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Matsukawa A, Yanagisawa T, Shimizu K, Shariat SF, Kimura T, Miki J. Percutaneous cryoablation of renal cell carcinomas in patients with Von Hippel-Lindau disease: Functional and oncological outcomes. Int J Urol 2024; 31:448-451. [PMID: 38168039 DOI: 10.1111/iju.15381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Akihiro Matsukawa
- Department of Urology, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Kanichiro Shimizu
- Department of General Medicine, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
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Yoshida K, Oida N, Kondo T, Kobari Y, Ishihara H, Fukuda H, Iizuka J, Kobayashi H, Ishida H, Takagi T. Surgical and functional outcomes of repeat robot-assisted laparoscopic partial nephrectomy compared with repeat open partial nephrectomy. Int J Urol 2024; 31:355-361. [PMID: 38146740 DOI: 10.1111/iju.15369] [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: 08/05/2023] [Accepted: 12/05/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES To examine the surgical and functional outcomes of patients who have undergone repeat open partial nephrectomy (reOPN) or robot-assisted laparoscopic partial nephrectomy (reRAPN). METHODS Until May 2022, 3310 patients with renal tumors underwent nephron-sparing surgery (NSS) at affiliated institutions. Of these, 22 and 17 patients who underwent reOPN and reRAPN, respectively, were included in this study. RESULTS No significant differences were found between the groups in terms of sex, age, comorbidities, recurrent tumor size at repeat NSS, interval from recurrence to initial NSS, and nephrometry score. ReRAPN had a shorter operative time (median: 138.0 vs. 214.0 min; p = 0.0023) and less estimated blood loss (median: 50.0 vs. 255.0 mL; p = 0.0261) than reOPN. The incidence of complications with Clavien-Dindo grade ≥ 2 was higher in the reOPN group than in the reRAPN group (31.8 vs. 5.9%; p = 0.0467). The mean decrease in the estimated glomerular filtration rate at 3 months postoperatively was not significantly different between the groups. The trifecta achievement rates in the reRAPN (64.7%) and reOPN (27.3%) groups were significantly different (p = 0.0194). On multivariate analysis, age and surgical method were significant predictors of trifecta achievement after partial nephrectomy. CONCLUSIONS There were no differences in postoperative renal functional outcomes between reOPN and reRAPN. ReRAPN is superior to reOPN in terms of surgical burden. Therefore, ReRAPN is an important minimally invasive surgery for recurrent renal cell carcinoma.
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Affiliation(s)
- Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nao Oida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Yuki Kobari
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hirohito Kobayashi
- Department of Urology, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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Shi X, Yu Y, Ye T, Yu G, Xu B, Zhang Z, Wang S, Liu Z, Chen K, Wang S, Li H. Initial Experience with Hybrid Partial Nephrectomy with Ultrasound-guided Balloon Catheter Occlusion of the Renal Artery for Recurrent Renal Tumors. EUR UROL SUPPL 2024; 60:47-53. [PMID: 38333046 PMCID: PMC10850398 DOI: 10.1016/j.euros.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/10/2024] Open
Abstract
Repeat partial nephrectomy (PN) is an effective treatment in improving the prognosis for patients with recurrent renal cancer after initial PN. However, salvage PN (sPN) is inevitably associated with a higher rate of complications, largely because of intraperitoneal adhesions and fibrosis. Here we describe three initial cases for which recurrent renal tumors were treated with a novel minimally invasive approach, namely Ultrasound-guided Renal Artery Balloon catheter Occluded Hybrid Partial Nephrectomy (UBo-HPN).With laparoscopic ultrasound (LUS) guiding a Fogarty catheter to occlude the arterial blood supply, dissection of the renal hilum and most of the abdominal cavity can be avoided. UBo-HPN was successfully performed in three patients. One case of postoperative fever (Clavien-Dindo grade II) occurred, with no other complications. The mean operative time was 106 min, with a mean warm ischemia time of 21 min. UBo-HPN may be considered a safe and effective alternative for sPN, with a minimally invasive surgical footprint and better surgical outcomes.
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Affiliation(s)
- Xu Shi
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Yu
- Department of Ultrasound, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tianrun Ye
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology of Hubei Province, Wuhan, China
| | - Gan Yu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology of Hubei Province, Wuhan, China
| | - Bin Xu
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Zongbiao Zhang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology of Hubei Province, Wuhan, China
| | - Shen Wang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology of Hubei Province, Wuhan, China
| | - Zheng Liu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology of Hubei Province, Wuhan, China
| | - Ke Chen
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology of Hubei Province, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology of Hubei Province, Wuhan, China
| | - Heng Li
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology of Hubei Province, Wuhan, China
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Antony MB, Anari PY, Gopal N, Chaurasia A, Firouzabadi FD, Homayounieh F, Kozel Z, Gautam R, Gurram S, Linehan WM, Turkbey EB, Malayeri AA, Ball MW. Preoperative Renal Parenchyma Volume as a Predictor of Kidney Function Following Nephrectomy of Complex Renal Masses. EUR UROL SUPPL 2023; 57:66-73. [PMID: 38020527 PMCID: PMC10658405 DOI: 10.1016/j.euros.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background The von Hippel-Lindau disease (VHL) is a hereditary cancer syndrome with multifocal, bilateral cysts and solid tumors of the kidney. Surgical management may include multiple extirpative surgeries, which ultimately results in parenchymal volume loss and subsequent renal function decline. Recent studies have utilized parenchyma volume as an estimate of renal function prior to surgery for renal cell carcinoma; however, it is not yet validated for surgically altered kidneys with multifocal masses and complex cysts such as are present in VHL. Objective We sought to validate a magnetic resonance imaging (MRI)-based volumetric analysis with mercaptoacetyltriglycine (MAG-3) renogram and postoperative renal function. Design setting and participants We identified patients undergoing renal surgery at the National Cancer Institute from 2015 to 2020 with preoperative MRI. Renal tumors, cysts, and parenchyma of the operated kidney were segmented manually using ITK-SNAP software. Outcome measurements and statistical analysis Serum creatinine and urinalysis were assessed preoperatively, and at 3- and 12-mo follow-up time points. Estimated glomerular filtration rate (eGFR) was calculated using serum creatinine-based CKD-EPI 2021 equation. A statistical analysis was conducted on R Studio version 4.1.1. Results and limitations Preoperative MRI scans of 113 VHL patients (56% male, median age 48 yr) were evaluated between 2015 and 2021. Twelve (10.6%) patients had a solitary kidney at the time of surgery; 59 (52%) patients had at least one previous partial nephrectomy on the renal unit. Patients had a median of three (interquartile range [IQR]: 2-5) tumors and five (IQR: 0-13) cysts per kidney on imaging. The median preoperative GFR was 70 ml/min/1.73 m2 (IQR: 58-89). Preoperative split renal function derived from MAG-3 studies and MRI split renal volume were significantly correlated (r = 0.848, p < 0.001). On the multivariable analysis, total preoperative parenchymal volume, solitary kidney, and preoperative eGFR were significant independent predictors of 12-mo eGFR. When only considering patients with two kidneys undergoing partial nephrectomy, preoperative parenchymal volume and eGFR remained significant predictors of 12-mo eGFR. Conclusions A parenchyma volume analysis on preoperative MRI correlates well with renogram split function and can predict long-term renal function with added benefit of anatomic detail and ease of application. Patient summary Prior to kidney surgery, it is important to understand the contribution of each kidney to overall kidney function. Nuclear medicine scans are currently used to measure split kidney function. We demonstrated that kidney volumes on preoperative magnetic resonance imaging can also be used to estimate split kidney function before surgery, while also providing essential details of tumor and kidney anatomy.
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Affiliation(s)
- Maria B. Antony
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Pouria Y. Anari
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Nikhil Gopal
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Aditi Chaurasia
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Fatemeh Homayounieh
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Zach Kozel
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rabindra Gautam
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sandeep Gurram
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - W. Marston Linehan
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Evrim B. Turkbey
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ashkan A. Malayeri
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Mark W. Ball
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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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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Lou P, Liu S, Wang Y, Lv K, Zhou X, Li L, Zhang Y, Chen Y, Cheng J, Lu Y, Liu J. Neonatal-Tissue-Derived Extracellular Vesicle Therapy (NEXT): A Potent Strategy for Precision Regenerative Medicine. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2300602. [PMID: 37148469 DOI: 10.1002/adma.202300602] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/27/2023] [Indexed: 05/08/2023]
Abstract
Extracellular vesicle (EV)-based therapies have emerged as a promising means in regenerative medicine. However, the conventional EV therapy strategy displays some limitations, such as inefficient EV production and lack of tissue-specific repair effects. Here, it is reported that neonatal-tissue-derived EV therapy (NEXT) is a potent strategy for precision tissue repair. In brief, large amounts of EVs with higher yield/purity can be readily isolated from desired tissues with less production time/cost compared to the conventional cell-culture-based method. Moreover, source factors, such as age and tissue type, can affect the repair efficacy of such tissue-derived EVs in different tissue injury models (skin wounds and acute kidney injury), and neonatal-tissue-derived EVs show superior tissue repair potency compared with adult-tissue-derived EVs. Different age- or tissue-type-derived EVs have distinct composition (e.g., protein) signatures that are likely due to the diverse metabolic patterns of the donor tissues, which may contribute to the specific repair action modes of NEXT in different types of tissue injury. Furthermore, neonatal-tissue-derived EVs can be incorporated with bioactive materials for advanced tissue repair. This study highlights that the NEXT strategy may provide a new avenue for precision tissue repair in many types of tissue injury.
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Affiliation(s)
- Peng Lou
- Department of Nephrology and NHC Key Laboratory of Transplant Engineering and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Shuyun Liu
- Department of Nephrology and NHC Key Laboratory of Transplant Engineering and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yizhuo Wang
- Department of Nephrology and NHC Key Laboratory of Transplant Engineering and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ke Lv
- Department of Nephrology and NHC Key Laboratory of Transplant Engineering and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiyue Zhou
- Department of Nephrology and NHC Key Laboratory of Transplant Engineering and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lan Li
- Department of Nephrology and NHC Key Laboratory of Transplant Engineering and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yong Zhang
- Institutes for Systems Genetics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Younan Chen
- Department of Nephrology and NHC Key Laboratory of Transplant Engineering and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jingqiu Cheng
- Department of Nephrology and NHC Key Laboratory of Transplant Engineering and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yanrong Lu
- Department of Nephrology and NHC Key Laboratory of Transplant Engineering and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jingping Liu
- Department of Nephrology and NHC Key Laboratory of Transplant Engineering and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, China
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Osman FH, Chan VWS, Breen DJ, King A, Nielsen TK, Garnon J, Alcorn D, Lagerveld B, Graumann O, Keeley FX, Walkden M, de Kerviler É, Wah TM. Oncological and Peri-Operative Outcomes of Percutaneous Cryoablation of Renal Cell Carcinoma for Patients with Hereditary RCC Diseases-An Analysis of European Multi-Centre Prospective EuRECA Registry. Cancers (Basel) 2023; 15:3322. [PMID: 37444432 DOI: 10.3390/cancers15133322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/08/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023] Open
Abstract
This study aims to evaluate the safety, efficacy, and renal function preservation of percutaneous cryoablation (PCA) for small renal masses (SRMs) in inherited RCC syndromes. Patients with inherited T1N0M0 RCCs (<7 cm) undergoing PCA from 2015 to 2021 were identified from the European Registry for Renal Cryoablation (EuRECA). The primary outcome was local recurrence-free survival (LRFS). The secondary outcomes included technical success, peri-operative outcomes, and other oncological outcomes estimated using the Kaplan-Meier method. Simple proportions, chi-squared tests, and t-tests were used to analyse the peri-operative outcomes. A total of 68 sessions of PCA were performed in 53 patients with RCC and 85 tumours were followed-up for a mean duration of 30.4 months (SD ± 22.0). The overall technical success rate was 99%. The major post-operative complication rate was 1.7%. In total, 7.4% (2/27) of patients had >25% reduction in renal function. All oncological events were observed in VHL patients. Estimated 5-year LRFS, metastasis-free survival, cancer-specific survival, and overall survival were 96.0% (95% CI 75-99%), 96.4% (95% CI 77-99%), 90.9% (95% CI 51-99%), and 90.9% (95% CI 51-99%), respectively. PCA of RCCs for patients with hereditary RCC SRMs appears to be safe, offers low complication rates, preserves renal function, and achieves good oncological outcomes.
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Affiliation(s)
- Filzah Hanis Osman
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
| | - Vinson Wai-Shun Chan
- Leeds Institute of Medical Research, University of Leeds, Leeds LS2 9JT, UK
- Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, UK
- Division of Surgery and Interventional Science, University College London, London WC1E 6BT, UK
| | - David J Breen
- Department of Radiology, Southampton University Hospitals, Southampton SO16 6YD, UK
| | - Alexander King
- Department of Radiology, Southampton University Hospitals, Southampton SO16 6YD, UK
| | | | - Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1 Place de l'Hôpital, 67000 Strasbourg, France
| | - Des Alcorn
- Department of Interventional Radiology, Gartnavel General Hospital, Glasgow G12 0YN, UK
| | | | - Ole Graumann
- Department of Radiology, Odense University Hospital, 5000 Odense, Denmark
| | | | - Miles Walkden
- Department of Imaging, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
| | - Éric de Kerviler
- Radiology Department, Saint-Louis Hospital, AP-HP, 1 Avenue Claude-Vellefaux, 75475 Paris, CEDEX 10, France
| | - Tze Min Wah
- Leeds Institute of Medical Research, University of Leeds, Leeds LS2 9JT, UK
- Department of Diagnostic and Interventional Radiology, Institute of Oncology, St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
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Webster BR, Gopal N, Ball MW. Tumorigenesis Mechanisms Found in Hereditary Renal Cell Carcinoma: A Review. Genes (Basel) 2022; 13:2122. [PMID: 36421797 PMCID: PMC9690265 DOI: 10.3390/genes13112122] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 09/29/2023] Open
Abstract
Renal cell carcinoma is a heterogenous cancer composed of an increasing number of unique subtypes each with their own cellular and tumor behavior. The study of hereditary renal cell carcinoma, which composes just 5% of all types of tumor cases, has allowed for the elucidation of subtype-specific tumorigenesis mechanisms that can also be applied to their sporadic counterparts. This review will focus on the major forms of hereditary renal cell carcinoma and the genetic alterations contributing to their tumorigenesis, including von Hippel Lindau syndrome, Hereditary Papillary Renal Cell Carcinoma, Succinate Dehydrogenase-Deficient Renal Cell Carcinoma, Hereditary Leiomyomatosis and Renal Cell Carcinoma, BRCA Associated Protein 1 Tumor Predisposition Syndrome, Tuberous Sclerosis, Birt-Hogg-Dubé Syndrome and Translocation RCC. The mechanisms for tumorigenesis described in this review are beginning to be exploited via the utilization of novel targets to treat renal cell carcinoma in a subtype-specific fashion.
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Affiliation(s)
| | | | - Mark W. Ball
- Center for Cancer Research, Urologic Oncology Branch, National Cancer Institute/NIH, 10 Center Drive, CRC Room 2W-5940, Bethesda, MD 20892, USA
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Cinque A, Minnei R, Floris M, Trevisani F. The Clinical and Molecular Features in the VHL Renal Cancers; Close or Distant Relatives with Sporadic Clear Cell Renal Cell Carcinoma? Cancers (Basel) 2022; 14:5352. [PMID: 36358771 PMCID: PMC9657498 DOI: 10.3390/cancers14215352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 10/27/2022] [Indexed: 11/24/2022] Open
Abstract
Von Hippel-Lindau (VHL) disease is an autosomal dominant inherited cancer syndrome caused by germline mutations in the VHL tumor suppressor gene, characterized by the susceptibility to a wide array of benign and malign neoplasms, including clear-cell renal cell carcinoma. Moreover, VHL somatic inactivation is a crucial molecular event also in sporadic ccRCCs tumorigenesis. While systemic biomarkers in the VHL syndrome do not currently play a role in clinical practice, a new promising class of predictive biomarkers, microRNAs, has been increasingly studied. Lots of pan-genomic studies have deeply investigated the possible biological role of microRNAs in the development and progression of sporadic ccRCC; however, few studies have investigated the miRNA profile in VHL patients. Our review summarize all the new insights related to clinical and molecular features in VHL renal cancers, with a particular focus on the overlap with sporadic ccRCC.
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Affiliation(s)
- Alessandra Cinque
- Biorek S.r.l., San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Roberto Minnei
- Nephrology, Dialysis, and Transplantation, G. Brotzu Hospital, University of Cagliari, 09134 Cagliari, Italy
| | - Matteo Floris
- Nephrology, Dialysis, and Transplantation, G. Brotzu Hospital, University of Cagliari, 09134 Cagliari, Italy
| | - Francesco Trevisani
- Biorek S.r.l., San Raffaele Scientific Institute, 20132 Milan, Italy
- Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
- Unit of Urology, San Raffaele Scientific Institute, 20132 Milan, Italy
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10
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Sanyal SR, Arora A, Nisreen A, Mohamed K, Mohammad SK, Baruah D. Imaging Tips and Tricks in Management of Renal and Urothelial Malignancies. Indian J Radiol Imaging 2022; 32:213-223. [PMID: 35924135 PMCID: PMC9340167 DOI: 10.1055/s-0042-1744520] [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] [Indexed: 10/25/2022] Open
Abstract
AbstractManagement of urological malignancies has evolved significantly with continually changing guidelines and treatment options which demand more centralized involvement of radiology than ever before.Radiologists play a pivotal role in interpreting complex cancer scans and guiding clinical teams toward the best management options in the light of clinical profile. Management of complex uro-oncology cases is often discussed in multidisciplinary meetings which are essential checkpoints to evaluate an overall picture and formulate optimal treatment plans.The aim of this article is to provide a radiological perspective with practical guidance to fellow radiologists participating in uro-oncology multidisciplinary meetings based on commonly encountered case scenarios, updated guidelines, and cancer pathways.Crucial imaging tips with regards to renal and urinary tract cancers, upon which therapeutic decisions are made, have been condensed in this article after reviewing several complex cases from urology multidisciplinary meetings and European Association of Urology guidelines.Outline of various diagnostic and management strategies, key staging features, surveillance guidelines, and, above all, what the onco-urologists want to know from radiologists have been succinctly discussed in this article.
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Affiliation(s)
| | - Ankur Arora
- Department of Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trusst, Liverpool, United Kingdom
| | - Amin Nisreen
- Department of Radiology, Royal Preston Hospital, Preston, United Kingdom
| | - Khattab Mohamed
- Department of Radiology, Royal Preston Hospital, Preston, United Kingdom
| | | | - Deb Baruah
- Department of Radiology, Tezpur Medical College, Assam, India
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Wessendorf J, König A, Heers H, Mahnken AH. Repeat Percutaneous Radiofrequency Ablation of T1 Renal Cell Carcinomas is Safe in Patients with Von Hippel-Lindau Disease. Cardiovasc Intervent Radiol 2021; 44:2022-2025. [PMID: 34414496 PMCID: PMC8626382 DOI: 10.1007/s00270-021-02935-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/22/2021] [Indexed: 01/20/2023]
Abstract
Purpose Patients with Von Hippel-Lindau disease often develop multifocal, metachronous renal cell carcinomas which require therapy. The purpose of this retrospective single-center study is to evaluate the outcomes of radiofrequency ablation (RFA) in the treatment of renal cell carcinomas in patients with Von Hippel-Lindau disease. Materials and Methods 9 patients (4 male, 5 female, 47.9 ± 10.7 y/o) with Von Hippel-Lindau disease underwent 18 CT-guided percutaneous RFA procedures for the treatment 21 renal cell carcinomas (largest diameter: 32.9 ± 8.6 mm, cT1a: 16, cT1b: 5). Seven patients were previously treated either by partial or radical nephrectomy. Technical success, effectiveness, safety, progression-free survival, overall survival and tumor characteristics were analyzed. Results All RFA procedures were technically successful without major complications. There were 5 minor complications. No residual or recurrent tumor was seen in the ablation zone during a follow-up of 34.0 ± 18.1 months (0–58 months). No patient required dialysis during follow-up. One patient died after 63 months after the first treatment due to complications from a cerebellar hemangioblastoma. No endpoint was reached for overall or progression-free survival. Conclusions The results from this limited case series suggest that RFA of RCCs in patients with VHL is a safe and effective therapy, which can preserve sufficient renal function even after renal surgery.
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Affiliation(s)
- Joel Wessendorf
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, D, Philipps University Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Alexander König
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, D, Philipps University Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Hendrik Heers
- Department of Urology, Marburg University Hospital, D, Baldingerstrasse, 35043, Marburg, Germany
| | - Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, D, Philipps University Marburg, Baldingerstrasse, 35043, Marburg, Germany.
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12
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A 25 year perspective on the evolution and advances in an understanding of the biology, evaluation and treatment of kidney cancer. Urol Oncol 2021; 39:548-560. [PMID: 34092483 DOI: 10.1016/j.urolonc.2021.04.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 01/20/2023]
Abstract
The diagnosis, evaluation and management of patients with renal cell carcinoma has transformed in the 21st century. Utilizing biological discoveries and technological advances, the field has moved from blunt surgical and largely ineffective medical treatments, to nuanced and fine-tuned approaches based on biology, extent of disease and patient preferences. In this review we will summarize the last 25 years of progress in kidney cancer.
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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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14
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Chandrasekar T, Boorjian SA, Capitanio U, Gershman B, Mir MC, Kutikov A. Collaborative Review: Factors Influencing Treatment Decisions for Patients with a Localized Solid Renal Mass. Eur Urol 2021; 80:575-588. [PMID: 33558091 DOI: 10.1016/j.eururo.2021.01.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/15/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT With the addition of active surveillance and thermal ablation (TA) to the urologist's established repertoire of partial (PN) and radical nephrectomy (RN) as first-line management options for localized renal cell carcinoma (RCC), appropriate treatment decision-making has become increasingly nuanced. OBJECTIVE To critically review the treatment options for localized, nonrecurrent RCC; to highlight the patient, renal function, tumor, and provider factors that influence treatment decisions; and to provide a framework to conceptualize that decision-making process. EVIDENCE ACQUISITION A collaborative critical review of the medical literature was conducted. EVIDENCE SYNTHESIS We identify three key decision points when managing localized RCC: (1) decision for surveillance versus treatment, (2) decision regarding treatment modality (TA, PN, or RN), and (3) decision on surgical approach (open vs minimally invasive). In evaluating factors that influence these treatment decisions, we elaborate on patient, renal function, tumor, and provider factors that either directly or indirectly impact each decision point. As current nomograms, based on preselected patient datasets, perform poorly in prospective settings, these tools should be used with caution. Patient decision aids are an underutilized tool in decision-making. CONCLUSIONS Localized RCC requires highly nuanced treatment decision-making, balancing patient- and tumor-specific clinical variables against indirect structural influences to provide optimal patient care. PATIENT SUMMARY With expanding treatment options for localized kidney cancer, treatment decision is highly nuanced and requires shared decision-making. Patient decision aids may be helpful in the treatment discussion.
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Affiliation(s)
- Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
| | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Maria Carmen Mir
- Department of Urology, Fundación Instituto Valenciano Oncologia, Valencia, Spain
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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15
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Abstract
Partial nephrectomy (PN) is increasingly considered the gold standard treatment for localized renal cell carcinomas (RCCs) where technically feasible. The advantage of nephron-sparing surgery lies in preservation of parenchyma and hence renal function. However, this advantage is counterbalanced with increased surgical risk. In recent years with the popularization of minimally invasive partial nephrectomy (laparoscopic and robotic), the contemporary role of open PN (OPN) has changed. OPN has several advantages, particularly in complex patients such as those with a solitary kidney, multi-focal tumors, and significant surgical history, as well as providing improved application of renoprotective measures. As such, it is a technique that remains relevant in current urology practice. In this article we discuss the evidence, indications, operative considerations and surgical technique, along with the role of OPN in contemporary nephron-sparing surgery.
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Affiliation(s)
- Ellen O'Connor
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Brennan Timm
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Australia.,North Eastern Urology, Heidelberg, Australia
| | - Nathan Lawrentschuk
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Joseph Ischia
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Australia
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Abstract
PURPOSE OF REVIEW To describe current paradigms for genetic testing, screening, and treatment of patients with inherited kidney cancer syndromes. RECENT FINDINGS We describe various new aspects of hereditary kidney cancer. Recent data now support that hereditary kidney cancer may account for 5-8% of kidney cancers diagnosed. Methods of testing have evolved including the introduction of multigene next-generation sequencing panels. We continue to learn more about the natural history and management of classic hereditary cancer syndromes. New emerging conditions with lower kidney cancer penetrance have been recognized adding the growing list of syndromes associated with kidney cancer development. The surgical management strategies of enucleation remain however systemic therapy options are being explored both for localized and advanced settings. SUMMARY Genetic predisposition to kidney cancer is likely more common than once thought. Knowledge of clinical manifestation and genetic testing strategies are needed to properly identify and treat patient and their families.
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O'Connor LP, Lebastchi AH, Brems J, Wang AZ, Linehan WM, Ball MW. Salvage robotic transmesenteric off-clamp partial nephrectomy after multiple prior open kidney surgeries. Urol Case Rep 2020; 30:101135. [PMID: 32140418 PMCID: PMC7044506 DOI: 10.1016/j.eucr.2020.101135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/18/2020] [Indexed: 11/02/2022] Open
Abstract
Repeat renal surgery is technically demanding with a high morbidity rate. We describe a novel surgical approach, a salvage robotic transmesenteric off-clamp partial nephrectomy for the management of a renal cell carcinoma in a patient with a history of VHL and multiple prior renal surgeries on the affected kidney. Upon pathological review, the specimen was diagnosed as clear cell RCC, Fuhrman Grade 3, with negative surgical margins. The patient suffered no post-operative complications and had a rapid convalescence. This approach is a feasible and safe alternative in select patients with a significant history of renal surgeries and favorable anatomy.
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Affiliation(s)
- Luke P O'Connor
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amir H Lebastchi
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jacob Brems
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alex Z Wang
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - W Marston Linehan
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark W Ball
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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18
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Clinical outcomes of repeat partial nephrectomy compared to initial partial nephrectomy of a solitary kidney. Int J Clin Oncol 2020; 25:1155-1162. [PMID: 32065298 DOI: 10.1007/s10147-020-01633-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/05/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND When local recurrence of renal cell carcinoma (RCC) occurs after nephron-sparing surgery (NSS) on the ipsilateral side, some surgeons hesitate to perform reoperative surgery because of possible difficulties. We aimed to evaluate the clinical outcomes of repeat partial nephrectomy (RePN) compared with those of initial partial nephrectomy (iPN) for RCC of a solitary kidney. METHODS Until September 2017, 1671 patients with renal tumors underwent NSS. Of these, 79 patients who underwent NSS for sporadic RCC of a solitary kidney were included. Parameters were compared using the Mann-Whitney U, Pearson Chi-square, and Fisher exact tests. RESULTS Eleven patients underwent RePN and 68 underwent iPN. The RePN group had a relatively smaller tumor size (p = 0.0432), longer operative time (p = 0.0432), and higher estimated blood loss (p = 0.0002) than the iPN group. No significant differences in the other clinical factors were found between the groups. The rates of perioperative complications greater than Clavien-Dindo grade II were 18.2% and 17.6% in the RePN group and iPN group, respectively. The mean decreasing rate of estimated glomerular filtration rate was not different between the groups at 3 and 6 months postoperatively. No significant differences were found in hemodialysis-free survival (p = 0.7392) and intrarenal recurrence-free survival (p = 0.4924) between the groups. CONCLUSIONS The clinical outcomes of RePN were not significantly different compared with those of iPN for patients with sporadic RCC of a solitary kidney. RePN is technically feasible with acceptable complication and local recurrence rates with better postoperative kidney function.
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Baiocco JA, Ball MW, Pappajohn AK, Rayn KN, Bratslavsky G, Boyle SL, Linehan WM, Metwalli AR. A comparison of outcomes for standard and multiplex partial nephrectomy in a solitary kidney: The National Cancer Institute experience. Urol Oncol 2019; 37:356.e1-356.e7. [PMID: 30902489 DOI: 10.1016/j.urolonc.2019.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/04/2019] [Accepted: 02/25/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To study the short and intermediate surgical, renal functional, and oncologic outcomes of multiplex partial nephrectomy (mPN) and standard partial nephrectomy (sPN) in the setting of a solitary kidney. PATIENTS AND METHODS Review of a prospectively maintained database of patients undergoing solitary kidney partial nephrectomy at our institution was performed. Patients were stratified into 2 cohorts: mPN-where 3 or more renal tumors were resected and sPN-where 1 or 2 tumors were resected. Perioperative, renal functional, and oncological outcomes were compared. RESULTS Ninety-three patients with a solitary kidney underwent a total of 121 surgical procedures; 43 (35.5%) were sPN and 78 (64.4%) were mPN. The total and major (Clavien Grade III and IV) complication rates between sPN and mPN were similar (57.1% vs. 70.1%, P = 0.2; 31.0% vs. 35.1%, P = 0.3). At 12 months post-op, the percentage of patients with eGFR > 45 was similar in each group (sPN 87.0%, mPN 73.7%; P = 0.2), and long-term hemodialysis rates were 4.7% and 6.4%, respectively. Completion nephrectomy was performed in 2.3% of sPN and 2.6% of mPN. At a median follow-up of 40.1 months, the metastasis rate was 8.6% in the sPN group and 4.1% in the mPN group (P = 0.4). CONCLUSIONS Partial nephrectomy in the setting of a solitary kidney can effectively preserve renal function. The renal functional and oncologic outcomes were similar in sPN and mPN, with low hemodialysis rates and complication rates within the expected range of these operations. Three or more tumors in a solitary kidney should not be a contraindication for nephron sparing surgery.
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Affiliation(s)
- Joseph A Baiocco
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mark W Ball
- Department of Urology, Upstate Medical University, Syracuse, New York.
| | - Asha K Pappajohn
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Kareem N Rayn
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Shawna L Boyle
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - William M Linehan
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Adam R Metwalli
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
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20
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Systematic Review of the Management of Local Kidney Cancer Relapse. Eur Urol Oncol 2018; 1:512-523. [PMID: 31158097 DOI: 10.1016/j.euo.2018.06.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/03/2018] [Accepted: 06/15/2018] [Indexed: 12/26/2022]
Abstract
CONTEXT Management of locally recurrent renal cancer is complex. OBJECTIVE In this systematic review we analyse the available literature on the management of local renal cancer recurrence. EVIDENCE ACQUISITION A systematic search (PubMed, Web of Science, CINAHL, Clinical Trials, and Scopus) of English literature from 2000 to 2017 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. EVIDENCE SYNTHESIS The search identified 1838 articles. Of those, 36 were included in the evidence synthesis. The majority of the studies identified were retrospective and not controlled. Local recurrence after thermal ablation (TA) may be managed with repeat TA. Alternatively, salvage nephrectomy is possible. However, a higher rate of complications should be expected than after primary nephrectomy. Salvage nephrectomy and TA represent treatment options for local recurrence after partial nephrectomy. Local retroperitoneal recurrence after radical nephrectomy is ideally treated with surgical resection, for which minimally invasive approaches might be applicable to select patients. For large recurrences, addition of intraoperative radiation may improve local control. Local tumour destruction appears to be more beneficial than systemic therapy alone for local recurrences. CONCLUSIONS Management of local renal cancer relapse varies according to the clinical course and prior treatments. The available data are mainly limited to noncontrolled retrospective series. After nephron-sparing treatment, TA represents an effective treatment with low morbidity. For local recurrence after radical nephrectomy, the low-level evidence available suggests superiority of surgical excision relative to systemic therapy or best supportive care. As a consequence, surgery should be prioritised when feasible and applicable. PATIENT SUMMARY In renal cell cancer, the occurrence and management of local recurrence depend on the initial treatment. This cancer is a disease with a highly variable clinical course. After initial organ-sparing treatment, thermal ablation offers good cancer control and low rates of complications. For recurrence after radical nephrectomy, surgical excision seems to provide the best long-term cancer control and it is superior to medical therapy alone.
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21
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Baiocco JA, Metwalli AR. Multiplex Partial Nephrectomy, Repeat Partial Nephrectomy, and Salvage Partial Nephrectomy Remain the Primary Treatment in Multifocal and Hereditary Kidney Cancer. Front Oncol 2017; 7:244. [PMID: 29104862 PMCID: PMC5654838 DOI: 10.3389/fonc.2017.00244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/28/2017] [Indexed: 01/20/2023] Open
Abstract
The standard of care treatment for solitary renal cell carcinoma (RCC) tumors 4 cm or less is partial nephrectomy (PNx). However, multifocal kidney cancer presents unique challenges for treating physicians. Historically, total nephrectomy and hemodialysis with possible renal transplant later was the primary therapeutic strategy for these patients. Later, as nephron sparing surgical approaches improved, PNx became the standard of care for patients presenting with multifocal and hereditary RCC. Surgeries to remove multiple renal tumors simultaneously produce different perioperative outcomes and increased risk of complications. Due to these differences in technique and outcomes, the term multiplex partial nephrectomy (MxPNx) has been coined to designate these differences. Here, we discuss the role that MxPNx continues to play in multifocal RCC.
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Affiliation(s)
- Joseph A Baiocco
- Urologic Oncology Branch, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Adam R Metwalli
- Urologic Oncology Branch, National Institutes of Health (NIH), Bethesda, MD, United States
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22
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Watson MJ, Sidana A, Diaz AW, Siddiqui MM, Hankins RA, Bratslavsky G, Linehan WM, Metwalli AR. Repeat Robotic Partial Nephrectomy: Characteristics, Complications, and Renal Functional Outcomes. J Endourol 2016; 30:1219-1226. [PMID: 27650937 DOI: 10.1089/end.2016.0517] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Multifocal and hereditary kidney cancers often require repeated ipsilateral nephron sparing procedures with higher blood loss and complication rates compared to first time renal surgery. Consequently, many surgeons avoid minimally invasive techniques in the setting. We present the characteristics, complications, and short-term renal functional outcomes of patients who underwent a repeat robotic partial nephrectomy (rRPNx). MATERIALS AND METHODS A database was retrospectively reviewed to identify patients who underwent robotic partial nephrectomies between January 2007 and December 2013. Selection criteria for the rRPNx cohort included patients who had undergone at least two ipsilateral renal surgeries, with the second procedure being an rRPNx. All other patients comprised the initial robotic partial nephrectomy (iRPNx) group. RESULTS One hundred twenty-four patients who underwent robotic partial nephrectomy during the study period were identified. rRPNx constituted 26 (21%) of the total cases. Age of the rRPNx cohort was similar (p = 0.56), but number of tumors resected was two-fold greater in the rRPNx group (p = 0.44). Neither surgery time nor renal clamp time was significantly longer in either group (p = 0.18 and p = 0.65, respectively). Importantly, estimated blood loss (EBL) was significantly larger than in the iRPNx group (p = 0.01). Both groups had similar intravenous pain medication administration durations (p = 0.32), but postsurgical length of stay was greater for the rRPNx patients (p = 0.011). There were no significant differences in clavian complication rates (p = 0.17-0.39), with the exception of urine leak which occurred more frequently in the rRPNx group (p = 0.01). There was no difference in percent change in serum creatinine or estimated glomerular filtration rate (p = 0.89 and p = 0.67, respectively). CONCLUSIONS rRPNx is safe and feasible in select patients. EBL, postoperative lengths of stay, and urine leak were the only factors significantly associated with rRPNx compared to iRPNx. Patient 3-month follow-up revealed excellent and comparable outcomes between the two groups.
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Affiliation(s)
- Matthew J Watson
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Abhinav Sidana
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Annerleim Walton Diaz
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - M Minhaj Siddiqui
- 2 Department of Urology, University of Maryland , Baltimore, Maryland
| | - Ryan A Hankins
- 3 Department of Urology, Georgetown University Hospital , Washington, District of Columbia
| | | | - W Marston Linehan
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
| | - Adam R Metwalli
- 1 Urologic Oncology Branch, National Cancer Institute, National Institutes of Health , Bethesda, Maryland
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Sidana A, Walton-Diaz A, Truong H, Siddiqui MM, Miao N, Shih J, Mannes A, Bratslavsky G, Linehan WM, Metwalli AR. Postoperative elevation in creatine kinase and its impact on renal function in patients undergoing complex partial nephrectomy. Int Urol Nephrol 2016; 48:1047-1053. [PMID: 27093966 DOI: 10.1007/s11255-016-1284-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 03/29/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To identify the risk factors associated with development of postoperative elevation of creatine kinase (CK) and study its effect on renal function in patients who underwent complex multifocal partial nephrectomy (PN). METHODS Patients who underwent PN at National Cancer Institute between January 2007 and December 2012 were included in the study. Elevated serum CK was defined as >2000 U/L. Kidney function was assessed using serum creatinine and estimated glomerular filtration rate (eGFR). Changes were reported as percent change from preoperative values and compared using the Wilcoxon test. Regression analysis was performed to identify the predictors of elevation in CK and decline in eGFR. RESULTS From 407 total cases, 207 had adequate CK data for analysis. Median number of tumors removed was 3 (1-70). Median peak CK was 1458 (82-36,788). Forty-two percent developed CK elevation >2000 U/L. Factors associated with postoperative elevation of CK > 2000 were young age (p = 0.009), high BMI (p = 0.003) and operating room time (p < 0.001). Although CK > 2000 was associated with significantly greater decline in eGFR (37.4 vs. 20.3 %, p < 0.001) in immediate postoperative period, this change largely resolved to a much less clinically relevant (9.2 vs 3.3 %, p = 0.040) change after 3 months. On multivariate analysis, postoperative elevation in CK was not found to be an independent factor determining renal function at 3 months. CONCLUSION In our cohort, a significant proportion of patients developed CK elevations >2000 U/L. While patients with elevated CK had more decline in eGFR in immediate postoperative period, postoperative elevations of CK did not appear to impact overall long-term renal function in patients undergoing PN.
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Affiliation(s)
- Abhinav Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Annerleim Walton-Diaz
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Hong Truong
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - M Minhaj Siddiqui
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Ning Miao
- Department of Perioperative Medicine, Clinical Research Center, National Institutes of Health, Bethesda, MD
| | - Johanna Shih
- Biometric Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Andrew Mannes
- Department of Perioperative Medicine, Clinical Research Center, National Institutes of Health, Bethesda, MD
| | | | - W Marston Linehan
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Adam R Metwalli
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Bratslavsky G, Woodford MR, Daneshvar M, Mollapour M. Sixth BHD Symposium and First International Upstate Kidney Cancer Symposium: latest scientific and clinical discoveries. Oncotarget 2016; 7:15292-8. [PMID: 26933819 PMCID: PMC4941241 DOI: 10.18632/oncotarget.7733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 01/29/2016] [Indexed: 12/28/2022] Open
Abstract
The Sixth BHD Symposium and First International Upstate Kidney Cancer Symposium concluded in September 2015, in Syracuse, NY, USA. The program highlighted recent findings in a variety of areas, including drug development, therapeutics and surgical management of patients with BHD and multi-focal renal tumors, as well as multidisciplinary approaches for patients with localized, locally advanced and metastatic renal cell carcinoma.
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Affiliation(s)
- Gennady Bratslavsky
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
- Cancer Research Institute, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Mark R. Woodford
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
- Cancer Research Institute, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Biochemistry and Molecular Biology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Michael Daneshvar
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
- Cancer Research Institute, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Mehdi Mollapour
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
- Cancer Research Institute, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Biochemistry and Molecular Biology, SUNY Upstate Medical University, Syracuse, NY, USA
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Zou YU, Xu J, Zhang M. Long-term follow-up and clinical course of a rare case of von Hippel-Lindau disease: A case report and review of the literature. Oncol Lett 2016; 11:3273-3278. [PMID: 27123102 PMCID: PMC4841067 DOI: 10.3892/ol.2016.4387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/15/2016] [Indexed: 12/12/2022] Open
Abstract
von Hippel-Lindau (VHL) disease is an autosomal dominantly inherited neoplastic syndrome that increases susceptibility to a variety of benign and malignant neoplasms. It has been well documented that, despite complete excision of initial neoplasms, VHL patients may develop further lesions, in some cases many years after the initial diagnosis. Therefore, the varied and complex clinical manifestations and radiological findings of VHL are of interest. The current study is the first to describe a case of VHL disease with lateral ventricular hemangioblastomas and subsequent pancreatic neuroendocrine tumor, bilateral renal cysts and renal cell carcinoma. The complete clinical course, radiological findings, including ultrasound, computed tomography and magnetic resonance imaging (MRI), and associated pathological findings are presented. Radiology is critical in the accurate diagnosis, treatment and follow-up of VHL. Continuous close and long-term follow-up with radiological examination, particularly MRI, must be conducted in patients with VHL disease. To the best of our knowledge, the current case is a rare phenomenon that has not yet been described in the English literature.
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Affiliation(s)
- Y U Zou
- Department of Radiology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310006, P.R. China
| | - Jingjing Xu
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
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Surgical Management of Local Recurrences of Renal Cell Carcinoma. Surg Res Pract 2016; 2016:2394942. [PMID: 26925458 PMCID: PMC4746394 DOI: 10.1155/2016/2394942] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/10/2016] [Indexed: 01/20/2023] Open
Abstract
Surgical resection either in the form of radical nephrectomy or in the form of partial nephrectomy represents the mainstay options in the treatment of kidney cancer. In most instances, resecting the tumor bearing kidney or the tumor itself provides durable cancer specific survival rates. However, recurrences may rarely develop in the renal fossa or remnant kidney. Despite its rarity, locally recurrent RCC is a challenging condition in terms of the possible management options and relatively poor prognosis. If technically feasible, wide surgical excision and ensuring negative surgical margins are the most effective treatment options. Repeat surgeries (completion nephrectomy, excision of locally recurrent tumor, or repeat partial nephrectomy) may often be complicated, and perioperative morbidity is a major concern. Open approach has been extensively applied in this context and 5-year cancer specific survival rates have been reported to be around 50%. The roles of minimally invasive surgical options (laparoscopic and robotic approach) and nonsurgical alternatives (cryoablation, radiofrequency ablation) have yet to be described. In selected patients, surgical resection may have to be complemented with (neo)adjuvant radiotherapy or medical treatment.
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Abstract
PURPOSE OF REVIEW Despite the controversy surrounding the benefits of nephron-sparing surgery, multiple absolute indications for nephron-sparing surgery still exist, including the classic indications of hereditary and bilateral kidney tumors. RECENT FINDINGS Multiple genetic mutations have been identified which lead to hereditary kidney cancer conditions. These are briefly reviewed because the surgical management of hereditary kidney tumors depends on the genetic and histologic subtypes involved. Clear understanding of these hereditary conditions is crucial for proper surgical management of these tumors. SUMMARY Complex partial nephrectomy for multiple renal tumors, or multiplex partial nephrectomy, requires not only exceptional surgical skills but expertise of numerous nonsurgical methodologies, such as hands-on intraoperative ultrasonography and interpretation of multiple imaging modalities. In addition, multidisciplinary management is crucial for optimal outcomes in patient care. This review evaluates the most advanced surgical techniques and perioperative management required to successfully care for these challenging cases.
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Byler TK, Bratslavsky G. Hereditary renal cell carcinoma: genetics, clinical features, and surgical considerations. World J Urol 2014; 32:623-30. [PMID: 24710684 DOI: 10.1007/s00345-014-1287-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 03/19/2014] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Hereditary renal cancer syndromes have been described and have illuminated novel methods to treat sporadic renal cell carcinoma. In this work, we aimed to review the genetic basis, molecular pathology and clinical manifestations of hereditary syndromes, as well as outline principles of surgical management and use of targeted therapy. METHODS We performed a comprehensive review of selected peer-reviewed publications regarding hereditary renal cancer syndromes, their genetic basis, and recommendations for surgical management. RESULTS The major syndromes contributing to hereditary renal cell carcinoma are discussed along with relevant literature guiding their management. The evolving surgical and molecular treatments are discussed. CONCLUSIONS Identification of genetic basis of hereditary carcinomas provides opportunity for targeted therapy of metastatic sporadic renal cell carcinoma. Appropriate and timely surgical management of hereditary renal cancers decreases the possibility of development of metastatic disease, and allows for preservation of renal function despite the need for repeat surgical interventions.
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Affiliation(s)
- Timothy K Byler
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
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Bamps S, Calenbergh FV, Vleeschouwer SD, Loon JV, Sciot R, Legius E, Goffin J. What the neurosurgeon should know about hemangioblastoma, both sporadic and in Von Hippel-Lindau disease: A literature review. Surg Neurol Int 2013; 4:145. [PMID: 24340227 PMCID: PMC3841920 DOI: 10.4103/2152-7806.121110] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 09/28/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hemangioblastomas are associated with Von Hippel-Lindau disease (VHLD) in 10-40% of cases. Based upon a literature review we state the core features the neurosurgeon should be aware of. METHODS We performed a selective literature (Cochrane and Medline) search for hemangioblastoma, both sporadic and VHL associated. We reviewed general characteristics (epidemiology, symptomatology, diagnosis, and management) and focused on follow-up as well as screening modalities for sporadic and VHL associated lesions. RESULTS Based upon our literature search, we established guidelines for screening and follow-up in both sporadic and VHL associated hemangioblastoma patients. CONCLUSIONS Screening for retinal angiomas, abdominal masses, and pheochromocytomas as well as genetic analysis is recommended for every patient with a newly diagnosed hemangioblastoma. Follow-up is by magnetic resonance imaging (MRI) of the clinical neuronal region at 6 and at 12-24 months postoperatively. For VHL-associated hemangioblastomas yearly investigation for craniospinal hemangioblastoma by MRI and yearly screening and follow-up for retinal angiomas is recommended. Annual abdominal ultrasound with triennial computed tomography (CT) imaging for abdominal masses is postulated. Annual audiometry is to be performed for possible endolymphatic sac tumor, detailed radiographic imaging of the skull base should be performed upon abnormality in auditory testing. Investigations for cystadenomas of the epidydimis and broad ligament only are mandatory on indication. Annual investigation for pheochromocytoma is recommended.
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Affiliation(s)
- Sven Bamps
- Department of Neurosurgery, University Hospitals Leuven, Herestraat, Belgium
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Boris RS, Gupta GN, Benson JS, Linehan WM, Pinto PA, Bratslavsky G. Feasibility and outcomes of laparoscopic renal intervention after prior open ipsilateral retroperitoneal surgery. J Endourol 2013; 27:196-201. [PMID: 22963658 DOI: 10.1089/end.2012.0483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND PURPOSE Treating patients with renal-cell carcinoma (RCC) after previous retroperitoneal surgery (renal or adrenal) is technically challenging. We present our initial experience with laparoscopic renal interventions (LRI) after previous open retroperitoneal surgery in patients needing ipsilateral renal intervention. We report on feasibility, functional and oncologic outcomes of LRI after previous open retroperitoneal surgery. PATIENTS AND METHODS We reviewed records of patients undergoing attempted laparoscopic or robot-assisted renal intervention after at least one previous open ipsilateral retroperitoneal surgery. We identified 34 patients who underwent 39 staged attempted LRI after 48 previous open ipsilateral renal or adrenal surgeries. The LRI included 20 minimally invasive partial nephrectomies (MIPN), 11 laparoscopic radiofrequency ablations (LRFA), and 8 laparoscopic nephrectomies (LTN). Demographic, perioperative, renal functional, and oncologic outcome data were collected. Statistical analyses were performed to identify risks for conversion to open surgery. RESULTS No attempted nephron-sparing procedure resulted in kidney loss. Overall conversion rate of the cohort was 28% and was highest in the MIPN group (40%). On univariate analysis, only multiple tumors that were treated significantly increased chances of open conversion (P<0.01). Subset analysis demonstrated similar rates of blood loss, operative times, and conversion rates in patients undergoing partial nephrectomy having previous open partial nephrectomy compared with previous open adrenal surgery only. There was no significant difference in preservation of renal function between MIPN and LRFA, with more than 85% of preoperative renal function preserved. Mean follow-up of 11.9 months (range 1-97.5 mos) metastasis-free survival and overall survival was 94.1% and 97%, respectively. CONCLUSIONS LRI after previous open ipsilateral retroperitoneal surgery is feasible. Repeated partial nephrectomy has the highest conversion risks among the laparoscopic renal interventions and appears to be independent of previous renal or adrenal procedure. Attempting repeated LRI for multiple tumors is a significant risk factor for open conversion. Renal functional and oncologic outcomes are encouraging at early follow-up.
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Affiliation(s)
- Ronald S Boris
- National Institutes of Health, National Cancer Institute, Urologic Oncology Branch, Bethesda, Maryand, USA
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31
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Nephron sparing surgery in von Hippel-Lindau associated renal cell carcinoma; clinicopathological long-term follow-up. Fam Cancer 2013; 11:387-94. [PMID: 22426863 DOI: 10.1007/s10689-012-9525-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We evaluated the clinicopathological outcome of von Hippel-Lindau (VHL)-patients who had mainly undergone nephron sparing surgery (NSS) for renal cell carcinoma (RCC) when the tumour diameter has reached 4.0 cm. Multiple, bilateral RCC with high recurrence rates and subsequent repeated interventions, followed by increasing risk for end-stage renal failure and metastases is characteristic for VHL. NSS is widely used for VHL-associated RCC at 3.0 cm cut-off. 54 VHL patients underwent NSS, nephrectomy or thermal ablation for RCC. We analysed time to second treatment, overall and cancer specific survival, intra- and post-operative data as well as tumour characteristics. We also examined the effects of delaying removal of RCC to 4.0 cm cut-off. Median follow-up was 67 months. 54 patients underwent 97 kidney treatments. 96 % of first and 67 % of second interventions comprised of NSS. 0 % metastases were observed in the group with largest tumour size ≤4 cm. The probability for second surgery was 21 %, at 5 years and 42 % at 10 years. Median time to second NSS was 149.6 months. The overall and cancer specific survival rate was 96.5 and 100 % at 5-year follow-up, and 82.5 and 90.5 % respectively at 10-year follow-up. Median delay to second NSS at 4.0 cm cut-off versus 3.0 cm was 27.8 months. NSS was both successfully used in first and second surgery and to some extent even in third surgery. By following a strict surveillance protocol it is possible to support a 4.0 cm-threshold strategy for NSS, based on the assumption that delaying time to second NSS prevents patients from premature renal failure.
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Park BK, Kim CK, Park SY, Shen SH. Percutaneous radiofrequency ablation of renal cell carcinomas in patients with von Hippel Lindau disease: indications, techniques, complications, and outcomes. Acta Radiol 2013; 54:418-27. [PMID: 23446745 DOI: 10.1177/0284185113475441] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Renal cell carcinoma (RCC) in patients with von Hippel Lindau (VHL) disease tends to be multifocal, bilateral, and recur or develop new tumors after removal. These characteristics make treating hereditary RCCs difficult for urologists or radiologists compared to treating a sporadic RCC. Radiofrequency ablation (RFA) is a minimally-invasive treatment for small hereditary RCCs associated with a low complication rate and a minimal decrease in renal function. No RFA guidelines have been established about what to treat and when and how to ablate RCCs in patients with VHL disease. Besides, reports on complications and treatment outcomes in this patient group are rare. The purpose of this review is to discuss the indications, techniques, complications, and outcomes of RFA in treating RCC in patients with VHL disease.
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Affiliation(s)
- Byung Kwan Park
- The Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Kyo Kim
- The Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Yoon Park
- The Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shu-Huei Shen
- The Department of Radiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan
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Singer EA, Vourganti S, Lin K, Gupta GN, Pinto PA, Rastinehad AR, Linehan WM, Bratslavsky G. Outcomes of patients with surgically treated bilateral renal masses and a minimum of 10 years of followup. J Urol 2012; 188:2084-8. [PMID: 23083858 PMCID: PMC3810017 DOI: 10.1016/j.juro.2012.08.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Indexed: 12/15/2022]
Abstract
PURPOSE Nephron sparing surgery has been advocated for patients with bilateral renal masses but long-term functional and oncological outcomes are lacking. We report the outcomes of patients with bilateral renal masses and a minimum 10-year followup. MATERIALS AND METHODS Patients with bilateral renal masses evaluated at our institution who were treated with initial surgery at least 10 years ago and underwent interventions on each renal unit were included in the analysis. Collected data included demographics, hereditary diagnosis, number of renal interventions, renal function and mortality status. Overall and renal cell carcinoma specific survival was assessed. Comparisons were made of renal function and overall survival between groups with 2 renal units and a surgically solitary kidney. RESULTS A total of 128 patients met study inclusion criteria. Median followup in our cohort was 16 years (mean 17, range 10 to 49). The median number of surgical interventions was 3 (range 2 to 10). Of the patients 87 (68%) required repeat interventions on the ipsilateral renal unit at last followup with a median of 6.2 years (range 0.7 to 21) between interventions. Overall and renal cell cancer specific survival was 88% and 97%, respectively. Six patients (4.7%) ultimately underwent bilateral nephrectomy. Although renal function was better preserved in patients with 2 kidneys (70 vs 53 ml/minute/1.73 m(2), p = 0.0002), there was no difference in overall survival between those with bilateral kidneys or a surgically solitary kidney. CONCLUSIONS At a minimum 10-year followup after initial surgery, nephron sparing surgery allowed for excellent oncological and functional outcomes. Despite the need for repeat surgical interventions, nephron sparing surgery enabled dialysis to be avoided in more than 95% of patients.
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Affiliation(s)
- Eric A. Singer
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Srinivas Vourganti
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kelly Lin
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gopal N. Gupta
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A. Pinto
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ardeshir R. Rastinehad
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - W. Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gennady Bratslavsky
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Urology, Upstate Medical University, Syracuse, NY
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Zhang J, Pan JH, Dong BJ, Xue W, Liu DM, Huang YR. Active surveillance of renal masses in von Hippel-Lindau disease: growth rates and clinical outcome over a median follow-up period of 56 months. Fam Cancer 2012; 11:209-14. [PMID: 22203439 DOI: 10.1007/s10689-011-9503-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
To evaluate the natural outcome of a surveillance strategy for enhancing renal masses associated with von Hippel-Lindau disease (VHL). From January 1988 to June 2011, a watchful waiting strategy was carried out in 16 cases with 42 enhancing renal masses. Clinical data were reviewed to determine tumor growth rate, subsequent interventions, and outcome of follow-up. During a median follow-up of 83 months (range, 55-279), 18 surgical interventions were performed in 13 cases; local recurrence of tumor occurred in 4 cases; 4 patients died (two of metastasis disease, one of CNS Hemangioblastomas with hemorrhage, and one of an unrelated disease) and 12 survived. The median follow-up duration for 42 renal masses was 56 months (range, 19-116 months). The mean tumor growth rate observed was 0.529 cm/year (range, 0.036-1.870 cm/year). The mean growth rate of the tumors larger than 3 cm was 0.573 cm/year, which was not significantly different from that of those smaller tumors (growth rate 0.507 cm/year, P = 0.5905). There was no significant correlation between initial tumor size and growth rate in our cohort with a correlation coefficient of 0.149(P = 0.3480). At the last follow-up, 38 (90.5%) tumors were larger than 3 cm and no metastasis disease developed among tumors ≤4 cm. Progression to metastatic disease was detected in 2 patients. The majority of the enhancing renal masses with VHL disease may still be indolent and do not metastasize during a long period of follow-up even in tumors larger than 3 cm. Metastatic potential during active surveillance appears to be low in VHL patients with Renal tumors ≤4 cm.
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Affiliation(s)
- Jin Zhang
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dong Fang Road, Shanghai, 200127, People's Republic of China
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Agochukwu NQ, Metwalli AR, Kutikov A, Pinto PA, Linehan WM, Bratslavsky G. Economic burden of repeat renal surgery on solitary kidney--do the ends justify the means? A cost analysis. J Urol 2012; 188:1695-700. [PMID: 22998899 PMCID: PMC3817487 DOI: 10.1016/j.juro.2012.07.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Indexed: 12/29/2022]
Abstract
PURPOSE Despite the high morbidity of repeat renal surgery in patients with multifocal recurrent renal carcinoma, in most patients adequate renal function is preserved to obviate the need for dialysis. To our knowledge the economic burden of repeat renal surgery has not been evaluated. We provide a cost analysis for patients requiring repeat renal surgery on a solitary kidney. MATERIALS AND METHODS We reviewed the charts of patients treated at the National Cancer Institute who required repeat renal surgery from 1989 to 2010. Functional, oncological and surgical outcomes were evaluated and the costs of repeat renal surgery were calculated. We then compared costs in a cohort of 33 patients who underwent repeat renal surgery on a solitary kidney and in a hypothetical patient cohort treated with uncomplicated nephrectomy, fistula placement and dialysis. All costs were calculated based on Medicare reimbursement rates derived from CPT codes. Cost analysis was performed. RESULTS Despite a high 45% complication rate, 87% of patients maintained renal function that was adequate to avoid dialysis and 96% remained metastasis free at an average followup of 3.12 years (range 0.3 to 16.4). Compared to the hypothetical dialysis cohort, the financial benefit of repeat renal surgery was reached at 0.68 years. CONCLUSIONS Repeat renal surgery is a viable alternative for patients with multifocal renal cell carcinoma requiring multiple surgical interventions, especially when left with a solitary kidney. Despite the high complication rate, renal function is preserved in most patients and they have an excellent oncological outcome. The financial benefit of repeat renal surgery is reached at less than 1 year.
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Affiliation(s)
- Nnenaya Q. Agochukwu
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Adam R. Metwalli
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - W. Marston Linehan
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Gennady Bratslavsky
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY
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Sorbellini M, Bratslavsky G. Decreasing the indications for radical nephrectomy: a study of multifocal renal cell carcinoma. Front Oncol 2012; 2:84. [PMID: 22888474 PMCID: PMC3412268 DOI: 10.3389/fonc.2012.00084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 07/16/2012] [Indexed: 12/11/2022] Open
Abstract
Multifocal renal cell carcinoma (RCC) has been reported in 5-25% of cases worldwide. Although management of patients with multifocal RCC has not been clearly defined, presence of multifocal renal masses in one kidney and a normal contralateral kidney has often been considered a reason for performing radical nephrectomy. This study reviews the world literature to provide an accurate estimate of the prevalence of multifocal RCC and evaluates the oncologic outcomes of multifocal RCC after exclusion of patients with known hereditary and familial renal syndromes. A PubMed search of the literature was performed for articles in the English language using the following terms for the query: "multifocal RCC," "multifocality and RCC," "multicentric RCC," or "bilateral RCC." The references of the published articles were also reviewed for additional publications. Articles that did not specifically exclude patients with familial RCC or known hereditary RCC syndromes were excluded for estimation of multifocality prevalence and oncologic outcomes. After applying our exclusion criteria, nine articles were selected and form the basis of the current analysis. Weighted averages were used to calculate the prevalence of multifocality. Multifocal RCC was found in 6.8% of cases (373 of 5433 patients). Ipsilateral multifocality was found in 6.8% of cases. Bilateral multifocality was found in 11.7% of cases. Of all cases reported in this study, only 10% underwent partial nephrectomy. The rest of the study cohort underwent radical nephrectomy. The review of the literature showed that the use of nephron-sparing techniques in patients with multifocal disease did not compromise oncologic outcomes, despite the need for reoperation in certain cases. In conclusion, multifocal RCC remains a prevalent entity. Most clinicians still prefer to perform radical nephrectomies in these patients despite proven equivalent oncologic outcomes compared to nephron-sparing techniques. Urologists should be aware of these data when proposing treatment options to patients with multifocal RCC.
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Chen YB, Tickoo SK. Spectrum of preneoplastic and neoplastic cystic lesions of the kidney. Arch Pathol Lab Med 2012; 136:400-9. [PMID: 22458902 DOI: 10.5858/arpa.2011-0485-ra] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
CONTEXT Cystic lesions of the kidney may be accompanied by a range of neoplasms with distinct prognoses and future risks of developing additional tumors. In addition, some renal tumors, with or without accompanying renal cysts, may show a prominent cystic component. In the adult population, neoplasms occurring in a background of renal cystic diseases and cystic renal neoplasms often pose diagnostic challenges because of their many overlapping features. OBJECTIVE To review the clinicopathologic characteristics of common entities in the spectrum of neoplastic and potential preneoplastic cystic lesions encountered in adults, with an emphasis on renal cystic diseases associated with tumor development and on renal neoplasms with predominantly cystic morphology. DATA SOURCES The relevant English-language literature was reviewed, accompanied by the authors' experience at their practicing institution. CONCLUSIONS The presence of multiple renal cysts, both acquired and syndromic, can be associated with a variety of renal tumors. The morphology of the cysts and associated tumor types can help predict the genetic or acquired basis of the lesions, and particularly in specimens with no accompanying pertinent clinical history, such potential associations should be suggested in surgical pathology reports.
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Affiliation(s)
- Ying-Bei Chen
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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Iwamoto Y, Kanda H, Yamakado K, Soga N, Arima K, Takeda K, Sugimura Y. Management of renal tumors in Von Hippel-Lindau disease by percutaneous CT fluoroscopic guided radiofrequency ablation: preliminary results. Fam Cancer 2012; 10:529-34. [PMID: 21503747 DOI: 10.1007/s10689-011-9440-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We evaluated the feasibility and safety of percutaneous radiofrequency (RF) ablation of renal cell carcinomas (RCCs) in patients with Von Hippel-Lindau (VHL) disease. A total of 12 RCCs were treated by RF ablation in 7 patients with VHL disease. RF electrodes were placed under CT fluoroscopic guidance with conscious sedation. Technical success, technical effectiveness (disappearance of tumor enhancement), local tumor progression, complications and change in the estimated glomerular filtration rate (eGFR) were evaluated. A total of 9 sessions were undertaken. All procedures were performed with a planned protocol with a technical success rate of 100%. Tumor enhancement disappeared in all 12 tumors indicating a technical effectiveness rate of 100%. Local tumor progression was not found in any patient during the mean follow-up of 22 ± 11 months (range 12-46 months). There were no complications related to the RF procedures. The mean eGFR decreased from 65.3 ± 10.9 ml/min (range 48.5-77.5 ml/min) to 60.3 ± 11.3 ml/min (range, 45.8-73.4 ml/min, P < 0.03). The mean percentage decrease in eGFR after the last ablation was 7.6% (range 0-21.6%). Renal RF ablation is a safe and effective treatment for renal tumours that may allow patients with VHL disease to avoid major surgical interventions.
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Affiliation(s)
- Yoichi Iwamoto
- Department of Urologic Surgery and Andrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
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Shuch B, Linehan WM, Bratslavsky G. Repeat partial nephrectomy: surgical, functional and oncological outcomes. Curr Opin Urol 2011; 21:368-75. [PMID: 21788903 PMCID: PMC3173810 DOI: 10.1097/mou.0b013e32834964ea] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW The greater utilization of partial nephrectomy and ablative procedures has increased the incidence of patients presenting with local renal recurrence. The choice to either perform a partial or radical nephrectomy in these situations can be a challenging decision. RECENT FINDINGS Repeat and salvage partial nephrectomy, while challenging and potentially associated with increased complications, offers patients the ability to maintain excellent renal functional outcomes and promising oncologic outcomes at intermediate follow-up. SUMMARY Surgeons should be familiar with the surgical complications and the functional and oncologic outcomes of reoperative nephron-sparing surgery (NSS). Recent data and outcome analysis support utilization of these procedures in patients presenting with either local recurrence or de-novo lesions in the ipsilateral kidney.
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Affiliation(s)
| | | | - Gennady Bratslavsky
- Correspondence: Gennady Bratslavsky, M.D., Senior Staff, Urologic Oncology Branch, National Cancer Institute National Institutes of Health, 10 Center Drive MSC 1107, Building 10, CRC, Room 2W-5942, Bethesda, Maryland 20892-1107, , Tel: (301) 496-6353, Fax:(301) 480-5626
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Yang B, Autorino R, Remer EM, Laydner HK, Hillyer S, Altunrende F, White MA, Khanna R, Stein RJ, Haber GP, O'Malley CM, Kaouk JH. Probe ablation as salvage therapy for renal tumors in von Hippel-Lindau patients: the Cleveland Clinic experience with 3 years follow-up. Urol Oncol 2011; 31:686-92. [PMID: 21723752 DOI: 10.1016/j.urolonc.2011.05.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 05/10/2011] [Accepted: 05/10/2011] [Indexed: 01/20/2023]
Abstract
BACKGROUND To evaluate the efficacy and safety of probe ablative therapy as salvage treatment for renal tumor in von Hippel-Lindau (VHL) patients after previous partial nephrectomy (PN). METHODS Medical records of VHL patients undergoing probe ablative treatment for renal tumors from March 2003 to January 2010 at our institution were retrospectively analyzed. RESULTS Fourteen VHL patients who were submitted to salvage probe ablative therapy were included in the analysis. Twelve patients (85%) had a solitary kidney. Overall, 33 tumors were ablated by either percutaneous cryoablation (P-Cryo) (n of procedures = 13), radiofrequency ablation (RFA) (n = 14), and laparoscopic cryoablation (L-Cryo) (n = 3). Average maximal renal tumor diameter was 2.6 ± 1 cm. Average ablation time was 18.3 ± 2.1 minutes for P-Cryo, 36.7 ± 17 minutes for RFA, and 17.3 ± 4 minutes for L-Cryo. All procedures were successfully completed without transfusions and intraoperative complications. No early postoperative complications were recorded. Postoperative decline in renal function was minimal and not clinically significant. With a mean follow-up of 37.6 months (range 12-82), 4 patients had a suspicious recurrence on computed tomography/magnetic resonance imaging (CT/MRI) scan and in 3 of them a re-ablation was performed. Actuarial overall and cancer-specific survivals were 92% and 100%, respectively. CONCLUSIONS Probe ablative therapy seems to represent a suitable treatment option for VHL patients with a previous history of PN as it offers a repeatable operation, with a high technical success rate and causing minor changes in renal function.
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Affiliation(s)
- Bo Yang
- Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland, OH 44195, USA
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Joly D, Méjean A, Corréas JM, Timsit MO, Verkarre V, Deveaux S, Landais P, Grünfeld JP, Richard S. Progress in Nephron Sparing Therapy for Renal Cell Carcinoma and von Hippel-Lindau Disease. J Urol 2011; 185:2056-60. [DOI: 10.1016/j.juro.2011.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Dominique Joly
- Faculté de Médicine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut National de la Santé et de la Recherche Médicale U845, Hôpital Necker-Enfants Malades, Paris, France
- Centre de Référence Cancers Rares Institut National du Cancer, Prédispositions héréditaires au cancer du rein de l'adulte, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Arnaud Méjean
- Faculté de Médicine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service d'Urologie, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence Cancers Rares Institut National du Cancer, Prédispositions héréditaires au cancer du rein de l'adulte, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Jean-Michel Corréas
- Faculté de Médicine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Radiologie, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence Cancers Rares Institut National du Cancer, Prédispositions héréditaires au cancer du rein de l'adulte, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Marc-Olivier Timsit
- Faculté de Médicine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service d'Urologie, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence Cancers Rares Institut National du Cancer, Prédispositions héréditaires au cancer du rein de l'adulte, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Virginie Verkarre
- Service d'Anatomie Pathologique, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence Cancers Rares Institut National du Cancer, Prédispositions héréditaires au cancer du rein de l'adulte, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Sophie Deveaux
- Centre de Référence Cancers Rares Institut National du Cancer, Prédispositions héréditaires au cancer du rein de l'adulte, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Paul Landais
- Faculté de Médicine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Biostatistique (EA 4067), Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Pierre Grünfeld
- Faculté de Médicine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Richard
- Faculté de Médicine, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
- Service de Néphrologie, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence Cancers Rares Institut National du Cancer, Prédispositions héréditaires au cancer du rein de l'adulte, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Service d'Urologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
- Génétique Oncologique Ecole Pratique des Hautes Etudes, Institut National de la Santé et de la Recherche Médicale U753, Institut de cancérologie Gustave Roussy Villejuif, Le Kremlin-Bicêtre, France
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Fadahunsi AT, Sanford T, Linehan WM, Pinto PA, Bratslavsky G. Feasibility and outcomes of partial nephrectomy for resection of at least 20 tumors in a single renal unit. J Urol 2011; 185:49-53. [PMID: 21074206 PMCID: PMC3164501 DOI: 10.1016/j.juro.2010.09.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Indexed: 01/20/2023]
Abstract
PURPOSE Patients with hereditary renal cancer are at increased risk for recurrent bilateral multifocal tumors and may require aggressive nephron sparing surgery to prevent renal replacement therapy. We evaluated feasibility and outcomes in patients who underwent partial nephrectomy with removal of at least 20 tumors in a single renal unit at 1 setting. MATERIALS AND METHODS We retrospectively reviewed the records of 30 patients who underwent a total of 34 partial nephrectomies with removal of at least 20 tumors at our institution from 1993 to 2008. Operative reports and hospital records were reviewed for perioperative data, and renal functional and oncologic outcomes. We compared preoperative and postoperative renal function with the 2-tailed t test. RESULTS There were no deaths and only 1 renal unit was lost. A median of 26.5 tumors was removed. Median estimated blood loss was 3,500 ml and median operative time was 9 hours. Perioperative complications developed in greater than 50% of cases. There was a statistically significant decrease in the estimated glomerular filtration rate at 3 months (67 vs 59 ml/minute/1.73 m(2), p < 0.001). Only 1 patient had metastatic disease. Eight of the 34 operated kidneys required subsequent intervention during the median followup of 52 months (range 4 to 187). CONCLUSIONS Aggressive partial nephrectomy to resect multiple tumors is technically feasible. There was a significant decrease in postoperative renal function but more than 80% of preoperative renal function was preserved in this cohort except in 1 patient. Also, oncologic outcomes were encouraging at intermediate term followup.
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Affiliation(s)
- Amaka T. Fadahunsi
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Thomas Sanford
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - W. Marston Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Peter A. Pinto
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
| | - Gennady Bratslavsky
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
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Benhammou JN, Boris RS, Pacak K, Pinto PA, Linehan WM, Bratslavsky G. Functional and oncologic outcomes of partial adrenalectomy for pheochromocytoma in patients with von Hippel-Lindau syndrome after at least 5 years of followup. J Urol 2010; 184:1855-9. [PMID: 20846682 PMCID: PMC3164541 DOI: 10.1016/j.juro.2010.06.102] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Indexed: 01/20/2023]
Abstract
PURPOSE Although the safety and feasibility of partial adrenalectomy in patients with von Hippel-Lindau syndrome have been established, long-term outcomes have not been examined. In this study we evaluate the recurrence and functional outcomes in a von Hippel-Lindau syndrome cohort treated for pheochromocytoma with partial adrenalectomy with a followup of at least 5 years. MATERIALS AND METHODS We reviewed the records of patients with von Hippel-Lindau syndrome treated with partial adrenalectomy for pheochromocytoma at the National Cancer Institute. Demographic, germline mutation status, surgical indication, oncologic and functional outcome data were collected. Local recurrence was defined as radiographic evidence of recurrent tumor on the ipsilateral side of partial adrenalectomy. Patients were considered steroid dependent if they required steroids at most recent followup. RESULTS A total of 36 partial adrenalectomies for pheochromocytoma were performed in 26 patients with von Hippel-Lindau syndrome between September 1995 and December 2003. Of these cases 23 were performed open and 13 were performed laparoscopically. Prior surgical history was obtained for all patients. At a median followup of 9.25 years (range 5 to 46) metastatic pheochromocytoma had not developed in any patients. In 3 patients (11%) there were 5 local recurrences treated with surgical extirpation or active surveillance. All recurrences were asymptomatic and detected by radiographic imaging on followup. In addition, 3 of 26 patients (11%) subsequently required partial adrenalectomy for pheochromocytoma on the contralateral adrenal gland. In the entire cohort only 3 patients became steroid dependent (11%). CONCLUSIONS Outcomes of partial adrenalectomy in patients with von Hippel-Lindau syndrome with pheochromocytoma are encouraging at long-term followup and should be recommended as a primary surgical approach whenever possible. Adrenal sparing surgery can obviate the need for steroid replacement in the majority of patients. Local recurrence rates appear to be infrequent and can be managed successfully with subsequent observation or intervention.
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Affiliation(s)
| | | | | | | | | | - Gennady Bratslavsky
- Correspondence: Gennady Bratslavsky, M.D., Urologic Oncology Branch, National Cancer Institute, Building 10 Room 1-5940, Bethesda, Maryland 20892-1107, Tel: 301 496-6353, Fax: 301 402-0922,
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Abstract
Patients with bilateral multifocal renal cell carcinoma are at increased risk of developing locally recurrent or de novo tumors after nephron-sparing procedures. When dealing with recurrent renal masses the options are limited to observation, total nephrectomy, ablation, or repeat surgical intervention. The main reason for recurrence after nephron-sparing surgery is likely to be the presence of multifocal disease, which is identified in 4.3-25.0% of radical nephrectomy specimen. Bilateral renal involvement is seen in almost 90% of cases of multifocal renal carcinoma, and conversely the majority of patients with bilateral disease will have multifocal tumors. Many patients who are treated for multifocal disease, therefore, require subsequent surgical interventions. The outcome data for repeat renal interventions demonstrate reasonable functional and oncologic outcomes despite higher rates of perioperative complications. Our own results support the use of reoperative renal surgery rather than total nephrectomy and renal replacement therapy.
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Gupta GN, Peterson J, Thakore KN, Pinto PA, Linehan WM, Bratslavsky G. Oncological outcomes of partial nephrectomy for multifocal renal cell carcinoma greater than 4 cm. J Urol 2010; 184:59-63. [PMID: 20478582 PMCID: PMC3197267 DOI: 10.1016/j.juro.2010.03.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Indexed: 12/18/2022]
Abstract
PURPOSE Despite aggressive screening patients with hereditary renal cancers can present with large multifocal tumors. We present oncological outcomes in patients with hereditary renal cell carcinoma treated with partial nephrectomy for multifocal solid tumors with the largest lesion greater than 4 cm. MATERIALS AND METHODS Between 1995 and 2008 we identified 58 patients with hereditary renal cell carcinoma treated at our institution with partial nephrectomy for solid tumors greater than 4 cm. Data collected included demographic parameters, tumor size, pathological findings and laterality. Overall and metastasis-free survival was calculated based on information from the most recent followup evaluation and imaging. RESULTS The cohort included 41 patients (71%) with von Hippel-Lindau disease, 10 (17%) with Birt-Hogg-Dubé syndrome and 7 (11%) with hereditary papillary renal carcinoma. Mean age was 43.7 years (range 18 to 63) and mean largest tumor size was 5.3 cm (range 4 to 13). A mean of 6.4 kidney tumors (range 1 to 44) was resected. There was a predominance of nuclear grade 2 tumors (51 cases or 85%) and clear cell histology (44 or 73%), followed by papillary type I histology (7 or 11.7%). Overall and metastasis-free survival rates were 93% and 96.5%, respectively, at a median followup of 45 months (range 2 to 163). CONCLUSIONS Metastasis-free and overall survival of our patients is similar to that in the literature of those who undergo partial nephrectomy for T1B tumors in the sporadic population. Multifocality does not affect oncological outcomes at intermediate followup. Partial nephrectomy can be offered to patients with hereditary disease who present with multifocal tumors greater than 4 cm.
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Affiliation(s)
- Gopal N Gupta
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Tsivian M, Moreira DM, Caso JR, Mouraviev V, Madden JF, Bratslavsky G, Robertson CN, Albala DM, Polascik TJ. Predicting Occult Multifocality of Renal Cell Carcinoma. Eur Urol 2010; 58:118-26. [DOI: 10.1016/j.eururo.2010.03.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 03/05/2010] [Indexed: 01/20/2023]
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Abstract
von Hippel-Lindau disease (VHL) disease increases susceptibility to several malignancies, including renal cell carcinoma, haemangioblastomas of the central nervous system or retina and phaeochromocytomas. The VHL tumour suppressor gene, responsible for the disease, encodes for a major regulator of the hypoxic response by targeting the transcription factor hypoxia inducible factor (HIF) for degradation. In this review, we present a synopsis of clinical features of the disease and emphasise unique aspects of VHL syndrome in the paediatric population. Genotype-phenotype associations based on the risk of phaeochromocytoma have pointed to the existence of additional, HIF-independent functions of VHL that remain underexplored. We also examine the progress on these pleiotropic roles of VHL, which contribute to explain clinical features of VHL disease. These advances have important translational implications and are likely to offer a new host of therapeutic options to individuals affected by the disease in the future.
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Affiliation(s)
- Marta Barontini
- Center for Endocrinological Investigations (CEDIE), Hospital de Ninos R. Gutierrez, Buenos Aires, Argentina.
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Park BK, Kim CK. Percutaneous Radio Frequency Ablation of Renal Tumors in Patients With von Hippel-Lindau Disease: Preliminary Results. J Urol 2010; 183:1703-7. [DOI: 10.1016/j.juro.2010.01.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Byung Kwan Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Kyo Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Liu NW, Khurana K, Sudarshan S, Pinto PA, Linehan WM, Bratslavsky G. Repeat partial nephrectomy on the solitary kidney: surgical, functional and oncological outcomes. J Urol 2010; 183:1719-24. [PMID: 20299057 DOI: 10.1016/j.juro.2010.01.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Indexed: 01/20/2023]
Abstract
PURPOSE We examined outcomes in patients with recurrent or de novo renal lesions treated with repeat partial nephrectomy on a solitary kidney. MATERIALS AND METHODS We reviewed the records of patients who underwent nephron sparing surgery at the National Cancer Institute from 1989 to 2008. Patients were included in analysis if they underwent repeat partial nephrectomy on a solitary kidney. Perioperative, functional and oncological outcomes were assessed. Functional outcomes were evaluated using the Modification of Diet in Renal Disease equation for the estimated glomerular filtration rate. Oncological efficacy was examined by the need for subsequent repeat renal surgery and the development of metastatic disease. RESULTS A total of 25 patients were included in the analysis. A median of 4 tumors were resected. Median estimated blood loss was 2,400 ml and median operative time was 8.5 hours. Perioperative complications occurred in 52% of patients, including 1 death and the loss of 3 renal units. There was a decrease in the estimated glomerular filtration rate at followup visit 1 within 3 months after surgery but at 1-year followup the difference was not significant (p <0.01 and 0.12, respectively). Surgical intervention was recommended in 8 patients (38%) for recurrent or de novo tumors at a median of 36 months. The average metastasis-free survival rate in the cohort was 95% at 57 months (median 50, range 3 to 196). CONCLUSIONS Repeat partial nephrectomy in patients with solitary kidney is a high risk alternative. The complication rate is high and there is a modest decrease in renal function but most patients remain free of dialysis with acceptable oncological outcomes at intermediate followup.
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Affiliation(s)
- Nick W Liu
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-1414, USA
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