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Naughton A, Ryan ÉJ, Keenan R, Thomas AZ, Smyth LG, Manecksha RP, Flynn RJ, Casey RG. Surgical Approach for Partial Nephrectomy in the Management of Small Renal Masses: A Systematic Review and Network Meta-Analysis. J Endourol 2024; 38:358-370. [PMID: 38149582 DOI: 10.1089/end.2023.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Background: A variety of surgical and nonsurgical management options for small renal masses (SRMs) now exist. Surgery in the form of partial nephrectomy (PN) has three different approaches. It is unclear which PN approach, if any, offers superior clinical outcomes. Aim: The aim of this study is to compare outcomes in patients with SRMs <4 cm undergoing PN through the open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), or robotic partial nephrectomy (RPN) approach and to establish the advantages and disadvantages of the various approaches. Methods: A systematic literature search was conducted for studies comparing at least two of the above techniques. Eighteen studies and 17,013 patients were included in our study. A network meta-analysis with a frequentist framework was performed. OPN was used as the baseline comparator. The prespecified primary outcome was R0 resection rates. Secondary outcomes included operating time, ischemia time, blood loss, transfusion rates, urine leak rates, significant morbidity, length of stay, and recurrence. Results: There was no significant difference between the techniques in terms of R0 rates, tumor recurrence, urine leak rates, renal function, and >3a Clavien-Dindo complications. LPN had a longer ischemic time and operating time. OPN had a longer length of stay and higher average intraoperative blood loss. RPN had lower blood transfusion rates. Discussion: All approaches are acceptable from an oncological perspective. The minimally invasive approaches (i.e., RPN and LPN) offer advantages in terms of morbidity; however, LPN may increase ischemic time and operative duration. Variations between perioperative outcomes may influence the choice of approach on a case-by-case and institutional basis.
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Affiliation(s)
- Ailish Naughton
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - Éanna J Ryan
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Robert Keenan
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - Arun Z Thomas
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Lisa G Smyth
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rustom P Manecksha
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Robert J Flynn
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rowan G Casey
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
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Nicaise E, Feldman AS, Gusev A, Yu A, Nimmagadda N, Wszolek MF, McGovern F, Blute ML, Dahl DM. A contemporary comparison of laparoscopic versus open partial nephrectomy for renal cell carcinoma. BMC Urol 2024; 24:58. [PMID: 38475808 DOI: 10.1186/s12894-024-01423-w] [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: 08/12/2023] [Accepted: 02/01/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE To analyze surgical and oncologic outcomes of patients undergoing open partial nephrectomy (OPN) versus laparoscopic partial nephrectomy (LPN) for treatment of renal cell carcinoma (RCC). METHODS We retrospectively investigated our institutional RCC database for patients who underwent PN for RCC from 1997 to 2018. Decision for technique was at the discretion of the operating urologist, following practice patterns and training history. Outcomes analyzed included pre/peri/post-operative parameters, pathologic outcomes, and disease recurrence rates. RESULTS 1088 patients underwent PN from 1997 to 2018. After exclusionary criteria, 631 patients who underwent 647 unique PNs for a total of 162 OPN and 485 LPN remained. Baseline, pre-op, and pathologic characteristics were not statistically different. Surgical time was lower in laparoscopic cases [185 vs. 205 min] (p = 0.013). Margin involvement was not statistically different; LPN had lower estimated blood loss (EBL) [150 vs. 250 mL] (p < 0.001) and longer ischemia time [21 vs. 19 min] (p = 0.005). LPN had shorter length of stay [2 vs. 4 days] (p < 0.001), fewer overall complications (p < 0.001), and no significant difference in high-grade complications [2.89 vs. 4.32%] (p = 0.379). Fewer LPN patients developed metastases [1.65 vs. 4.94%] (p = 0.0499). Local recurrence rates were not statistically different [1.24 vs. 3.09%] (p = 0.193). Renal function was equivalent between cohorts post-operatively. CONCLUSION Long-term oncologic outcomes were not significantly different between LPN versus OPN, with no statistical difference in patient and tumor characteristics. LPN was associated with lower EBL, shorter length of stay, and lower overall complication risk. Renal function was not significantly different between cohorts.
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Affiliation(s)
- Edouard Nicaise
- Department of Urology, Massachusetts General Hospital, 55 Fruit Street GRB 1102, 02114, Boston, MA, USA
| | - Adam S Feldman
- Department of Urology, Massachusetts General Hospital, 55 Fruit Street GRB 1102, 02114, Boston, MA, USA.
| | - Andrew Gusev
- Department of Urology, Massachusetts General Hospital, 55 Fruit Street GRB 1102, 02114, Boston, MA, USA
| | - Alice Yu
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Naren Nimmagadda
- The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew F Wszolek
- Department of Urology, Massachusetts General Hospital, 55 Fruit Street GRB 1102, 02114, Boston, MA, USA
| | - Francis McGovern
- Department of Urology, Massachusetts General Hospital, 55 Fruit Street GRB 1102, 02114, Boston, MA, USA
| | - Michael L Blute
- Department of Urology, Massachusetts General Hospital, 55 Fruit Street GRB 1102, 02114, Boston, MA, USA
| | - Douglas M Dahl
- Department of Urology, Massachusetts General Hospital, 55 Fruit Street GRB 1102, 02114, Boston, MA, USA
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3
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Butaney M, Wilder S, Wang Y, Bhayani S, Qi J, Van Till M, Mirza M, Johnson A, Perkins S, Noyes S, Weizer A, Johnson L, Patel A, Semerjian A, Lane BR, Rogers C. Positive surgical margins in partial nephrectomy: a collaborative effort to maintain surgical quality. BJU Int 2024; 133:273-275. [PMID: 37953479 DOI: 10.1111/bju.16223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Affiliation(s)
- Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | - Samantha Wilder
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | - Yuzhi Wang
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | - Sonia Bhayani
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | - Ji Qi
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Monica Van Till
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mahin Mirza
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Anna Johnson
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sara Perkins
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | - Sabrina Noyes
- Corewell Health Hospital System, Grand Rapids, MI, USA
| | - Alon Weizer
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lewis Johnson
- Bronson Urology and Continence Specialists, Kalamazoo, MI, USA
| | - Amit Patel
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | | | - Brian R Lane
- Corewell Health Hospital System, Grand Rapids, MI, USA
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Craig Rogers
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
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4
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Bosnalı E, Baynal EA, Çınar NB, Akdas EM, Telli E, Yaprak Bayrak B, Teke K, Yılmaz H, Dillioğlugil Ö, Kara Ö. Oncological and functional outcomes of patients who underwent open partial nephrectomy for kidney tumor. Arch Ital Urol Androl 2023; 95:12130. [PMID: 38193219 DOI: 10.4081/aiua.2023.12130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 12/02/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE To report long-term functional and oncological outcomes of OPN Methods: We enrolled 182 patients who underwent consecutive OPN with a diagnosis of kidney tumor in our clinic between April 2002 and February 2020 and were selected from our prospective OPN database. Preoperative demographic and clinical characteristics, intraoperative and pathological results, and patients' postoperative functional and oncological follow-up data were retrospectively analyzed. Overall survival (OS) and disease- free survival (DFS) were evaluated using Kaplan-Meier survival analysis. The time-dependent variation between preoperative and postoperative functional results was statistically analyzed and presented in a graph. RESULTS AND LIMITATIONS The mean age was 54.4 ± 10.8 yr, and the median age-adjusted Charlson comorbidity index (ACCI) was 1 (interquartile range [IQR] 0-1). The mean tumor size was 3.1 ± 1.2 cm, and the median RENAL score was 6 (IQR 5-8). The most common malign histopathological subtype was clear cell carcinoma with 76.6%, and five cases (3.4%) had positive surgical margins (PSMs). The most common surgical techniques were the retroperitoneal approach (98.9%) and cold ischemia (88.5%). Estimated glomerular filtration rate (eGFR) preservation was 92% (80.8-99.3, IQR), which translates to 32% chronic kidney disease (CKD) upstaging. Acute kidney injury (AKI) was detected in 27 (14.8%) patients according to RIFLE criteria. The intraoperative complication rate was 5.5%, and the postoperative overall complication rate (Clavien-Dindo 1-5) was 30.2%. Major complications (Clavien-Dindo 3-5) were observed in 13 (7.1%) patients. The median oncological follow-up was 42 mo (21.3- 84.6, IQR), and the 5- and 10-yr OS were 90.1% and 78.6%, 5 and 10-yr DFS were 99.4% and 92.1%, respectively. No local recurrence was observed in 5 (3.4%) patients with PSMs; only one had distant metastasis in the 8th postoperative month. The retrospective design, the small number of patients who underwent PN based on mandatory indication, and one type of surgical approach may limit the generalizability of our findings. CONCLUSIONS This study confirms excellent long-term oncologic and functional outcomes after OPN in a cohort of patients selected from a single institution. In light of the information provided by the literature and our study, our recommendation is to push the limits of PN under every technically feasible condition in the treatment of kidney tumors to protect the kidney reserve and achieve near-perfect oncological results.
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Affiliation(s)
- Efe Bosnalı
- University of Health Sciences, Derince Training and Research Hospital, Department of Urology, Kocaeli.
| | | | - Naci Burak Çınar
- Kocaeli University, School of Medicine, Department of Urology, Kocaeli.
| | - Enes Malik Akdas
- Kocaeli University, School of Medicine, Department of Urology, Kocaeli.
| | - Engin Telli
- Kocaeli University, School of Medicine, Department of Urology, Kocaeli.
| | | | - Kerem Teke
- Kocaeli University, School of Medicine, Department of Urology, Kocaeli.
| | - Hasan Yılmaz
- Kocaeli University, School of Medicine, Department of Urology, Kocaeli.
| | | | - Önder Kara
- Kocaeli University, School of Medicine, Department of Urology, Kocaeli.
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Hattori Y, Kambe T, Mine Y, Hagimoto H, Kokubun H, Abe Y, Yamashita D, Tsutsumi N, Arizono S, Yamasaki T, Kawakita M. Impact of renal sinus protrusions on achieving trifecta in robot-assisted partial nephrectomy. BJUI COMPASS 2023; 4:584-590. [PMID: 37636206 PMCID: PMC10447216 DOI: 10.1002/bco2.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/27/2023] [Accepted: 04/16/2023] [Indexed: 08/29/2023] Open
Abstract
Objective The objective of this work is to assess the relationship between the morphological characteristics of a central tumour and the perioperative outcomes of robot-assisted partial nephrectomy (RAPN). Subjects and Methods We retrospectively analysed the data from 186 patients with central tumours involving the renal sinus, who underwent RAPN in a single-centre study between February 2015 and June 2022. All cases were assigned a RENAL nephrometry score based on preoperative images. The shape of the protruding portion of the tumour was classified into four types: 'flat', 'spherical', 'single-hump', and 'complex-hump', and was independently assessed by two readers. The trifecta is defined as the warm ischemia time within 25 min, negative surgical margins, and no major postoperative complications. Univariate and multivariate analyses were performed to identify the factors associated with the failing trifecta. Results Trifecta was achieved in 113 cases (60.8%), and the achievement rate in flat, spherical, single-hump, and complex-hump types was 83.3%, 74.5%, 64.3%, and 21.3%, respectively. Prolonged warm ischemia time was the primary cause of the failure to achieve the trifecta. The rate of positive surgical margins and upstage to pathological T3a was greater for complex humps while the rate of major complications and postoperative GFR preservation did not differ between shapes. On multivariate analysis for failing trifecta achievement, the complex-hump protrusion was found to be an independent positive predictor (odds ratio: 15.8; p < 0.001), whereas the height and width of protrusion were not significantly related. Conclusions The degree of difficulty varied among central tumours, and it was not possible to precisely measure it with existing scoring systems. Complex-hump protrusions strongly correlate with failure to achieve the trifecta. Preoperative assessment of the morphology of protrusion is useful for predicting outcomes.
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Affiliation(s)
- Yuto Hattori
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
| | - Takanari Kambe
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
| | - Yuta Mine
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
| | - Hiroki Hagimoto
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
| | - Hidetoshi Kokubun
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
| | - Yohei Abe
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
| | - Daisuke Yamashita
- Department of PathologyKobe City Medical Centre General HospitalKobeJapan
| | - Naofumi Tsutsumi
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
| | - Shigeki Arizono
- Department of Diagnostic RadiologyKobe City Medical Centre General HospitalKobeJapan
| | | | - Mutsushi Kawakita
- Department of UrologyKobe City Medical Centre General HospitalKobeJapan
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6
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Bai R, Gao L, Wang J, Jiang Q. Positive surgical margins may not affect the survival of patients with renal cell carcinoma after partial nephrectomy: A meta-analysis based on 39 studies. Front Oncol 2022; 12:945166. [PMID: 36033492 PMCID: PMC9399599 DOI: 10.3389/fonc.2022.945166] [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: 05/16/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background So far, whether positive surgical margin(PSM) has adverse effects on the prognosis of patients is still controversial, so we designed this study to systematically evaluate the effect of PSM on the prognosis of patients with renal cell carcinoma (RCC) after partial nephrectomy (PN). Methods On the basis of three electronic databases (PubMed, Embase and the Cochrane Library) up to May 2022, all case-control studies (CCSs) comparing the effects of PSM and negative surgical margin (NSM) after PN on the oncological results of RCC patients were included. Two evaluators independently conducted a systematic literature search and extracted the data we needed. The methodological quality of all studies was evaluated by the modified Newcastle-Ottawa scale. The odds ratio (OR) was used to describe the results for dichotomous variables, and the meta-analysis was conducted using Cochrane Review Manager 5.2 and Stata 14.2. Results A total of 39 studies involving 21461 patients were included in our meta-analysis. The pooled results showed that the rates of tumor recurrence (OR 3.93, 95% CI 2.95-5.24; p < 0.00001) and metastasis (OR 4.63, 95% CI 3.11-6.88; p < 0.00001) in the PSM group were significantly higher than those in the NSM group. However, there were no significant differences in the rates of all-cause death (OR 1.35, 95% CI 0.92-1.99; p = 0.13) or cancer-specific death (OR 0.99, 95% CI 0.51-1.94; p = 0.99) between the two groups. In addition, subgroup analyses were carried out according to different average follow-ups, which revealed similar results. Conclusion Insignificant differences in survival between the PSM and NSM groups were observed, although significant differences in recurrence and metastasis in the PSM group were reported. Our study supported that close monitoring might be another effective choice for patients with PSM after PN. Considering the possible limitations, we recommended cautious interpretation of our results.
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Affiliation(s)
- Renran Bai
- Department of Nephrology, Qianjiang Central Hospital, Chongqing, China
| | - Liang Gao
- Department of Urology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiawu Wang
- Department of Urology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Jiang
- Department of Urology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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7
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Luis-Cardo A, Herranz-Amo F, Rodríguez-Cabero M, Quintana-Álvarez R, Esteban Labrador L, Rodríguez-Fernández E, Mayor-de Castro J, Barbas Bernardos G, Ramírez Martín D, Hernández-Fernández C. Laparoscopic nephron sparing surgery and radical nephrectomy in cT1 renal tumors. Comparative analysis of complications and survival. Actas Urol Esp 2022; 46:340-347. [PMID: 35637154 DOI: 10.1016/j.acuroe.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/25/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Comparative analysis of postoperative complications and survival between laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) in cT1 renal cell carcinoma (RCC). MATERIAL AND METHOD Retrospective study of patients with two kidneys and single renal tumor cT1 treated in our center between 2005 and 2018 by laparoscopic PN or RN. RESULTS 372 patients met the inclusion criteria for the study. RN was performed in 156 (41.9%) patients and PN in 216 (58.1%). Clavien Dindo III-V complications were observed in 10 (4,6%) PN and 6 (3,9%) RN patients (p = 0.75). The comorbidity Charlson index (CCI) was identified as an independent predictor variable of complications (p = 0.02) and surgical approach did not affect multivariate analysis. Estimated overall survival (OS) was 81.2% and 56.8% at 5 and 10 years in the RN group and 90.2% and 75.7% in the PN group, respectively (p = 0.0001). Obesity (HR 2.77, p = 0.01), CCI ≥ 3 (HR 3.69, p = 0.001) and glomerular filtration rate (GFR) <60 mL/min/1.73 m2 at discharge (HR 1.87, p = 0.03) were identified as predictors of overall mortality. Nephrectomy approach showed no influence on OS. Estimated recurrence-free survival (RFS) was 86.1% at 5 and 10 years in the RN group and 93.5% and 83.6% in the PN group, respectively (p = 0.22). CONCLUSIONS Laparoscopic PN is not inferior to RN in terms of oncologic and surgical safety in cT1 RCC. Nephrectomy approach did not influence patient OS, however, obesity, CCI ≥ 3 and GFR <60 mL/min/1.73 m2 at discharge did behave as predictors.
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Affiliation(s)
- A Luis-Cardo
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - F Herranz-Amo
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Otaola-Arca H, Krebs A, Bermúdez H, Lyng R, Orvieto M, Bustamante A, Stein C, Labra A, Schultz M, Fernández MI. Long-Term Oncological and Functional Outcomes After Robot-Assisted Partial Nephrectomy for Clinically Localized Renal Cell Carcinoma. Ann Surg Oncol 2022; 29:2484-2494. [PMID: 34988833 DOI: 10.1245/s10434-021-11133-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/08/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND To evaluate long-term oncological and renal function outcomes in patients treated with robot-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC). PATIENTS AND METHODS Patients undergoing RAPN for clinically localized RCC between January 2014 and December 2019 at a tertiary robotic reference center were evaluated. Clinical course, pathologic characteristics, and long-term outcomes were obtained from our institutional review board-approved RCC database. RESULTS A total of 234 patients were available for analysis. Median follow-up was 46 months (10.8-97.8 months), with 77 patients (32.9%) having at least 5-years of follow-up. Pathology revealed clear-cell RCC in 67.5% (n = 158). Among unfavorable factors, nuclear grades 3 or 4 were found in 67 (29.4%), lymphovascular invasion in 10 (4.3%), positive surgical margins in 22 (9.4%), necrosis in 21 (9%), and sarcomatoid pattern in 2 patients (0.9%). At 12 months, mean serum creatinine was 1.04 mg/dL and 12.9% of patients experienced upstaging in chronic kidney disease. Overall recurrence-free survival at 5-years was 97.8%. There were five local (2.1%) and two distant (0.9%) recurrences, none of them resulting in cancer-specific death. Median time to recurrence was 20 months (11-64 months). Warm ischemia time [hazard ratio (HR) = 1.14, p = 0.034] and sarcomatoid pattern (HR = 124.57, p = 0.001) were the only variables associated with local relapse. CONCLUSIONS Data from this large cohort demonstrate that patients undergoing RAPN have a low incidence of local and distant relapse, resulting in excellent long-term survival while preserving stable renal function in most patients.
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Affiliation(s)
- Hugo Otaola-Arca
- Department of Urology, Clínica Alemana de Santiago, Santiago, Chile.,Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Alfred Krebs
- Department of Urology, Clínica Alemana de Santiago, Santiago, Chile.,Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Hugo Bermúdez
- Department of Urology, Clínica Alemana de Santiago, Santiago, Chile.,Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Raúl Lyng
- Department of Urology, Clínica Alemana de Santiago, Santiago, Chile.,Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Marcelo Orvieto
- Department of Urology, Clínica Alemana de Santiago, Santiago, Chile.,Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Alberto Bustamante
- Department of Urology, Clínica Alemana de Santiago, Santiago, Chile.,Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Conrado Stein
- Department of Urology, Clínica Alemana de Santiago, Santiago, Chile.,Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Andrés Labra
- Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.,Department of Radiology, Clínica Alemana de Santiago, Santiago, Chile
| | - Marcela Schultz
- Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.,Department of Pathology, Clínica Alemana de Santiago, Santiago, Chile
| | - Mario I Fernández
- Department of Urology, Clínica Alemana de Santiago, Santiago, Chile. .,Faculty of Medicine, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.
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9
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Tian J, Zeng X, Wan J, Gan J, Ke C, Guan W, Hu Z, Yang C. Partial and Radical Nephrectomy Provides Equivalent Oncologic Outcomes in pT3a Renal Cell Carcinoma: A Population-Based Study. Front Oncol 2022; 11:819098. [PMID: 35155208 PMCID: PMC8826755 DOI: 10.3389/fonc.2021.819098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To compare the cause-specific survival (CSS) and overall survival (OS) of patients with localized T3a renal cell carcinoma (RCC) after partial nephrectomy (PN) or radical nephrectomy (RN). Methods We obtained the demographic and clinicopathological data of 7,127 patients with localized T3a RCC and who underwent PN or RN from the Surveillance, Epidemiology, and End Results (SEER) database. These patients were divided into fat invasion cohort and venous invasion cohort for subsequent analysis. Kaplan–Meier analysis (KMA) and univariate and multivariate Cox proportional hazards regression analyses were used to evaluate the effects of PN or RN on OS and CSS. Meanwhile, 65 cases with clinical T1 (cT1) RCC upstaged to pathological T3a (pT3a) who were treated in Tongji Hospital (TJH) from 2011 to 2020 and underwent PN or RN were identified. Results In the study cohort, 2,085 (29.3%) patients died during the 1–172 months’ follow-up, of whom 1,155 (16.2%) died of RCC. In the two cohorts of fat invasion and venous invasion, KMA indicated that the PN group had favorable survival (p < 0.001). However, after propensity score matching (PSM), univariate and multivariate Cox regression analyses showed that the PN and RN groups had comparable CSS in the fat invasion cohort (p = 0.075) and the venous invasion cohort (p = 0.190). During 1–104 months of follow-up, 9 cases in the Tongji cohort had disease recurrence. There was no significant difference in recurrence-free survival between the RN group and the PN group (p = 0.170). Conclusions Our analysis showed that after balancing these factors, patients with localized pT3a RCC receiving PN or RN can achieve comparable oncologic outcomes. PN is safe for selected T3a patients.
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Affiliation(s)
- Jihua Tian
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Xing Zeng
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Jie Wan
- Department of Pathology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiahua Gan
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Chunjin Ke
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Wei Guan
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Chunguang Yang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
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Luis-Cardo A, Herranz-Amo F, Rodríguez-Cabero M, Quintana-Álvarez R, Esteban-Labrador L, Rodríguez-Fernández E, Mayor-de Castro J, Barbas-Bernardos G, Ramírez-Martín D, Hernández-Fernández C. Nefrectomía parcial y radical laparoscópica en tumores renales cT1. Análisis comparativo de complicaciones y supervivencia. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Iwamoto H, Nosaka K, Miyoshi H, Makishima K, Ochiai R, Shimizu R, Yumioka T, Morizane S, Honda M, Takenaka A. Is Preoperative Magnetic Resonance Imaging in a Daily Clinical Setting Useful to Evaluate Tumor Invasion Beyond the Pseudocapsule in Renal Cell Carcinoma? Yonago Acta Med 2021; 64:345-352. [PMID: 34849083 DOI: 10.33160/yam.2021.11.004] [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: 07/02/2021] [Accepted: 11/01/2021] [Indexed: 11/05/2022]
Abstract
Background We wanted to clarify whether preoperative magnetic resonance imaging (MRI) in the clinical setting can evaluate the pathologic pseudocapsule (PC) morphology with high accuracy in renal cell carcinoma (RCC). Methods We retrospectively analyzed 34 consecutive patients who underwent MRI (1.5 or 3.0T, 5 mm slices) prior to partial nephrectomy (PN) for RCC at our institution between January 2010 and December 2019. First, the correlation between PC morphology (complete or incomplete) and tumor infiltration to the renal parenchyma was examined as pathologic validation. Second, the concordance rate of PC morphology between pathologic tissue and preoperative MRI was evaluated as radiologic validation. Third, risk factor for renal parenchymal invasion in RCC was analyzed. Results In the pathologic validation, parenchymal invasion rates were 11% and 28% in the "complete PC" and "incomplete PC" groups, respectively. In the radiologic validation, pathological PC morphology could be diagnosed on preoperative MRI in 17 patients (50.0%). "None PC" on MRI had the lowest positive predictive value (PPV) (0%), "partial PC" on MRI had a good PPV (76.5%), "complete PC" on MRI had a relatively low PPV (33.3%). Unfortunately, these data were insufficient for diagnostic accuracy. As risk factor for renal parenchymal invasion in RCC, only pathologic subtype (non-clear cell) was found to have significant differences in the multivariate analysis. Conclusion The results of this study suggest that renal tumors with pathologically incomplete PC have a high possibility of renal parenchymal invasion. However, it is currently difficult to accurately evaluate pathologic PC morphology by preoperative MRI in the clinical setting.
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Affiliation(s)
- Hideto Iwamoto
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Kanae Nosaka
- Department of Pathology, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Hidenao Miyoshi
- Division of Radiology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Karen Makishima
- Department of Pathology, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Ryouya Ochiai
- Division of Radiology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Ryutarou Shimizu
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Tetsuya Yumioka
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
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Hakam N, Abou Heidar N, Khabsa J, Hneiny L, Akl EA, Khauli R. Does a Positive Surgical Margin After Nephron Sparing Surgery Affect Oncological Outcome in Renal Cell Carcinoma? A Systematic Review and Meta-analysis. Urology 2021; 156:e30-e39. [PMID: 34186133 DOI: 10.1016/j.urology.2021.04.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/11/2021] [Accepted: 04/14/2021] [Indexed: 01/11/2023]
Abstract
We systematically evaluated the impact of positive surgical margins (PSM) on oncological outcomes after partial nephrectomy for renal cell carcinoma. Forty-two studies comprising 101,153 subjects were included and five distinct meta-analyses were performed. PSM was associated with increased risk of local recurrence (hazard ratio (HR) 6.11-high certainty), metastasis (HR 3.29-moderate certainty), overall relapse (HR 2.25-high certainty), overall mortality (HR 1.30-moderate certainty), and may be associated with increased cancer-specific mortality (HR 1.91-low certainty). Patients with PSM should be counseled for the possibility of additional surgery, novel adjuvant therapies, and more rigorous surveillance.
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Affiliation(s)
- Nizar Hakam
- Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon; The Breyer Lab, University of California San Francisco, San Francisco, CA
| | - Nassib Abou Heidar
- Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Layal Hneiny
- Saab Medical Library, University Libraries, American University of Beirut, Beirut, Lebanon
| | - Elie A Akl
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Raja Khauli
- Division of Urology and Renal Transplantation, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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13
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Guo P, Wang Y, Han Y, Wei D, Zhao J, Li M, Jiang Y, Luo Y. Oncological Outcomes of Patients With Different Pathological Features of pT3a Renal Tumor: A Systematic Review and Quantitative Synthesis. Front Oncol 2021; 11:678459. [PMID: 34150642 PMCID: PMC8209473 DOI: 10.3389/fonc.2021.678459] [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: 03/09/2021] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To identify the differences in oncological outcomes for patients with different pT3a renal tumor invasion patterns and pathological features. Methods The protocol of this study was registered on PROSPERO (CRD42021234475). Relevant studies were identified by searching the PubMed, Cochrane library, Embase, and Web of Science databases. Cancer-specific survival (CSS) was selected as the endpoint. Pooled hazard ratio (HR) and 95% confidence interval (CI) extracted from multivariate Cox models were evaluated to identify the hazard association. Results A total of 22 studies, which enrolled 12384 patients were included for quantitative synthesis. Sinus fat invasion (SFI) + perinephric fat invasion (PFI) was associated with inferior CSS compared to SFI only (p = 0.02). Comparable CSS was observed between SFI and PFI (p = 0.57). SFI ± PFI showed inferior CSS compared to PFI only (p = 0.0002). The presence of pelvicalyceal system invasion significantly increased the risk of cancer-specific mortality (p = 0.0005). Renal vein invasion (RVI) indicated poor oncological outcomes in terms of CSS (p = 0.002). The concomitant RVI and fat invasion (FI) significantly increased the risk of deterioration of CSS compared to RVI or FI (p < 0.0001). Multiple invasion patterns translated into a significantly decreased CSS (p < 0.0001). Aggressive tumor behavior, including lymph node involvement (p = 0.006), distant metastases (p < 0.00001), sarcomatoid differentiation (p < 0.0001), necrosis (p < 0.0001), Fuhrman grade III or IV (p < 0.0001), positive margin (p < 0.0001), and tumor size >7cm (p < 0.0001) were the predictors of inferior CSS. The lymphovascular invasion (p = 0.67) was indolent in terms of CSS. Conclusion This study confirmed the heterogenicity of pT3a renal tumors. Multiple invasion patterns could translate into a significantly decreased CSS, and SFI should not be merged in the SFI + PFI group. The presence of PSI or RVI could significantly increase the risk of cancer-specific mortality. Lymph node involvement, distant metastases, sarcomatoid differentiation, necrosis, high Fuhrman grade, positive margin, and size >7cm were the predictors of inferior CSS. A precise-risk grade of CSS for different invasion patterns including comprehensive combinations may be useful for the further refinements of the TNM system. Systematic Review Registration The current study was registered on PROSPERO, and the registration numbers is CRD42021234475.
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Affiliation(s)
- Pengju Guo
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongxing Wang
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yili Han
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dechao Wei
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiahui Zhao
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mingchuan Li
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yongguang Jiang
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yong Luo
- Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Wang X, Lu Y, Tuo Z, Zhou H, Zhang Y, Cao Z, Peng L, Yu D, Bi L. Role of SIRT1/AMPK signaling in the proliferation, migration and invasion of renal cell carcinoma cells. Oncol Rep 2021; 45:109. [PMID: 33907836 PMCID: PMC8082341 DOI: 10.3892/or.2021.8060] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/05/2021] [Indexed: 12/27/2022] Open
Abstract
Renal cell carcinoma (RCC) is a lethal urologic tumor commonly seen in men that best responds to partial nephrectomy. An enhanced understanding of the molecular pathogenesis of RCC can broaden treatment options and tumor prevention strategies. Sirtuin 1 (SIRT1) is a NAD+-dependent deacetylase that regulates several bioactive substances, and the present study aimed to identify the role of SIRT1/AMP-activated protein kinase (AMPK) signaling in RCC progression. SIRT1 expression was detected in 100 patients with RCC using tissue microarray immunohistochemistry. SIRT1-knockdown and overexpression were performed via RNA interference and plasmid transfection. Inhibition of AMPK was used for the phenotypic rescue assays to verify whether AMPK was a downstream target of SIRT1. Reverse transcription-quantitative PCR was performed to verify transfection efficiency. Transwell, MTT and flow cytometry apoptosis assays were performed to evaluate the migration, invasion, proliferation and early apoptosis level of RCC cells. SIRT1 and AMPK protein expression in human RCC tissues and cell lines (786-O and ACHN) was detected using western blotting and immunofluorescence staining. The current results, combined with data from The Cancer Genome Atlas database, revealed that SIRT1 expression in RCC tissues was downregulated compared with in adjacent normal tissues. Additionally, high SIRT1 expression was associated with an improved prognosis in patients with RCC. Overexpression of SIRT1 inhibited the proliferation, migration and invasion of RCC cell lines and induced apoptosis, while inhibition of SIRT1 expression had the opposite effects. Further experiments indicated that SIRT1 may serve an anticancer role by upregulating the expression levels of downstream AMPK, thus revealing a potential therapeutic target for RCC.
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Affiliation(s)
- Xin Wang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Youlu Lu
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Zhouting Tuo
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Huan Zhou
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Ying Zhang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Zhangjun Cao
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Longfei Peng
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Dexin Yu
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Liangkuan Bi
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China
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15
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Koukourikis P, Alqahtani AA, Almujalhem A, Lee J, Han WK, Rha KH. Robot-assisted partial nephrectomy for high-complexity tumors (PADUA score ≥10): Perioperative, long-term functional and oncologic outcomes. Int J Urol 2021; 28:554-559. [PMID: 33604916 DOI: 10.1111/iju.14507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/27/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To evaluate the safety and efficacy, and long-term functional and oncologic outcomes of robot-assisted partial nephrectomy in high-complexity tumors. METHODS Data of 155 patients with a high-complexity tumor (PADUA score ≥10) were reviewed. Trifecta achievement, intra-, perioperative, functional, and oncologic outcomes were analyzed and compared between patients with increasing complexity. RESULTS Of the 155 patients, 65 (41.9%) patients had a PADUA score of 10, 55 (35.5%) had a PADUA score of 11, and 35 (22.6%) had a PADUA score of 12-13, respectively. The median (interquartile range) operative time, warm ischemia time and estimated blood loss were 150 min (112-186 min), 26 min (23-32 min) and 250 mL (100-500 mL), respectively. Postoperatively, complications occurred in 25 (16.1%) patients, and positive surgical margins in 15 (10.5%) patients. Trifecta was achieved in 67 (43.2%) patients. At a median follow-up period of 58 months, the median estimated glomerular filtration rate preservation was 87% (78-110), and 12 (7.7%) patients developed new-onset chronic kidney disease. Recurrence-free survival and overall survival rates were 93.6% and 96.7%, respectively. Positive surgical margins were statistically different between the groups of PADUA score 10, 11 and 12-13 (P = 0.017), whereas functional and oncologic outcomes were similar. In multivariate logistic regression analysis, increasing tumor size (odds ratio 1.48, 95% confidence interval 1.21-1.87; P < 0.001) and the American Society of Anesthesiologists score 2/3 (odds ratio 0.48, 95% confidence interval 0.24-0.96; P = 0.041) were independent predictors of trifecta failure. CONCLUSIONS Robot-assisted partial nephrectomy is a safe and effective treatment for high-complexity tumors providing excellent long-term functional and oncologic outcomes.
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Affiliation(s)
- Periklis Koukourikis
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ali Abdullah Alqahtani
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ahmad Almujalhem
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jongsoo Lee
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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16
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Carvalho JAM, Nunes P, Tavares-da-Silva E, Parada B, Jarimba R, Moreira P, Retroz E, Caetano R, Sousa V, Cipriano A, Figueiredo A. Impact of Positive Surgical Margins After Partial Nephrectomy. EUR UROL SUPPL 2020; 21:41-46. [PMID: 34337467 PMCID: PMC8317835 DOI: 10.1016/j.euros.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 01/27/2023] Open
Abstract
Background The impact of positive surgical margins (PSMs) after partial nephrectomy (PN) is controversial. Objective To evaluate the risk factors for a PSM and its impact on overall survival. Design, setting, and participants This is a retrospective study of 388 patients were submitted to PN between November 2005 and December 2016 in a single centre. Two groups were created: PSM and negative surgical margin (NSM) after PN. A p value of <0.05 was considered significant. Outcome measurements and statistical analysis Relationships with outcome were assessed using univariable and multivariable tests and log-rank analysis. Results and limitations The PSM rate was 3.8% (N = 16). The mean age at the time of surgery (PSM group: 64.1 ± 11.3 vs NSM group: 61.8 ± 12.8 yr, p = 0.5) and the mean radiological tumour size (4.0 ± 1.5 vs 3.4 ± 1.8 cm, p = 0.2) were similar. Lesion location (p = 0.3), surgical approach (p = 0.4), warm ischaemia time (p = 0.9), and surgery time (p = 0.06) had no association with PSM. However, higher surgeon experience was associated with a lower PSM incidence (2.6% if ≥30 PNs vs 9.6% if <30 PNs; p = 0.02). Higher operative blood loss (p = 0.02), higher-risk tumours (p = 0.03), and larger pathological size (p = 0.05) were associated with an increase in PSM. In the PSM group, recurrence rate (18.7% vs 4.2%, p = 0.007) and secondary total nephrectomy rate (25% vs 4.4%, p < 0.001) were higher. However, overall survival was similar. Multivariate analysis revealed that high-risk tumour (p = 0.05) and low experience (p = 0.03) could predict a PSM. Limitations include retrospective design and reduced follow-up time. Conclusions PSMs were mainly associated with high-risk pathological tumour (p = 0.05) and low-volume surgeon experience. Recurrence rate and need for total nephrectomy were higher in that group, but no impact on survival was noticed. Patient summary The impact of positive surgical margins (PSMs) after partial nephrectomy is a matter of debate. In this study, we found that PSMs were mainly associated with aggressive disease and low surgeon experience.
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Affiliation(s)
- João André Mendes Carvalho
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Pedro Nunes
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Edgar Tavares-da-Silva
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Belmiro Parada
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Roberto Jarimba
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal
| | - Pedro Moreira
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal
| | - Edson Retroz
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal
| | - Rui Caetano
- Department of Pathology, Coimbra University Hospital Center, Coimbra, Portugal
| | - Vítor Sousa
- Faculty of Medicine, Coimbra University, Coimbra, Portugal.,Department of Pathology, Coimbra University Hospital Center, Coimbra, Portugal
| | - Augusta Cipriano
- Faculty of Medicine, Coimbra University, Coimbra, Portugal.,Department of Pathology, Coimbra University Hospital Center, Coimbra, Portugal
| | - Arnaldo Figueiredo
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
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17
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Srougi V, Iscaife A, Srougi M. Comment on: Shatagopam K, Bahler CD, Sundaram CP. Renorrhaphy techniques and effect on renal function with robotic partial nephrectomy. World J Urol. 2020;38: 1109-12. World J Urol 2020; 39:3695. [PMID: 32535647 DOI: 10.1007/s00345-020-03306-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Victor Srougi
- Division of Urology, Hospital das Clínicas de São Paulo, University of Sao Paulo Medical School, Av. Enéas de Carvalho Aguiar,255, São Paulo, SP, 05403-000, Brazil. .,Hospital Moriah, Sao Paulo, Brazil.
| | - Alexandre Iscaife
- Division of Urology, Hospital das Clínicas de São Paulo, University of Sao Paulo Medical School, Av. Enéas de Carvalho Aguiar,255, São Paulo, SP, 05403-000, Brazil
| | - Miguel Srougi
- Division of Urology, Hospital das Clínicas de São Paulo, University of Sao Paulo Medical School, Av. Enéas de Carvalho Aguiar,255, São Paulo, SP, 05403-000, Brazil
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18
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Sentell KT, Ferroni MC, Abaza R. Near-infrared fluorescence imaging for intraoperative margin assessment during robot-assisted partial nephrectomy. BJU Int 2020; 126:259-264. [PMID: 32320124 DOI: 10.1111/bju.15089] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To demonstrate how using a standardised dosing strategy of indocyanine green (ICG) dye with near-infrared fluorescence (NIRF) imaging can be used to differentiate renal tumours from normal renal parenchyma during robot-assisted partial nephrectomy (RAPN). PATIENTS AND METHODS We reviewed a prospectively collected database of 361 consecutive RAPNs using NIRF between June 2011 and March 2018, and determined the rate at which differential fluorescence was achieved. Tumour and kidney fluorescence or afluorescence were recorded intraoperatively and compared to histological results on final pathology. RESULTS Of 330 tumours, after 31 exclusions for nonvisible tumours due to adherent fat, completely intrarenal location or for incomplete data, 288 (87.3%) successfully exhibited differential fluorescence. Among the predominant histologies, 249 of 277 (89.9%) renal cell carcinomas did not fluoresce, as well as 23 of 32 (71.9%) oncocytomas. Real-time gross assessment of resection margin for fluorescence yielded a positive margin rate on final pathology of 0.30%. CONCLUSION When administered with a standardised ICG-dosing strategy, NIRF successfully achieved differential fluorescence in a large majority of tumours during RAPN with an exceedingly low positive margin rate.
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Affiliation(s)
- Katherine T Sentell
- OhioHealth Robotic Urologic and Cancer Surgery, OhioHealth Dublin Methodist Hospital, Dublin, OH, USA
| | - Matthew C Ferroni
- OhioHealth Robotic Urologic and Cancer Surgery, OhioHealth Dublin Methodist Hospital, Dublin, OH, USA
| | - Ronney Abaza
- OhioHealth Robotic Urologic and Cancer Surgery, OhioHealth Dublin Methodist Hospital, Dublin, OH, USA
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Aubert C, Rolley C, Mauny M, Heuveline J, Silve E, Humeau M, Le Corre V, Lebdai S, Brassart E, Culty T, Baize N, Rousselet MC, Nedelcu C, Aubé C, Bouvier A, Bigot P. [Impact of partial nephrectomy in a hybrid operating room on the activity of kidney cancer surgery]. Prog Urol 2020; 30:288-295. [PMID: 32234422 DOI: 10.1016/j.purol.2020.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 02/01/2020] [Accepted: 02/13/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Partial nephrectomy (NP) after embolization of tumor vessels (NPESH) in a hybrid room combines embolization of tumor vessels and enucleation of the tumor under laparoscopy in the same operative time. The purpose of this study was to assess the impact of the use of NPESH in the management of patients treated with surgery for a localized kidney tumor. MATERIAL AND METHODS Using the uroCCR database, we included all consecutive patients operated in a university hospital for localized kidney tumor. From 2011 to May 2015, patients were treated by Standard Partial Nephrectomy (NPS) Laparoscopic or Open and from May 2015 to May 2019 by NPESH. We evaluated characteristics of patients, tumors, perioperative data and complications. These data were compared by Student and Khi2 tests. RESULTS 87 NPS were performed during Period 1 and 137 NPS were performed during period 2. The ASA score of patients undergoing NPESH was higher than NPS (P<0.0001). The tumor complexity and median tumor size were similar in the two groups (P=0.852 and P=0.48). The complication rate for NPS and NPESH was 55.2% and 33.6% (P=0.002). There were less severe complications in the NEPSH group (P=0.012). The median length of stay was 8 and 4 days for the NPS and NPESH groups (P<0.0001). Positive surgical margins were 2 (2.3%) and 6 (4.6%) for the NPS and NPESH group (P=0.713). DISCUSSION NPESH is an efficient technique compared to NPS. It seems to be an interesting alternative to limit renal ischemia, complication rate and length of stay for the management of localized kidney tumors.
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Affiliation(s)
- C Aubert
- Service d'urologie, CHU de Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - C Rolley
- UTTIOM, unité transversale de thérapeutiques innovantes en oncologie médicale, CHU de Angers, 4, rue Larrey, 49933 Angers, France
| | - M Mauny
- Faculté de médecine d'Angers, 49000 Angers, France
| | - J Heuveline
- Faculté de médecine d'Angers, 49000 Angers, France
| | - E Silve
- Faculté de médecine d'Angers, 49000 Angers, France
| | - M Humeau
- Faculté de médecine d'Angers, 49000 Angers, France
| | - V Le Corre
- Service d'urologie, CHU de Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - S Lebdai
- Service d'urologie, CHU de Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - E Brassart
- Service d'urologie, CHU de Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - T Culty
- Service d'urologie, CHU de Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - N Baize
- UTTIOM, unité transversale de thérapeutiques innovantes en oncologie médicale, CHU de Angers, 4, rue Larrey, 49933 Angers, France
| | - M C Rousselet
- Département d'anatomopathologie, CHU de Angers, 4, rue Larrey, 49933 Angers, France
| | - C Nedelcu
- Service de radiologie, CHU de Angers, 4, rue Larrey, 49933 Angers, France
| | - C Aubé
- Service de radiologie, CHU de Angers, 4, rue Larrey, 49933 Angers, France
| | - A Bouvier
- Service de radiologie, CHU de Angers, 4, rue Larrey, 49933 Angers, France
| | - P Bigot
- Service d'urologie, CHU de Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
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Marszalek M. Risk reduction in kidney surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S89. [PMID: 31576297 DOI: 10.21037/atm.2019.04.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Martin Marszalek
- Department of Urology and Andrology, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria
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21
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Demirdag C, Citgez S, Gevher F, Simsekoglu F, Yalcin V. Trifecta Outcomes of Laparoscopic Partial Nephrectomy for T1a and T1b Renal Tumors: A Single-Center Experience in a Tertiary Care Institution. J Laparoendosc Adv Surg Tech A 2019; 29:790-795. [DOI: 10.1089/lap.2018.0756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Cetin Demirdag
- Department of Urology, University of Istanbul Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Sinharib Citgez
- Department of Urology, University of Istanbul Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Fatih Gevher
- Department of Urology, Bezmialem University, Istanbul, Turkey
| | - Fatih Simsekoglu
- Department of Urology, University of Istanbul Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Veli Yalcin
- Department of Urology, University of Istanbul Cerrahpasa School of Medicine, Istanbul, Turkey
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Ayangbesan A, Golombos DM, Golan R, O'Malley P, Lewicki P, Wu X, Scherr DS. Surgical Approach Does Not Impact Margin Status After Partial Nephrectomy for Large Renal Masses. J Endourol 2019; 33:50-60. [PMID: 29914269 PMCID: PMC6918521 DOI: 10.1089/end.2018.0144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE While surgical approach has recently been associated with positive surgical margin (PSM) after partial nephrectomy (PN) for small (<4 cm) renal masses, its impact on margin status for large (>4 cm) masses is unclear. We sought to evaluate the relationship between margin and surgical approach in patients undergoing PN for large renal masses. MATERIALS AND METHODS Using the National Cancer Database (NCDB), we identified patients undergoing PN for pathological T1b and T2a renal-cell carcinoma diagnosed from 2010 to 2013. Conversions to open surgery were also included in our analysis. The primary outcome was surgical margin status. Multivariable regression modeling was performed to identify factors associated with PSM. A propensity score matching analysis was then performed to evaluate the impact of margin status on overall survival (OS). RESULTS Of the 7495 patients undergoing PN for pT1b and pT2a renal masses over the study period, 504 (6.7%) had PSM. On multivariable analysis, surgical approach (laparoscopic or robot assisted vs open) was not significantly associated with surgical margin (p = 0.12 and p = 0.44, respectively). Tumor stage (T2a vs T1b) also showed no significant association (p = 0.18). A subsequent multivariable analysis using clinical staging showed that surgical approach (p = 0.28 and p = 0.54, respectively), tumor stage (p = 0.78), and conversion-to-open surgery (p = 0.98) had no significant association with PSM. Propensity score matched analysis showed that PSM was not significantly associated with OS (hazard ratio 0.95 [95% confidence interval 0.47-1.92] p = 0.88). CONCLUSION In a contemporary nation-wide cohort, surgical approach was not associated with an increased risk of PSM for large, noninvasive renal masses. Furthermore, increased size from T1b to T2a was not associated with an increased risk of PSM. These data suggest that surgical approach should be selected by surgeon comfort level with an individual tumor, rather than the size of the tumor itself.
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Affiliation(s)
- Abimbola Ayangbesan
- Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - David M. Golombos
- Department of Urology, Stony Brook School of Medicine, Stony Brook, New York
| | - Ron Golan
- Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | | | - Patrick Lewicki
- Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
| | - Xian Wu
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Douglas S. Scherr
- Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York
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23
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Malkoç E, Maurice MJ, Kara Ö, Ramirez D, Nelson RJ, Dagenais J, Fareed K, Fergany A, Stein RJ, Mouracade P, Kaouk JH. Predictors of positive surgical margins in patients undergoing partial nephrectomy: A large single-center experience. Turk J Urol 2019; 45:17-21. [PMID: 30668306 DOI: 10.5152/tud.2018.57767] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 11/01/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify preoperative factors that predict positive surgical margins in partial nephrectomy. MATERIAL AND METHODS Using our institutional partial nephrectomy database, we investigated the patients who underwent partial nephrectomy for malignant tumors between January 2011 and December 2015. Patient, tumor, surgeon characteristics were compared by surgical margin status. Multivariable logistic regression was used to identify independent predictors of positive surgical margins. RESULTS A total of 1025 cases were available for analysis, of which 65 and 960 had positive and negative surgical margins, respectively. On univariate analysis, positive margins were associated with older age (64.3 vs. 59.6, p<0.01), history of prior ipsilateral kidney surgery (13.8% vs. 5.6%, p<0.01), lower preoperative eGFR (74.7 mL/min/1.73 m2 vs. 81.2 mL/min/1.73 m2, p=0.01), high tumor complexity (31.8% vs. 19.0%, p=0.03), hilar tumor location (23.1% vs. 12.5%, p=0.01), and lower surgeon volume (p<0.01). Robotic versus open approach was not associated with the risk of positive margins (p=0.79). On multivariable analysis, lower preoperative eGFR, p=0.01), hilar tumor location (p=0.01), and lower surgeon volume (p<0.01) were found to be independent predictors of positive margins. CONCLUSION In our large institutional series of partial nephrectomy cases, patient, tumor, and surgeon factors influence the risk of positive margins. Of these, surgeon volume is the single most important predictor of surgical margin status, indicating that optimal oncological outcomes are best achieved by high-volume surgeons.
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Affiliation(s)
- Ercan Malkoç
- Department of Urology, Health Sciences University, Sultan Abdülhamid Han Education and Training Hospital, İstanbul, Turkey
| | - Matthew J Maurice
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Önder Kara
- Department of Urology, Kocaeli University School of Medicine, İzmit, Turkey
| | - Daniel Ramirez
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ryan J Nelson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Julien Dagenais
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaled Fareed
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amr Fergany
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert J Stein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pascal Mouracade
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Li G, Zhu DS, Lang ZQ, Wang AX, Li YH, Zhang RY, Niu YJ. Classification of positive surgical margins and tumor recurrence after nephron-sparing surgery for small renal masses. Cancer Manag Res 2018; 10:6591-6598. [PMID: 30584355 PMCID: PMC6283258 DOI: 10.2147/cmar.s181843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The association of positive margin and local recurrence after nephron-sparing surgery (NSS) remains a notably controversial issue. The aim of the present study was to investigate the relationship between classification of positive surgical margins (PSMs) and tumor recurrence based pathological findings. METHODS Clinical, pathological, and follow-up data of 600 small renal cancer patients who underwent NSS between November 2007 and November 2017 at four hospitals in China were analyzed retrospectively. RESULTS Of the 600 reviewed patients, 20 had positive margins. During the follow-up period of 56 months, only three cases of tumor recurrence were identified. Pathological examination was performed, and subsequently a new classification criteria were proposed: 1) False PSMs, which could be further divided into three subtypes: i) no standard processing performed on pathological specimens (seven patients); ii) incidental incision into the tumor during operation, with the tumor bed free of tumor residues (four patients); iii) part of the tumor pseudocapsule was noted to be remained in the tumor bed, with no signs of tumor residue (four patients). 2) True PSMs with two subtypes: i) a large number of residual tumor cells at the surgical margin (three patients); ii) incision of satellite tumor nodules detected around a large tumor (two patients). CONCLUSION Taken together, PSMs in NSS were rarely found. Based on the pathological examination findings, PSMs can be divided into false positive and true positive. This being said, PSMs were determined to be poor predictors for local recurrence, with no predominant association with true tumor remnants in the majority of our evaluated cases. Through the key findings of our study, we concluded that PSMs should be carefully analyzed and treated on a case-by-case basis.
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Affiliation(s)
- Gang Li
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China,
| | - Dong-Sheng Zhu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China,
| | - Zhi-Qiang Lang
- Department of Pathology, Yuhuangding Hospital of Qingdao University, Yantai 264000, China
| | - Ai-Xiang Wang
- Department of Pathology, Tianjin Institute of Urology, Tianjin 300211, China
| | - Yu-Hong Li
- Department of Pathology, The People's Hospital of Liaocheng, Liaocheng 252000, China
| | - Ren-Ya Zhang
- Department of Pathology, Affiliated Hospital of Jining Medical University, Jining 272029, China
| | - Yuan-Jie Niu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China,
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Tsai SH, Tseng PT, Sherer BA, Lai YC, Lin PY, Wu CK, Stoller ML. Open versus robotic partial nephrectomy: Systematic review and meta-analysis of contemporary studies. Int J Med Robot 2018; 15:e1963. [PMID: 30265760 DOI: 10.1002/rcs.1963] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 09/13/2018] [Accepted: 09/21/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To compare perioperative outcomes of robotic-assisted partial nephrectomy (RaPN) with open partial nephrectomy (OPN). METHODS Systematically search through PubMed, Embase, ClinicalKey, Cochrane Library, ProQuest, ScienceDirect, Web of Science, and ClinicalTrials.gov for eligible studies was performed to April 11, 2018. A meta-analysis was conducted for studies comparing RaPN and OPN. Confounding variables were assessed by meta-regression or subgroup analysis. RESULTS This study included 34 studies with 60 808 patients. Meta-analysis revealed less blood loss, less transfusion, longer operative time, less postoperative complications, lower readmission rate, shorter length of stay, and less estimated glomerular filtration rate (eGFR) decline in RaPN groups. The superiority of RaPN in blood loss was attenuated with highly complex renal masses. The superiority of RaPN in intraoperative complications was strengthened with renal hilar control. The advantage of RaPN in surgical margin was increased in patient with body mass index (BMI) < 28. CONCLUSIONS Compared with OPN, RaPN provided lower morbidities and better renal function preservation.
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Affiliation(s)
- Sheng-Han Tsai
- Department of Urology, Cheng Hsin General Hospital, Taipei City, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ping-Tao Tseng
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung, Taiwan.,WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan
| | - Benjamin A Sherer
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Yi-Chen Lai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiology, Veteran General Hospital, Taipei, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ching-Kuan Wu
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung, Taiwan
| | - Marshall L Stoller
- Department of Urology, University of California, San Francisco, San Francisco, California
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Herlemann A, Odisho AY, Porten SP. Partial Nephrectomy is the Surgical Treatment of Choice for (Most) Complex Localized Renal Tumors. KIDNEY CANCER 2018. [DOI: 10.3233/kca-180039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Annika Herlemann
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Anobel Y. Odisho
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Sima P. Porten
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
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Ficarra V, Crestani A, Inferrera A, Novara G, Rossanese M, Subba E, Giannarini G. Positive Surgical Margins After Partial Nephrectomy: A Systematic Review and Meta-Analysis of Comparative Studies. KIDNEY CANCER 2018. [DOI: 10.3233/kca-180037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Vincenzo Ficarra
- Department of Human and Paediatric Pathology “Gaetano Barresi”, Urologic Section, University of Messina, Messina, Italy
| | - Alessandro Crestani
- Urology Unit, Academic Medical Centre “Santa Maria della Misericordia”, Udine, Italy
| | - Antonino Inferrera
- Department of Human and Paediatric Pathology “Gaetano Barresi”, Urologic Section, University of Messina, Messina, Italy
| | - Giacomo Novara
- Department of Surgical, Oncologic, and Gastrointestinal Disease, Urologic Unit, University of Padua, Padua, Italy
| | - Marta Rossanese
- Department of Human and Paediatric Pathology “Gaetano Barresi”, Urologic Section, University of Messina, Messina, Italy
| | - Enrica Subba
- Department of Human and Paediatric Pathology “Gaetano Barresi”, Urologic Section, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre “Santa Maria della Misericordia”, Udine, Italy
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Shah PH, Alom MA, Leibovich BC, Thompson RH, Uzzo RG, Kavoussi LR, Richstone L, Bhindi B, Habermann EB, Joshi V, Boorjian SA. The Temporal Association of Robotic Surgical Diffusion with Overtreatment of the Small Renal Mass. J Urol 2018; 200:981-988. [PMID: 29792881 DOI: 10.1016/j.juro.2018.05.081] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE We evaluated contemporary practice patterns in the management of small renal masses. MATERIALS AND METHODS We identified 52,804 patients in the NCDB (National Cancer Database) who were diagnosed with a small renal mass (4 cm or less) between 2010 and 2014. Utilization trends of active surveillance, ablation and robotic, laparoscopic and open surgical techniques were compared among all comers, elderly patients 75 years old or older and individuals with competing health risks, defined as a Charlson index of 2 or greater. Multivariable logistic regression models were used to assess factors associated with robotic renal surgery and active surveillance. RESULTS Surgery remained the primary treatment modality across all years studied, performed in 75.0% and 74.2% of cases in 2010 and 2014, respectively. Although increases in active surveillance from 4.8% in 2010 to 6.0% in 2014 (p <0.001) and robotic renal surgery (22.1% in 2010 to 39.7% in 2014, p <0.001) were observed, the increase in the proportion of small renal masses treated with robotic partial and radical nephrectomy was greater than that of active surveillance (82.0% and 63.0%, respectively, vs 25.0%). Subgroup analyses in individuals 75 years old or older, or with a Charlson index of 2 or greater likewise revealed preferential increases in robotic surgery vs active surveillance. On multivariable analysis later year of diagnosis was associated with increased performance of robotic renal surgery compared to active surveillance (2014 vs 2010 OR 1.44, 95% CI 1.20-1.72, p <0.001) and nonrobotic procedural interventions (2014 vs 2010 OR 2.59, 95% CI 2.30-2.93, p <0.001). CONCLUSIONS Robotic surgical extirpation has outpaced the adoption of active surveillance of small renal masses. This raises concern that the diffusion of robotic technology propagates overtreatment, particularly among elderly and comorbid individuals.
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Affiliation(s)
- Paras H Shah
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Manaf A Alom
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Robert G Uzzo
- Division of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Louis R Kavoussi
- Department of Urology, Northwell Health, New Hyde Park, New York
| | - Lee Richstone
- Department of Urology, Northwell Health, New Hyde Park, New York
| | - Bimal Bhindi
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth B Habermann
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Vidhu Joshi
- Department of Urology, Mayo Clinic, Rochester, Minnesota
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Marchiñena PG, Tirapegui S, Gonzalez IT, Jurado A, Gueglio G. Positive surgical margins are predictors of local recurrence in conservative kidney surgery for pT1 tumors. Int Braz J Urol 2018; 44:475-482. [PMID: 29368873 PMCID: PMC5996790 DOI: 10.1590/s1677-5538.ibju.2017.0039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 10/30/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The clinical significance of positive surgical margin (PSM) after a Nephron Sparing Surgery (NSS) is controversial. The aim of this study is to evaluate the association between PSM and the risk of disease recurrence in patients with pT1 kidney tumors who underwent NSS. MATERIALS AND METHODS Retrospective cohort study. A total of 314 patients submitted to a NSS due to stage pT1 renal tumor between January 2010 and June 2015 were included. Recurrence-free survival was estimated. The Cox model was used to adjust the tumor size, histological grade, pathological stage, age, surgical margins and type of approach. RESULTS Overall PSM was 6.3% (n=22). Recurrence was evidenced in 9.1% (n=2) of patients with PSM and 3.5% (n=10) for the group of negative surgical margin (NSM). The estimated local recurrence-free survival rate at 3 years was 96.4% (95% CI 91.9 to 100) for the NSM group and 87.8% (95% CI 71.9 to 100) for PSM group (p=0.02) with no difference in metastasis-free survival. The PSM and pathological high grade (Fuhrman grade III or IV) were independent predictors of local recurrence in the multivariate analysis (HR 12.9, 95%CI 1.8-94, p=0.011 / HR 38.3, 95%CI 3.1-467, p=0.004 respectively). Fuhrman grade proved to be predictor of distant recurrence (HR 8.1, 95%CI 1.6-39.7, p=0.011). CONCLUSIONS The PSM in pT1 renal tumors showed to have higher risk of local recurrence and thus, worse oncological prognosis.
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Affiliation(s)
| | - Sebastián Tirapegui
- Department of Urology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Alberto Jurado
- Department of Urology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Gueglio
- Department of Urology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Edwards DC, Cahn DB, Smaldone MC, Kutikov A. Use of administrative data for comparative effectiveness research in the treatment of non-prostate genitourinary malignancies. Urol Oncol 2018; 36:193-212. [DOI: 10.1016/j.urolonc.2017.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/30/2017] [Accepted: 08/04/2017] [Indexed: 01/13/2023]
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Kumar S, Modi PR, Pal BC, Kothari V, Mishra A. Retroperitoneoscopic partial nephrectomy for renal cell carcinoma: A single-center Indian experience. Urol Ann 2018; 10:400-405. [PMID: 30386094 PMCID: PMC6194790 DOI: 10.4103/ua.ua_20_18] [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] [Indexed: 11/04/2022] Open
Abstract
Objective Retroperitoneoscopy, by avoiding peritoneal breach and injury to intra-abdominal organs, provides a more direct and rapid access to the kidney and the renal hilum. Laparoscopic partial nephrectomy by retroperitoneal route (LPNR) is less commonly performed than transperitoneal route for early stage renal cancer. The objective of this study is to carry out the outcomes of partial nephrectomy using retroperitoneal approach. Materials and Methods Patients, who underwent LPNR from period 2008 to 2014, were retrospectively analyzed. Outcomes of interest included demographic data, preoperative data, perioperative variables, surgical complications, recurrence of disease, and mortality, if any, during their follow-up. Results Among 24 patients, 16 were male, and 8 were female. Mean age and mean body mass index, respectively, were 49.16 years (range: 25-75) and 25.35 kg/m2 (17.84-34.25). Among renal masses, the right-sided to left-sided distribution was 13:11. The proportions of low-risk and intermediate-risk nephrometry score (NS) cases were 13 (54.17%) and 11 (45.83%), respectively, as assessed by renal NS. Mean operative duration, mean warm ischemia time, mean estimated blood loss, and mean hospital stay, respectively, were 132.5 min (90-170), 21.83 min (15-44), 106 ml (25-300) ml, and 5.25 days. During the postoperative period, complications encountered were lung atelectasis in one, bleeding in two, and urinary leakage in one. Histopathology revealed malignancy in 23 patients and leiomyoma in the remaining one. All patients but two experienced a disease free survival during a median follow- up period of 33 months. Conclusion Overall outcomes for LPNR is comparable to the outcomes for open and transperitoneal laparoscopic partial nephrectomy mentioned in the literature and is equally safe for the right-sided and left-sided lesions.
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Affiliation(s)
- Suresh Kumar
- Department of Urology and Transplantation Surgery, Institute of Kidney Disease and Research Centre, Dr. H.L. Trivedi Institute of Transplant Sciences, Civil Hospital Campus, Ahmedabad, Gujarat, India
| | - Pranjal R Modi
- Department of Urology and Transplantation Surgery, Institute of Kidney Disease and Research Centre, Dr. H.L. Trivedi Institute of Transplant Sciences, Civil Hospital Campus, Ahmedabad, Gujarat, India
| | - Bipin C Pal
- Department of Urology and Transplantation Surgery, Institute of Kidney Disease and Research Centre, Dr. H.L. Trivedi Institute of Transplant Sciences, Civil Hospital Campus, Ahmedabad, Gujarat, India
| | - Vivek Kothari
- Department of Urology and Transplantation Surgery, Institute of Kidney Disease and Research Centre, Dr. H.L. Trivedi Institute of Transplant Sciences, Civil Hospital Campus, Ahmedabad, Gujarat, India
| | - Amit Mishra
- Department of Urology and Transplantation Surgery, Institute of Kidney Disease and Research Centre, Dr. H.L. Trivedi Institute of Transplant Sciences, Civil Hospital Campus, Ahmedabad, Gujarat, India
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Chen VS, Abouassaly R, Gonzalez CM, Kutikov A, Smaldone MC, Meropol NJ, Psutka SP, Williams SB, O’Malley R, Sedlacek HM, Kim SP. Association of race and margin status among patients undergoing robotic partial nephrectomy for T1 renal cell carcinoma: Results from a population-based cohort. Urol Oncol 2017; 35:662.e17-662.e21. [DOI: 10.1016/j.urolonc.2017.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/23/2017] [Accepted: 07/10/2017] [Indexed: 12/17/2022]
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Augmented reality in a tumor resection model. Surg Endosc 2017; 32:1192-1201. [DOI: 10.1007/s00464-017-5791-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/28/2017] [Indexed: 01/20/2023]
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35
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Tufek I, Mourmouris P, Doganca T, Obek C, Argun OB, Tuna MB, Keskin MS, Kural AR. Robot-Assisted Partial Nephrectomy for T1b Tumors: Strict Trifecta Outcomes. JSLS 2017; 21:JSLS.2016.00113. [PMID: 28352149 PMCID: PMC5357684 DOI: 10.4293/jsls.2016.00113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background and Objectives: “Trifecta” in partial nephrectomy consists of negative surgical margins, minimal renal function decrease and absence of complications. In the present article, our single-center robot-assisted partial nephrectomy (RAPN) experience in T1b renal masses is reported in terms of strict Trifecta outcomes. Methods: This is a retrospective analysis of patients with a tumor diameter between 4 and 7 cm (stage T1b), who underwent RAPN by a single surgeon. Preoperative, intraoperative, and postoperative data were recorded and analyzed to evaluate short-term functional and oncologic outcomes. Patients with absence of grade ≥ 2 Clavien-Dindo complications, warm ischemia time (WIT) ≤25 minutes, ≤15% postoperative estimated glomerular filtration rate (eGFR) decrease and negative surgical margins were reported to achieve strict Trifecta outcomes. P < .05 was indicated statistically significant. Results: A total of 150 patients underwent RAPN, and 50 patients were identified with tumor size between 4 and 7 cm. Mean WIT was 20.8 ± 6.2 minutes and mean estimated blood loss (EBL) was 269 ± 191 mL. Surgical margins were negative in all patients. Eleven patients (22%) had a >15% eGFR decrease after surgery. Nine patients (18%) had WIT longer than 25 minutes. Four patients (8%) had grade ≥2 Clavien-Dindo complications. Twenty-nine (58%) patients had strict Trifecta outcomes. Mean follow-up was 44.2 ± 27.2 months. Tumor recurrence was not observed in any patient. Conclusions: Robot-assisted laparoscopic partial nephrectomy for T1b renal masses can be safely performed in experienced hands. Optimal strict Trifecta outcomes and recurrence rates can be achieved.
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Affiliation(s)
- Ilter Tufek
- Department of Urology, School of Medicine, Istanbul Acıbadem University, Istanbul, Turkey
| | - Panagiotis Mourmouris
- Department of Urology, School of Medicine, Istanbul Acıbadem University, Istanbul, Turkey
| | - Tunkut Doganca
- Department of Urology, Taksim Acıbadem Hospital, Istanbul, Turkey
| | - Can Obek
- Department of Urology, Taksim Acıbadem Hospital, Istanbul, Turkey
| | - Omer Burak Argun
- Department of Urology, School of Medicine, Istanbul Acıbadem University, Istanbul, Turkey
| | | | - Mehmet Selcuk Keskin
- Department of Urology, School of Medicine, Istanbul Acıbadem University, Istanbul, Turkey
| | - Ali Rıza Kural
- Department of Urology, Acıbadem Maslak Hospital, Istanbul, Turkey
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Laganosky DD, Filson CP, Master VA. Surgical Margins in Nephron-Sparing Surgery for Renal Cell Carcinoma. Curr Urol Rep 2017; 18:8. [DOI: 10.1007/s11934-017-0651-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Kim SP, Campbell SC, Gill I, Lane BR, Van Poppel H, Smaldone MC, Volpe A, Kutikov A. Collaborative Review of Risk Benefit Trade-offs Between Partial and Radical Nephrectomy in the Management of Anatomically Complex Renal Masses. Eur Urol 2016; 72:64-75. [PMID: 27988238 DOI: 10.1016/j.eururo.2016.11.038] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 11/29/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND While partial nephrectomy (PN) is the recommended treatment for many small renal masses, anatomically complex tumors necessitate a clear understanding of the potential risks and benefits of PN and radical nephrectomy (RN). OBJECTIVE To critically review the comparative effectiveness evidence of PN versus RN; to describe key trade-offs involved in this treatment decision; and to highlight gaps in the current literature. EVIDENCE ACQUISITION A collaborative critical review of the medical literature was conducted. EVIDENCE SYNTHESIS Patients who undergo PN for an anatomically complex or large mass may be exposed to perioperative and potential oncologic risks that could be avoided if RN were performed, while patients who undergo RN may forgo long-term benefits of renal preservation. Decision-making regarding the optimal treatment with PN or RN among patients with anatomically complex or large renal mass is highly nuanced and must balance the risks and benefits of each approach. Currently, high-quality evidence on comparative effectiveness is sparse. Retrospective comparisons are plagued by selection biases, while the one existing prospective randomized trial, albeit imperfect, suggests that nephron-sparing surgery may not benefit all patients. CONCLUSIONS For anatomically complex tumors, PN preserves renal parenchyma but may expose patients to higher perioperative risks than RN. The risks and benefits of each surgical approach must be better objectified for identification of patients most suitable for complex PN. A prospective randomized trial is warranted and would help in directing patient counseling. PATIENT SUMMARY Treatment decisions for complex renal masses require shared decision-making regarding the risk trade-offs between partial and radical nephrectomy.
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Affiliation(s)
- Simon P Kim
- University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Seidman Cancer Center, Urology Institute, Center of Healthcare Outcomes and Quality, Cleveland, OH, USA; Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, CT, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Inderbir Gill
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Brian R Lane
- Spectrum Health Medical Group, Urology, Grand Rapids, MI, USA
| | - Hein Van Poppel
- Department of Urology, University Hospitals of Katholieke Universiteit Leuven, Leuven, Belgium
| | - Marc C Smaldone
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Alessandro Volpe
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Alexander Kutikov
- Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA.
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Matulewicz RS, Tosoian JJ, Stimson CJ, Ross AE, Chappidi M, Lotan TL, Humphreys E, Partin AW, Schaeffer EM. Implementation of a Surgeon-Level Comparative Quality Performance Review to Improve Positive Surgical Margin Rates during Radical Prostatectomy. J Urol 2016; 197:1245-1250. [PMID: 27916711 DOI: 10.1016/j.juro.2016.11.102] [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] [Accepted: 11/28/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE Success in the era of value-based payment will depend on the capacity of health systems to improve quality while controlling costs. Comparative quality performance review can be used to drive improvements in surgical outcomes and thereby reduce costs. We sought to determine the efficacy of a comparative quality performance review to improve a surgeon-level measure of surgical oncologic quality, that is the positive surgical margin rate at the time of radical prostatectomy. MATERIALS AND METHODS Eight surgeons who performed consecutive radical prostatectomies at a single high volume institution between January 1, 2015 and December 31, 2015 were included in analysis. Individual surgeons were provided with confidential report cards every 6 months detailing their case mix, case volume and pT2 radical prostatectomy positive surgical margin rate relative to 1) their own self-matched data, 2) the de-identified data of their colleagues and 3) institutional aggregate data during the study period. Positive surgical margin rates were compared before and after intervention. Hierarchal logistic regression analysis was used to examine the association of study period on the odds of positive surgical margins, adjusted for prostate specific antigen level and National Comprehensive Cancer Network® risk group. RESULTS Overall, 1,822 (1,392 before and 430 after intervention) radical prostatectomies were performed that met study inclusion criteria. The aggregate departmental unadjusted positive surgical margin rates were 10.6% and 7.4% in the pre-intervention and post-intervention groups, respectively. After adjusting for higher risk cancer in the post-intervention group, there was a significant protective association of post-intervention status on positive margins (OR 0.64, 95% CI 0.43-0.97, p = 0.03). All 5 surgeons with positive surgical margin rates higher than the aggregate department rate in the pre-intervention period showed improvement after intervention. CONCLUSIONS Comparative quality performance review can be implemented at the surgeon level and can promote improvement in an objective measure of surgical oncology quality.
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Affiliation(s)
- Richard S Matulewicz
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Jeffrey J Tosoian
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - C J Stimson
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Ashley E Ross
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Meera Chappidi
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Tamara L Lotan
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Elizabeth Humphreys
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Alan W Partin
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Edward M Schaeffer
- Department of Urology, Northwestern University Feinberg School of Medicine (RSM, EMS), Chicago, Illinois; The James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland.
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Utilization trends and outcomes up to 3 months of open, laparoscopic, and robotic partial nephrectomy. J Robot Surg 2016; 11:223-229. [DOI: 10.1007/s11701-016-0650-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/25/2016] [Indexed: 12/22/2022]
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Simpfendörfer T, Gasch C, Hatiboglu G, Müller M, Maier-Hein L, Hohenfellner M, Teber D. Intraoperative Computed Tomography Imaging for Navigated Laparoscopic Renal Surgery: First Clinical Experience. J Endourol 2016; 30:1105-1111. [PMID: 27530774 DOI: 10.1089/end.2016.0385] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Laparoscopic partial nephrectomy (LPN) remains challenging in endophytic and complex kidney tumors as the clear understanding of tumor location and spreading depends on a precise analysis of available imaging. The purpose of this study was to investigate navigated kidney surgery using intraoperative cone-beam computed tomography (CBCT) images in conjunction with a previously proposed method for augmented reality (AR) guidance for safe LPN. MATERIALS AND METHODS The concept proposed is based on using an intraoperative CBCT scan for (1) marker-based AR guidance for fast and reliable tumor access and (2) enhancement of real-time fluoroscopy images for accurate tumor resection. Workflow and accuracy of the system were assessed using a porcine kidney model. Ten patients with complex or endophytic tumor localization and R.E.N.A.L. Nephrometry Score of at least nine scheduled for LPN were included in this study. Patients received an intraoperative CBCT after marker placement. Defining the resection line was assisted by AR. In addition, fluoroscopy imaging for depth perception was used for assistance during dissection. Feasibility and performance were assessed by histopathological results, peri- and postoperative data. RESULTS Surgery was performed successfully and negative margins were found in all cases. Segmental branches of the renal artery shifted as much as 10 mm in the vertical and 11 mm in the sagittal axis intraoperatively compared to preoperative imaging. Fluoroscopy to intraoperative computed tomography image fusion enabled enhanced depth perception during dissection in all cases. Radiation dose area product was 4.8 mGym2. CONCLUSIONS The application of the navigation system is feasible and allows for safe and direct access to complex or endophytic renal masses. Radiation limits the application to selected indications.
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Affiliation(s)
| | - Claudia Gasch
- 1 Department of Urology, University of Heidelberg , Heidelberg, Germany
| | - Gencay Hatiboglu
- 1 Department of Urology, University of Heidelberg , Heidelberg, Germany
| | | | - Lena Maier-Hein
- 3 Junior Group Computer-Assisted Interventions, German Cancer Research Center (DKFZ) , Heidelberg, Germany
| | | | - Dogu Teber
- 1 Department of Urology, University of Heidelberg , Heidelberg, Germany
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Kim SP, Abouassaly R. Treatment of Patients with Positive Margins after Partial Nephrectomy. J Urol 2016; 196:301-2. [DOI: 10.1016/j.juro.2016.05.078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Simon P. Kim
- University Hospital Case Medical Center, Urology Institute, Center of Outcomes and Health Care Quality, Cleveland, Ohio
- University Hospitals Case Medical Center, Seidman Cancer Center, University Hospital, Cleveland, Ohio
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut
| | - Robert Abouassaly
- University Hospital Case Medical Center, Urology Institute, Center of Outcomes and Health Care Quality, Cleveland, Ohio
- University Hospitals Case Medical Center, Seidman Cancer Center, University Hospital, Cleveland, Ohio
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Oh JJ, Lee JK, Kim K, Byun SS, Lee SE, Hong SK. Comparison of the Width of Peritumoral Surgical Margin in Open and Robotic Partial Nephrectomy: A Propensity Score Matched Analysis. PLoS One 2016; 11:e0158027. [PMID: 27336438 PMCID: PMC4918926 DOI: 10.1371/journal.pone.0158027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/08/2016] [Indexed: 12/14/2022] Open
Abstract
Background To compare the surgical margin status after open partial nephrectomy (OPN) and robotic partial nephrectomy (RPN) performed in patients with T1a renal cell carcinoma (RCC). Methods This was a propensity score-matched study including 702 patients with cT1a RCC treated with partial nephrectomy (PN) between May 2003 and July 2015. Perioperative parameters, including surgical margin width after PN, were compared between two surgical methods. After determining propensity score for tumor size and location, the width of peritumoral surgical margin was investigated. Multivariate logistic analysis to predict peritumoral surgical margin less than 1mm was analyzed. Results The mean width of peritumoral surgical margin was 2.61 ± 2.15 mm in OPN group (n = 385), significantly wider than the 2.29 ± 2.00 mm of RPN group (n = 317) (p = 0.042). The multivariate analysis showed surgical methods was significant factors to narrow surgical margin less than 1mm (p = 0.031). After propensity score matching, the surgical margin width was significantly longer in OPN (2.67 ± 2.14 mm) group than RPN (2.25 ± 2.03 mm) group (p = 0.016). A positive resection margin occurred in 7 (1.8%) patients in the OPN group and 4 (1.3%) in the RPN group. During the median follow-up of 48.3 months, two patients who underwent OPN had tumor bed recurrence. Conclusions RPN may result in a narrower peritumoral surgical margin than OPN. Further investigation on the potential impact of such a phenomenon should be performed in a larger-scale study.
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Affiliation(s)
- Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Keun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwangmo Kim
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
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Maurice MJ, Zhu H, Kim SP, Abouassaly R. Reexamining the Association Between Positive Surgical Margins and Survival After Partial Nephrectomy in a Large American Cohort. J Endourol 2016; 30:698-703. [DOI: 10.1089/end.2016.0031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Matthew J. Maurice
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hui Zhu
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
- Division of Urology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
| | - Simon P. Kim
- Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Robert Abouassaly
- Urology Institute, University Hospitals Case Medical Center, Cleveland, Ohio
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Maurice MJ, Zhu H, Kim SP, Abouassaly R. Increased use of partial nephrectomy to treat high-risk disease. BJU Int 2015; 117:E75-86. [DOI: 10.1111/bju.13262] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Matthew J. Maurice
- Urology Institute; University Hospitals Case Medical Center; Case Western Reserve University School of Medicine; Cleveland OH USA
- Division of Urology; Louis Stokes Cleveland VA Medical Center; Cleveland OH USA
| | - Hui Zhu
- Division of Urology; Louis Stokes Cleveland VA Medical Center; Cleveland OH USA
- Glickman Urologic and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Simon P. Kim
- Urology Institute; University Hospitals Case Medical Center; Case Western Reserve University School of Medicine; Cleveland OH USA
| | - Robert Abouassaly
- Urology Institute; University Hospitals Case Medical Center; Case Western Reserve University School of Medicine; Cleveland OH USA
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45
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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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