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Gupta K, Omil-Lima D, Sheyn D, Shoag J. Temporal improvements in renal surgery outcomes across surgical approaches. Int Urol Nephrol 2021; 53:1311-1316. [PMID: 33591487 DOI: 10.1007/s11255-021-02811-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/08/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate patient outcomes in a contemporary cohort of patients undergoing partial nephrectomy (PN) or radical nephrectomy (RN). METHODS The NSQIP database was used to identify patients undergoing PN or RN for renal neoplasms between 2010 and 2018. The SEER database was also queried to assess changes in tumor staging during the study period. Logistic regression was used to assess the independent relationship between surgery year and approach on postoperative complications. RESULTS Between 2010 and 2018, NSQIP captured 58,020 cases, including 26,745 (46%) PN and 31,275 (54%) RN. The proportion of PN increased annually, from 39.8% in 2010 to 48.7% in 2018. This rise in PN coincided with a decrease in the proportion of patients experiencing complications, irrespective of surgical approach (20.4% of total cases to 14.2% of total cases). While limited by a lack of information on tumor characteristics, multivariable analysis controlling for patient characteristics demonstrated that RN was associated with an increased risk of complications, OR 1.42 (95% CI 1.35-1.49). CONCLUSION Here, we report an 8.9% increase in the proportion of patients undergoing PN between 2010 and 2018, with no associated increase in perioperative morbidity/mortality. Given that there was no concurrent shift in stage or size of kidney tumors undergoing resection during the study period, these data therefore suggest markedly improved surgical technique and perioperative management nationally. Furthermore, the relative burden of complications has shifted from patients undergoing PN to those undergoing RN. Therefore PN, when technically feasible, should be increasingly considered.
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Affiliation(s)
- Karishma Gupta
- Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Danly Omil-Lima
- Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David Sheyn
- Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jonathan Shoag
- Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, USA
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2
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Russo P. Historical Perspective on Partial Nephrectomy and Renal Functional Preservation. Urology 2020; 145:314-315. [DOI: 10.1016/j.urology.2020.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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3
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Metcalf MR, Cheaib JG, Wainger J, Peña VN, Patel HD, Singla N, Pierorazio PM. Gender Differences in the Clinical Management of clinical T1a Renal Cell Carcinoma. Urology 2020; 151:129-137. [PMID: 32890618 DOI: 10.1016/j.urology.2020.08.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/16/2020] [Accepted: 08/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate gender differences in the management of clinical T1a (cT1a) renal cell carcinoma (RCC) before and after release of the AUA guidelines for management in 2009, which prioritized nephron-sparing approaches. METHODS Patients aged ≥66 years diagnosed with cT1a RCC from 2004 to 2013 in Surveillance, Epidemiology, and End Results-Medicare were analyzed. Multivariable mixed-effects logistic regression models were used to evaluate factors associated with radical nephrectomy (RN) for cT1a RCC before (2004 to 2009) and after (2010 to 2013) guidelines release. Predictors of pathologic T3 upstaging and high grade pathology in the postguidelines period were examined using multivariable logistic regression among patients who underwent RN or partial nephrectomy. RESULTS Twelve thousand four hundred and two patients with cT1a RCC were identified, 42% of whom were women. Overall, the likelihood of RN decreased postguidelines (odds ratio [OR] = 0.44, P <.001), but women were at increased odds of undergoing RN both before and after guideline release (OR = 1.27, P <.001 and OR = 1.37, P <.001, respectively) upon multivariable mixed-effects logistic regression. Tumor size >2 cm was also associated with increased likelihood of RN before and after guidelines (OR = 2.61, P <.001 and OR = 2.51, P <.001, respectively). In the postguidelines period, women had significantly lower odds of pathologic upstaging (OR = 0.75, P = .024) and harboring high grade pathology (OR = 0.71, P <.001) compared to men. CONCLUSION Gender differences persist in the management of cT1a RCC, with women having higher odds of undergoing RN, even after release of AUA guidelines and despite having lower odds of pathologic upstaging and high-grade disease.
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Affiliation(s)
- Meredith R Metcalf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Joseph G Cheaib
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julia Wainger
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vanessa N Peña
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hiten D Patel
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nirmish Singla
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
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Forbes MK, Owens EP, Wood ST, Gobe GC, Ellis RJ. Variability in surgical management of kidney cancer between urban and rural hospitals in Queensland, Australia: a population-based analysis. Transl Androl Urol 2020; 9:1210-1221. [PMID: 32676404 PMCID: PMC7354325 DOI: 10.21037/tau-19-775] [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] [Indexed: 12/03/2022] Open
Abstract
Background International guidelines recommend partial over radical nephrectomy for management of kidney tumours, due to perceived advantages of kidney function preservation. In Queensland, oncological nephrectomy is performed in both metropolitan and rural hospitals. Previous studies have shown that patients from rural areas with kidney tumours are less likely to undergo partial nephrectomy compared with those in major cities. The aim of this study was to investigate patterns of partial nephrectomy according to geographical area, and to identify patient- and health-service-level characteristics associated with partial nephrectomy. Methods All 3,799 incident kidney cancer cases in Queensland (Jan 2009 to Dec 2014) were ascertained. Patients aged <18 yrs (n=47), who did not receive surgery (n=988), or had end-stage kidney disease (ESKD) before surgery (n=17) were excluded. The final sample included 2,747 patients. Data were analysed using multivariable logistic regression in order to identify associations with partial nephrectomy. Results Of 2,747 patients, 637 (25%) underwent partial nephrectomy. The likelihood of undergoing partial nephrectomy increased with more recent year of surgery (P<0.001) and higher socioeconomic status (P<0.001). The likelihood of undergoing partial nephrectomy decreased for patients managed in lower-volume centres (P=0.004), with increasing age (P<0.001), and hospital location outside of a major city (P<0.001). Overall, the number of nephrectomies, and proportion/number of partial nephrectomies, performed in rural hospitals has increased over the study period. Conclusions Our results suggest that, although patients who are managed in major cities are more likely to undergo partial nephrectomy, likelihood of undergoing partial nephrectomy in rural centres is increasing, consistent with international best practice.
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Affiliation(s)
- Megan K Forbes
- Centre for Kidney Disease Research, University of Queensland, Translational Research Institute, Brisbane, Australia
| | - Evan P Owens
- Centre for Kidney Disease Research, University of Queensland, Translational Research Institute, Brisbane, Australia.,NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia
| | - Simon T Wood
- Centre for Kidney Disease Research, University of Queensland, Translational Research Institute, Brisbane, Australia.,Department of Urology, Princess Alexandra Hospital, Brisbane, Australia
| | - Glenda C Gobe
- Centre for Kidney Disease Research, University of Queensland, Translational Research Institute, Brisbane, Australia.,NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia.,School of Biomedical Sciences, University of Queensland, Brisbane, Australia
| | - Robert J Ellis
- Centre for Kidney Disease Research, University of Queensland, Translational Research Institute, Brisbane, Australia.,Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,School of Biomedical Sciences, University of Queensland, Brisbane, Australia
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Gobara A, Yoshizako T, Yoshida R, Nakamura M, Shiina H, Kitagaki H. T1a renal cell carcinoma on unenhanced CT: analysis of detectability and imaging features. Acta Radiol Open 2019; 8:2058460119849706. [PMID: 31205754 PMCID: PMC6535905 DOI: 10.1177/2058460119849706] [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: 12/19/2018] [Accepted: 04/15/2019] [Indexed: 12/05/2022] Open
Abstract
Background Increasing use of unenhanced computed tomography (CT) has been associated with the increasing incidental detection of renal cell carcinoma (RCC) at an earlier stage. Purpose To evaluate the characteristics in detecting and differentiating T1a RCCs on unenhanced CT. Material and Methods We retrospectively reviewed 68 patients with 68 T1a RCCs and 39 benign regions. Two radiologists interpreted the images on unenhanced axial CT and performed a blinded and independent review of T1a RCCs. The readers evaluated the presence of RCC and differentiated the detected lesions. Results The consensus of two readers detected 53 (78%) RCCs. Of the 53 detected RCCs, 42 (62%) RCCs were correctly diagnosed and 11 (16%) masses were misdiagnosed as benign. Of the 39 benign regions, 29 (74%) cysts were diagnosed correctly, but 10 (26%) cysts were misdiagnosed as malignant. The following values of the radiologists were obtained by consensus: sensitivity = 61.8% (42/68); specificity = 74.4% (29/39); positive predictive value = 80.8% (42/52); negative predictive value = 55.0% (29/55); accuracy = 66.4% (71/107). The receiver operating characteristic curve of consensus was 0.754. Inter-observer correlation was κ = 0.849. There was a significant difference in tumor size (P = 0.019) and the contour type of tumor (P = 0.0207) between correctly diagnosed RCCs and not correctly diagnosed RCCs. Conclusion Our findings showed that tumor size and contour type could affect the detection and differentiation of T1a RCC on unenhanced CT. To detect and differentiate T1a RCC on unenhanced CT is difficult. However, the findings from this study may help detection of RCCs on unenhanced CT.
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Affiliation(s)
- Aiko Gobara
- Department of Radiology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Takeshi Yoshizako
- Department of Radiology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Rika Yoshida
- Department of Radiology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Megumi Nakamura
- Department of Radiology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Hiroaki Shiina
- Department of Urology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Hajime Kitagaki
- Department of Radiology, Shimane University Faculty of Medicine, Izumo, Japan
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Vilaseca A, Guglielmetti G, Vertosick EA, Sjoberg DD, Grasso A, Benfante NE, Nguyen DP, Corradi RB, Coleman J, Russo P, Vickers AJ, Touijer KA. Value of Partial Nephrectomy for Renal Cortical Tumors of cT2 or Greater Stage: A Risk-benefit Analysis of Renal Function Preservation Versus Increased Postoperative Morbidity. Eur Urol Oncol 2019; 3:365-371. [PMID: 31411969 DOI: 10.1016/j.euo.2019.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/23/2019] [Accepted: 04/03/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Indications for partial nephrectomy (PN) have expanded to include larger tumors. Compared with radical nephrectomy (RN), PN reduces the risk of chronic kidney disease but is associated with higher morbidity. OBJECTIVE To explore whether the benefit of PN (preservation of estimated glomerular filtration rate [eGFR] ≥60ml/min/1.73m2 1yr postoperatively) over RN is offset by higher morbidity for cT2-cT3a tumors. DESIGN, SETTING, AND PARTICIPANTS A total of 1921 patients with renal cortical tumors who underwent nephrectomy between 2000 and 2012 were analyzed, with 297 having clinical stage T2 or higher disease. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable logistic regression models adjusted for age, tumor size, and comorbidities were used to calculate the risk of complications within 90d and the risk of low eGFR across a range of tumor sizes. Models were created separately for RN and PN, and the difference between risk estimates was calculated. RESULTS AND LIMITATIONS For tumors with diameters between 7 and 12cm, the risk of eGFR downgrade associated with RN was higher than the risk of complications associated with PN. The magnitude of the risk of eGFR downgrade was similar to the magnitude of complications risk across all tumor sizes. Our analysis was performed at a single institution, and used only tumor size to compare the risk and benefits of surgery. CONCLUSIONS Our study suggests that PN is associated with higher eGFR preservation than RN for cT2 or greater renal tumors. The magnitude of this advantage offsets the higher morbidity observed with PN. PATIENT SUMMARY When treating a large kidney tumor, it is difficult to decide whether it is better to remove the whole kidney or remove just the tumor. The second option improves postoperative renal function but is more complex. We tried to find whether there is a tumor size at which one technique should be used over the other.
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Affiliation(s)
- Antoni Vilaseca
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Urology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Giuliano Guglielmetti
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily A Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Angelica Grasso
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicole E Benfante
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel P Nguyen
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Renato B Corradi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karim A Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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7
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Kang HW, Seo SP, Kim WT, Yun SJ, Lee SC, Kim WJ, Hwang EC, Kang SH, Hong SH, Chung J, Kwon TG, Kim HH, Kwak C, Byun SS, Kim YJ. Trends in clinical, operative, and pathologic characteristics of surgically treated renal mass in a Korean center: A surgical series from 1988 through 2015. Investig Clin Urol 2019; 60:184-194. [PMID: 31098426 PMCID: PMC6495035 DOI: 10.4111/icu.2019.60.3.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/19/2019] [Indexed: 01/15/2023] Open
Abstract
Purpose To analyze trends over a period of 28 years in the clinical, operative, and pathologic characteristics of patients with a renal mass who underwent surgical resection in Korea. Materials and Methods Consecutive patients (n=6,231) with a renal mass who underwent surgical resection at eight Korean institutions between 1988 and 2015 were reviewed. Patients were assigned to one of three groups according to the date of surgery: group 1, 1988-1999; group 2, 2000-2009; and group 3, 2010-2015. Results Age at the time of surgery, body mass index, smoking status, incidence of diabetes and hypertension, and the number of incidentally identified renal masses increased significantly over time. The proportion of patients undergoing partial nephrectomy (PN) or minimally invasive surgery (MIS) increased sharply during the last two time periods. From 2010, the rate of robot-assisted nephrectomy rose sharply, occurring in 37.8% of MIS cases. Benign pathology was identified in 1.8% and 5.2% of cases in the middle and last periods, respectively; angiomyolipoma was the most common pathology. In later years, tumors were more often localized, although tumor grade increased. Sub-group analysis of small renal masses ≤4 cm revealed similar trends in operative and pathologic characteristics over time. Conclusions Between 1988 and 2015, there was a substantial change in the clinical, operative, and histological characteristics of patients who underwent resection of a renal mass in Korea. The most notable changes were stage migration towards localized disease and widespread use of PN and MIS.
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Affiliation(s)
- Ho Won Kang
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sung Pil Seo
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Won Tae Kim
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seok Joong Yun
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sang-Cheol Lee
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Wun-Jae Kim
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Sung-Hoo Hong
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jinsoo Chung
- Department of Urology, National Cancer Center, Goyang, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University College of Medicine, Daegu, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong-June Kim
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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Chen K, Lee A, Huang HH, Tay KJ, Sim A, Lee LS, Cheng CWS, Ng LG, Ho HSS, Yuen JSP. Evolving trends in the surgical management of renal masses over the past two decades: A contemporary picture from a large prospectively‐maintained database. Int J Urol 2019; 26:465-474. [DOI: 10.1111/iju.13909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/16/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Kenneth Chen
- Department of Urology Singapore General Hospital Singapore
| | - Alvin Lee
- Department of Urology Singapore General Hospital Singapore
| | | | - Kae Jack Tay
- Department of Urology Singapore General Hospital Singapore
| | - Allen Sim
- Department of Urology Singapore General Hospital Singapore
| | - Lui Shiong Lee
- Department of Urology Singapore General Hospital Singapore
| | | | - Lay Guat Ng
- Department of Urology Singapore General Hospital Singapore
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Autorino R, Mayer Grob B, Guruli G, Hampton LJ. Partial Versus Total Nephrectomy: Indications, Limitations, and Advantages. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Bensalah K, Albiges L, Bernhard JC, Bigot P, Bodin T, Boissier R, Correas JM, Gimel P, Hetet JF, Long JA, Nouhaud FX, Ouzaïd I, Rioux-Leclercq N, Méjean A. Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : prise en charge du cancer du rein. Prog Urol 2018; 28 Suppl 1:R5-R33. [DOI: 10.1016/j.purol.2019.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/15/2018] [Indexed: 12/15/2022]
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11
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Bensalah K, Albiges L, Bernhard JC, Bigot P, Bodin T, Boissier R, Correas JM, Gimel P, Hetet JF, Long JA, Nouhaud FX, Ouzaïd I, Rioux-Leclercq N, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : prise en charge du cancer du reinFrench ccAFU guidelines – Update 2018–2020: Management of kidney cancer. Prog Urol 2018; 28:S3-S31. [PMID: 30473002 DOI: 10.1016/j.purol.2018.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/15/2018] [Indexed: 12/15/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: DOI:10.1016/j.purol.2019.01.004.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the DOI:10.1016/j.purol.2019.01.004.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- K Bensalah
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033, Rennes cedex, France.
| | - L Albiges
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Département d'oncologie génito-urinaire, Gustave-Roussy, 94805, Villejuif cedex, France
| | - J-C Bernhard
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie et transplantation rénale, CHU de Bordeaux, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - P Bigot
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, CHU d'Angers, 4, rue Larrey, 49000, Angers, France
| | - T Bodin
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Centre d'urologie Prado-Louvain, 188, rue du Rouet, 13008, Marseille, France
| | - R Boissier
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie et transplantation rénale, CHU Conception, 147, boulevard Baille, 13005, Marseille, France
| | - J-M Correas
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'imagerie médicale (radiologie), hôpital universitaire Necker-Enfants-malades, 149, rue de Sèvres, 75015, Paris, France
| | - P Gimel
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Centre d'urologie, site Médipôle, 5, avenue Ambroise-Croizat, 66330, Cabestany, France
| | - J-F Hetet
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service de chirurgie urologique, clinique Jules-Verne, 2-4, route de Paris, 44314, Nantes, France
| | - J-A Long
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service de chirurgie urologique et de la transplantation rénale, hôpital Michallon, CHU Grenoble, boulevard de la Chantourne, 38700, La Tronche, France
| | - F-X Nouhaud
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, CHU de Rouen, 1, rue de Germont, 76000, Rouen, France
| | - I Ouzaïd
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Clinique urologique, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018, Paris, France
| | - N Rioux-Leclercq
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'anatomie et cytologie pathologiques, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033, Rennes cedex 9, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015, Paris, France
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Song E, Ma X, An R, Zhang P, Zhang X, Wang B, Shi T, Sun S. Retroperitoneal Laparoscopic Partial Nephrectomy for Tumors Larger than 7 cm in Renal Cell Carcinoma: Initial Experience of Single-Institution. J Laparoendosc Adv Surg Tech A 2017; 27:1127-1131. [PMID: 28304214 DOI: 10.1089/lap.2016.0668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Erlin Song
- Department of Urinary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, P.R. China
- Key Laboratory of Cardiovascular Medicine Research, Ministry of Education, Harbin Medical University, Harbin, P.R. China
| | - Xin Ma
- Department of Urology, Chinese PLA General Hospital/Chinese PLA Medical Academy/State Key Laboratory of Kidney Diseases, Beijing, P.R. China
| | - Ruihua An
- Department of Urinary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, P.R. China
| | - Peng Zhang
- Department of Urology, Chinese PLA General Hospital/Chinese PLA Medical Academy/State Key Laboratory of Kidney Diseases, Beijing, P.R. China
| | - Xu Zhang
- Department of Urology, Chinese PLA General Hospital/Chinese PLA Medical Academy/State Key Laboratory of Kidney Diseases, Beijing, P.R. China
| | - Baojun Wang
- Department of Urology, Chinese PLA General Hospital/Chinese PLA Medical Academy/State Key Laboratory of Kidney Diseases, Beijing, P.R. China
| | - Taoping Shi
- Department of Urology, Chinese PLA General Hospital/Chinese PLA Medical Academy/State Key Laboratory of Kidney Diseases, Beijing, P.R. China
| | - Shengkun Sun
- Department of Urology, Chinese PLA General Hospital/Chinese PLA Medical Academy/State Key Laboratory of Kidney Diseases, Beijing, P.R. China
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Partial Versus Total Nephrectomy: Indications, Limitations, and Advantages. Urol Oncol 2017. [DOI: 10.1007/978-3-319-42603-7_62-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gupta N, Patel A, Ensor J, Ahrar K, Ahrar J, Tam A, Odisio B, Huang S, Murthy R, Mahvash A, Avritscher R, McRae S, Sabir S, Wallace M, Matin S, Gupta S. Multiple Renal Artery Pseudoaneurysms in Patients Undergoing Renal Artery Embolization Following Partial Nephrectomy: Correlation with RENAL Nephrometry Scores. Cardiovasc Intervent Radiol 2016; 40:202-209. [PMID: 27681271 DOI: 10.1007/s00270-016-1473-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/19/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores. MATERIALS AND METHODS The medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization. RESULTS Twenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92 %) were symptomatic, presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n = 5) or without (n = 20) AV fistulae. Sixteen patients (64 %) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56 %). Clinical success was achieved after one (n = 22) or two (n = 3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR. CONCLUSION A majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.
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Affiliation(s)
- Nakul Gupta
- Houston Methodist Hospital, Houston, TX, USA
| | - Anish Patel
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joe Ensor
- The Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, TX, USA
| | - Kamran Ahrar
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Judy Ahrar
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Alda Tam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Bruno Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Stephen Huang
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Ravi Murthy
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Armeen Mahvash
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Rony Avritscher
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Stephen McRae
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Sharjeel Sabir
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Michael Wallace
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Surena Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanjay Gupta
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA.
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Nephron sparing surgery for renal cell carcinoma up to 7 cm in the context of guideline development: a contribution of healthcare research. World J Urol 2016; 35:753-759. [DOI: 10.1007/s00345-016-1905-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 07/22/2016] [Indexed: 01/20/2023] Open
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Patel MI, Strahan S, Bang A, Vass J, Smith DP. Predictors of surgical approach for the management of renal cell carcinoma: a population-based study from New South Wales. ANZ J Surg 2016; 87:E193-E198. [DOI: 10.1111/ans.13653] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/25/2016] [Accepted: 05/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Manish I. Patel
- Discipline of Surgery, Sydney Medical School; The University of Sydney; Sydney New South Wales Australia
- Department of Urology; Westmead Hospital; Sydney New South Wales Australia
| | - Stephen Strahan
- Department of Urology; Westmead Hospital; Sydney New South Wales Australia
| | - Albert Bang
- Cancer Research Division; NSW Cancer Council; Sydney New South Wales Australia
| | - Justin Vass
- Cancer Research Division; NSW Cancer Council; Sydney New South Wales Australia
- Royal North Shore Hospital; Sydney New South Wales Australia
| | - David P. Smith
- Cancer Research Division; NSW Cancer Council; Sydney New South Wales Australia
- Menzies Health Institute Queensland; Griffith University; Brisbane Queensland Australia
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Laguna MP. Re: Partial vs Radical Nephrectomy for T1 Renal Tumours: An Analysis from the British Association of Urological Surgeons Nephrectomy Audit. J Urol 2016; 195:1377-1379. [PMID: 27186720 DOI: 10.1016/j.juro.2016.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
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Secin FP, Castillo OA, Rozanec JJ, Featherston M, Holst P, Milfont JCA, García Marchiñena P, Jurado Navarro A, Autrán A, Rovegno AR, Faba OR, Palou J, Teixeira Dubeux V, Nuñez Bragayrac L, Sotelo R, Zequi S, Guimarães GC, Álvarez-Maestro M, Martínez-Piñeiro L, Villoldo G, Villaronga A, Abreu Clavijo D, Decia R, Frota R, Vidal-Mora I, Finkelstein D, Monzó Gardiner JI, Schatloff O, Hernández-Porrás A, Santaella-Torres F, Quesada ET, Sánchez-Salas R, Dávila H, Mavric HV. American Confederation of Urology (CAU) experience in minimally invasive partial nephrectomy. World J Urol 2016; 35:57-65. [PMID: 27137994 DOI: 10.1007/s00345-016-1837-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 04/18/2016] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To describe the perioperative and oncology outcomes in a series of laparoscopic or robotic partial nephrectomies (PN) for renal tumors treated in diverse institutions of Hispanic America from the beginning of their minimally invasive (MI) PN experience through December 2014. METHODS Seventeen institutions participated in the CAU generated a MI PN database. We estimated proportions, medians, 95 % confidence intervals, Kaplan-Meier curves, multivariate logistic and Cox regression analyses. Clavien-Dindo classification was used. RESULTS We evaluated 1501 laparoscopic (98 %) or robotic (2 %) PNs. Median age: 58 years. Median surgical time, warm ischemia and intraoperative bleeding were 150, 20 min and 200 cc. 81 % of the lesions were malignant, with clear cell histology being 65 % of the total. Median maximum tumor diameter is 2.7 cm, positive margin is 8.2 %, and median hospitalization is 3 days. One or more postoperative complication was recorded in 19.8 % of the patients: Clavien 1: 5.6 %; Clavien 2: 8.4 %; Clavien 3A: 1.5 %; Clavien 3B: 3.2 %; Clavien 4A: 1 %; Clavien 4B: 0.1 %; Clavien 5: 0 %. Bleeding was the main cause of a reoperation (5.5 %), conversion to radical nephrectomy (3 %) or open partial nephrectomy (6 %). Transfusion rate is 10 %. In multivariate analysis, RENAL nephrometry score was the only variable associated with complications (OR 1.1; 95 % CI 1.02-1.2; p = 0.02). Nineteen patients presented disease progression or died of disease in a median follow-up of 1.37 years. The 5-year progression or kidney cancer mortality-free rate was 94 % (95 % CI 90, 97). Positive margins (HR 4.98; 95 % CI 1.3-19; p = 0.02) and females (HR 5.6; 95 % CI 1.7-19; p = 0.005) were associated with disease progression or kidney cancer mortality after adjusting for maximum tumor diameter. CONCLUSION Laparoscopic PN in these centers of Hispanic America seem to have acceptable perioperative complications and short-term oncologic outcomes.
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Affiliation(s)
- Fernando P Secin
- San Lázaro and FUNDES Foundation, Buenos Aires, Argentina.
- CEMIC University Hospital, Buenos Aires, Argentina.
| | | | | | | | - Pablo Holst
- British and Austral Hospital, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | | | | | - Rene Sotelo
- Centro de Cirugía Robótica y de Invasión Mínima (C.I.M.I.), Caracas, Venezuela
| | | | | | | | | | | | | | | | | | - Rodrigo Frota
- Quinta Dor and Samaritano Hospital, Rio de Janeiro, Brazil
| | - Ivar Vidal-Mora
- Clínica INDISA and Universidad Andrés Bello, Santiago, Chile
| | | | | | - Oscar Schatloff
- Clínica INDISA and Universidad Andrés Bello, Santiago, Chile
| | | | | | | | | | - Hugo Dávila
- Hospital Universitario de Caracas, Caracas, Venezuela
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Park DS, Hong YK, Lee SR, Hwang JH, Kang MH, Oh JJ. Three-dimensional reconstructive kidney volume analyses according to the endophytic degree of tumors during open partial or radical nephrectomy. Int Braz J Urol 2016; 42:37-46. [PMID: 27120779 PMCID: PMC4811224 DOI: 10.1590/s1677-5538.ibju.2014.0417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 02/05/2015] [Indexed: 01/20/2023] Open
Abstract
Objectives To investigate the renal function outcomes and contralateral kidney volume change measured by using a 3-dimensional reconstructive method after open partial nephrectomy (PN) or open radical nephrectomy (RN) according to the endophytic degree of tumors. Materials and Methods We included 214 PN and 220 RN patients. According to the endophytic degree of the tumors, we divided patients into 3 groups. Patients were assessed for renal function and kidney volume change both preoperatively and postoperatively at 6 months. Kidney volume was calculated by using personal computer-based software. Subgroup analyses was performed for tumor >4cm. Results Larger and complex tumors were more frequent in the RN group than PN group. Among patients with exophytic and mild endophytic tumors, the mean postoperative renal function was well preserved in PN group and the mean contralateral kidney volume significantly increased in the RN compared to the PN group (PN, 145.55 to 149.98mL; 3.0% versus RN, 143.93 to 169.64mL;17.9% p=0.006). However, in fully endophytic tumors, compensatory hypertrophy of the contralateral kidney was similar between PN and RN (PN, 138.16 to 159.64mL; 15.5 % versus RN, 138.65 to 168.04mL; 21.2% p=0.416) and renal functional outcomes were similar between both groups. These results were also confirmed in tumors >4cm in size. Conclusions In fully endophytic tumors, especially large tumors, the postoperative renal function and contralateral kidney volume were similar; therefore, we should consider RN preferentially as surgical option for these tumors.
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Affiliation(s)
- Dong Soo Park
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Young Kwon Hong
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seung Ryeol Lee
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jin Ho Hwang
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Moon Hyung Kang
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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Vilaseca A, Musquera M, Nguyen D, Di Paola G, Romeo L, Melnick A, García-Cruz E, Ribal M, Huguet J, Alcaraz A. Changing patterns in the surgical management of renal masses. Actas Urol Esp 2016; 40:148-54. [PMID: 26687094 DOI: 10.1016/j.acuro.2015.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/07/2015] [Accepted: 08/08/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To describe the temporal trends in surgical techniques for the management of renal masses at a single Spanish academic institution and identify factors associated with partial nephrectomy (PN) decision. MATERIALS AND METHODS A total of 646 patients were treated by surgery for clinically localised renal masses from January 2004 to December 2012 at a tertiary referral center. Surgical techniques included open radical nephrectomy (RN), open PN, laparoscopic RN, and laparoscopic PN. Descriptive statistics were used to compare baseline characteristics and proportions of patients treated by different surgical techniques. Annual trends in the proportion of procedures performed were determined. Adjusted odds ratios (OR) and 95% confidence intervals were calculated to evaluate clinical variables predictive of PN. RESULTS During the 9-year study period, the proportion of PN relative to RN increased from 21% to 55%. With regard to surgical approach, open procedures for both RN and PN decreased gradually in favor of minimally invasive approaches (83% in 2004 to 4% in 2011-2012). While median tumor size did not significantly change over the study period, laparoscopic PN became the most commonly performed kidney procedure in 2011-2012 (49% of all procedures). Clinical variables independently predictive of partial nephrectomy were ASA score, baseline renal function and tumor size (all P<.05). CONCLUSIONS At our academic institution, temporal trends in the management of renal masses have established PN as the most common surgical option. Although PN was increasingly used over the study period, a parallel increase in minimally invasive approaches for RN and PN was seen.
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Kotb AF, Attia D, Hashad MM, Youssif TMA, Abdelkawy N, Ismail A, Elabbady A, Adel Atta M. Renal cell carcinoma: Are we attacking a different tumor over the past 10 years? Int J Health Sci (Qassim) 2016; 10:191-195. [PMID: 27103901 PMCID: PMC4825892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE There is a noticeable increase in the presentation of different types of urological malignancies at a younger age of presentation, in our institution. The objective of our study was to investigate cases presented with renal cell carcinoma, managed in the past 10 years for any possible epidemiological and cancer characteristics changes. METHODOLOGY Retrospective data collection for cases managed by our institution in the time period (2002-2012) was done. We included patients with complete data and pathologically proven renal cell carcinoma at final diagnosis. RESULTS Complete data could be retrieved for 334 patients. The mean age of cases was 43.5 years, with 279 (83%), 200 (60%) and 128 (38%) of patients younger than 60, 50 and 40 years respectively. Males and females involvement were 191 (57%) and 143 (43%) respectively. By histopathology, 200 (60%) of patients had clear cell (CC) RCC and 134 (40%) patients had non-clear cell type (papillary or chromophobe). The mean tumor size was 10.9 cm and partial nephrectomy was applied for 16% of all the cases, including 65% for cases with tumor size less than 4 cm. CONCLUSION There is a marked increase in the prevalence of renal cell carcinoma in the past 10 years, among younger age group, with higher rate for involvement of female gender. RCC is tending to present with large tumor size and more prevalence of non-clear cell histopathology. The use of partial nephrectomy is accepted for patients presented with renal mass and can safely challenge larger sized tumors.
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Affiliation(s)
- Ahmed Fouad Kotb
- Corresponding author: Ahmed Fouad Kotb; MD, MRCS, FEBU, Lecturer and Consultant of Urology, Urology Department, Alexandria University, Alexandria, Egypt. Address: Faculty of Medicine, Azarita, Sultan Hussein Street, Alexandria, Egypt. Cell phone: +2 01203021316,
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Reinstatler L, Klaassen Z, Barrett B, Terris MK, Moses KA. Body mass index and comorbidity are associated with postoperative renal function after nephrectomy. Int Braz J Urol 2016; 41:697-704. [PMID: 26401862 PMCID: PMC4756998 DOI: 10.1590/s1677-5538.ibju.2014.0383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/23/2014] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To explore the association of body mass index (BMI) and comorbidity with renal function after nephrectomy. MATERIALS AND METHODS We retrospectively analyzed 263 patients submitted to partial or radical nephrectomy from 2000-2013. Variables assessed included BMI, Charlson Comorbidity Index (CCI), race, tobacco use, tumor histology, surgical approach, Fuhrman nuclear grade, and tumor (T) classification. Glomerular filtration rate (GFR) was estimated using the Cockroft-Gault equation, adjusted for gender. Logistic regression was performed and included all interaction terms. RESULTS Median follow-up was 19.6 months (IQR 5.2, 53.7). Median preoperative GFR was 86.2 mL/min/1.73 m2 and median postoperative GFR was 68.4 mL/min/1.73 m2. BMI (OR 1.07, 95%CI 1.02-1.11), CCI (OR 1.19, 95%CI 1.04-1.37), and radical nephrectomy (OR 3.09, 95%CI 1.51-6.33) were significantly associated with a decline in renal function of ≥ 25%. CONCLUSION BMI and CCI are associated with postoperative decline in renal function after nephrectomy. Additionally, radical nephrectomy is significantly associated with decreasing renal function compared to partial nephrectomy. These findings highlight the importance of assessing patient comorbidity in the decision making process for patients presenting with a renal mass.
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Affiliation(s)
- Lael Reinstatler
- Department of Surgery, Section of Urology, Medical College of Georgia-Georgia Regents University, Augusta, GA
| | - Zachary Klaassen
- Department of Surgery, Section of Urology, Medical College of Georgia-Georgia Regents University, Augusta, GA
| | - Brittani Barrett
- Department of Surgery, Section of Urology, Medical College of Georgia-Georgia Regents University, Augusta, GA
| | - Martha K Terris
- Department of Surgery, Section of Urology, Medical College of Georgia-Georgia Regents University, Augusta, GA
| | - Kelvin A Moses
- Department of Surgery, Section of Urology, Medical College of Georgia-Georgia Regents University, Augusta, GA
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Abstract
The diagnosis and management of renal cell carcinoma have changed remarkably rapidly. Although the incidence of renal cell carcinoma has been increasing, survival has improved substantially. As incidental diagnosis of small indolent cancers has become more frequent, active surveillance, robot-assisted nephron-sparing surgical techniques, and minimally invasive procedures, such as thermal ablation, have gained popularity. Despite progression in cancer control and survival, locally advanced disease and distant metastases are still diagnosed in a notable proportion of patients. An integrated management strategy that includes surgical debulking and systemic treatment with well established targeted biological drugs has improved the care of patients. Nevertheless, uncertainties, controversies, and research questions remain. Further advances are expected from translational and clinical studies.
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Affiliation(s)
- Umberto Capitanio
- Department of Urology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Francesco Montorsi
- Division of Experimental Oncology, URI, Urological Research Institute, Renal Cancer Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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THE FACTORS THAT AFFECT THE DECISION TO PERFORM LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR SMALL RENAL TUMOR. Nihon Hinyokika Gakkai Zasshi 2016; 107:73-78. [PMID: 28442673 DOI: 10.5980/jpnjurol.107.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
(Objectives) Nephron sparing surgery (NSS) is strongly recommended for patients with T1a renal cell carcinoma (RCC) whenever surgically feasible. However, partial nephrectomy, particularly laparoscopic approach, remains underutilized in Japan compared to laparoscopic radical nephrectomy (LRN). In this study, we examined the safety and efficacy of laparoscopic partial nephrectomy (LPN) for T1a RCC compared to LRN. We also assessed the factors that affect the decision to perform LPN or LRN. (Patients and methods) From March 2001 to September 2014, 112 patients with T1a renal tumors received renal surgery at our institution. Of these, 100 patients (LPN: 36 patients, LRN: 64 patients) underwent laparoscopic surgery. Treatment outcomes including surgical and oncological outcomes among each approach were compared. In addition, multivariate analysis was performed to reveal the factors that affect the decision on surgical approach. (Results) The ratio of patients more than 75 years old and the RENAL nephrometry score were higher in LRN group than those in LPN group. Operating time was longer but renal function was well preserved in LPN group. Importantly, blood loss, intraoperative and postoperative complication rate, and oncological outcome (recurrence-free survival and overall survival) were similar in both groups. Multivariate analysis revealed that age (≥75 years old), high RENAL nephrometry score, operation period (before 2011), and the absence of Endoscopic Surgical Skill Qualification (ESSQ) in surgeon were independent predictive factors that select LRN. (Conclusions) Our data suggests that LPN for T1a renal tumor could be performed safely and the decision whether LPN or LRN were performed were associated with technical factors such as the presence of ESSQ or operation period, as well as patient's factor such as age and tumor factor such as tumor complexity.
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Meyer C, Hansen J, Becker A, Schmid M, Pradel L, Strini K, Chromecki T, Jesche-Chromecki J, Fisch M, Zigeuner R, Chun FKH. The Adoption of Nephron-Sparing Surgery in Europe - A Trend Analysis in Two Referral Centers from Austria and Germany. Urol Int 2015; 96:330-6. [PMID: 26699625 DOI: 10.1159/000442215] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 11/04/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the trends of partial nephrectomy (PN) and radical nephrectomy (RN) in 2 European tertiary referral centers with regards to guideline changes. MATERIALS AND METHODS A total of 1,573 patients who underwent RN or PN for localized (≤T2) renal cell carcinoma (RCC) were included. Logistic regression analyses assessed the predictors of PN and laparoscopy over time. RESULTS Out of the total, 1,013 patients (65.6%) were treated with RN and 560 patients (34.4%) with PN. Also, 1,233 patients (80%) had open surgery whereas 340 patients (22%) were treated with a laparoscopic approach. Laparoscopic RN and PN were performed in 216 (13.7%) and 124 (7.8%) patients, respectively. T1b tumors were 73% less likely (p < 0.001) to be treated with PN compared to T1a tumors. The odds of undergoing PN or laparoscopy in 2008-2010 relative to 2000-2001 were 6.5-fold (p < 0.001) and 36-fold higher (p < 0.001), respectively. CONCLUSIONS Tumor size and year of surgery are independent predictors of PN in our cohort. Our data exemplify the adoption of PN for RCC in tertiary care centers in Austria and Germany in line with implemented guideline changes. The utilization of PN has increased over time regardless of surgical approach. Further studies need to address the use of robot-assisted surgery and care in community hospitals.
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Affiliation(s)
- Christian Meyer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Shin SJ, Ko KJ, Kim TS, Ryoo HS, Sung HH, Jeon HG, Jeong BC, Seo SI, Lee HM, Choi HY, Jeon SS. Trends in the Use of Nephron-Sparing Surgery over 7 Years: An Analysis Using the R.E.N.A.L. Nephrometry Scoring System. PLoS One 2015; 10:e0141709. [PMID: 26599436 PMCID: PMC4657937 DOI: 10.1371/journal.pone.0141709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 10/12/2015] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To analyze trends in the use of partial nephrectomy, we evaluated which individual factors of renal nephrometry score (RNS) influenced the operative approach bi-annually from 2008 to 2014. MATERIALS AND METHODS We performed a retrospective review of renal cell carcinoma treated by surgery in 2008, 2010, 2012, and 2014. The complexity of renal masses was measured using the R.E.N.A.L. nephrometry scoring system with CT or MRI. Group comparison in terms of operation year and surgical type (partial nephrectomy versus radical nephrectomy) was performed. We developed a nomogram to quantitate the likelihood of selecting partial nephrectomy over radical nephrectomy. RESULTS A total of 1106 cases (237 in 2008, 225 in 2010, 292 in 2012, and 352 in 2014) were available for the study. Over the study period, the proportion of partial nephrectomies performed increased steadily from 21.5% in 2008 to 66.5% in 2014 (p < 0.05). Furthermore, use of partial nephrectomy increased steadily in all RNS complexity groups (low, moderate, and high) (p < 0.05). In the analysis of individual components of RNS, values of the R and N components increased statistically by year in the partial nephrectomy group (p < 0.05). Average AUC was 0.920. CONCLUSIONS The proportion of partial nephrectomies performed sharply increased over the study period. Additionally, over the study period, more partial nephrectomies were performed for renal masses of larger size and closer to the collecting system and main renal vessels. A nomogram developed based on this recent data set provides significant predictive value for surgical decision making.
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Affiliation(s)
- Seung Jea Shin
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Jin Ko
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sun Kim
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Soo Ryoo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Chopra S, Satkunasivam R, Kundavaram C, Liang G, Gill IS. Outlining the limits of partial nephrectomy. Transl Androl Urol 2015; 4:294-300. [PMID: 26236649 PMCID: PMC4520710 DOI: 10.3978/j.issn.2223-4683.2015.06.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Amongst nephron-sparing modalities, partial nephrectomy (PN) is the standard of care in the treatment of renal cell carcinoma (RCC). Despite the increasing utilization of PN, particularly propagated by robot-assisted, minimally invasive approaches for small renal masses (SRMs), the limits of PN appear to be also evolving. In this review, we sought to address the tumour stage beyond which PN may be oncologically perilous. While the evidence supports PN in the treatment of tumours < pT2a, PN may have a role in advanced or metastatic RCC. Other scenarios wherein PN has limited utility are also explored, including anatomical or surgical factors that dictate the difficulty of the case, such as prior renal surgery. Lastly, we discuss the emerging role of molecular biomarkers, specifically epigenetics, to aid in the risk stratification of SRMs and to select tumours optimally suited for PN.
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Affiliation(s)
- Sameer Chopra
- USC Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Raj Satkunasivam
- USC Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Chandan Kundavaram
- USC Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Gangning Liang
- USC Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Inderbir S Gill
- USC Institute of Urology, Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
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Lavallée LT, Tanguay S, Jewett MA, Wood L, Kapoor A, Rendon RA, Moore RB, Lacombe L, Kawakami J, Pautler SE, Drachenberg DE, Black PC, Lattouf JB, Morash C, Cagiannos I, Liu Z, Breau RH. Surgical management of stage T1 renal tumours at Canadian academic centres. Can Urol Assoc J 2015; 9:99-106. [PMID: 26085866 DOI: 10.5489/cuaj.2598] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The proportion of patients with stage 1 renal tumours receiving partial nephrectomy is considered a quality of care indicator. The objective of this study was to characterize surgical practice patterns at Canadian academic institutions for the treatment of these tumours. METHODS The Canadian Kidney Cancer Information System (CKCis) is a multicentre collaboration of 13 academic institutions in Canada. All patients with pathologic stage T1 renal tumours in CKCis were identified. Descriptive statistics were performed to characterize practice patterns over time. Associations between patient, tumour, and treatment factors with the use of partial nephrectomy were determined. RESULTS From 1988 to April 2014, 1453 patients with pathologic stage 1 renal tumours were entered in the CKCis database. Of these, 977 (67%) patients had pT1a tumours; of these, 765 (78%) received partial nephrectomy. Of the total number of patients (1453), 476 (33%) had pT1b tumours; of these, 204 (43%) received partial nephrectomy. The use of partial nephrectomy increased over time from 60% to 90% for pT1a tumours and 20% to 60% for pT1b tumours. Stage pT1b (relative risk [RR] 0.56, 95% confidence interval [CI] 0.50-0.63) and minimally invasive surgical approach (RR 0.78, 95% CI 0.73-0.84 for pT1a and RR 0.23, 95% CI 0.17-0.30 for pT1b) were associated with decreased use of partial nephrectomy. Most patient factors including age, gender, body mass index, hypertension, and renal function were not significantly associated with use of partial nephrectomy (p > 0.05). CONCLUSION Almost all pT1a and most pT1b renal tumours managed surgically at academic centres in Canada receive partial nephrectomy. The use of partial versus radical nephrectomy appears to occur independently of patient age and comorbid status, which may indicate that urologists are performing partial nephrectomy whenever technically feasible based on tumour factors. Although the ideal proportion patients receiving partial nephrectomy cannot be determined, treatment distribution observed in this cohort may indicate an achievable case distribution among experienced surgeons.
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Affiliation(s)
- Luke T Lavallée
- Division of Urology, University of Ottawa, Ottawa, ON; ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, QC
| | | | - Lori Wood
- Department of Medicine and Urology, Dalhousie University, Halifax, NS
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON
| | | | - Ronald B Moore
- Division of Urology, University of Alberta, Edmonton, AB
| | - Louis Lacombe
- Division of Urology, Université Laval, Quebec City, QC
| | - Jun Kawakami
- Division of Urology, University of Calgary, Calgary, AB
| | | | | | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | | | | | | | - Zhihui Liu
- Cancer Care Ontario, Toronto, Ontario, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON; ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
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Hadjipavlou M, Khan F, Fowler S, Joyce A, Keeley FX, Sriprasad S. Partial vs radical nephrectomy for T1 renal tumours: an analysis from the British Association of Urological Surgeons Nephrectomy Audit. BJU Int 2015; 117:62-71. [DOI: 10.1111/bju.13114] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Fahd Khan
- Department of Urology; Darent Valley Hospital; Dartford Kent UK
| | - Sarah Fowler
- British Association of Urological Surgeons; London UK
| | - Adrian Joyce
- Department of Urology; St James's University Hospital; Leeds UK
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Partial nephrectomy for renal tumors in solitary kidneys: postoperative renal function dynamics. World J Urol 2015; 33:2023-9. [PMID: 25966661 DOI: 10.1007/s00345-015-1581-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To describe renal functional outcomes after partial nephrectomy (PN) for a tumor in a solitary kidney using the estimated glomerular filtration rate eGFR (MDRD equation). PATIENTS AND METHODS A retrospective review of 103 cases of PN in a solitary kidney at Memorial Sloan-Kettering Cancer Center from December 1989 to July 2010 was conducted. The postoperative eGFR measurements were broken into three timeframes: 1-10 days after PN, 10 days-8 weeks after PN, and 4-12 months after PN. Several factors were analyzed for their impact on postoperative eGFR on univariate and multivariable analyses. To illustrate the change in eGFR after surgery over time, a univariate generalized estimating equation (GEE) model was constructed. RESULTS Median preoperative eGFR was 47 ml/min/1.72 m(2) (IQR 39, 58). Higher preoperative eGFR, younger age at the time of PN, less estimated blood loss during PN, increased time between PN and previous radical nephrectomy, and decreased arterial clamp (ischemia) time were all significantly associated with increased postoperative eGFR in the early postoperative period on multivariable analysis. Younger age and higher preoperative eGFR were the only variables significantly associated with increased postoperative eGFR at all three time points. From the GEE model, postoperative eGFR continues to rise after PN until it reaches a plateau approximately 1 month after PN without attaining preoperative levels. CONCLUSION PN for tumors in a solitary kidney is feasible and safe. In our model, non-modifiable factors predict the long-term postoperative eGFR: Young patients with healthy kidneys have superior renal functional results.
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Review of robot-assisted partial nephrectomy in modern practice. J Kidney Cancer VHL 2015; 2:30-44. [PMID: 28326257 PMCID: PMC5345538 DOI: 10.15586/jkcvhl.2015.23] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 03/27/2015] [Indexed: 01/20/2023] Open
Abstract
Partial nephrectomy (PN) is currently the standard treatment for T1 renal tumors. Minimally invasive PN offers decreased blood loss, shorter length of stay, rapid convalescence, and improved cosmesis. Due to the challenges inherent in laparoscopic partial nephrectomy, its dissemination has been stifled. Robot-assisted partial nephrectomy (RAPN) offers an intuitive platform to perform minimally invasive PN. It is one of the fastest growing robotic procedures among all surgical subspecialties. RAPN continues to improve upon the oncological and functional outcomes of renal tumor extirpative therapy. Herein, we describe the surgical technique, outcomes, and complications of RAPN.
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Lane BR, Derweesh IH, Kim HL, O'Malley R, Klink J, Ercole CE, Palazzi KL, Thomas AA, Rini BI, Campbell SC. Presurgical sunitinib reduces tumor size and may facilitate partial nephrectomy in patients with renal cell carcinoma. Urol Oncol 2014; 33:112.e15-21. [PMID: 25532471 DOI: 10.1016/j.urolonc.2014.11.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/27/2014] [Accepted: 11/13/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine whether presurgical sunitinib reduces primary renal cell carcinoma (RCC) size and facilitates partial nephrectomy (PN). METHODS Data from potential candidates for PN treated with sunitinib with primary RCC in situ were reviewed retrospectively. Primary outcome was reduction in tumor bidirectional area. RESULTS Included were 72 potential candidates for PN who received sunitinib before definitive renal surgery on 78 kidneys. Median primary tumor size was 7.2 cm (interquartile range [IQR]: 5.3-8.7 cm) before and 5.3 cm (IQR: 4.1-7.5 cm) after sunitinib treatment (P<0.0001), resulting in 32% reduction in tumor bidirectional area (IQR: 14%-46%). Downsizing occurred in 65 tumors (83%), with 15 partial responses (19%). Tumor complexity per R.E.N.A.L. score was reduced in 59%, with median posttreatment score of 9 (IQR: 8-10). Predictors of lesser tumor downsizing included clinical evidence of lymph node metastases (P<0.0001), non-clear cell histology (P = 0.0017), and higher nuclear grade (P = 0.023). Surgery was performed for 68 tumors (87%) and was not delayed in any patient owing to sunitinib toxicity. Grade ≥ 3 surgical complications occurred in 5 patients (7%). PN was performed for 49 kidneys (63%) after sunitinib, including 76% of patients without and 41% with metastatic disease (P = 0.0026). PN was completed in 100%, 86%, 65%, and 60% of localized cT1a, cT1b, cT2, and cT3 tumors, respectively. CONCLUSION Presurgical sunitinib leads to modest tumor reduction in most primary RCC, and many patients can be subsequently treated with PN with acceptable morbidity and preserved renal function. A randomized trial is required to definitively determine whether presurgical therapy enhances feasibility of PN.
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Affiliation(s)
- Brian R Lane
- Division of Urology, Spectrum Health Hospital System, Michigan State University, Grand Rapids, MI.
| | - Ithaar H Derweesh
- Department of Urology, University of California-San Diego, La Jolla, CA
| | - Hyung L Kim
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
| | - Rebecca O'Malley
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY; Department of Urology, University of Albany, Albany, NY
| | - Joseph Klink
- Department of Urologic Oncology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Cesar E Ercole
- Department of Urologic Oncology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Kerrin L Palazzi
- Department of Urology, University of California-San Diego, La Jolla, CA
| | - Anil A Thomas
- Department of Urologic Oncology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Brian I Rini
- Department of Urologic Oncology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Steven C Campbell
- Department of Urologic Oncology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH
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Abstract
Historically, open radical nephrectomy (ORN) represented the standard of care for localized renal cell carcinoma (RCC). While the incidence of T1 RCC is rising, treatment options are developing fast and the standard of care according to European and American guidelines has changed to partial nephrectomy (PN), or laparoscopic radical nephrectomy in patients not suitable for PN. To assess the implementation of guideline recommendations and to profile recent surgical and technical innovations, we reviewed the current literature. We observed that ORN still represents the most commonly used treatment in T1 RCC patients. Utilization of PN increased over time but implementation is still in progress. Whereas PN is frequently used in tertiary care centers, population-based studies suggest discrepancies in the diffusion of standard of care treatments. Alternative minimally invasive approaches for PN are available but their superiority is not yet proven. Further efforts in improving the training of urologic surgeons are required to continue the implementation of guideline recommendations.
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Affiliation(s)
- Jonas Schiffmann
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Rendon RA, Kapoor A, Breau R, Leveridge M, Feifer A, Black PC, So A. Surgical management of renal cell carcinoma: Canadian Kidney Cancer Forum Consensus. Can Urol Assoc J 2014; 8:E398-412. [PMID: 25024794 DOI: 10.5489/cuaj.1894] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Anil Kapoor
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON
| | - Rodney Breau
- Division of Urology, University of Ottawa, Ottawa, ON
| | - Michael Leveridge
- Departments of Urology and Oncology, Queen's University, Kingston, ON
| | | | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
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Abstract
Current guidelines increasingly recommend organ-preserving surgical procedures in the treatment of renal tumors. Both the open surgical and minimally invasive surgical techniques are well established. In the literature, various systems for the systematic evaluation of comorbidities and complications have been reported. Already while taking the patient's history and preoperative planning prior to partial nephrectomy, it is recommended that a detailed risk assessment be carried out regarding expected complications. Essentially the two critical factors - the comorbidities of the patient and anatomic complexity level of the tumor - should be evaluated in order to achieve the best possible selection of patients for a partial nephrectomy and the determination of the surgical method.
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Affiliation(s)
- C Wülfing
- Abteilung für Urologie, Asklepios Klinik Altona, Paul-Ehrlich Straße 1, 22763, Hamburg, Deutschland,
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Laguna MP, Algaba F, Cadeddu J, Clayman R, Gill I, Gueglio G, Hohenfellner M, Joyce A, Landman J, Lee B, van Poppel H. Current patterns of presentation and treatment of renal masses: a clinical research office of the endourological society prospective study. J Endourol 2014; 28:861-70. [PMID: 24555480 DOI: 10.1089/end.2013.0724] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To assess epidemiologic characteristics, clinical and pathologic patterns of presentation, and treatment strategies in a contemporary population with renal masses (RMs). METHODS The Clinical Research Office of the Endourological Society collected prospective epidemiologic, clinical, and pathologic data on consecutive patients with RMs who were treated during a 1-year period in 98 centers worldwide. Preoperative assessment and treatment were performed according to local clinical practice guidelines. RESULTS From January 2010 to February 2012, 4288 patients (4355 cases, 4815 tumors) were treated for a RM. The mean age of the cohort was 61.5 years, and the ratio male:female 1.8:1. Caucasians represented 75% of the population, and the median body mass index was 27. The cohort exhibited a high rate of comorbidity (65.6%), including a 48.5% rate of hypertension; one-third of patients had a combination of two or more comorbidities. One-third of patients (36%) had risk factors for renal-cell carcinoma (RCC), of which smoking and obesity were the most common. Diagnosis was incidental in 67% of cases, and 22.2% of cases had chronic kidney disease stage ≥III at presentation. Median radiologic size was 44 mm (range 2-300 mm) and 68% were cT1. Radical nephrectomy and nephron-sparing surgery (NSS) including ablation were performed in 52% and 46% of cases, respectively, while 3.6% of cases were actively surveyed. Median pathologic size was 43 mm (range 2-300 mm) and 63% of the RCCs were pT1. CONCLUSIONS Current patterns of presentation of RMs are consistent with the decreasing trends in age and clinical or pathologic size and increasing incidental diagnosis. Patients exhibit a considerable basal comorbidity and presence of risk factors for RCC. Half of the cases are treated by a nephron-sparing modality with an increase in the penetration of NSS techniques in the contemporary urologic practice.
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Affiliation(s)
- M Pilar Laguna
- 1 Department of Urology, AMC University of Amsterdam , Amsterdam, The Netherlands
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Pignot G, Méjean A, Bernhard JC, Bigot P, Timsit MO, Ferriere JM, Zerbib M, Villers A, Mouracade P, Lang H, Bensalah K, Couapel JP, Rigaud J, Salomon L, Bellec L, Soulié M, Vaessen C, Roupret M, Baumert H, Gimel P, Patard JJ. The use of partial nephrectomy: results from a contemporary national prospective multicenter study. World J Urol 2014; 33:33-40. [DOI: 10.1007/s00345-014-1279-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 03/10/2014] [Indexed: 11/28/2022] Open
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Do we need to clamp the renal hilum liberally during the initial phase of the learning curve of robot-assisted nephron-sparing surgery? ScientificWorldJournal 2014; 2014:498917. [PMID: 24688393 PMCID: PMC3944210 DOI: 10.1155/2014/498917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/02/2014] [Indexed: 01/20/2023] Open
Abstract
Objective. We aimed to compare the results of our initial robot-assisted nephron-sparing surgeries (RANSS) performed with or without hilar clamping. Material and Method. Charts of the initial RANSSs (n = 44), which were performed by a single surgeon, were retrospectively reviewed. R.E.N.A.L. nephrometry system, modified Clavien classification, and M.D.R.D. equation were used to record tumoral complexity, complications, and estimated glomerular filtration rate (eGFR), respectively. Outcomes of the clamped (group 1, n = 14) versus off-clamp (group 2, n = 30) RANSSs were compared. Results. The difference between the two groups was insignificant regarding mean patient age, mean tumor size, and mean R.E.N.A.L. nephrometry score. Mean operative time, mean estimated blood loss amount, and mean length of hospitalization were similar between groups. A total of 4 patients in each group suffered 11 Clavien grade ≥2 complications early postoperatively. Open conversion rates were similar. The difference between the 2 groups in terms of the mean postoperative change in eGFR was insignificant. We did not encounter any local recurrence after a mean follow-up of 18.9 months. Conclusions. Creating warm-ischemic conditions during RANSS should not be a liberal decision, even in the initial phases of the learning curve for a highly experienced open surgeon.
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Sammon JD, Karakiewicz PI, Sun M, Ravi P, Ghani KR, Jeong W, Bianchi M, Hansen J, Perrotte P, Peabody JO, Rogers CG, Shariat SF, Menon M, Trinh QD. Robot-assisted vs. laparoscopic partial nephrectomy: utilization rates and perioperative outcomes. Int Braz J Urol 2014; 39:377-86. [PMID: 23849569 DOI: 10.1590/s1677-5538.ibju.2013.03.11] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 04/24/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To examine the effect of surgical approach on perioperative morbidity and mortality after partial nephrectomy. MATERIALS AND METHODS Within the Nationwide Inpatient Sample, patients who underwent RAPN or LPN between October 2008 and December 2009 were identified. Propensity-based matching was performed to adjust for potential baseline differences between the two groups. The rates of intraoperative and postoperative complications, blood transfusions, prolonged length of stay, and in-hospital mortality, stratified according to RAPN vs. LPN, were compared. RESULTS Overall, 851 (72.5%) patients underwent RAPN and 323 (27.5%) underwent LPN. For RAPN and LPN respectively, the following rates were recorded in the propensity-score matched cohort: blood transfusions, 4.5 vs. 6.8% (p = 0.223); intraoperative complications, 5.2 vs. 2.6% (p = 0.096); postoperative complications, 10.6 vs. 13.5% (p = 0.268); prolonged length of stay, 6.8 vs. 9.4% (p = 0.238); in-hospital mortality, 0.0 vs. 0.0%. CONCLUSIONS RAPN has supplanted LPN as the predominant minimally invasive surgical approach for renal masses. Perioperative outcomes after RAPN and LPN are comparable. Interpretation of these findings needs to take into account the lack of adjustment for case complexity and surgical expertise.
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Affiliation(s)
- Jesse D Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI 48202, USA.
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Filson CP, Schwartz K, Colt JS, Ruterbusch J, Linehan WM, Chow WH, Miller DC. Use of nephron-sparing surgery among renal cell carcinoma patients with diabetes and hypertension. Urol Oncol 2014; 32:27.e15-21. [PMID: 23419677 PMCID: PMC3762909 DOI: 10.1016/j.urolonc.2012.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 09/26/2012] [Accepted: 09/26/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Nephron-sparing surgery (NSS) is recommended for patients with renal cell carcinoma (RCC) at risk for chronic kidney disease (CKD). We assessed the prevalence of NSS among RCC patients with pre-existing diabetes or hypertension or both, who participated in a population-based epidemiologic RCC study. MATERIALS AND METHODS Patients with RCC were enrolled in the United States Kidney Cancer Study, a case-control study in the metropolitan areas of Detroit and Chicago from 2002 to 2007. After determining whether patients had diabetes or hypertension or both, we ascertained the proportion of patients from the Detroit site who received NSS. Bivariate and multivariate analyses were performed to evaluate associations between these CKD risk factors and receipt of NSS. RESULTS We identified 835 patients treated with radical nephrectomy (78%) or NSS (22%) from 2002 to 2007. Among this cohort, 60% had pre-existing diabetes or hypertension or both. Patients with both diabetes and hypertension were more than twice as likely to receive NSS (odds ratio [OR] 2.42, 95% confidence interval [CI] 1.47-3.96). Conversely, patients with only hypertension (OR 1.33, 95% CI 0.92-1.93) or diabetes (OR 0.97, 95% CI 0.92-1.93) were no more likely to receive NSS than patients with neither risk factor. CONCLUSIONS The more frequent utilization of NSS among patients with both diabetes and hypertension suggests growing recognition by urologists of the importance of these risk factors for future development of CKD among patients facing surgical therapy for RCC. However, the concurrent observation that patients with only one of these CKD risk factors did not receive increased utilization of NSS highlights an immediate opportunity to improve the surgical treatment of patients with RCC.
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Affiliation(s)
- Christopher P Filson
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Kendra Schwartz
- Karmanos Cancer Institute, Detroit, MI; Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI
| | - Joanne S Colt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | | | - Wong-Ho Chow
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - David C Miller
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
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Liu JJ, Leppert JT, Maxwell BG, Panousis P, Chung BI. Trends and perioperative outcomes for laparoscopic and robotic nephrectomy using the National Surgical Quality Improvement Program (NSQIP) database. Urol Oncol 2013; 32:473-9. [PMID: 24332644 DOI: 10.1016/j.urolonc.2013.09.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/20/2013] [Accepted: 09/10/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We sought to examine the trends in perioperative outcomes of kidney cancer surgery stratified by type (radical nephrectomy [RN] vs. partial nephrectomy [PN]) and approach (open vs. minimally invasive). METHODS We queried the National Surgical Quality Improvement Program database to identify kidney cancer operations performed from 2005 to 2011. We examined 30-day perioperative outcomes including operative time, transfusion rate, length of stay, major morbidity (cardiovascular, pulmonary, renal, and infectious), and mortality. RESULTS A total of 2,902 PN and 5,459 RN cases were identified. The use of PN increased over time, accounting for 39% of all nephrectomies in 2011. Minimally invasive approaches also increased over time for both RN and PN. Open surgery was associated with increased length of stay, receipt of transfusion, major complications, and perioperative mortality. Resident involvement and open approach were independent predictors of major complications for both PN and RN. Additionally, the presence of a medical comorbidity was also a risk factor for complications after RN. The overall complication rates decreased for all approaches over the study period. CONCLUSIONS Minimally invasive approaches to kidney cancer renal surgery have increased with favorable outcomes. The safety of open and minimally invasive PN improved significantly over the study period. Although pathologic features cannot be determined from this data set, these data show that complications from renal surgical procedures are decreasing in an era of increasing use.
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Affiliation(s)
- Jen-Jane Liu
- James Buchanan Brady Urologic Institute and Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD.
| | - John T Leppert
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Bryan G Maxwell
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA
| | - Periklis Panousis
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA
| | - Benjamin I Chung
- Department of Urology, Stanford University School of Medicine, Stanford, CA
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Ta AD, Bolton DM, Dimech MK, White V, Davis ID, Coory M, Millar J, Giles G. Contemporary management of renal cell carcinoma (RCC) in Victoria: implications for longer term outcomes and costs. BJU Int 2013; 112 Suppl 2:36-43. [PMID: 24127675 DOI: 10.1111/bju.12204] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe the contemporary patterns of care for renal cell carcinoma (RCC) using a whole of population series from Victoria. PATIENTS AND METHODS Retrospective review of medical records of all patients diagnosed and treated for RCC in Victoria in 2009. Patients were identified via the State-wide Victorian Cancer Registry. Patient demographic characteristics, symptoms, stage, and first-line treatment were assessed. Associations between case residential location (metropolitan or rural) and treatment were examined using multivariate logistic regression after adjusting for age, sex, socioeconomic status, treatment in private or public hospital and comorbidity. RESULTS Data were obtained for 499 of 577 eligible patients. In all, 413 patients (83%) underwent surgery. Laparoscopic radical nephrectomy (RN) was the most common procedure for Stage I pT1a/pT1b tumours (51.2%); partial nephrectomy (PN) was performed for 27% of Stage I RCC In multivariate analysis, regional patients were less likely to receive PN (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.18-0.85) for Stage I RCC, and less likely to receive systemic therapy for Stage IV RCC (OR 0.06, 95% CI 0.01-0.41). Multidisciplinary team meetings were recorded for only 25% of patients and 3% were enrolled in a clinical trial. CONCLUSION Most contemporary patients diagnosed with RCC are still treated with RN, including those with smaller tumours amenable to PN. This may impact future outcomes, including increased risk of chronic kidney disease and its potential financial healthcare burden. Patterns of treatment also appear to differ between metropolitan and regional populations.
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Affiliation(s)
- Anthony D Ta
- Department of Surgery, The Austin and Repatriation Medical Centre, Heidelberg; Department of Urology, The Austin and Repatriation Medical Centre, Heidelberg
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Tanagho YS, Bhayani SB, Kim EH, Figenshau RS. Renal Cryoablation Versus Robot-Assisted Partial Nephrectomy: Washington University Long-Term Experience. J Endourol 2013; 27:1477-86. [DOI: 10.1089/end.2013.0192] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Youssef S. Tanagho
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sam B. Bhayani
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Eric H. Kim
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - R. Sherburne Figenshau
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
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Hsi RS, Macleod LC, Gore JL, Wright JL, Harper JD. Comparison of selective parenchymal clamping to hilar clamping during robotic-assisted laparoscopic partial nephrectomy. Urology 2013; 83:339-44. [PMID: 24246321 DOI: 10.1016/j.urology.2013.09.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 08/19/2013] [Accepted: 09/27/2013] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare perioperative outcomes after robotic-assisted laparoscopic partial nephrectomy (RALPN) with hilar clamping vs parenchymal clamping. METHODS A retrospective, single-institution review of the patients undergoing RALPN with hilar or parenchymal clamping was performed. Associations between perioperative factors and clinicopathologic outcomes were determined using the t test, Fisher's exact test, and multivariate linear regression. RESULTS In 51 patients undergoing RALPN, 36 (71%) and 15 (29%) were performed with hilar and parenchymal clamping, respectively. Median tumor diameter was 2.8 cm for both groups (range, 1.1-6.1; P = .93). Tumor complexity by nephrometry score was mild (69% vs 80%), moderate (29% vs 20%), and high (2% vs 0%) in the respective groups (P = .65). Operative time was significantly shorter in the parenchymal clamp group (median 245 vs 320 minutes; P <.0001). There was no difference in blood loss and need for transfusion. On multivariate analysis, hilar clamping (P <.01), higher body mass index (P = .01), and higher complexity tumors (P = .02) were significantly associated with longer operative times. The parenchymal clamp group had better preservation of immediate postoperative glomerular filtration rate (GFR) from baseline to postoperative day 2 (median ΔGFR 0 vs -18 mL/min/1.73 m(2), P = .02). These differences from baseline did not persist (median ΔGFR -6 vs -7 mL/min/1.73 m(2), P = .35) at a median follow-up of 6.6 months. Final pathology determination of malignancy (P = .51) and positive margin rates (P = .26) were similar in both groups. CONCLUSION Compared with hilar clamping, selective regional ischemia with the parenchymal clamp for mild-moderately complex tumors is feasible and safe during RALPN. Parenchymal clamping is associated with enhanced immediate preservation of GFR and shorter operative times.
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Affiliation(s)
- Ryan S Hsi
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Liam C Macleod
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Jonathan L Wright
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, WA.
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Kates M, Whalen MJ, Badalato GM, McKiernan JM. The effect of race and gender on the surgical management of the small renal mass. Urol Oncol 2013; 31:1794-9. [DOI: 10.1016/j.urolonc.2012.05.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/09/2012] [Accepted: 05/09/2012] [Indexed: 01/13/2023]
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Small AC, Tsao CK, Moshier EL, Gartrell BA, Wisnivesky JP, Godbold J, Sonpavde G, Palese MA, Hall SJ, Oh WK, Galsky MD. Trends and variations in utilization of nephron-sparing procedures for stage I kidney cancer in the United States. World J Urol 2013; 31:1211-7. [PMID: 22622394 PMCID: PMC4744479 DOI: 10.1007/s00345-012-0873-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 04/12/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The incidental detection of early-stage kidney tumors is increasing in the United States. Nephron-sparing approaches (NS) to managing these tumors are equivalent to radical nephrectomy (RN) in oncologic outcomes and have a decreased impact on renal function. Our objective was to evaluate trends in the use of NS over the past decade and the socioeconomic factors associated with its use. METHODS The National Cancer Database was queried to identify patients with stage I kidney cancer between 2000 and 2008. Patients were classified by the type of surgery as NS (local destruction and local excision) or RN. Patients were further categorized by age, race, insurance status, and income. Log-binomial regression was used to estimate prevalence ratios (PR) for the proportion of NS to RN according to demographic and socioeconomic characteristics. RESULTS From 2000 to 2008, there were 142,194 cases of kidney cancer reported to the NCDB. In these cases, 43,034 (30.3 %) patients had NS, and 86,431 (60.78 %) patients had RN. The prevalence of NS increased 10 % per year (PR = 1.10, p < 0.0001)-from 20.0 % in 2000 to 45.1 % in 2008. Older age, lower income, Black race, Hispanic ethnicity, and lack of health insurance were associated with a decreased prevalence of NS. CONCLUSIONS NS as a treatment for stage I kidney cancer has increased steadily since 2000. Age, racial, and socioeconomic differences may exist in the utilization of NS. Additional analyses, with patient level data, are required to address the independent significance of these variables in an effort to develop strategies to mitigate these potential disparities.
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Affiliation(s)
- Alexander C Small
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Mount Sinai School of Medicine, 1 Gustave L Levy Place, New York, NY, 10029, USA
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von Klot C, Herrmann TR, Wegener G, Kuczyk MA, Hupe MC, Akkoyun M, Peters I, Kramer MW, Merseburger AS. Age distribution for partial and radical nephrectomy: whose nephrons are being spared? Adv Ther 2013; 30:924-32. [PMID: 24155056 DOI: 10.1007/s12325-013-0061-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Nephron sparing surgery (NSS) is recommended for patients with T1 renal cell carcinoma (RCC) whenever surgically feasible. By analyzing data from all urological clinics in the whole state of Lower Saxony, Germany, regardless of clinic size or level of expertise, we investigated whether current practice reflects the need for NSS in older patients on a broader scale. METHODS From 2005 to 2010, more than 100 medical facilities and urological clinics in Lower Saxony, Germany were evaluated for their individual rates of partial nephrectomy (PN) and radical nephrectomy (RN) based on patient's age in 5-year intervals. RESULTS Sufficient data on age were available for 3,332 out of 3,693 patients with RCC undergoing surgery. PN rates for all patients and for those with T1 RCC were 19.9% and 29.5%, respectively. For all patients with RCC, the rates for PN and RN below the median age (<66.8 years) were 365 (21.9%) and 1,302 (78.1%) and above the median age were 297 (17.8%) and 1,368 (82.2%), respectively (P = 0.003). For patients with T1 RCC, the rates for PN and RN below the median age (<66.5 years) were 341 (32.6%) and 704 (67.4%) and above the median age were 277 (26.4%) and 774 (73.6%), respectively (P = 0.002). The highest rate for each type of surgery was seen in those aged 65-70 years, except for patients with T1 RCC receiving RN who were mostly operated on when aged 70-75 years. CONCLUSION The rate of PN for all patients with RCC in this series and especially for patients with T1 RCC is significantly lower in older patients, thereby not reflecting the need and understanding for NSS in the higher age segment. Broader education and teaching of NSS might improve treatment of RCC in the future.
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Affiliation(s)
- Christoph von Klot
- Department of Urology and Urological Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany,
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Kaplan JR, Chang P, Percy AG, Wagner AA. Renal Transposition During Minimally Invasive Partial Nephrectomy: A Safe Technique for Excision of Upper Pole Tumors. J Endourol 2013; 27:1096-100. [DOI: 10.1089/end.2013.0225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Joshua R. Kaplan
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Peter Chang
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Andrew G. Percy
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Andrew A. Wagner
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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