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Rac G, James C, Ellis JL, Barton GJ, Blackwell RH, Gupta GN. Robotic-assisted enucleation for renal masses: A comparison of on-clamp and off-clamp approach. J Surg Oncol 2024. [PMID: 39138890 DOI: 10.1002/jso.27810] [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: 05/21/2024] [Accepted: 07/14/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION In surgically excising renal masses, studies have demonstrated that tumor enucleation is an effective option. However, there is limited literature comparing off-clamp to on-clamp tumor enucleation. MATERIALS AND METHODS We retrospectively reviewed the charts of 189 patients who underwent robotic-assisted laparoscopic partial nephrectomy via tumor enucleation by a single surgeon from March 2012 and April 2022. Patients were stratified based on use of renal hilar clamping intraoperatively. Surgical, oncologic, and renal functional outcomes were captured. Variables were analyzed and compared between the two groups using Student's T-tests and Chi-square tests. RESULTS Of 189 procedures analyzed, 124 were performed on-clamp and 65 were performed off-clamp. There were no differences in patient demographics or average length of follow-up. There were no differences in estimated blood loss, complications, or hospital length of stay. Recurrence rates were similar for the two groups. The absolute difference in estimated glomerular filtration rate change between the two groups at time of first follow-up was not significant (p = 0.25). CONCLUSIONS There is no significant difference in perioperative outcomes such as surgical time, blood loss, or complications between the two groups. Furthermore, there was no significant difference in postoperative kidney function between the two techniques.
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Affiliation(s)
- Goran Rac
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Christopher James
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jeffrey L Ellis
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Gregory J Barton
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Robert H Blackwell
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
- Department of Urology, Southern Illinois University, Springfield, Illinois, USA
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA
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Bertolo R, Francolini G, Bukavina L. Functional Outcomes of Stereotactic Ablative Radiotherapy: There Is Room for Improvement. Eur Urol Oncol 2024:S2588-9311(24)00177-9. [PMID: 39084966 DOI: 10.1016/j.euo.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Riccardo Bertolo
- Department of Urology, University of Verona, Borgo Trento Hospital, AOUI Verona, Verona, Italy.
| | - Giulio Francolini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Laura Bukavina
- Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA
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Uemura K, Ito H, Ikeda M, Uehara K, Tatenuma T, Komeya M, Ito Y, Muraoka K, Hasumi H, Makiyama K. Predictive factors for pentafecta achievement in robot-assisted partial nephrectomy for intermediate highly complex RENAL tumors (RENAL score ≥ 7). Int J Urol 2023; 30:1096-1102. [PMID: 37592739 DOI: 10.1111/iju.15274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/30/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES To investigate the predictive factors for pentafecta achievement of robot-assisted partial nephrectomy (RAPN) for intermediate highly complex renal tumors (RENAL score ≥ 7). METHODS We retrospectively analyzed the data of 247 patients with renal tumors with a RENAL score ≥ 7 who underwent RAPN. Baseline characteristics and perioperative outcomes were compared between the pentafecta achieved group and the unachieved group. A multivariable logistic regression model was used to identify the predictive factors for pentafecta achievement for cT1 renal tumors with a RENAL score ≥ 7. RESULTS Of the 247 patients, 75 (30.3%) patients were in the achieved group and 172 (69.7%) patients were in the unachieved group. The median warm ischemia time and total operation time were 18 min versus 23 min (p < 0.001) and 179 min versus 201 min (p < 0.001) in the achieved and unachieved groups, respectively. In the unachieved group, six patients (3.4%) had major perioperative complications (Clavien-Dindo classification system ≥3). The median preservation rates of estimated GFR at the 1-year postoperative period were 96.5% versus 83.0% (p < 0.001) in the achieved and unachieved groups. Multivariable logistic regression models revealed that age and tumor size were independent predictive factors for pentafecta achievement for cT1 renal tumors with a RENAL score ≥ 7. There were no significant differences in cancer-free survival between the two groups (p = 0.456). CONCLUSION Age and tumor size were independent predictive factors for pentafecta achievement, although there was no difference in oncological outcomes between the pentafecta achieved group and the unachieved group in RAPN for cT1 renal tumors with a RENAL score ≥ 7.
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Affiliation(s)
- Koichi Uemura
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Hiroki Ito
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Maiko Ikeda
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Koichiro Uehara
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Tomoyuki Tatenuma
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Mitsuru Komeya
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Yusuke Ito
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Kentaro Muraoka
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Hisashi Hasumi
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
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Daou S, Albeaini S, Mjaess G, Diamand R, Albisinni S, Roumeguère T, Aoun F. Renorrhaphy techniques in minimally invasive partial nephrectomy: a systematic review of the literature. Minerva Urol Nephrol 2023; 75:683-695. [PMID: 38126283 DOI: 10.23736/s2724-6051.23.05345-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
INTRODUCTION In the absence of consensus on the optimal approach to renorrhaphy in partial nephrectomy, this systematic review aims to assess the various renorrhaphy techniques and their impact on surgical outcomes. EVIDENCE ACQUISITION A systematic review of the literature was performed in March 2022, using PubMed and Scopus, without time restrictions and research filters for studies investigating renorrhaphy techniques in partial nephrectomy. Studies providing sufficient details on renorrhaphy techniques and their outcomes during minimally invasive partial nephrectomy (PN) were included in this analysis. EVIDENCE SYNTHESIS Thirty-one studies with 5720 patients were included in the analysis. In most studies, tumor diameter was <4 cm. RENAL and PADUA scores as well as tumor locations were heterogeneous between the studies. The results of the use of hemostatic agents were conflicting among different studies with limited evidence regarding the benefits of its routine use in partial nephrectomy. The use of barbed and running sutures was associated with a reduced warm ischemia time. While some studies showed a decreased warm ischemia time when omitting cortical renorrhaphy, others found that it may lead to higher incidence of minor complications without any significant improvement in other outcomes. CONCLUSIONS There is ongoing research to determine the optimal approach to renorrhaphy. The current evidence on the routine use of hemostatic agents is limited. The use of certain techniques such as barbed sutures, sliding clips and running sutures reduced the warm ischemia time. The omission of cortical renorrhaphy is still controversial.
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Affiliation(s)
- Samah Daou
- Faculty of Medicine, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon -
| | - Sylvana Albeaini
- Department of Urology, University Hospital of Brussels, Brussels, Belgium
| | - Georges Mjaess
- Department of Urology, University Hospital of Brussels, Brussels, Belgium
| | - Romain Diamand
- Department of Urology, University Hospital of Brussels, Brussels, Belgium
| | - Simone Albisinni
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Tor Vergata University of Rome, Rome, Italy
| | - Thierry Roumeguère
- Department of Urology, University Hospital of Brussels, Brussels, Belgium
| | - Fouad Aoun
- Faculty of Medicine, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
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Zhang S, Jin D, Zhang Y, Wang T. Risk factors and predictive model for acute kidney Injury Transition to acute kidney disease in patients following partial nephrectomy. BMC Urol 2023; 23:156. [PMID: 37794388 PMCID: PMC10552238 DOI: 10.1186/s12894-023-01325-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 09/15/2023] [Indexed: 10/06/2023] Open
Abstract
PURPOSE Acute kidney disease (AKD) is believed to be involved in the transition from acute kidney injury (AKI) to chronic kidney disease in general populations, but little is understood about this possibility among kidney surgical populations. This study aimed to elucidate the incidence of AKD after partial nephrectomy and risk factors that promote the AKI to AKD transition. METHODS From January 2010 to January 2020, this study retrospectively collected a dataset of consecutive patients with renal masses undergoing partial nephrectomy in 4 urological centers. Cox proportional regression analyses were adopted to identify risk factors that promoted the AKI to AKD transition. To avoid overfitting, the results were then verified by logistic least absolute shrinkage and selection operator (LASSO) regression. A nomogram was then constructed and validated for AKI to AKD transition prediction. RESULTS AKI and AKD occurred in 228 (21.4%) and 42 (3.9%) patients among a total of 1062 patients, respectively. In patients with AKI, multivariable Cox regression analysis and LASSO regression identified that age (HR 1.078, 1.029-1.112, p < 0.001), baseline eGFR (HR 1.015, 1.001-1.030, p < 0.001), RENAL score (HR1.612, 1.067-2.437, p = 0.023), ischemia time > 30 min (HR 7.284, 2.210-23.999, p = 0.001), and intraoperative blood loss > 300ml (HR 8.641, 2.751-27.171, p < 0.001) were risk factors for AKD transition. These five risk factors were then integrated into a nomogram. The nomogram showed excellent discrimination, calibration, and clinical net benefit ability. CONCLUSION Around 3.9% patients following partial nephrectomy would transit from AKI to AKD. Intraoperative blood loss and ischemia time need to be diminished to avoid on-going functional decline. Our nomogram can accurately predict the transition from AKI to AKD.
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Affiliation(s)
- Sizhou Zhang
- Department of Urology, People's Hospital of Hechuan Chongqing, Chongqing, P.R. China
| | - Dachun Jin
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
- Department of Urology, Daping Hospital/Army Medical Center, Army Medical University, Chongqing, P.R. China
| | - Yuanfeng Zhang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China.
| | - Tianhui Wang
- Department of Urology, People's Hospital of Fengjie, Chongqing, P.R. China.
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6
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Carson DS, Weiss T, Zhang LX, Psutka SP. Surgical Management of Localized Disease and Small Renal Masses. Hematol Oncol Clin North Am 2023; 37:877-892. [PMID: 37330345 DOI: 10.1016/j.hoc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The incidence of renal cancer has increased over the past several decades, but mortality has declined. This is thought to be related in part to earlier detection of renal masses which portend excellent 5-year survival rates. Management of small renal masses and localized disease include both nonsurgical and surgical options. The choice of intervention is ultimately based on comprehensive evaluation and shared decision-making. This article provides a comprehensive review of the current surgical management options for localized renal cancer.
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Affiliation(s)
- Daniel S Carson
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Tova Weiss
- Department of Urology, University of Washington, Seattle, WA, USA
| | | | - Sarah P Psutka
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Harborview Medical Center, 1959 NE Pacific Street, Box 356510, Seattle, WA 98195, USA.
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Margue G, Ingels A, Bensalah K, Doumerc N, Vaessen C, Roupret M, Audenet F, Mejean A, Bruyere F, Olivier J, Baumert H, Michel C, Paparel P, Parier B, Sebe P, Long JA, Lang H, Lebret T, Patard JJ, Bernhard JC. Late complications and 5 years outcomes of robotic partial nephrectomy in France: prospective assessment in the French Kidney Cancer Research Network (UroCCR 10). World J Urol 2023; 41:2281-2288. [PMID: 37407720 DOI: 10.1007/s00345-023-04491-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/10/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE To describe the practice of robotic-assisted partial nephrectomy (RAPN) in France and prospectively assess the late complications and long-term outcomes. METHODS Prospective, multicenter (n = 16), observational study including all patients diagnosed with a renal tumor who underwent RAPN. Preoperative, intraoperative, postoperative, and follow-up data were collected and stored in the French research network for kidney cancer database (UroCCR). Patients were included over a period of 12 months, then followed for 5 years. RESULTS In total, 466 patients were included, representing 472 RAPN. The mean tumor size was 3.4 ± 1.7 cm, most of moderate complexity (median PADUA and RENAL scores of 8 [7-10] and 7 [5-9]). Indication for nephron-sparing surgery was relative in 7.1% of cases and imperative in 11.8%. Intraoperative complications occurred in 6.8% of patients and 4.2% of RAPN had to be converted to open surgery. Severe postoperative complications were experienced in 2.3% of patients and late complications in 48 patients (10.3%), mostly within the first 3 months and mainly comprising vascular, infectious, or parietal complications. At 5 years, 29 patients (6.2%) had chronic kidney disease upstaging, 21 (4.5%) were diagnosed with local recurrence, eight (1.7%) with contralateral recurrence, 25 (5.4%) with metastatic progression, and 10 (2.1%) died of the disease. CONCLUSION Our results reflect the contemporary practice of French expert centers and is, to our knowledge, the first to provide prospective data on late complications associated with RAPN. We have shown that RAPN provides good functional and oncologic outcomes while limiting short- and long-term morbidity. TRIAL REGISTRATION NCT03292549.
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Affiliation(s)
- Gaëlle Margue
- Service d'urologie, Urology Department, Bordeaux University Hospital, CHU de Bordeaux, Place Amelie Raba Leon, 33000, Bordeaux, France.
| | - Alexandre Ingels
- Urology Department, Henri Mondor University Hospital, APHP, Paris, France
| | - Karim Bensalah
- Urology Department, Rennes University Hospital, Rennes, France
| | - Nicolas Doumerc
- Urology Department, Toulouse University Hospital, Toulouse, France
| | | | - Morgan Roupret
- Urology Department, Pitié-Saplétrière Hospital, APHP, Paris, France
| | - François Audenet
- Urology Department, European Georges Pompidou Hospital, Paris, France
| | - Arnaud Mejean
- Urology Department, European Georges Pompidou Hospital, Paris, France
| | - Franck Bruyere
- Urology Department, Tours University Hospital, Tours, France
| | | | - Hervé Baumert
- Urology Department, Saint Joseph Hospital, Paris, France
| | | | | | - Bastien Parier
- Urology Department, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Philippe Sebe
- Urology Department, Hospital Group Diaconesses Croix Saint-Simon, Paris, France
| | | | - Hervé Lang
- Urology Department, Strasbourg University Hospital, Strasbourg, France
| | - Thierry Lebret
- Urology Department, Foch Hospital, Paris Saclay University, Suresnes, France
| | | | - Jean-Christophe Bernhard
- Service d'urologie, Urology Department, Bordeaux University Hospital, CHU de Bordeaux, Place Amelie Raba Leon, 33000, Bordeaux, France
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Rosiello G, Larcher A, Fallara G, Cignoli D, Re C, Martini A, Tian Z, Karakiewicz PI, Mottrie A, Boarin M, Villa G, Trevisani F, Marandino L, Raggi D, Necchi A, Bertini R, Salonia A, Briganti A, Montorsi F, Capitanio U. A comprehensive assessment of frailty status on surgical, functional and oncologic outcomes in patients treated with partial nephrectomy-A large, retrospective, single-center study. Urol Oncol 2023; 41:149.e17-149.e25. [PMID: 36369233 DOI: 10.1016/j.urolonc.2022.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/23/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Partial nephrectomy (PN) is a challenging procedure, which can be associated with severe complications. In consequence, the search for accurate and independent indicators of unfavorable surgical outcomes appears warranted. We aimed at evaluating the impact of frailty status on surgical, functional and oncologic outcomes in patients undergoing PN for renal cell carcinoma (RCC). METHODS A retrospective, single-center study including 1,282 patients treated with PN for clinically localized cT1 RCC was performed. The modified Frailty Index (mFI) was used to assess preoperative frailty. Multivariable logistic, Poisson and linear regression analyses(MVA) tested the effect of frailty on complications, acute kidney injury(AKI), renal function decline after PN. Cumulative incidence and competing-risk analyses investigated survival outcomes. RESULTS Of 1,282 patients, 220 (17%) were frail. Overall, 982 (76%) vs. 123 (9.6%) vs. 171 (13%) patients underwent open vs. laparoscopic vs. robot-assisted PN. Median follow-up was 66 (IQR: 35-107) months. At MVA, frailty status predicted increased risk of complications [Odds ratio (OR): 1.46, 95%CI 1.17-1.84; P < 0.001]. Moreover, frail patients were at higher risk of postoperative AKI (OR: 1.95, 95%CI 1.13-3.35; P = 0.01). In frail patients, renal function permanently decreased over time (P = 0.01) without any renal function plateau or improvement during the follow-up, which were instead observed in the nonfrail cohort. At competing-risks analyses, frailty status predicted higher risk of other-cause mortality [Hazard ratio (HR): 1.67, 95%CI 1.05-2.66; P = 0.02], but not of cancer-specific mortality (P = 0.3). CONCLUSIONS Frailty status predicts higher risk of adverse surgical outcomes after PN. Moreover, greater renal function decline was observed in frail patients, compared with nonfrail patients. Finally, the risk of OCM significantly overcomes the risk of dying due to RCC in frail patients.
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Affiliation(s)
- Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Fallara
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Cignoli
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Re
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Martini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Mattia Boarin
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Trevisani
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Marandino
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Raggi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Necchi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Bertini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Salonia
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Capitanio
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Vartolomei MD, Remzi M, Fajkovic H, Shariat SF. Robot-Assisted Partial Nephrectomy Mid-Term Oncologic Outcomes: A Systematic Review. J Clin Med 2022; 11:jcm11206165. [PMID: 36294486 PMCID: PMC9605111 DOI: 10.3390/jcm11206165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/03/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Robot-assisted partial nephrectomy (RAPN) is used more and more in present days as a therapy option for surgical treatment of cT1 renal masses. Current guidelines equally recommend open (OPN), laparoscopic (LPN), or robotic partial nephrectomy (PN). The aim of this review was to analyze the most representative RAPN series in terms of reported oncological outcomes. (2) Methods: A systematic search of Webofscience, PUBMED, Clinicaltrials.gov was performed on 1 August 2022. Studies were considered eligible if they: included patients with renal cell carcinoma (RCC) stage T1, were prospective, used randomized clinical trials (RCT) or retrospective studies, had patients undergo RAPN with a minimum follow-up of 48 months. (3) Results: Reported positive surgical margin rates were from 0 to 10.5%. Local recurrence occurred in up to 3.6% of patients. Distant metastases were reported in up to 6.4% of patients. 5-year cancer free survival (CFS) estimates rates ranged from 86.4% to 98.4%. 5-year cancer specific survival (CSS) estimates rates ranged from 90.1% to 100%, and 5-year overall survival (OS) estimates rated ranged from 82.6% to 97.9%. (4) Conclusions: Data coming from retrospective and prospective series shows very good oncologic outcomes after RAPN. Up to now, 10-year survival outcomes were not reported. Taken together, RAPN deliver similar oncologic performance to OPN and LPN.
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Affiliation(s)
- Mihai Dorin Vartolomei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Institution Organizing University Doctoral Studies IOSUD, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania
- Correspondence:
| | - Mesut Remzi
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Harun Fajkovic
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow 119992, Russia
- Department of Urology, Weill Cornell Medical College, New York, NY 14853, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA
- Karl Landsteiner Institute of Urology and Andrology, 1090 Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, 15006 Prague, Czech Republic
- Hourani Center for Applied Scientific Research, Al Ahlizza Amman University, Amman 19328, Jordan
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10
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Assessing Trifecta Achievement after Percutaneous Cryoablation of Small Renal Masses: Results from a Multi-Institutional Collaboration. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081041. [PMID: 36013508 PMCID: PMC9412454 DOI: 10.3390/medicina58081041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: To assess efficacy and safety of Percutaneous Cryoablation (PCA) of small renal masses (SRMs) using Trifecta outcomes in a large cohort of patients who were not eligible for surgery. Materials and methods: All PCAs performed in four different centers between September 2009 and September 2019 were retrospectively evaluated. Patients were divided in two different groups depending on masses dimensional criteria: Group-A: diameter ≤ 25 mm and Group-B: diameter > 25 mm. Complications rates were reported and classified according to the Clavien−Dindo system. The estimate glomerular filtration rate (eGFR) was calculated before PCA and during follow-up schedule. Every patient received a Contrast Enhanced Ultrasound (CEUS) evaluation on the first postoperative day. Radiological follow-up was taken at 3, 6, and 12 months for the first year, then yearly. Radiological recurrence was defined as a contrast enhancement persistence and was reported in the study. Finally, Trifecta outcome, which included complications, RFS, and preservation of eGFR class, was calculated for every procedure at a median follow-up of 32 months. Results: The median age of the patients was 74 years. Group-A included 200 procedures while Group-B included 140. Seventy-eight patients were eligible for Trifecta evaluation. Trifecta was achieved in 69.6% of procedures in Group-A, 40.6% in Group-B (p = 0.02). We observed an increased rate of complication in Group-B (13.0% vs. 28.6; p < 0.001). However, 97.5% were <II Clavien−Dindo grade. No differences were found between the two groups regarding eGFR before and after treatment. Further, 24-months RFS rates were respectively 98.0% for Group-A and 92.1% in Group-B, while at 36 months were respectively 94.5% and 87.5% (p = 0.08). Conclusions: PCA seems to be a safe and effective treatment for SRM but in the need of more strict dimensional criteria to achieve a higher possible success rate.
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11
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Furukawa J, Hinata N, Teisima J, Takenaka A, Shiroki R, Kobayashi Y, Kanayama HO, Hattori K, Horie S, Tozawa K, Kato M, Ohyama C, Habuchi T, Kawamorita N, Eto M, Fujisawa M. Robot-assisted partial nephrectomy with minimum follow-up of 5 years: A multi-center prospective study in Japan. Int J Urol 2022; 29:1038-1045. [PMID: 35707848 DOI: 10.1111/iju.14960] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Robot-assisted partial nephrectomy is widely performed for small renal masses, achieving excellent perioperative and intermediate oncological outcomes. However, long-term oncological, functional, and quality of life outcomes after robot-assisted partial nephrectomy remain unclear. In this study, we aimed to evaluate quality of life at 1 year and oncological and functional outcomes of robot-assisted partial nephrectomy after a minimum follow-up of 5 years. METHODS Personal, perioperative, postoperative, functional, oncological, and quality of life data were evaluated. The EQ-5D-5L tool, which incorporates health profiles and a EuroQol Visual Analog Scale, was used to assess quality of life preoperatively and 365 days postoperatively. Regarding oncological and functional outcomes, overall survival, recurrence-free survival, and changes in estimated glomerular filtration rate were calculated. RESULTS There were few changes in levels between the two time points for all EQ-5D dimensions. The mean change in EQ-5D-5L was 0.020 (95% confidence interval 0.006-0.033, P = 0.006), and in EuroQol Visual Analog Scale score 4.60 (95% confidence interval 2.17-7.02, P = 0.0003). Overall and recurrence-free survival 5 years after robot-assisted partial nephrectomy were 97.9% and 92.8%, respectively. After an early postoperative decrease, the estimated glomerular filtration rate remained stable over time. CONCLUSIONS Robot-assisted partial nephrectomy in patients with a T1 renal tumor is safe, feasible, and effective from the perspective of quality of life and survival, even after 5 years. When making treatment decisions, perioperative and quality of life outcomes should be considered together with long-term oncological outcomes.
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Affiliation(s)
- Junya Furukawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuyuki Hinata
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jun Teisima
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yasuyuki Kobayashi
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiro-Omi Kanayama
- Department of Urology, Institute of Biochemical Sciences, Tokushima University, Graduate School, Tokushima, Japan
| | - Kazunori Hattori
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Keiichi Tozawa
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masashi Kato
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University School of Medicine, Akita, Japan
| | - Naoki Kawamorita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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12
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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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13
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Otaola-Arca H, Krebs A, Bermúdez H, Lyng R, Orvieto M, Bustamante A, Stein C, Labra A, Schultz M, Fernández MI. Long-Term Oncological and Functional Outcomes After Robot-Assisted Partial Nephrectomy for Clinically Localized Renal Cell Carcinoma. Ann Surg Oncol 2022; 29:2484-2494. [PMID: 34988833 DOI: 10.1245/s10434-021-11133-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/08/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND To evaluate long-term oncological and renal function outcomes in patients treated with robot-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC). PATIENTS AND METHODS Patients undergoing RAPN for clinically localized RCC between January 2014 and December 2019 at a tertiary robotic reference center were evaluated. Clinical course, pathologic characteristics, and long-term outcomes were obtained from our institutional review board-approved RCC database. RESULTS A total of 234 patients were available for analysis. Median follow-up was 46 months (10.8-97.8 months), with 77 patients (32.9%) having at least 5-years of follow-up. Pathology revealed clear-cell RCC in 67.5% (n = 158). Among unfavorable factors, nuclear grades 3 or 4 were found in 67 (29.4%), lymphovascular invasion in 10 (4.3%), positive surgical margins in 22 (9.4%), necrosis in 21 (9%), and sarcomatoid pattern in 2 patients (0.9%). At 12 months, mean serum creatinine was 1.04 mg/dL and 12.9% of patients experienced upstaging in chronic kidney disease. Overall recurrence-free survival at 5-years was 97.8%. There were five local (2.1%) and two distant (0.9%) recurrences, none of them resulting in cancer-specific death. Median time to recurrence was 20 months (11-64 months). Warm ischemia time [hazard ratio (HR) = 1.14, p = 0.034] and sarcomatoid pattern (HR = 124.57, p = 0.001) were the only variables associated with local relapse. CONCLUSIONS Data from this large cohort demonstrate that patients undergoing RAPN have a low incidence of local and distant relapse, resulting in excellent long-term survival while preserving stable renal function in most patients.
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Affiliation(s)
- Hugo Otaola-Arca
- Department of Urology, Clínica Alemana de Santiago, Santiago, Chile.,Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Alfred Krebs
- Department of Urology, Clínica Alemana de Santiago, Santiago, Chile.,Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Hugo Bermúdez
- Department of Urology, Clínica Alemana de Santiago, Santiago, Chile.,Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Raúl Lyng
- Department of Urology, Clínica Alemana de Santiago, Santiago, Chile.,Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Marcelo Orvieto
- Department of Urology, Clínica Alemana de Santiago, Santiago, Chile.,Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Alberto Bustamante
- Department of Urology, Clínica Alemana de Santiago, Santiago, Chile.,Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Conrado Stein
- Department of Urology, Clínica Alemana de Santiago, Santiago, Chile.,Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Andrés Labra
- Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.,Department of Radiology, Clínica Alemana de Santiago, Santiago, Chile
| | - Marcela Schultz
- Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.,Department of Pathology, Clínica Alemana de Santiago, Santiago, Chile
| | - Mario I Fernández
- Department of Urology, Clínica Alemana de Santiago, Santiago, Chile. .,Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.
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14
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Rosiello G, Piazza P, Puliatti S, Mazzone E, Amato M, Tames V, Farinha R, De Groote R, Berquin C, Develtere D, Sinatti C, Larcher A, Capitanio U, D'Hondt F, Schatteman P, Briganti A, Montorsi F, De Naeyer G, Mottrie A. Simplified PADUA renal (SPARE) nephrometry score validation and long-term outcomes after robot-assisted partial nephrectomy. Urol Oncol 2021; 40:65.e1-65.e9. [PMID: 34824015 DOI: 10.1016/j.urolonc.2021.09.021] [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: 06/16/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND International guidelines suggest the use of anatomic scores to predict surgical outcomes after partial nephrectomy (PN). We aimed at validating the use of Simplified PADUA Renal (SPARE) nephrometry score in robot-assisted PN (RAPN). MATERIALS AND METHODS Three hundred and sixty-eight consecutive RAPN patients were included. Primary endpoints were overall complications, postoperative acute kidney injury (AKI) and TRIFECTA achievement. Secondary endpoint was estimated glomerular filtration rate (eGFR) decrease at last follow-up. Multivariable logistic and linear regression models were used. RESULTS Of 368 patients, 229 (62%) vs. 116 (31%) vs. 23 (6.2%) harboured low- vs. intermediate- vs. high-risk renal mass, according to SPARE classification. SPARE score predicted higher risk of overall complications (Odds ratio [OR]: 1.23, 95%CI 1.09-1.39; P < 0.001), and postoperative AKI (OR: 1.20, 95%CI 1.08-1.35; P < 0.01). Moreover, SPARE score was associated with lower TRIFECTA achievement (OR: 0.89, 95%CI 0.81-0.98; P = 0.02). Predicted accuracy was 0.643, 0.614 and 0.613, respectively. After a median follow-up of 40 (IQR: 21-66) months, eGFR decrease ranged from -7% in low-risk to -17% in high-risk SPARE. CONCLUSIONS SPARE scoring system predicts surgical success in RAPN patients. Moreover, SPARE score is associated with eGFR decrease at long-term follow-up. Thus, the adoption of SPARE score to objectively assess tumor complexity prior to RAPN may be preferable.
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Affiliation(s)
- Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium.
| | - Pietro Piazza
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Bologna, Bologna, Italy
| | - Stefano Puliatti
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Elio Mazzone
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Amato
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Victor Tames
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, Bellvitge University Hospital, Barcelona, Spain
| | - Rui Farinha
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Camille Berquin
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Dries Develtere
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Celine Sinatti
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Capitanio
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Frederiek D'Hondt
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Peter Schatteman
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
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15
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Chowdhury A, Tan LGL, Chiong E, Rha KH, Tiong HY. Transitioning to robotic partial nephrectomy with a team-based proctorship achieves the desired improved outcomes over open and laparoscopic partial nephrectomy. Updates Surg 2021; 73:1189-1196. [PMID: 33891279 DOI: 10.1007/s13304-021-01028-0] [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: 10/26/2020] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
Proctoring may facilitate a safe transition to robotic-assisted partial nephrectomy (RAPN) for centres performing open (OPN) and laparoscopic partial nephrectomies (LPN). This study compared the 5-year outcomes of RAPN, initiated with a team-based proctorship, with OPN and LPN. Following an observation course at the proctor's institution and a 3-surgeon performance of proctored RAPN in August 2014, a review of 90 RAPN, 29 LPN and 43 OPN consecutively performed by the same team from 2013 to 2019 at National University Hospital, Singapore was conducted. Peri-operative data, functional and oncological outcomes were compared amongst the three groups. Most cases were performed robotically after 2015 with comparable baseline characteristics in all groups. Median RENAL Nephrometry Score was not significantly different between RAPN (8 [IQR 6, 9]) and OPN (9 [IQR 7, 10]) (P = 0.12) but was significantly lower for LPN (7 [IQR 5, 8]) compared to RAPN (P = 0.002). RAPN achieved the lowest blood loss (226 ml vs.348 ml and 263 ml for OPN and LPN respectively, P = 0.02), transfusion rate (3% vs.21% and 17% respectively, P = 0.003) and median length of stay after surgery (4 vs.6 and 5 days respectively, P = 0.001). Complication rates, warm ischemic times were similar between the three approaches with no differences in 1-year and long-term renal function. The rate of positive surgical margin was 8%, 8% and 3% for RAPN, LPN and OPN, respectively (P = 0.76), with a single recurrence in each arm. Despite modest hospital volume, a team-based proctorship facilitated the transition to the Da Vinci robotic platform to perform partial nephrectomies of equivalent complexities as open surgery, achieving improved perioperative outcomes, while maintaining oncological and kidney functional results.
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Affiliation(s)
- Asrif Chowdhury
- Department of Urology, National University Hospital, 5 Kent Ridge Road, Singapore, 119228, Singapore
| | - Lincoln Guan Lim Tan
- Department of Urology, National University Hospital, 5 Kent Ridge Road, Singapore, 119228, Singapore
| | - Edmund Chiong
- Department of Urology, National University Hospital, 5 Kent Ridge Road, Singapore, 119228, Singapore
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Severance Hospital, Yongsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, 5 Kent Ridge Road, Singapore, 119228, Singapore.
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16
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Carbonara U, Simone G, Capitanio U, Minervini A, Fiori C, Larcher A, Checcucci E, Amparore D, Crocerossa F, Veccia A, Weprin S, Ditonno P, Brassetti A, Bove A, Mari A, Grosso AA, Carini M, Montorsi F, Hampton LJ, Gallucci M, Porpiglia F, Autorino R. Robot-assisted partial nephrectomy: 7-year outcomes. Minerva Urol Nephrol 2020; 73:540-543. [PMID: 33200907 DOI: 10.23736/s2724-6051.20.04151-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The role of robot-assisted partial nephrectomy (RAPN) in the management of renal masses has exponentially grown over the past 10 years. Nevertheless, data on long term outcomes of the procedure remains limited. Herein we report oncological and functional outcomes of patients who underwent RAPN for a malignant mass with a median follow-up of 7 years, the longest follow-up to date. METHODS A retrospective analysis of an international multicenter database was performed. All consecutive patients undergoing surgery between 2009 and 2013 with a minimum of 3-year follow-up and complete data on renal function were included. Demographics, surgical and perioperative outcomes were analyzed. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analysis. RESULTS Overall, our study cohort was composed of eighty-five patients with a median follow-up of 88 months. Median clinical tumor size was 3 cm, with mostly (74.1%) clinical stage T1a, and median RENAL score 6. Final histopathologic analysis revealed clear cell RCC in 76.5% of cases. PSM was present in seven patients (8.2%). Eleven overall deaths (12.9%) occurred in the cohort during the follow-up period. Two of these (2.33%) were attributed to metastatic RCC. The OS, CSS, and DFS rates were 91.7%, 97.7%, and 91.7% at 84 months, respectively. Regarding the renal functional outcomes, seventeen patients (20.1%) presented a CKD upstaging in our cohort. CONCLUSIONS Our findings show excellent 7-year oncologic and functional outcomes of the procedure, which duplicate those achieved in historical series of open and laparoscopic surgery.
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Affiliation(s)
- Umberto Carbonara
- Division of Urology, VCU Health, Richmond, VA, USA.,Department of Urology, University of Bari, Bari, Italy
| | | | - Umberto Capitanio
- Unit of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Alessandro Larcher
- Unit of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Enrico Checcucci
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | | | | | - Pasquale Ditonno
- Department of Urology, University of Bari, Bari, Italy.,Unit of Urology, Giovanni Paolo II National Cancer Institute IRCCS, Bari, Italy
| | - Aldo Brassetti
- Department of Urology, Regina Elena Institute, Rome, Italy
| | - Alfredo Bove
- Department of Urology, Regina Elena Institute, Rome, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Montorsi
- Unit of Urology, IRCCS San Raffaele Hospital, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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17
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Is partial nephrectomy safe and effective in the setting of frail comorbid patients affected by renal cell carcinoma? Insights from the RECORD 2 multicentre prospective study. Urol Oncol 2020; 39:78.e17-78.e26. [PMID: 33127300 DOI: 10.1016/j.urolonc.2020.09.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/06/2020] [Accepted: 09/14/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND To investigate the perioperative and morbidity outcomes after partial nephrectomy (PN) in patients with short life expectancy (SLE) (≥95% 10-year expected mortality (10y-EM)), to assess the main predictors of outcomes in this population and to compare these results with those of a group at the opposite upper range with long LE (LLE, ≤5% 10y-EM) relying on a multicenter Italian prospective registry of kidney surgery (the RECORD 2 project). METHODS Clinical data of 4,325 patients undergone kidney surgery were collected at 26 urological Italian Centers from 2013 to 2016. SLE was defined as a ≥95% 10y-EM (assessed using the age-adjusted Charlson comorbidity index [CCI]). A multivariable logistic regression for overall postoperative complications, acute kidney injury (AKI), positive surgical margins (SM) and ∆ estimated glomerular filtration rate (eGFR) ≥25% at 2 years from surgery was performed in patients with SLE including clinically relevant variables. Adjusted outcomes reported as mean (SD) of the 2 groups were generated using separate multivariable logistic regression models and compared. RESULTS Overall, 559 patients with SLE were selected. Patients had an ASA score ≥3 in 58.4% of cases. A clinical T1a, T1b, and T2 stage was found in 412 (74.5%), 124 (22.4%), and 17 (3.1%) patients. The median PADUA score was 7 (6-8). Surgical and medical postoperative complication rates were registered in 14.8% and 6% cases. Postoperative AKI was reported in 27.3% cases, positive surgical margins (PSM) in 9.3% cases. In this subgroup of patients, ASA score, cerebrovascular disease, surgery in low volume centers, and open surgery were independent predictors of overall complications. ASA and PADUA scores, renal clamping, resection technique and lower eGFR at baseline were independent predictors of AKI. PADUA score, open approach and resection technique were independent predictors of PSM. Cardiovascular disease, hilar clamping, and resection technique were independent predictors of eGFR decrease >25% at 2 years from surgery. Patients with SLE were compared with those with LLE (n = 302). All analyzed parameters at baseline were significantly different among the groups with the exception of cancer laterality. After adjusting for several clinical variables, the SLE group had a significantly higher risk rate of adjusted overall postoperative complication rate compared to the LLE group (20.6% ± 0.36 vs. 9.9% ± 0.65, P < 0.0001), while the overall intraoperative complications (4.1% ±0.13 vs. 2.3% ± 0.23), overall postoperative major complications (3.8% ± 0.09 vs. 1.9% ± 0.14) adjusted AKI (24.2% ± 0.37 vs. 22.6% ± 0.92), positive surgical margins (8% ± 0.22 vs. 6.4% ± 0.49), and 2-year RF loss (13.4% ± 0.17 vs. 12.4% ± 0.74). CONCLUSION In selected patients with SLE, PN is feasible with an acceptable safety profile that is overall comparable to patients with no LE limitations. While a robotic approach and surgery performed in high volume centers could reduce the risk of complications, an off-clamp approach and a SE surgical technique may decrease the risk of postoperative AKI and of longer term eGFR decrease.
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Falagario U, Veccia A, Weprin S, Albuquerque EV, Nahas WC, Carrieri G, Pansadoro V, Hampton LJ, Porpiglia F, Autorino R. Robotic-assisted surgery for the treatment of urologic cancers: recent advances. Expert Rev Med Devices 2020; 17:579-590. [PMID: 32342705 DOI: 10.1080/17434440.2020.1762487] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION As the medical field is moving toward personalized and tailored approaches, we entered the era of precision surgery for the management of genitourinary cancers1. This is facilitated by the implementation of new technologies, among which robotic surgery stands out for the significant impact in the surgical field over the last two decades. AREAS COVERED This article reviews the latest evidence on robotic surgery for the treatment of urologic cancers, including prostate, kidney, bladder, testis, and penile cancer. Functional and oncologic outcomes, new surgical techniques, new imaging modalities, and new robotic platforms are discussed. EXPERT OPINION Robotic surgery had a growing role in the management of genitourinary cancers over the past 10 years. Despite a lack of high-quality evidence comparing the effectiveness of robotic to open surgery, the robotic approach allowed a larger adoption of a minimally invasive surgical approach, translating into lower surgical morbidity and shorter hospital stay. New robotic platforms might allow to explore novel surgical approaches, and new technologies might facilitate surgical navigation and intraoperative identification of anatomical structures, allowing a more tailored and precise surgery. It is an exciting time for robotic surgery, and upcoming technological advances will offer better outcomes to urologic cancer patients.
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Affiliation(s)
- Ugo Falagario
- Division of Urology, VCU Health System , Richmond, Virginia, USA.,Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia , Foggia, Italy
| | - Alessandro Veccia
- Division of Urology, VCU Health System , Richmond, Virginia, USA.,Urology Unit, ASST Spedali Civili Hospital , Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia , Italy
| | - Samuel Weprin
- Division of Urology, VCU Health System , Richmond, Virginia, USA
| | - Emanuel V Albuquerque
- Divisão De Urologia, Faculdade De Medicina Da Universidade De São Paulo, Instituto Do Câncer De Estado De São Paulo , São Paulo, Brazil
| | - William C Nahas
- Divisão De Urologia, Faculdade De Medicina Da Universidade De São Paulo, Instituto Do Câncer De Estado De São Paulo , São Paulo, Brazil
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia , Foggia, Italy
| | - Vito Pansadoro
- Department of Urology, Vincenzo Pansadoro Foundation , Rome, Italy
| | - Lance J Hampton
- Division of Urology, VCU Health System , Richmond, Virginia, USA
| | - Francesco Porpiglia
- Division of Urology, University of Turin, San Luigi Gonzaga Hospital , Orbassano, Italy
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Rothberg MB, Peak TC, Reynolds CR, Hemal AK. Long-term oncologic outcomes of positive surgical margins following robot-assisted partial nephrectomy. Transl Androl Urol 2020; 9:879-886. [PMID: 32420203 PMCID: PMC7214993 DOI: 10.21037/tau.2019.11.21] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Previous reports on positive surgical margin (PSM) after robot-assisted partial nephrectomy (RAPN) have reached inconsistent conclusions as to the impact of a PSM on oncologic outcomes. We sought to determine the effect of PSM on long-term cancer recurrence and survival outcomes. Methods We queried our renal oncology database for patients having undergone RAPN and compared recurrence-free survival (RFS) and overall survival (OS) between patients with PSM and negative surgical margin (NSM). Kaplan-Meier analysis was also performed for RFS and OS for PSM versus NSM. Results Of the 432 patients who underwent RAPN we identified 29 (6.7%) patients with PSM and 403 (93.3%) patients with NSM. Median follow-up for the overall cohort was 45.1 months. Three of the 29 patients with PSM and fourteen of the 403 patients with NSM had disease recurrence (P=0.09). RFS at 24, 48, and 72 months was 95.8%, 90%, and 85.5% for patients with NSM and 96.6%, 86.6%, and 80.4% for patients with PSM, respectively (log-rank P value =0.382). OS at 24, 48, and 72 months was 98%, 93.1%, and 89.7% for patients with NSM and 96.3%, 91.2%, and 85.2% for patients with PSM, respectively (log-rank P value =0.584). Conclusions While PSM are relatively uncommon, their presence still serves as a potential risk factor for worse oncologic outcomes. In instances of PSM, immediate secondary intervention is most likely unnecessary and more attentive long-term clinical follow-up, especially in patients with high-risk features, may be more advisable.
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Affiliation(s)
- Michael B Rothberg
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Taylor C Peak
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Bertolo R, Campi R, Mir MC, Klatte T, Kriegmair MC, Salagierski M, Ouzaid I, Capitanio U. Systematic Review and Pooled Analysis of the Impact of Renorrhaphy Techniques on Renal Functional Outcome After Partial Nephrectomy. Eur Urol Oncol 2018; 2:572-575. [PMID: 31412012 DOI: 10.1016/j.euo.2018.11.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/19/2018] [Indexed: 01/20/2023]
Abstract
Despite the important relationship between renorrhaphy and functional outcomes of partial nephrectomy, the urological guidelines do not provide recommendations about the optimal renorrhaphy technique. We carried out the first pooled literature analysis of the impact of suture technique on ultimate renal function after partial nephrectomy. Three studies comparing interrupted versus running suture including data on glomerular filtration rate (GFR) were included, for a total of 124 versus 269 patients. No significant differences were found between pre- and postoperative GFR in either patients who received an interrupted suture (weighted mean difference, -4.88ml/min, 95% confidence interval [CI] -11.38; 1.63, p=0.14) or those who received a running suture (-3.42ml/min, 95% CI -9.96; 3.12, p=0.31). Three studies comparing single- versus double-layer renorrhaphy included data on GFR (321 vs 199 patients). A benefit in functional outcomes favored single-layer technique (-3.19ml/min, 95% CI -8.09; 1.70, p=0.2 vs -6.07ml/min, 95% CI -10.75; -1.39, p=0.01). In conclusion, our quantitative synthesis suggests a renal functional benefit of the single-layer closure during partial nephrectomy. PATIENT SUMMARY: The available studies on renal functional data included in the present review suggest that "less is more" for renorrhaphy after partial nephrectomy. The single-layer renorrhaphy technique showed advantages in renal functional outcomes compared with the double-layer technique.
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Affiliation(s)
- Riccardo Bertolo
- Department of Urology, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Riccardo Campi
- Department of Urology, University of Florence, Florence, Italy
| | - Maria Carmen Mir
- Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth and Christchurch Hospitals NHS Trust, Bournemouth, UK; Department of Surgery, University of Cambridge, Cambridge, UK
| | | | - Maciej Salagierski
- The Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland
| | - Idir Ouzaid
- Department of Urology, Bichat Hospital, APHP, Paris Diderot University, Paris, France
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
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