of RPR surgery were associated with a significantly increased risk of death from RCC. CONCLUSION Aggressive surgical resection of RPR after RN represents a potentially curative treatment for selected RCC patients without synchronous metastases, resulting in significantly longer CSS than targeted therapy alone.
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Wang Y, Huang J, Zhang C, Hu X, Wang P, Shi G, Zhang J, Kong W, Chen Y, Huang Y, Ye D, Xia D, Guo J, He Z, Xue W. Special issue "The advance of solid tumor research in China": Presurgical therapy in the management of local retroperitoneal recurrence of renal cell carcinoma after radical nephrectomy. Int J Cancer 2022; 152:24-30. [PMID: 35712762 DOI: 10.1002/ijc.34173] [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: 11/18/2021] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/08/2022]
Abstract
Local retroperitoneal recurrence (RPR) after radical nephrectomy (RN) is rare in patients with renal cell carcinoma (RCC); however, it is associated with poor prognosis and lacks standard treatment. Our study aimed to assess oncological outcomes and prognostic factors of patients that underwent targeted therapy for RPR after RN, and to evaluate the role of presurgical targeted therapy in this context. This was a retrospective multicenter study of 85 patients with RPR treated with targeted therapy for RPR after RN (July 2008-October 2020). Clinical and pathological characteristics were reported using descriptive statistics. Cancer-specific survival (CSS) was examined using the Cox proportional hazards model. The median follow-up time was 50 months (95% confidence interval [CI]: 33.3-66.7) after the RPR diagnosis. The median CSS was 96 months in the presurgical targeted therapy followed by surgical resection group and 42 months (95% CI: 28.8-55.2) in the targeted therapy alone group (P = .0011). In multivariate analysis, International Metastatic RCC Database Consortium classification intermediate/poor risk, number of recurrence lesions and surgical resection were independent predictors of CSS. Presurgical targeted therapy may increase the feasibility of tumor resection for RPR after RN. Patients who underwent surgical resection following presurgical targeted therapy had better CSS than those treated with targeted therapy alone.
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Affiliation(s)
- Yueming Wang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiwei Huang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Cuijian Zhang
- Department of Urology, First Hospital of Peking University, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xiaoyi Hu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ping Wang
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Guohai Shi
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jin Zhang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Kong
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yonghui Chen
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiran Huang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Dan Xia
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Jianming Guo
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhisong He
- Department of Urology, First Hospital of Peking University, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Wei Xue
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Carbonara U, Amparore D, Gentile C, Bertolo R, Erdem S, Ingels A, Marchioni M, Muselaers CH, Kara O, Marandino L, Pavan N, Roussel E, Pecoraro A, Crocerossa F, Torre G, Campi R, Ditonno P. Current strategies to diagnose and manage of positive surgical margins and local recurrence after partial nephrectomy. Asian J Urol 2022; 9:227-242. [PMID: 36035342 PMCID: PMC9399527 DOI: 10.1016/j.ajur.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022] Open
Abstract
Objective No standard strategy for diagnosis and management of positive surgical margin (PSM) and local recurrence after partial nephrectomy (PN) are reported in literature. This review aims to provide an overview of the current strategies and further perspectives on this patient setting. Methods A non-systematic review of the literature was completed. The research included the most updated articles (about the last 10 years). Results Techniques for diagnosing PSMs during PN include intraoperative frozen section, imprinting cytology, and other specific tools. No clear evidence is reported about these methods. Regarding PSM management, active surveillance with a combination of imaging and laboratory evaluation is the first option line followed by surgery. Regarding local recurrence management, surgery is the primary curative approach when possible but it may be technically difficult due to anatomy resultant from previous PN. In this scenario, thermal ablation (TA) may have the potential to circumvent these limitations representing a less invasive alternative. Salvage surgery represents a valid option; six studies analyzed the outcomes of nephrectomy on local recurrence after PN with three of these focused on robotic approach. Overall, complication rates of salvage surgery are higher compared to TA but ablation presents a higher recurrence rate up to 25% of cases that can often be managed with repeat ablation. Conclusion Controversy still exists surrounding the best strategy for management and diagnosis of patients with PSMs or local recurrence after PN. Active surveillance is likely to be the optimal first-line management option for most patients with PSMs. Ablation and salvage surgery both represent valid options in patients with local recurrence after PN. Conversely, salvage PN and radical nephrectomy have fewer recurrences but are associated with a higher complication rate compared to TA. In this scenario, robotic surgery plays an important role in improving salvage PN and radical nephrectomy outcomes.
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Affiliation(s)
- Umberto Carbonara
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
- Corresponding author. Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy.
| | - Daniele Amparore
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cosimo Gentile
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Riccardo Bertolo
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy
| | - Selcuk Erdem
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Division of Urologic Oncology, Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Alexandre Ingels
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Department of Urology, University Hospital Henri Mondor, APHP, Créteil, France
| | - Michele Marchioni
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University of Chieti, Chieti, Italy
| | - Constantijn H.J. Muselaers
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Onder Kara
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Laura Marandino
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Pavan
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Eduard Roussel
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Angela Pecoraro
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Torre
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Riccardo Campi
- European Association of Urology (EAU), Young Academic Urologists (YAU), Renal Cancer Working Group
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
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Variability in prognostic models for localized renal cell carcinoma. Nat Rev Urol 2022; 19:385-386. [DOI: 10.1038/s41585-022-00590-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Oncological outcomes of surgery for isolated retroperitoneal recurrence in renal cancer patients after radical nephrectomy. Urol Oncol 2021; 40:111.e27-111.e34. [PMID: 34961683 DOI: 10.1016/j.urolonc.2021.11.028] [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: 06/27/2021] [Revised: 10/15/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022]
Abstract
AIMS Isolated retroperitoneal recurrence (IRR) in renal cancer patients after radical nephrectomy (RN) is a rare event and poses a therapeutic dilemma. We evaluated oncologic outcomes in surgically treated patients with IRR and established prognostic factors associated with survival. The benefit of metastasis-directed therapy (MDT) in those with clinical progression after extirpation of IRR was assessed. METHODS This was a retrospective single-institutional study in which 60 renal cancer patients after previous RN underwent surgery for suspicion of IRR within the period of 2004-2019; in 55 of them, RCC recurrence was histologically confirmed. No patient had distant metastatic disease at the time of IRR diagnosis. In cases of clinical progression after IRR surgery, MDT (metastasectomy, stereotactic radiotherapy) was selectively used. Kaplan-Meier curves were used to estimate survival outcomes. Univariable and multivariable Cox proportional hazards regression analyses were used to evaluate associations between clinicopathological parameters and cancer-specific survival. RESULTS Median age at IRR diagnosis was 64 years (range 23-81). IRR was diagnosed at a median of 42 months (IQR 19-99) after RN. Surgical complications of grade 3-5 after IRR extirpation were rare (7%). Median follow-up time was 50 months (IQR 19-80). Five-year recurrence-free survival and cancer-specific survival rates were 32% and 66%, respectively. Radiographic progression was observed in 34 (62%) patients at a median of 11 months after IRR surgery, out of which 22 patients (40%) underwent MDT. When compared with 12 patients without MDT, the MDT patients had a prolonged median time to systemic treatment of 58 (vs. 16 months), and median cancer-specific survival of 88 (vs. 46 months). Upon multivariable analysis, the interval from nephrectomy ≤12 months (HR 7.77), tumour grade 3-4 (HR 13.24) and female sex (HR 7.42) were determined to be independent prognostic factors of cancer-related mortality. CONCLUSION Aggressive surgical therapy of IRR is feasible with relatively low morbidity. More than half of the patients experience long-term survival. The interval from nephrectomy to IRR less than 12 months, tumour grade 3-4 and female sex were negative prognostic predictors. In the case of progression, metastasis-directed therapy may prolong the interval to initiation of systemic treatment.
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Matsushita Y, Iwashita Y, Ohtsuka S, Ohnishi I, Yamashita T, Miyake H, Sugimura H. A DNA adductome analysis revealed a reduction in the global level of C5-hydroxymethyl-2'-deoxycytidine in the non-tumoral upper urinary tract mucosa of urothelial carcinoma patients. Genes Environ 2021; 43:52. [PMID: 34852853 PMCID: PMC8638144 DOI: 10.1186/s41021-021-00228-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/11/2021] [Indexed: 02/07/2023] Open
Abstract
Background DNA adducts, covalent modifications to DNA due to exposure to specific carcinogens, cause the mispairing of DNA bases, which ultimately results in DNA mutations. DNA methylation in the promoter region, another type of DNA base modification, alters the DNA transcription process, and has been implicated in carcinogenesis in humans due to the down-regulation of tumor suppressor genes. Difficulties are associated with demonstrating the existence of DNA adducts or chemically modified bases in the human urological system. Apart from aristolochic acid-DNA adducts, which cause urothelial carcinoma and endemic nephropathy in a particular geographical area (Balkan), limited information is currently available on DNA adduct profiles in renal cell carcinoma and upper urinary tract urothelial carcinoma, including renal pelvic cancer and ureteral cancer. Method To elucidate the significance of DNA adducts in carcinogenesis in the urothelial system, we investigated 53 DNA adducts in the non-tumoral renal parenchyma and non-tumoral renal pelvis of patients with renal cell carcinoma, upper urinary tract urothelial carcinoma, and other diseases using liquid chromatography coupled with tandem mass spectrometry. A comparative analysis of tissue types, the status of malignancy, and clinical characteristics, including lifestyle factors, was performed. Results C5-Methyl-2′-deoxycytidine, C5-hydroxymethyl-2′-deoxycytidine (5hmdC), C5-formyl-2′-deoxycytidine, 2′-deoxyinosine, C8-oxo-2′-deoxyadenosine, and C8-oxo-2′-deoxyguanosine (8-OHdG) were detected in the renal parenchyma and renal pelvis. 8-OHdG was more frequently detected in the renal pelvis than in the renal cortex and medulla (p = 0.048 and p = 0.038, respectively). 5hmdC levels were significantly lower in the renal pelvis of urothelial carcinoma patients (n = 10) than in the urothelium of patients without urothelial carcinoma (n = 15) (p = 0.010). Regarding 5hmdC levels in the renal cortex and medulla, Spearman’s rank correlation test revealed a negative correlation between age and 5hmdC levels (r = − 0.46, p = 0.018 and r = − 0.45, p = 0.042, respectively). Conclusions The present results revealed a reduction of 5hmdC levels in the non-tumoral urinary tract mucosa of patients with upper urinary tract urothelial carcinoma. Therefore, the urothelial cell epithelia of patients with upper urinary tract cancer, even in non-cancerous areas, may be predisposed to urothelial cancer. Supplementary Information The online version contains supplementary material available at 10.1186/s41021-021-00228-9.
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Affiliation(s)
- Yuto Matsushita
- Department of Tumor Pathology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.,Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Yuji Iwashita
- Department of Tumor Pathology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Shunsuke Ohtsuka
- Department of Tumor Pathology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Ippei Ohnishi
- Department of Tumor Pathology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Takashi Yamashita
- Department of Tumor Pathology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Haruhiko Sugimura
- Department of Tumor Pathology, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
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Thomson A, Hennessey D, Goad J, Kinnear N. Large and rapid local recurrence of clear cell renal cell carcinoma. BMJ Case Rep 2021; 14:e247106. [PMID: 34789533 PMCID: PMC8601066 DOI: 10.1136/bcr-2021-247106] [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] [Accepted: 11/02/2021] [Indexed: 11/03/2022] Open
Abstract
After radical nephrectomy, clear cell renal cell carcinoma (ccRCC) recurs locally in <3% of patients. Recurrences typically occur 1-2 years postoperatively and grow at 5-20 mm per year. In contrast, this patient's recurrence was unexpectedly large and swift. A 71-year-old woman was initially found on workup for recurrent urinary tract infections to have a 12 cm left renal tumour. After negative staging scans, she progressed to left open radical nephrectomy. Histology revealed a stage T2b 12 cm ccRCCwith sarcomatoid differentiation, International Society of Urological Pathology (ISUP) grade 4, with clear margins. Only 3 months later, the patient developed left-sided abdominal pain, and CT scans revealed a 15 cm left retroperitoneal local recurrence, as well as widespread peritoneal tumours. In discussion with her treating team, the patient and her family elected not to undergo biopsy or systemic therapy. The patient was palliated and passed away 8 days after re-presentation.
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Affiliation(s)
- Alice Thomson
- Dept of Urology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Derek Hennessey
- Dept of Urology, Mercy University Hospital, Cork, Ireland
- Dept of Urology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Jeremy Goad
- Dept of Urology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Ned Kinnear
- Dept of Urology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Dept of Urology, Mercy University Hospital, Cork, Ireland
- Dept of Urology, Austin Hospital, Heidelberg, Victoria, Australia
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Kim SH, Choi MG, Shin JH, Kim YA, Chung J. A Real-World, Population-Based Retrospective Analysis of Therapeutic Survival for Recurrent Localized Renal Cell Carcinoma After Nephrectomy. Front Oncol 2021; 11:693831. [PMID: 34568023 PMCID: PMC8456083 DOI: 10.3389/fonc.2021.693831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/16/2021] [Indexed: 01/22/2023] Open
Abstract
We retrospectively analyzed therapeutic strategies and risk factors for overall survival (OS) in disease recurrence following curative nephrectomy for localized renal cell carcinoma (loRCC) using the Korean National Cancer Registry Database. We selected 1295 recurrent loRCC patients who underwent either partial or radical nephrectomy from 2007-2013. Patients were excluded for age <19 years, secondary RCC, multiple primary tumors, other SEER stages except for a localized or regional stage, postoperative recurrence within 3-month, and non-nephrectomized cases. Four therapeutic groups were statistically analyzed for OS and risk factors: surgery (OP, 12.0%), other systemic therapy (OST, 59.5%), radiotherapy (RT, 2.8%), and targeted therapy (TT, 25.8%). The overall mortality rate for recurrent loRCC was 32.5%, including 82.4% for RCC-related deaths. The baseline comparison among groups showed statistical differences for the diagnostic age of cancer and the SEER stage (p<0.05). Multivariate analysis of OS showed significance for the TT (hazard ratio [HR]: 6.27), OST (HR: 7.05), and RT (HR: 7.47) groups compared with the OP group, along with significance for the sex, SEER stage, and the time from nephrectomy to treatment for disease recurrence (p<0.05). The median OS curve showed a significantly better OS in the OP group (54.9 months) compared with the TT, OST, and RT groups (41.7, 42.9, and 38.0 months, respectively; p<0.001). In conclusion, the surgery-treated group had the best OS among the different therapeutic strategies for recurrent loRCC after nephrectomy, and the importance of the time from nephrectomy to secondary treatment was a significant prognostic factor.
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Affiliation(s)
- Sung Han Kim
- Department of Urology, Center for Urologic Cancer, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Min Gee Choi
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Ji Hye Shin
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Young-Ae Kim
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
| | - Jinsoo Chung
- Department of Urology, Center for Urologic Cancer, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
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Marchioni M, Sountoulides P, Furlan M, Mir MC, Aretano L, Rubio-Briones J, Alvarez-Maestro M, Di Nicola M, Bazán AA, Antonelli A, Simeone C, Schips L. Management of local recurrence after radical nephrectomy: surgical removal with or without systemic treatment is still the gold standard. Results from a multicenter international cohort. Int Urol Nephrol 2021; 53:2273-2280. [PMID: 34417970 PMCID: PMC8494713 DOI: 10.1007/s11255-021-02966-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/30/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the survival outcomes of patients with local recurrence after radical nephrectomy (RN) and to test the effect of surgery, as monotherapy or in combination with systemic treatment, on cancer-specific mortality (CSM). METHODS Patients with local recurrence after RN were abstracted from an international dataset. The primary outcome was CSM. Cox's proportional hazard models tested the main predictors of CSM. Kaplan-Meier method estimates the 3-year survival rates. RESULTS Overall, 96 patients were included. Of these, 44 (45.8%) were metastatic at the time of recurrence. The median time to recurrence after RN was 14.5 months. The 3-year cancer-specific survival rates after local recurrence were 92.3% (± 7.4%) for those who were treated with surgery and systemic therapy, 63.2% (± 13.2%) for those who only underwent surgery, 22.7% (± 0.9%) for those who only received systemic therapy and 20.5% (± 10.4%) for those who received no treatment (p < 0.001). Receiving only medical treatment (HR: 5.40, 95% CI 2.06-14.15, p = 0.001) or no treatment (HR: 5.63, 95% CI 2.21-14.92, p = 0.001) were both independently associated with higher CSM rates, even after multivariable adjustment. Following surgical treatment of local recurrence 8 (16.0%) patients reported complications, and 2/8 were graded as Clavien-Dindo ≥ 3. CONCLUSIONS Surgical treatment of local recurrence after RN, when feasible, should be offered to patients. Moreover, its association with a systemic treatment seems to warrantee adjunctive advantages in terms of survival, even in the presence of metastases.
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Affiliation(s)
- Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, Urology Unit, SS Annunziata Hospital, Chieti, Italy.
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University "G. d'Annunzio" Chieti-Pescara, Via dei Vestini, Campus universitario, 66100, Chieti, Italy.
| | | | - Maria Furlan
- Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Maria Carmen Mir
- Department of Urology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - Lucia Aretano
- Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Jose Rubio-Briones
- Department of Urology, Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti, Chieti, Italy
| | | | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, Urology Unit, SS Annunziata Hospital, Chieti, Italy
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Martini A, Turri F, Barod R, Rocco B, Capitanio U, Briganti A, Montorsi F, Mottrie A, Challacombe B, Lagerveld BW, Bensalah K, Abaza R, Badani KK, Mehrazin R, Buscarini M, Larcher A. Salvage Robot-assisted Renal Surgery for Local Recurrence After Surgical Resection or Renal Mass Ablation: Classification, Techniques, and Clinical Outcomes. Eur Urol 2021; 80:730-737. [PMID: 34088520 DOI: 10.1016/j.eururo.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/06/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Salvage treatment for local recurrence after prior partial nephrectomy (PN) or local tumor ablation (LTA) for kidney cancer is, as of yet, poorly investigated. OBJECTIVE To classify the treatments and standardize the nomenclature of salvage robot-assisted renal surgery, to describe the surgical technique for each scenario, and to investigate complications, renal function, and oncologic outcomes. DESIGN, SETTING, AND PARTICIPANTS Sixty-seven patients underwent salvage robot-assisted renal surgery from October 2010 to December 2020 at nine tertiary referral centers. SURGICAL PROCEDURE Salvage robot-assisted renal surgery classified according to treatment type as salvage robot-assisted partial or radical nephrectomy (sRAPN or sRARN) and according to previous primary treatment (PN or LTA). MEASUREMENTS Postoperative complications, renal function, and oncologic outcomes were assessed. RESULTS AND LIMITATIONS A total of 32 and 35 patients underwent salvage robotic surgery following PN and LTA, respectively. After prior PN, two patients underwent sRAPN, while ten underwent sRARN for a metachronous recurrence in the same kidney. No intra- or perioperative complication occurred. For local recurrence in the resection bed, six patients underwent sRAPN, while 14 underwent sRARN. For sRAPN, the intraoperative complication rate was 33%; there was no postoperative complication. For sRARN, there was no intraoperative complication and the postoperative complication rate was 7%. At 3 yr, the local recurrence-free rates were 64% and 82% for sRAPN and sRARN, respectively, while the 3-yr metastasis-free rates were 80% and 79%, respectively. At 33 mo, the median estimated glomerular filtration rates (eGFRs) were 57 and 45 ml/min/1.73 m2 for sRAPN and sRARN, respectively. After prior LTA, 35 patients underwent sRAPN and no patient underwent sRARN. There was no intraoperative complication; the overall postoperative complications rate was 20%. No local recurrence occurred. The 3-yr metastasis-free rate was 90%. At 43 mo, the median eGFR was 38 ml/min/1.73 m2. The main limitations are the relatively small population and the noncomparative design of the study. CONCLUSIONS Salvage robot-assisted surgery has a safe complication profile in the hands of experienced surgeons at high-volume institutions, but the risk of local recurrence in this setting is non-negligible. PATIENT SUMMARY Patients with local recurrence after partial nephrectomy or local tumor ablation should be aware that further treatment with robot-assisted surgery is not associated with a worrisome complication profile, but also that they are at risk of further recurrence.
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Affiliation(s)
- Alberto Martini
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo Turri
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Ravi Barod
- Specialist Centre for Kidney Cancer Royal Free Hospital, London, UK
| | - Bernardo Rocco
- Department of Urology, Azienda Ospedaliero-Universitaria, Urological Residency School Network, University of Modena & Reggio Emilia, Modena, Italy
| | - Umberto Capitanio
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Ben Challacombe
- Department of Urology, Guys and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | - Ronney Abaza
- Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, Columbus, OH, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Maurizio Buscarini
- Department of Urology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alessandro Larcher
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy.
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Percutaneous CT-Guided Renal Cryoablation: Technical Aspects, Safety, and Long-Term Oncological Outcomes in a Single Center. ACTA ACUST UNITED AC 2021; 57:medicina57030291. [PMID: 33804740 PMCID: PMC8003936 DOI: 10.3390/medicina57030291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/18/2021] [Indexed: 12/15/2022]
Abstract
Background and objectives: Cryoablation is emerging as a safe and effective therapeutic option for treating renal cell carcinoma. This study analyzed the safety and long-term oncological outcomes of cryoablation in our center. Materials and methods: Patients who underwent computed tomography (CT)-guided percutaneous cryoablation between February 2011 and June 2020 for one or more clinically localized renal tumors were identified. Technical success and treatment efficacy were assessed. Post-procedural complications were classified according to the Clavien-Dindo system. Recurrence-free survival was determined for biopsy-proven malignant renal tumors. Results: A total of 174 renal tumors, 78 of which were biopsy-proven malignant carcinomas, were treated in 138 patients (97 males and 41 females, mean age: 73 years, range: 43-89 years). Mean tumor size was 2.25 cm and 54.6% of the lesions required a complex approach. Technical success was achieved in 171 out of 174 tumors (98.3%). Primary treatment efficacy was 95.3% and increased to 98.2% when retreats were taken into account. The overall complication rate was 29.8%. No complications of Clavien-Dindo grade III or more were encountered. Median follow-up was 21.92 months (range: 0.02-99.87). Recurrence-free survival was 100% at 1 year, 95.3% (95% CI: 82.1%-98.8%) at 3 years, and 88.6% (95% CI: 71.8%-95.7%) at 5 years. Conclusions: Cryoablation is a safe and effective technique for the treatment of small renal lesions, with no major complications when performed by expert interventional radiologists. The multidisciplinary discussion is essential, especially considering the high number of histologically undetermined lesions. Our long-term oncological outcomes are encouraging and in line with the literature.
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Brassier M, Khene ZE, Bernhard JC, Dang VT, Ouzaid I, Nouhaud FX, Olivier J, Nedelcu C, Grenier N, Beuzit L, Doumerc N, Bensalah K, Bigot P. Percutaneous Ablation Versus Surgical Resection for Local Recurrence Following Partial Nephrectomy for Renal Cell Cancer: A Propensity Score Analysis (REPART Study-UroCCR 71). Eur Urol Focus 2021; 8:210-216. [PMID: 33622625 DOI: 10.1016/j.euf.2021.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/20/2020] [Accepted: 02/09/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Data comparing percutaneous ablation (PCA) and surgical resection (SR) for an isolated local recurrence (LR) following partial nephrectomy (PN) for renal cell carcinoma (RCC) are lacking. OBJECTIVE To examine the outcomes between PCA and SR for an isolated LR following PN for RCC. DESIGN, SETTING, AND PARTICIPANTS Patients who underwent PN for RCC and developed an LR between 2013 and 2019 were included. An LR was defined as the appearance of a mass in contact with the resection bed or the development of a tumor in the same region of the homolateral kidney as the original site. INTERVENTION PCA or SR. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS To achieve balance in baseline characteristics, we used inverse probability of treatment weighting (IPTW) based on propensity to receive treatment. Oncological outcomes, complications, and renal function were evaluated between groups using logistic, linear, and Cox proportional hazard regression models. RESULTS AND LIMITATIONS A total of 81 patients with an isolated LR were included (PCA: 42; SR: 39). The median follow-up was 23 mo. After adjustment, excellent balance was achieved for the majority of propensity score variables. In IPTW analysis, PCA was associated with a lower risk of postoperative complications (odds ratio=0.22; p=0.006) and a smaller change in eGFR (beta=-16.18; p=0.001). There were no significant differences in the risk of disease recurrence (hazard ratio [HR]=0.72; p=0.61), new LR (HR=1.51; p=0.59), and distant metastasis (HR=0.19; p=0.09). Limitations include the sample size and unmeasured confounding factors. CONCLUSIONS Our results suggest that PCA provides comparable oncological outcomes to repeat surgery with fewer complications and better renal function preservation for the management of an LR after PN. PATIENT SUMMARY This report shows that percutaneous ablation can be used for treating a local recurrence of renal cell carcinoma after partial nephrectomy, without significantly compromising cancer control.
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Affiliation(s)
- Marie Brassier
- Department of Urology, Angers University Hospital, Angers, France.
| | | | | | - Van Thi Dang
- Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France
| | - Idir Ouzaid
- Department of Urology, Bichat Hospital, APHP, Paris Diderot University, Paris, France
| | | | | | - Cosmina Nedelcu
- Department of Radiology, Angers University Hospital, Angers, France
| | - Nicolas Grenier
- Department of Radiology, Bordeaux University Hospital, Bordeaux, France
| | - Luc Beuzit
- Department of Radiology, Rennes University Hospital, Rennes, France
| | - Nicolas Doumerc
- Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France
| | - Karim Bensalah
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Pierre Bigot
- Department of Urology, Angers University Hospital, Angers, France
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23
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Yuasa T. A novel classification for local recurrence after surgical removal of renal cell cancer. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:970. [PMID: 32953770 PMCID: PMC7475408 DOI: 10.21037/atm.2020.03.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Takeshi Yuasa
- Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
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24
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Zequi SDC, Abreu D. Consideration in the management of renal cell carcinoma during the COVID-19 Pandemic. Int Braz J Urol 2020; 46:69-78. [PMID: 32549075 PMCID: PMC7720004 DOI: 10.1590/s1677-5538.ibju.2020.s108] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/10/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: Recently the COVID-19 pandemic became the main global priority; main efforts and health infrastructures have been prioritized in favor of COVID-19 battle and the treatment of benign diseases has been postponed. Renal cell cancer (RCC) patients configure a heterogenous populations: some of them present indolent cases which can safely have postponed their treatments, others present aggressive tumors, deserving immediate care. These scenarios must be properly identified before a tailored therapeutic choice. Objectives We propose a risk- based approach for patients with RCC, to be used during this unprecedented viral infection time. Materials and Methods: After a literature review focused in COVID-19 and current RCC treatments, we suggest therapeutic strategies of RCC in two sections: surgical approach and systemic therapy, in all stages of this malignance. Results: Patients with cT1a tumors (and complex cysts, Bosniak III/IV), must be put under active surveillance and delayed intervention. cT1b-T2a/b cases must be managed by partial or radical nephrectomy, some selected T1b-T2a (≤7cm) cases can have the surgery postponed by 60-90 days). Locally advanced tumors (≥cT3 and or N+) must be promptly resected. As possible, minimally invasive surgery and early hospital discharge are encouraged. Upfront cytoreduction, is not recommendable for low risk oligometastatic patients, which must start systemic treatment or even could be put under surveillance and delayed therapy. Intermediate and poor risk metastatic patients must start target therapy and/or immunotherapy (few good responders intermediate cases can have postponed cytoreduction). The recommendation about hereditary RCC syndromes are lacking, thus we recommend its usual care. Local or loco regional recurrence must have individualized approaches. For all cases, we suggest the application of a specific informed consent and a shared therapeutic choice. Conclusion: In the pandemic COVID -19 times, a tailored risk-based approach must be used for a safe management of RCC, aiming to not compromise the oncological outcomes of the patients.
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Affiliation(s)
- Stênio de Cássio Zequi
- Divisão de Urologia, A.C. Camargo Cancer Center, Fundação A. Prudente, São Paulo, Brasil.,Instituto Nacional de Ciência e Tecnologia em Oncogenômica e Inovação Terapêutica - INCIT - INOTE, A. C. Camargo Cancer Center, Fundação A. Prudente, São Paulo, Brasil.,Latin American Renal Cancer Group - LARCG, São Paulo, SP, Brasil
| | - Diego Abreu
- Latin American Renal Cancer Group - LARCG, São Paulo, SP, Brasil.,Department of Urology, Pasteur Hospital, Montevideo, Uruguay
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25
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Ismail A, Elmansy H, Shahrour W, Prowse O, Kotb A. Very late locally recurrent chromophobe renal cell carcinoma: 15 years following radical nephrectomy for low-stage disease. J Surg Case Rep 2019; 2019:rjz257. [PMID: 31528331 PMCID: PMC6736281 DOI: 10.1093/jscr/rjz257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 11/16/2022] Open
Abstract
The majority of patients with renal cell carcinoma develop recurrence within 5 years following radical nephrectomy. Very late sole local recurrence beyond 10 years is rare, and all reported cases had clear cell histology. Surgical resection of local recurrence remains the best option for disease management. This case opens the way for further studying the rare histological variants of renal cancer and to encourage prolonged follow-up and offering surgery as the best option for managing these cases.
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Affiliation(s)
- Asmaa Ismail
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Hazem Elmansy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Owen Prowse
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Ahmed Kotb
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
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26
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Zlatev DV, Blute ML. Management of Local Kidney Cancer Relapse. Eur Urol Oncol 2019; 1:524. [PMID: 31158098 DOI: 10.1016/j.euo.2018.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Dimitar V Zlatev
- Department of Urologic Surgery, Stanford Hospital and Clinics, Stanford, CA, USA; Department of Urology, Massachusetts General Hospital, Boston, MA, USA.
| | - Michael L Blute
- Department of Urology, Massachusetts General Hospital, Boston, MA, USA
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