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Aikawa K, Yanagisawa T, Fukuokaya W, Shimizu K, Miyajima K, Nakazono M, Iwatani K, Matsukawa A, Obayashi K, Kimura S, Tsuzuki S, Sasaki H, Abe H, Sadaoka S, Miki J, Kimura T. Percutaneous cryoablation versus partial nephrectomy for cT1b renal tumors: An inverse probability weight analysis. Urol Oncol 2023; 41:150.e11-150.e19. [PMID: 36604229 DOI: 10.1016/j.urolonc.2022.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/13/2022] [Accepted: 11/27/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To investigate differential clinical outcomes in patients treated with partial nephrectomy (PN) vs. percutaneous cryoablation (PCA) for cT1b renal tumors. MATERIALS AND METHODS We retrospectively analyzed the records of 119 patients who had undergone PN (n = 90) or PCA (n = 29) for cT1b renal tumors. Inverse probability weighting (IPW) was used for balancing patient demographics, including renal function and tumor complexity. Perioperative complications, renal function preservation rates, and oncological outcomes such as local recurrence-free, metastasis-free, cancer-specific, and overall survival were compared using IPW-adjusted restricted mean survival times (RMSTs). RESULTS PCA was more likely to be selected for octogenarians (odds ratio: 11.4, 95% confidence interval [CI]: 3.33-45.1). During the median follow-up of 43 months in the PCA group and 36.5 months in the PN group, unablated local residue or local recurrence was noted in 6 patients in the PCA group and local recurrence was noted in 4 patients in the PN groups. Of the 6 patients in the PCA group, 4 underwent salvage PCA, and local control had been achieved at the last visit. In the IPW-adjusted population, PCA had significantly worse local recurrence-free survival compared with PN (IPW-adjusted RMST difference: -22.7 months, 95% CI: -45.3 to -0.4, P = 0.046). IPW-adjusted RMST for metastasis-free survival (P = 0.23), cancer-specific survival (P = 0.77), and overall survival (P = 0.11) did not differ between PCA and PN. In addition, PN was not a predictor for local control failure at the last visit (odds ratio: 0.30, 95%CI: 0.05-1.29). There were no statistically significant differences between PN and PCA in renal function preservation or overall/severe complication rates. CONCLUSIONS In patients with cT1b renal tumor, although the local recurrence rate is higher for PCA than for PN, PCA provides comparable distant oncologic outcomes. PCA can be an alternative treatment option for elderly, comorbid patients, even those with cT1b renal tumors.
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Affiliation(s)
- Koichi Aikawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Wataru Fukuokaya
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kanichiro Shimizu
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiichiro Miyajima
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Minoru Nakazono
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiro Matsukawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Koki Obayashi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shoji Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Sasaki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirokazu Abe
- Department of Urology, Kameda Medical Center, Chiba, Japan
| | - Shunichi Sadaoka
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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Staehler M, Rodler S, Schott M, Casuscelli J, Stief C, Spek A, Schlenker B. Polyethylene glycol-coated collagen patch (hemopatch ®) in open partial nephrectomy. World J Urol 2022; 40:127-132. [PMID: 34480235 PMCID: PMC8813698 DOI: 10.1007/s00345-021-03827-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/27/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To describe the results of a polyethylene glycol-coated collagen patch, Hemopatch® on blood loss, surgical time and renal function in partial nephrectomy (PN) for renal cell carcinoma (RCC). METHODS Out of a single surgeon cohort of n = 565 patients undergoing conventional open PN (CPN) between 01/2015 and 12/2017 at the University of Munich a consecutive subgroup (n = 42) was operated on using a polyethylene glycol-coated collagen-based sealant Hemopatch® (Baxter International Inc., Deerfield, IL, USA) (HPN). RESULTS Median age was 65.2 years (range 12.7-95.2) with median follow-up of 9.43 months (0.03-49.15). Baseline renal function (CKD-EPI) was 78.56 ml/min/1.73 m2 (range 20.38-143.09) with a non-significant decline to 74.78 ml/min/1.73 m2 (range 3.75-167.74) at follow-up. In CPN 46% had low complexity, 33% moderate complexity and 20% high complexity lesions with 33% low, 40% moderate and 27% high complexity masses in HPN. Median tumor size was 4.3 cm (range 1-38 cm) in CPN with 4.8 cm (range 3.8-18.3 cm) with HPN, p = 0.293. Median blood loss and duration of surgery was significantly lower in the HPN group vs. CPN (146 ml ± 195 vs. 114 ml ± 159 ml; p = 0.021; 43 min ± 27 for HPN vs. 53 min ± 49; p = 0.035) with no difference in clamping time (12.6 min ± 8.6 for HPN vs. 12.0 min ± 9.5; p = 0.701). CONCLUSIONS Hemopatch® supported renoraphy shows promising results compared to standard renoraphy in PN. No side effects were seen. Further studies should evaluate the prevention of arterio-venous or urinary fistulas. In complex partial nephrectomies Hemopatch® supported renoraphy should be considered.
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Affiliation(s)
- Michael Staehler
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany.
- Multidisciplinary Center On Renal Tumors, Department of Urology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - S Rodler
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - M Schott
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - J Casuscelli
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - C Stief
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - A Spek
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - B Schlenker
- Department of Urology, University Hospital Munich-Grosshadern, Ludwig Maximilian University, Munich, Germany
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Joe WB, Zarzour JG, Gunn AJ. Renal Cell Carcinoma Ablation: Preprocedural, Intraprocedural, and Postprocedural Imaging. Radiol Imaging Cancer 2019; 1:e190002. [PMID: 33778679 DOI: 10.1148/rycan.2019190002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 01/20/2023]
Abstract
The rising incidence of renal cell carcinoma (RCC) in recent decades necessitates careful consideration of additional treatment options, especially for patients who may be poor surgical candidates. An emerging body of evidence suggests that ablation may be performed effectively and safely even in patients with multiple comorbidities. Accordingly, clinical guidelines now include thermal ablation as an alternative for such patients with localized tumors that are 4.0 cm or smaller. Recent experience with these minimally invasive techniques has led to a greater understanding of the imaging findings that merit close attention when ablation is anticipated, or after it is performed. These imaging findings may guide the interventionalist's perception of the risks, technical challenges, and likelihood of treatment success associated with RCC ablation. The present review provides an overview of clinically relevant radiologic findings during the preprocedural, intraprocedural, and postprocedural period in the context of image-guided renal ablation. Keywords: Interventional-Body, Kidney, Percutaneous, Urinary © RSNA, 2019.
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Affiliation(s)
- Winston B Joe
- University of Alabama at Birmingham School of Medicine, Birmingham, Ala (W.B.J.); and Divisions of Abdominal Imaging (J.G.Z.) and Vascular and Interventional Radiology (A.J.G.), Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249
| | - Jessica G Zarzour
- University of Alabama at Birmingham School of Medicine, Birmingham, Ala (W.B.J.); and Divisions of Abdominal Imaging (J.G.Z.) and Vascular and Interventional Radiology (A.J.G.), Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249
| | - Andrew J Gunn
- University of Alabama at Birmingham School of Medicine, Birmingham, Ala (W.B.J.); and Divisions of Abdominal Imaging (J.G.Z.) and Vascular and Interventional Radiology (A.J.G.), Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35249
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Yallappa S, Imran R, Rizvi I, Aboumarzouk OM, Bhatt R, Patel P. Validation of radius exophytic/endophytic nearness anterior/posterior location and preoperative aspects and dimensions used for an anatomical nephrometric scores in patients undergoing partial nephrectomy for renal cancer: A single-center experience and literature review. Urol Ann 2018; 10:270-279. [PMID: 30089985 PMCID: PMC6060594 DOI: 10.4103/ua.ua_11_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Introduction: Nephrometric scores are used to predict perioperative and postoperative complications, with no uniform results in the current literature. Materials and Methods: A retrospective study of 141 patients in a single center who underwent open partial nephrectomy between June 2006 and 2016 for T1a and T1b renal tumor was conducted. Univariate and multivariate analyses were used to evaluate the correlations between preoperative aspects and dimensions used for an anatomical (PADUA) and radius exophytic/endophytic nearness anterior/posterior location (RENAL) scores and their components with pre-, peri-, and post-operative parameters. Linear regression (F-tests) and logical regression models were used to test for significance of the association and predictability of outcomes. Results: Total RENAL score (P = 0.032), its components R (P = 0.004), E (P = 0.022), L (P = 0.011), and total PADUA score (P = 0.016) were significantly associated with ischemic time. In postoperative complications, the PADUA components: sinus line location (P = 0.008), lateral/medial rim score (P = 0.029), and collecting system score (P = 0.006) showed significance. None of the variables showed correlation with operation time and change in estimated glomerular filtration rate (eGFR). On multivariate analysis, sinus line location and gender (P = 0.012) showed significance in predicting eGFR changes and RENAL score component: A (P = 0.049) was significant in predicting estimated blood loss. Both RENAL and PADUA components were significantly associated with hospital length of stay. Conclusion: Both RENAL and PADUA scores showed important correlation in predicting outcomes. We further demonstrated the importance of knowing the individual components of the scores, which can independently give outcome predictions. The scoring systems can still be improved and standardized for broad clinical use with larger cohort and multicenter-based studies.
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Affiliation(s)
- Sachin Yallappa
- Department of Urology, Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, UK.,The Urology Research and Training Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Rizwana Imran
- Department of Urology, Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, UK
| | - Ishtiakul Rizvi
- Department of Urology, Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, UK
| | - Omar M Aboumarzouk
- The Urology Research and Training Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Rupesh Bhatt
- Department of Urology, Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, UK
| | - Prashant Patel
- Department of Urology, Queen Elizabeth Hospital, University Hospital of Birmingham, Birmingham, UK
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Bier G, Bier S, Bongers MN, Othman A, Ernemann U, Hempel JM. Value of computed tomography texture analysis for prediction of perioperative complications during laparoscopic partial nephrectomy in patients with renal cell carcinoma. PLoS One 2018; 13:e0195270. [PMID: 29668695 PMCID: PMC5905959 DOI: 10.1371/journal.pone.0195270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 03/19/2018] [Indexed: 01/20/2023] Open
Abstract
Purpose Tumorous texture is a marker for tumor tissue inhomogeneity. Based on this assumption, this study aims to evaluate the value of computed tomography texture analysis for imaging-based prediction of perioperative complications during laparoscopic partial tumor nephrectomy. Methods A total of 106 patients with histologically confirmed renal cell carcinoma and pre-operative CT were included and volumetric texture analysis of the tumors was performed by two readers. Texture analysis parameter ratios and differences were calculated using the kidney parenchyma as reference (“reference-corrected”). Regression analysis was performed, regarding the value of the texture analysis parameters, for assessment of the tumor nuclear grade and the prediction of peri- and postoperative complications and approximated blood loss. Moreover, the inter-rater agreement in terms of the intra-class correlation coefficient (ICC) was calculated. Results Regarding the reference-corrected values, the predictive value of texture analysis parameters for severe perioperative complications was highest for the standard deviation of the mean attenuation (Area under curve/AUC, .615; sensitivity, 93.8%, specificity, 30.0%), followed by the uniformity (AUC, .599; sensitivity, 62.5%, specificity, 60.0%), and the uniformity of distribution of positive pixels (AUC, .597; sensitivity, 62.5%; specificity, 61.1%). Regarding the blood loss, the uniformity of positive pixel values (UPP; AUC, 0.638), uniformity (AUC, 0.635), and entropy (AUC, 0.633) yielded the best predictive values, whilst the tumor grade was a weaker predictor (AUC, 0.574). The applied texture analysis parameters did not correlate with the time of surgery or the warm ischemic time. All measured parameters were better predictors for complications than the tumor diameter alone. The inter-rater agreement was almost perfect (ICC, .982). Conclusion CT and CT texture analysis parameters are valuable for prediction of perioperative outcome before laparoscopic partial nephrectomy in patients with renal cell carcinoma.
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Affiliation(s)
- Georg Bier
- Department of Neuroradiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
- * E-mail:
| | - Simone Bier
- Department of Urology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Malte Niklas Bongers
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Ahmed Othman
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Ulrike Ernemann
- Department of Neuroradiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Johann-Martin Hempel
- Department of Neuroradiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
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Gury-Coupier L, Audenet F, Delavaud C, Timsit MO, Mejean A. [Retrospective comparison of the reproducibility and the performances of R.E.N.A.L. score, 12 segments score and UPRCC score for the partial nephrectomy]. Prog Urol 2017; 27:1050-1057. [PMID: 29097040 DOI: 10.1016/j.purol.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 05/28/2017] [Accepted: 09/12/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Compare three morphometrics scores of the kidney on the reproductibility and the predictability of complications per- and post-partial nephrectomy. MATERIALS AND METHODS This comparative study analyzed a monocentric retrospective cohort of 47 patients affected by a unique renal tumor and operated by partial nephrectomy by lumbotomy excluding the genetic diseases from January till December, 2014. The preoperative scanners were reviewed in double-blind by a radiologist and an internal surgeon who classified each tumor according to the three classifications: R.E.N.A.L. score, score in 12 segments and the University Paris Renal Cancer Classification (UPRCC). The judging criteria were the operative and ischemic duration, the blood loss, the preoperative injuries, the length of the hospital stay, the postoperative complications according to the Clavien-Dindo classification. The Cohen's kappa coefficient and the one-way analysis of variance were used respectively to compare the inter-observer reproducibility and the predictability of the complications for each classification. RESULTS Forty-four tumors of which 30 (64%) were on the left kidney, with an average size of 55.19mm with 17 (39%) on the upper pole, 12 (27%) on the lower pole and 15 (34%) medio-renal. The UPRCC was the most reproductible classification with 90% inter-observer concordance against 84% for the R.E.N.A.L. score and 72% for the score in 12 segments. The most predictable classification of complications was the score in 12 segments in particular thanks to the subgroup including the number of segments reached which allows to predict significantly the risk of a duration of intervention, prolonged ischemia and the risk of blood loss (P=0.03, 0.06 and <0.001). CONCLUSION The main result of this study is that, as in the majority of the previous studies on morphometrics scores, no score allows to predict the postoperative complications. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- L Gury-Coupier
- Service d'urologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Service de radiologie, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France.
| | - F Audenet
- Service d'urologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Service de radiologie, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France
| | - C Delavaud
- Service d'urologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Service de radiologie, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France
| | - M-O Timsit
- Service d'urologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Service de radiologie, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France
| | - A Mejean
- Service d'urologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Service de radiologie, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France
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Schulman AA, Tay KJ, Polascik TJ. Expanding thermal ablation to the 'intermediate-sized' renal mass: clinical utility in T1b tumors. Transl Androl Urol 2017; 6:127-130. [PMID: 28217461 PMCID: PMC5313302 DOI: 10.21037/tau.2017.01.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Ariel A Schulman
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kae Jack Tay
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Thomas J Polascik
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Rodriguez Faba O, Sanguedolce F, Grange P, Kooiman G, Bakavicius A, De la Torre P, Palou J. Kidney cancer focal cryoablation trend: does location or approach matter? World J Urol 2015; 34:917-23. [PMID: 26498138 DOI: 10.1007/s00345-015-1716-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/16/2015] [Indexed: 01/16/2023] Open
Abstract
PURPOSE We evaluated the current indications and surgical and survival outcomes for cryoablation (CA) using either a percutaneous (PCA) or a laparoscopic approach (LCA). We also investigated the ability of the PADUA score to predict the risk of complications and local recurrence. METHODS A retrospective analysis was performed at two European tertiary referral centers. Parameters analyzed included size, location, approach, operative time, hospital stay, complications, and functional and oncologic outcomes. Univariate and multivariate analyses were performed. An ROC analysis was conducted to evaluate the accuracy of the PADUA score. RESULTS Eighty patients were included. Mean tumor size was 2.6 cm. PCA was more often performed in posterior (95 vs. 60 %), inferior (72 vs. 32 %), and lateral (87 vs. 55 %) tumors. The global complication rate was 8.75 %, although proximity to the renal sinus resulted in a higher rate (30 vs. 4 %). Mean follow-up was 34 and 23 months for LCA and PCA, respectively. The 5-year recurrence-free survival was 76 and 90 % for LCA and PCA, respectively. Multivariate analysis showed that tumor involvement of the collecting system was predictive of recurrence. Under ROC analysis, PADUA score was a mild predictor for complications (AUC = 0.601) and a good predictor for recurrence (AUC = 0.723); PADUA ≥8 was identified as a cutoff for patients to a higher risk of recurrence. CONCLUSIONS The percutaneous approach is confirmed to be the preferred CA technique for posterior and lateral tumors. CA in deeper renal lesions and tumors with PADUA score ≥8 might entail a higher risk of recurrence, and closer follow-up should be considered in these patients.
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Affiliation(s)
- O Rodriguez Faba
- Department of Urology and Radiology, Fundació Puigvert, Barcelona, Spain.
| | | | - P Grange
- King's College Hospital, London, UK
| | | | - A Bakavicius
- Department of Urology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - P De la Torre
- Department of Urology and Radiology, Fundació Puigvert, Barcelona, Spain
| | - J Palou
- Department of Urology and Radiology, Fundació Puigvert, Barcelona, Spain
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Crispen PL. How Best to Predict Tumor Control and Renal Function after Treatment of Renal Masses. J Urol 2015; 194:867-8. [PMID: 26184068 DOI: 10.1016/j.juro.2015.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Paul L Crispen
- Department of Urology, University of Florida, Gainesville, Florida
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