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Burile GC, Chandankhede V, Sewani Y, Arya N, Fating T. Optimizing Early Recovery Through Timely Mobilization in Nephrectomy Patients: A Case Report. Cureus 2024; 16:e56874. [PMID: 38659547 PMCID: PMC11041085 DOI: 10.7759/cureus.56874] [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: 11/07/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Nephrectomy, a surgical method involving the partial or complete removal of one or both kidneys, is performed if there is the presence of a tumor or many other reasons. In the above case, a 60-year-old female patient with a history of recurring symptoms, stomach pain, and fever, as well as a previous history of tuberculosis was brought to a tertiary care hospital. The patient underwent a left-sided nephrectomy. An X-ray and a complete blood count (CBC) were done during the investigations. Patients experienced various post-operative complications like respiratory discomfort, secretions, early fatigue, and intensive care unit-acquired weakness (ICUAW). The patient was referred for physiotherapy. Throughout the intervention, outcome assessments showed progressive improvement in lung capacity, inspiratory pressure, and quality of life scores. Goal-oriented physiotherapy was planned according to the severity of the symptoms of the patient. The physical therapy rehabilitation program in the above case was planned for six weeks focusing on symptoms like shortness of breath, early fatigue, secretions, respiratory discomfort, difficulty in maintaining good posture because of pain at the incision site, reduced mobility, and various post-operative complications. The study focuses on the efficacy of an integrated physiotherapy strategy in increasing lung compliance, secretion clearance, and overall respiratory health. Early mobilization strategies were crucial in reducing post-surgery problems, hastening functional recovery, and shortening hospital stays.
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Affiliation(s)
- Ghanishtha C Burile
- Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vaibhav Chandankhede
- Otolaryngology - Head and Neck Surgery, Indira Gandhi Government Medical College and Hospital, Nagpur, IND
| | - Yogesh Sewani
- General Medicine, Indira Gandhi Government Medical College and Hospital, Nagpur , IND
| | - Neha Arya
- Cardiovascular and Respiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejaswini Fating
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Borregales LD, Pecoraro A, Roussel E, Mari A, Grosso AA, Checcucci E, Montorsi F, Larcher A, Van Poppel H, Porpiglia F, Capitanio U, Minervini A, Albersen M, Serni S, Amparore D, Campi R. Morbidity of elective surgery for localized renal masses among elderly patients: A contemporary multicenter study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107014. [PMID: 37573666 DOI: 10.1016/j.ejso.2023.107014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/30/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The aging population and the incidence of renal cell carcinoma (RCC) are increasing worldwide. Over 25% of newly diagnosed LRM (localized renal masses) occur in patients over the eighth decade of life. The decision-making and treatment approach to LRM in this population represents a clinical dilemma due to inherited decreased functional reserve and competing mortality risks. Current literature reports conflicting evidence regarding age as a risk factor for worst surgical outcomes. As such, we aimed to evaluate the contemporary morbidity of elective surgery for LRM among elderly patients, focusing on intraoperative and postoperative complications. METHODS After Ethical Committee approval, we queried our prospectively maintained databases to identify patients with preoperative eGFR ≥60 ml/min/1.73 m [(David and Bloom, 2022) 22 and a normal contralateral kidney who underwent partial or radical nephrectomy (PN or RN) for a single cT1-T2N0M0 LRM between 1/2015-12/2021 at four high-volume European Academic Institutions. Patients were categorized by age groups: <50 yrs (young) vs. 50-75 (middle-aged) yrs vs.> 75 yrs (elderly). Postoperative complications were recorded according to Clavien-Dindo (CD) classification. The primary objectives were the proportion of patients experiencing intraoperative (IOC), any grade (AGC), and high-grade postoperative complications (HGC), defined as CD grade 3-5. RESULTS Overall, 2469/3076 (80.2%) patients met the inclusion criteria. Of these, 363 (14.7%) were young, 1682 (68.1%) were middle-aged, and 424 (17.2%) were elderly. Compared to middle-aged and young patients, elderly patients had a higher median Charlson Comorbidity Index (6 vs. 4 vs. 0, p < 0.01) and a higher proportion of cT1 renal mass (87.6% vs. 93.0% vs. 93.6%, p < 0.01). No differences among the study groups were found regarding surgical approach (open vs. minimally-invasive) and type of surgery (PN vs. RN). We found that older patients experienced similar IOC (4.5% vs. 4.2% vs. 3.3%, p = 0.7) and AGC (23.1% vs. 20.0% vs. 21.5%, p = 0.4) compared to middle-aged and young patients, respectively. Similarly, there were no significant differences in HGC between the study cohorts (0.7% vs. 1.4% vs. 1.7%, p = 0.8). At multivariable analysis, open approach and PN significantly predicted the occurrence of AGCs, while only the open surgical approach was associated with the occurrence of HGCs. CONCLUSION In kidney cancer tertiary referral centers, the risk of IOC and postoperative HGC after PN or RN for localized renal masses (LRM) is low, despite a non-negligible risk of AGC, especially in elderly patients. Further efforts should focus on identifying multidisciplinary strategies to select patients most likely to benefit from surgery among elderly candidates with LRMs and decrease the morbidity of surgery in this specific setting.
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Affiliation(s)
- Leonardo D Borregales
- Department of Urology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands
| | - Andrea Mari
- Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Antonio Andrea Grosso
- Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Alessandro Larcher
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | | | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Umberto Capitanio
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Minervini
- Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniele Amparore
- Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands; Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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Kumar BS. Recent Advances and Applications of Ambient Mass Spectrometry Imaging in Cancer Research: An Overview. Mass Spectrom (Tokyo) 2023; 12:A0129. [PMID: 37789912 PMCID: PMC10542858 DOI: 10.5702/massspectrometry.a0129] [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: 07/18/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023] Open
Abstract
Cancer metabolic variability has a significant impact on both diagnosis and treatment outcomes. The discovery of novel biological indicators and metabolic dysregulation, can significantly rely on comprehension of the modified metabolism in cancer, is a research focus. Tissue histology is a critical feature in the diagnostic testing of many ailments, such as cancer. To assess the surgical margin of the tumour on patients, frozen section histology is a tedious, laborious, and typically arbitrary method. Concurrent monitoring of ion images in tissues facilitated by the latest advancements in mass spectrometry imaging (MSI) is far more efficient than optical tissue image analysis utilized in conventional histopathology examination. This article focuses on the "desorption electrospray ionization (DESI)-MSI" technique's most recent advancements and uses in cancer research. DESI-MSI can provide wealthy information based on the variances in metabolites and lipids in normal and cancerous tissues by acquiring ion images of the lipid and metabolite variances on biopsy samples. As opposed to a systematic review, this article offers a synopsis of the most widely employed cutting-edge DESI-MSI techniques in cancer research.
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Affiliation(s)
- Bharath S. Kumar
- Correspondence to: Bharath S. Kumar, 21, B2, 27th Street, Nanganallur, Chennai, India, e-mail:
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Noël J, Mascarenhas A, Nwaiwu CA, Liu Y, Moschovas M, Buharin VE, Oberlin J, Mehrotra S, Dechert AF, Kim PCW, Patel V. Laser speckle contrast imaging compared with indocyanine green in renal perfusion of a porcine model. Curr Urol 2023; 17:141-145. [PMID: 37691993 PMCID: PMC10489255 DOI: 10.1097/cu9.0000000000000155] [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: 04/21/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022] Open
Abstract
Background When viewed under near-infrared light, indocyanine green (ICG) signal for kidney perfusion can be utilized in partial nephrectomy. Laser speckle contrast imaging (LSCI) uses coherent light to detect perfusion during real-time laparoscopic surgery. Materials and methods Laser speckle contrast imaging or ActivSight, an imaging sensor adapter, was used during laparoscopy of an anesthetized porcine kidney model. ActivSight's "perfusion mode" and "quantification mode" displayed the blood flow as a heatmap and numerical signal intensity, respectively. Results After the upper segmental renal artery was clamped, ICG was seen in the lower pole, and LSCI showed low unit (dark color) quantification and perfusion in the upper pole. Indocyanine green was retained in the lower pole after the upper segmental artery was unclamped, and LSCI perfusion was demonstrated in the entire kidney. Conclusions Laser speckle contrast imaging is a dye-free, repeatable, real-time adjunct for renal parenchymal perfusion assessment applicable to minimally invasive renal surgery to complement the technology of ICG near-infrared fluorescence and advance digital surgery.
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Affiliation(s)
- Jonathan Noël
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, USA
| | | | - Chibueze A. Nwaiwu
- Department of Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
- Department of Research, Activ Surgical Inc., Boston, MA, USA
| | - Yao Liu
- Department of Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
- Department of Research, Activ Surgical Inc., Boston, MA, USA
| | - Marcio Moschovas
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, USA
| | | | - John Oberlin
- Department of Research, Activ Surgical Inc., Boston, MA, USA
| | - Saloni Mehrotra
- Department of Research, Activ Surgical Inc., Boston, MA, USA
- Department of Surgery, University of Buffalo, Buffalo, NY, USA
| | | | - Peter C. W. Kim
- Department of Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
- Department of Research, Activ Surgical Inc., Boston, MA, USA
| | - Vipul Patel
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, USA
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Perioperative outcomes following robot-assisted partial nephrectomy in elderly patients. World J Urol 2022; 40:2789-2798. [PMID: 36203102 DOI: 10.1007/s00345-022-04171-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/23/2022] [Indexed: 10/10/2022] Open
Abstract
OBJECTIVE To compare perioperative outcomes following robot-assisted partial nephrectomy (RAPN) in patients with age ≥ 70 years to age < 70 years. METHODS Using Vattikuti Collective quality initiative (VCQI) database for RAPN we compared perioperative outcomes following RAPN between the two age groups. Primary outcome of the study was to compare trifecta outcomes between the two groups. Propensity matching using nearest neighbourhood method was performed with trifecta as primary outcome for sex, body mass index (BMI), solitary kidney, tumor size and Renal nephrometery score (RNS). RESULTS Group A (age ≥ 70 years) included 461 patients whereas group B included 1932 patients. Before matching the two groups were statistically different for RNS and solitary kidney rates. After propensity matching, the two groups were comparable for baselines characteristics such as BMI, tumor size, clinical symptoms, tumor side, face of tumor, solitary kidney and tumor complexity. Among the perioperative outcome parameters there was no difference between two groups for operative time, blood loss, intraoperative transfusion, intraoperative complications, need for radical nephrectomy, positive margins and trifecta rates. Warm ischemia time was significantly longer in the younger age group (18.1 min vs. 16.3 min, p = 0.003). Perioperative complications were significantly higher in the older age group (11.8% vs. 7.7%, p = 0.041). However, there was no difference between the two groups for major complications. CONCLUSION RAPN in well-selected elderly patients is associated with comparable trifecta outcomes with acceptable perioperative morbidity.
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Numakura K, Nakai Y, Kojima T, Osawa T, Narita S, Nakayama M, Kitamura H, Nishiyama H, Shinohara N. Overview of clinical management for older patients with renal cell carcinoma. Jpn J Clin Oncol 2022; 52:665-681. [PMID: 35397166 DOI: 10.1093/jjco/hyac047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
The rapidly increasing pool of older patients being diagnosed with and surviving their cancer is creating many challenges. Regarding localized renal cell carcinoma, surgery is considered as gold standard treatment options even in older men, whereas active surveillance and ablation therapy are alternative options for a proportion of these patients. With regard to advanced disease, anti-vascular endothelial growth factor tyrosine kinase inhibitors (VEGFR-TKI) and immune check point inhibitor are standard treatment modalities, although treatment choice from multiple regimens and prevention of adverse events need to be considered. Better assessment techniques, such as comprehensive geriatric assessment to meet the unique needs of older patients, are a central focus in the delivery of high-quality geriatric oncology care. Through this process, shared decision-making should be adopted in clinical care to achieve optimal goals of care that reflect patient and caregiver hopes, needs and preferences. It is necessary to continue investigating oncological outcomes and complications associated with treatment in this population to ensure appropriate cancer care. In this narrative review, we completed a literature review of the various treatments for renal cell carcinoma in older patients that aimed to identify the current evidence related to the full range of the treatments including active surveillance, surgery, ablation therapy and systemic therapy. Prospectively designed studies and studies regarding geriatric assessment were preferentially added as references. Our goals were to summarize the real-world evidence and provide a decision framework that guides better cancer practices for older patients with renal cell carcinoma.
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Affiliation(s)
| | - Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | | | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | | | - Masashi Nakayama
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | | | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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Vilson FL, Schmidt B, White L, Soerensen SJC, Ganesan C, Pao AC, Enemchukwu E, Chertow GM, Leppert JT. Removing Race from eGFR calculations: Implications for Urologic Care. Urology 2022; 162:42-48. [PMID: 33798557 PMCID: PMC10812382 DOI: 10.1016/j.urology.2021.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/01/2021] [Accepted: 03/18/2021] [Indexed: 12/15/2022]
Abstract
Equations estimating the glomerular filtration rate are important clinical tools in detecting and managing kidney disease. Urologists extensively use these equations in clinical decision making. For example, the estimated glomerular function rate is used when considering the type of urinary diversion following cystectomy, selecting systemic chemotherapy in managing urologic cancers, and deciding the type of cross-sectional imaging in diagnosing or staging urologic conditions. However, these equations, while widely accepted, are imprecise and adjust for race which is a social, not a biologic construct. The recent killings of unarmed Black Americans in the US have amplified the discussion of racism in healthcare and has prompted institutions to reconsider the role of race in estimation of glomerular filtration rate equations and raced-based medicine. Urologist should be aware of the consequences of removing race from these equations, potential alternatives, and how these changes may affect Black patients receiving urologic care.
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Affiliation(s)
| | - Bogdana Schmidt
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Lee White
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | | | - Calyani Ganesan
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, CA
| | - Alan C Pao
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, CA
| | - Ekene Enemchukwu
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Glenn M Chertow
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, CA
| | - John T Leppert
- Department of Urology, Stanford University School of Medicine, Stanford, CA; Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, CA.
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Ishiyama Y, Kondo T, Yoshida K, Iizuka J, Tanabe K, Takagi T. Efficacy and feasibility of robot-assisted partial nephrectomy for octogenarians: comparison with younger counterparts. J Robot Surg 2022; 16:1165-1173. [DOI: 10.1007/s11701-021-01350-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/29/2021] [Indexed: 01/31/2023]
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Gachupin FC, Lee BR, Chipollini J, Pulling KR, Cruz A, Wong AC, Valencia CI, Hsu CH, Batai K. Renal Cell Carcinoma Surgical Treatment Disparities in American Indian/Alaska Natives and Hispanic Americans in Arizona. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1185. [PMID: 35162208 PMCID: PMC8834853 DOI: 10.3390/ijerph19031185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 12/04/2022]
Abstract
American Indians/Alaska Natives (AI/AN) and Hispanic Americans (HA) have higher kidney cancer incidence and mortality rates compared to non-Hispanic Whites (NHW). Herein, we describe the disparity in renal cell carcinoma (RCC) surgical treatment for AI/AN and HA and the potential association with mortality in Arizona. A total of 5111 stage I RCC cases diagnosed between 2007 and 2016 from the Arizona Cancer Registry were included. Statistical analyses were performed to test the association of race/ethnicity with surgical treatment pattern and overall mortality, adjusting for patients' demographic, healthcare access, and socioeconomic factors. AI/AN were diagnosed 6 years younger than NHW and were more likely to receive radical rather than partial nephrectomy (OR 1.49 95% CI: 1.07-2.07) compared to NHW. Mexican Americans had increased odds of not undergoing surgical treatment (OR 1.66, 95% CI: 1.08-2.53). Analysis showed that not undergoing surgical treatment and undergoing radical nephrectomy were statistically significantly associated with higher overall mortality (HR 1.82 95% CI: 1.21-2.76 and HR 1.59 95% CI: 1.30-1.95 respectively). Mexican Americans, particularly U.S.-born Mexican Americans, had an increased risk for overall mortality and RCC-specific mortality even after adjusting for neighborhood socioeconomic factors and surgical treatment patterns. Although statistically not significant after adjusting for neighborhood-level socioeconomic factors and surgical treatment patterns, AI/AN had an elevated risk of mortality.
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Affiliation(s)
- Francine C. Gachupin
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ 85711, USA;
| | - Benjamin R. Lee
- Department of Urology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA; (B.R.L.); (J.C.); (K.R.P.); (A.C.); (A.C.W.); (K.B.)
| | - Juan Chipollini
- Department of Urology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA; (B.R.L.); (J.C.); (K.R.P.); (A.C.); (A.C.W.); (K.B.)
| | - Kathryn R. Pulling
- Department of Urology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA; (B.R.L.); (J.C.); (K.R.P.); (A.C.); (A.C.W.); (K.B.)
| | - Alejandro Cruz
- Department of Urology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA; (B.R.L.); (J.C.); (K.R.P.); (A.C.); (A.C.W.); (K.B.)
| | - Ava C. Wong
- Department of Urology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA; (B.R.L.); (J.C.); (K.R.P.); (A.C.); (A.C.W.); (K.B.)
| | - Celina I. Valencia
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ 85711, USA;
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA;
| | - Ken Batai
- Department of Urology, College of Medicine, University of Arizona, Tucson, AZ 85724, USA; (B.R.L.); (J.C.); (K.R.P.); (A.C.); (A.C.W.); (K.B.)
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Postoperative outcomes of elderly patients undergoing partial nephrectomy. Sci Rep 2021; 11:17201. [PMID: 34433877 PMCID: PMC8387350 DOI: 10.1038/s41598-021-96676-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/23/2021] [Indexed: 01/20/2023] Open
Abstract
To describe clinical outcomes of patients aged 75 years and above after partial nephrectomy (PN), and to assess independent factors of postoperative complications. We retrospectively reviewed information from our multi-institutional database. Every patient over 75 years old who underwent a PN between 2003 and 2016 was included. Peri-operative and follow up data were collected. Multivariate logistic regression was performed to determine independent predictive factors of postoperative complications. We reviewed 191 procedures including 69 (40%) open-surgery, and 122 (60%) laparoscopic procedures, of which 105 were robot-assisted. Median follow-up was 25 months. The mean age was 78 [75–88]. The American Society of Anesthesiologist’s score was 1, 2, 3 and 4 in 10.5%, 60%, 29% and 0.5% of patients respectively. The mean tumor size was 4.6 cm. Indication of PN was elective in 122 (65%) patients and imperative in 52 patients (28%). The median length of surgery was 150(± 60) minutes, and the median estimated blood loss 200 ml. The mean glomerular filtration rate was 71.5 ml/minute preoperatively, and 62 ml/min three months after surgery. The severe complications (Clavien III-V) rate was 6.2%. On multivariate analysis, the robotic-assisted procedure was an independent protective factor of medical postoperative complications (Odds Ration (OR) = 0.31 [0.12–0.80], p = 0.01). It was adjusted for age and RENAL score, robotic-assisted surgery (OR = 0.22 [0.06–0.79], p = 0.02), and tumor size (OR = 1.13 [1.02–1.26], p = 0.01), but the patients age did not forecast surgical complications. Partial nephrectomy can be performed safely in elderly patients with an acceptable morbidity, and should be considered as a viable treatment option. Robotic assistance is an independent protective factor of postoperative complications.
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Microwave ablation of cT1a renal cell carcinoma: oncologic and functional outcomes at a single center. Clin Imaging 2021; 76:199-204. [PMID: 33964597 DOI: 10.1016/j.clinimag.2021.04.016] [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: 12/06/2020] [Revised: 04/12/2021] [Accepted: 04/25/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE Percutaneous ablation is an established alternative to surgical intervention for small renal masses. Radiofrequency and cryoablation have been studied extensively in the literature. To date, series assessing the efficacy and safety of microwave ablation (MWA) are limited. We present a cohort of 110 renal tumors treated with MWA. METHODS A review of the medical record between January 2015 and July 2019 was performed, retrospectively identifying 101 patients (110 tumors). All ablations were performed by a single board-certified urologist/interventional radiologist. Demographic information, intraoperative, postoperative, and follow-up surveillance data were recorded. RESULTS Median (IQR) age was 69.7 years (60.8-77.0); 27 (24%) were female. Median (IQR) BMI was 27.0 (25.1-30.2) and Charleston Comorbidity Index was 5.0 (4.0-6.0). 82 tumors were biopsy-confirmed renal cell carcinoma/oncocytic neoplasms. Median (IQR) tumor size was 2.0 cm (1.5-2.6). Median (IQR) RENAL nephrometry score was 6.0 (5.0-8.0). Technical success was achieved in all patients and all but one patient were discharged on the same day. Median (IQR) eGFR at baseline and 1 year were 71.9 mL/min/1.73 m2 (56.5-82) and 63.0 mL/min/1.73 m2 (54.0-78.2); the difference was -5.3 (p = 0.12). Two Clavien-Dindo type-I complications, one type-II complication, and one type-III complication were experienced in this cohort. Median radiographic follow-up was 376.5 days with 2 tumors (2.4% of RCC/oncocytic neoplasms) having recurred to date. CONCLUSIONS MWA is a safe and efficacious treatment option for small renal masses with minimal adverse events and low rates of recurrence in this cohort of 101 patients. Continued follow-up is needed to assess long-term outcomes.
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Prevalence of benign pathology after partial nephrectomy for suspected renal tumor: A systematic review and meta-analysis. Int J Surg 2020; 84:161-170. [PMID: 33220454 DOI: 10.1016/j.ijsu.2020.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/13/2020] [Accepted: 11/09/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the overall prevalence of benign pathology after partial nephrectomy (PN) and identify predictive factors for benign pathology after PN. METHODS A systematic review was performed following the PRISMA guidelines. PubMed/Medline, Embase, and the Cochrane Library were searched up to January 2019PRISMA guidelines. The data for the meta-analysis and network meta-analysis were pooled using a random-effects model. RESULTS There were 144 studies included in the final analysis, which was comprised of 79 observational studies (n = 37,300) and 65 comparative studies (n = 18,552). The overall prevalence rate of benign pathology after PN was 0.19 (95% CI: 0.18-0.21). According to the procedure types, the prevalence rate of benign pathology was 0.17 (95% CI: 0.15-0.19), 0.24 (95% CI: 0.22-0.27), and 0.16 (95% CI: 0.15-0.18) in open partial nephrectomy, laparoscopic partial nephrectomy, and robot-assisted laparoscopic partial nephrectomy, respectively. The significant moderating factors were gender, publication year, the origin of the study, and procedure types. The three most common benign pathology types were oncocytomas, angiomyolipomas, and renal cysts (44.50%, 30.20%, and 10.99%, respectively). CONCLUSIONS The overall prevalence of benign pathology after PN was not low and it was affected by female gender, studies published before 2010, studies originating from Western areas, and laparoscopic procedure types.
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Bindayi A, Autorino R, Capitanio U, Pavan N, Mir MC, Antonelli A, Takagi T, Bertolo R, Maurer T, Ho Rha K, Long J, Yang B, Schips L, Lima E, Breda A, Linares E, Celia A, De Nunzio C, Dobbs R, Patel S, Hamilton Z, Tracey A, Larcher A, Trombetta C, Palumbo C, Tanabe K, Amiel T, Raheem A, Fiard G, Zhang C, Castellucci R, Palou J, Ryan S, Crivellaro S, Montorsi F, Porpiglia F, Derweesh IH. Trifecta Outcomes of Partial Nephrectomy in Patients Over 75 Years Old: Analysis of the REnal SURGery in Elderly (RESURGE) Group. Eur Urol Focus 2020; 6:982-990. [DOI: 10.1016/j.euf.2019.02.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/21/2019] [Accepted: 02/13/2019] [Indexed: 01/20/2023]
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14
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Vijayalakshmi K, Shankar V, Bain RM, Nolley R, Sonn GA, Kao CS, Zhao H, Tibshirani R, Zare RN, Brooks JD. Identification of diagnostic metabolic signatures in clear cell renal cell carcinoma using mass spectrometry imaging. Int J Cancer 2020; 147:256-265. [PMID: 31863456 PMCID: PMC8571954 DOI: 10.1002/ijc.32843] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/14/2019] [Accepted: 12/09/2019] [Indexed: 12/31/2022]
Abstract
Clear cell renal cell carcinoma (ccRCC) is the most common and lethal subtype of kidney cancer. Intraoperative frozen section (IFS) analysis is used to confirm the diagnosis during partial nephrectomy. However, surgical margin evaluation using IFS analysis is time consuming and unreliable, leading to relatively low utilization. In our study, we demonstrated the use of desorption electrospray ionization mass spectrometry imaging (DESI-MSI) as a molecular diagnostic and prognostic tool for ccRCC. DESI-MSI was conducted on fresh-frozen 23 normal tumor paired nephrectomy specimens of ccRCC. An independent validation cohort of 17 normal tumor pairs was analyzed. DESI-MSI provides two-dimensional molecular images of tissues with mass spectra representing small metabolites, fatty acids and lipids. These tissues were subjected to histopathologic evaluation. A set of metabolites that distinguish ccRCC from normal kidney were identified by performing least absolute shrinkage and selection operator (Lasso) and log-ratio Lasso analysis. Lasso analysis with leave-one-patient-out cross-validation selected 57 peaks from over 27,000 metabolic features across 37,608 pixels obtained using DESI-MSI of ccRCC and normal tissues. Baseline Lasso of metabolites predicted the class of each tissue to be normal or cancerous tissue with an accuracy of 94 and 76%, respectively. Combining the baseline Lasso with the ratio of glucose to arachidonic acid could potentially reduce scan time and improve accuracy to identify normal (82%) and ccRCC (88%) tissue. DESI-MSI allows rapid detection of metabolites associated with normal and ccRCC with high accuracy. As this technology advances, it could be used for rapid intraoperative assessment of surgical margin status.
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Affiliation(s)
| | - Vishnu Shankar
- Department of Biomedical Data Science, and Statistics, Stanford University, Stanford, California 94305 USA
| | - Ryan M. Bain
- Department of Chemistry, Stanford University, Stanford, California 94305 USA
- Present address: Dow Chemical Co. Midland, Michigan 48674 USA
| | - Rosalie Nolley
- Department of Urology, Stanford University, Stanford, California 94305 USA
| | - Geoffrey A. Sonn
- Department of Urology, Stanford University, Stanford, California 94305 USA
| | - Chia-Sui Kao
- Department of Pathology, Stanford University, Stanford, California 94305 USA
| | - Hongjuan Zhao
- Department of Urology, Stanford University, Stanford, California 94305 USA
| | - Robert Tibshirani
- Department of Biomedical Data Science, and Statistics, Stanford University, Stanford, California 94305 USA
| | - Richard N. Zare
- Department of Chemistry, Stanford University, Stanford, California 94305 USA
| | - James D. Brooks
- Department of Urology, Stanford University, Stanford, California 94305 USA
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15
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16
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Kim JH, Li S, Khandwala Y, Chung KJ, Park HK, Chung BI. Association of Prevalence of Benign Pathologic Findings After Partial Nephrectomy With Preoperative Imaging Patterns in the United States From 2007 to 2014. JAMA Surg 2019; 154:225-231. [PMID: 30516801 DOI: 10.1001/jamasurg.2018.4602] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance Although the intent of nephron-sparing surgery is to eradicate malignant tumors found on preoperative imaging, benign masses often cannot be differentiated from malignant tumors. However, in the past there have been discrepancies in the reported percentages of benign masses removed by partial nephrectomy (PNx). Objective To investigate the annual trend of prevalence of benign pathologic findings after PNx and to investigate what potential factors are associated with this prevalence. Design, Setting, and Participants A total of 18 060 patients who underwent PNx between 2007 and 2014 were selected from Truven Health MarketScan Research Databases. We selected those patients who underwent PNx as an inpatient from 2007 and set the surgery date as the index date. Overall, a total of 21 445 patients with International Classification of Diseases, Ninth Revision, Clinical Modification code of 55.4 were identified from 2007 to 2015. Main Outcomes and Measures The annual trend of benign pathologic findings was described as an actual number and as a proportion. Univariate and multiple analyses were performed to investigate factors predictive of a benign final pathologic diagnosis, including type of preoperative imaging modality or performance of a renal mass biopsy. Results Among the 18 060 patients, mean (SD) age was 57 (12) years, and there were 10637 (58.9%) men and 7423 (41.1%) women. The overall prevalence of benign pathologic findings was 30.9% and the annual trends demonstrated a prevalence of over 30% for nearly every year of the study period. On univariate analysis, the performance of magnetic resonance imaging (MRI) and renal mass biopsy was associated with benign pathologic findings (P = .02 and P < .001, respectively). On multivariable analysis, female sex (odds ratio [OR], 0.62; 95% CI, 0.58-0.66; P < .001), older age (>65 years) (OR, 0.99; 95% CI, 0.99-0.99; P < .001), and computed tomography (CT) only preoperative imaging (OR, 1.16; 95% CI, 1.05-1.28; P = .004) were associated with benign pathologic findings after PNx. Conclusions and Relevance We found that the overall prevalence of benign pathologic findings after PNx was higher than the literature suggests, with consistent year-over-year rates exceeding 30%. Female sex, older age (>65 years), and CT only preoperative imaging were predictive of a benign tumor. Further elucidation concerning covariates associated with a benign diagnosis should be the focus of future investigations to identify a cohort of patients who could potentially avoid unnecessary surgical intervention.
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Affiliation(s)
- Jae Heon Kim
- Department of Urology, Stanford University Medical Center, Stanford, California.,Department of Urology, Soonchunhyang University Hospital, Soonchuhyang University Medical College, Seoul, Korea
| | - Shufeng Li
- Department of Urology and Dermatology, Stanford University Medical Center, Stanford, California
| | - Yash Khandwala
- Department of Urology, Stanford University Medical Center, Stanford, California.,San Diego School of Medicine, University of California, San Diego
| | - Kyung Jin Chung
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Hyung Keun Park
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, California
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17
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Ali S, Ahn T, Papa N, Perera M, Teloken P, Coughlin G, Wood ST, Roberts MJ. Changing trends in surgical management of renal tumours from 2000 to 2016: a nationwide study of Medicare claims data. ANZ J Surg 2019; 90:48-52. [PMID: 31478323 DOI: 10.1111/ans.15385] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/29/2019] [Accepted: 07/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Guidelines recommend nephron sparing surgery where possible for patients with T1 renal tumours. The trends of nephron sparing surgery outside the USA are limited, particularly since the introduction of robotic-assisted partial nephrectomy (RAPN). The aim of this study was to describe contemporary surgical management patterns of renal tumours in Australia according to Medicare claims data. METHODS Claims data according to the Medicare Benefits Schedule on surgical management of renal tumours in adult Australians between January 2000 and December 2016 was collated. Analysis of absolute number, population-adjusted rate and renal cancer-adjusted rate of interventions according to age and gender were performed, as well as proportion of RAPN. RESULTS Between 2000 and 2016, the rate of partial nephrectomy (PN) increased while radical nephrectomy (RN) remained stable (PN: 0.87-4.16, RN: 6.52-6.70 per 100 000 population). Since 2015, PN has become more common than RN in patients aged 25 to 44 years (0.98 versus 0.95 procedures per 100 000 population). Renal cancer-adjusted rate exhibited a trend towards increasing utilization of PN and reduced RN across all age groups. An increase in overall surgical treatment was observed (25%-41%), mainly due to increased treatment of patients older than 75 years. The proportion of RAPN was seen to rapidly increase (4.7% in 2010 to 58% in 2016). CONCLUSIONS Treatment utilization for renal masses has markedly changed in Australia according to Medicare claims. PN is increasingly replacing RN in younger patients, and older patients are receiving more surgical treatment. The impact of increased RAPN utilization is yet to be determined.
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Affiliation(s)
- Stephen Ali
- Department of Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas Ahn
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nathan Papa
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marlon Perera
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick Teloken
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Geoffrey Coughlin
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Simon T Wood
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Queensland, Australia
| | - Matthew J Roberts
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Nepean Urology Research Group, Nepean Hospital, Sydney, New South Wales, Australia
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Sohlberg EM, Metzner TJ, Leppert JT. The Harms of Overdiagnosis and Overtreatment in Patients with Small Renal Masses: A Mini-review. Eur Urol Focus 2019; 5:943-945. [PMID: 30905599 DOI: 10.1016/j.euf.2019.03.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/25/2019] [Accepted: 03/10/2019] [Indexed: 10/27/2022]
Abstract
Overdiagnosis and overtreatment refer to the detection and treatment of conditions that would not ultimately affect an individual's health. With increasing detection of small renal masses there is growing awareness of the overdiagnosis and overtreatment of these tumors, supported by studies showing that 15-30% of nephrectomy specimens are pathologically benign, and that many small renal cell carcinomas are indolent. The harms of overdiagnosis and overtreatment are numerous, including psychosocial stressors and renal morbidity, in addition to unnecessary surgical complications. A greater understanding of the potential harms of overdiagnosis and overtreatment is crucial as clinicians focus on optimizing patient selection for renal mass biopsy, active surveillance protocols, and minimally invasive surgery. PATIENT SUMMARY: In this mini-review we discuss the issues of overdiagnosis and overtreatment in patients with kidney cancer. We enumerate the risks of overdiagnosis and overtreatment, and examine the next steps towards preventing these harms.
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Affiliation(s)
- Ericka M Sohlberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Thomas J Metzner
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA; The Stanford Kidney Cancer Research Program, Stanford, CA, USA
| | - John T Leppert
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA; The Stanford Kidney Cancer Research Program, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
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Kim JH, Li S, Khandwala Y, Del Giudice F, Chung KJ, Park HK, Chung BI. National trends of preoperative imaging modalities before partial nephrectomy for renal masses in the U.S. from 2007-2015. Can Urol Assoc J 2019; 13:E89-E94. [PMID: 30169151 DOI: 10.5489/cuaj.5414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although the performance of partial nephrectomies (PN) for renal masses has increased rapidly over the years, only a few studies have investigated the frequency and patterns of preoperative imaging modalities. The aim of this study was to investigate the frequency and patterns in preoperative imaging modalities before PN. METHODS A total of 21 445 patients who underwent PN between 2007 and 2015 were selected from a national representative population in the MarketScan database and included in this study. The annual incidence and proportion of PN, as well as the use of each preoperative imaging modality were analyzed. RESULTS Both annual crude number and frequency rate of PN decreased or became static since 2012. Computed tomography (CT) shows the greatest proportion of the crude number and percentage; despite a slight decrease in percentage, it is still >80%. Among the combinations, CT alone and CT combined with ultrasonography showed the highest performance rate during the complete observational period. The proportion of all other combinations, which include other complex combinations except CT alone, CT plus ultrasonography, CT plus magnetic resonance imaging (MRI), and CT plus MRI plus ultrasonography, was 13.95% in 2007, but increased to 19.04% in 2014. CONCLUSIONS CT still plays a major role in preoperative imaging for renal masses, whereby CT alone and CT combined with ultrasonography account for a major proportion of the preoperative imaging patterns. The use of other imaging combinations, as well as renal biopsies, shows an increasing trend. Additional studies are needed to investigate whether this trend in preoperative imaging is related to the frequency rate of PN.
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Affiliation(s)
- Jae Heon Kim
- Department of Urology, Stanford University Medical Center, Stanford, CA, United States.,Department of Urology, Soonchunhyang University Hospital, Soonchuhyang University Medical College, Seoul, Korea
| | - Shufeng Li
- Department of Urology and Dermatology, Stanford University Medical Center, CA, United States
| | - Yash Khandwala
- Department of Urology, Stanford University Medical Center, Stanford, CA, United States.,University of California, San Diego School of Medicine, San Diego, CA, United States
| | | | - Kyung Jin Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, United States
| | - Hyung Keun Park
- Department of Urology, Stanford University Medical Center, Stanford, CA, United States
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, United States
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Autorino R, Mayer Grob B, Guruli G, Hampton LJ. Partial Versus Total Nephrectomy: Indications, Limitations, and Advantages. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Ahn T, Ellis RJ, White VM, Bolton DM, Coory MD, Davis ID, Francis RS, Giles GG, Gobe GC, Hawley CM, Johnson DW, Marco DJT, McStea M, Neale RE, Pascoe EM, Wood ST, Jordan SJ. Predictors of new-onset chronic kidney disease in patients managed surgically for T1a renal cell carcinoma: An Australian population-based analysis. J Surg Oncol 2018; 117:1597-1610. [PMID: 29790163 DOI: 10.1002/jso.25037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/09/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND New-onset chronic kidney disease (CKD) following surgical management of kidney tumors is common. This study evaluated risk factors for new-onset CKD after nephrectomy for T1a renal cell carcinoma (RCC) in an Australian population-based cohort. METHODS There were 551 RCC patients from the Australian states of Queensland and Victoria included in this study. The primary outcome was new-onset CKD (eGFR <60 mL/min per 1.73 m2 ) and the secondary outcome was new-onset moderate-severe CKD (<45 mL/min per 1.73 m2 ). Multivariable logistic regression was used to evaluate associations between patient, tumor and health-service characteristics and these outcomes. RESULTS Forty percent (219/551) of patients developed new-onset CKD, and 12% (68/551) experienced new-onset moderate-severe CKD. Risk factors for new-onset CKD were age, lower preoperative eGFR, tumor size >20 mm, radical nephrectomy, lower hospital caseloads (<20 cases/year), and rural place of residence. The associations between rural place of residence and low center volume were a consequence of higher radical nephrectomy rates. CONCLUSION Risk factors for CKD after nephrectomy generally relate to worse baseline health, or likelihood of undergoing radical nephrectomy. Surgeons in rural centres and hospitals with low caseloads may benefit from formalized integration with specialist centers for continued professional development and case-conferencing, to assist in management decisions.
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Affiliation(s)
- Thomas Ahn
- Princess Alexandra Hospital, Brisbane, Australia
| | - Robert J Ellis
- Princess Alexandra Hospital, Brisbane, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Victoria M White
- Cancer Council Victoria, Melbourne, Australia.,Deakin University, Geelong, Australia
| | - Damien M Bolton
- Austin Health, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | | | - Ian D Davis
- Monash University, Melbourne, Australia.,Eastern Health, Melbourne, Australia
| | - Ross S Francis
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Graham G Giles
- Cancer Council Victoria, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Glenda C Gobe
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Carmel M Hawley
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - David W Johnson
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | | | - Megan McStea
- University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Elaine M Pascoe
- University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Simon T Wood
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Susan J Jordan
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,University of Queensland, Brisbane, Australia
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Leppert JT, Lamberts RW, Thomas IC, Chung BI, Sonn GA, Skinner EC, Wagner TH, Chertow GM, Brooks JD. Incident CKD after Radical or Partial Nephrectomy. J Am Soc Nephrol 2017; 29:207-216. [PMID: 29018140 DOI: 10.1681/asn.2017020136] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/19/2017] [Indexed: 01/30/2023] Open
Abstract
The comparative effectiveness of partial nephrectomy versus radical nephrectomy to preserve kidney function has not been well established. We determined the risk of clinically significant (stage 4 and higher) CKD after radical or partial nephrectomy among veterans treated for kidney cancer in the Veterans Health Administration (2001-2013). Among patients with preoperative eGFR≥30 ml/min per 1.73 m2, the incidence of CKD stage 4 or higher after radical (n=9759) or partial nephrectomy (n=4370) was 7.9% overall. The median time to stage 4 or higher CKD after surgery was 5 months, after which few patients progressed. In propensity score-matched cohorts, partial nephrectomy associated with a significantly lower relative risk of incident CKD stage 4 or higher (hazard ratio, 0.34; 95% confidence interval [95% CI], 0.26 to 0.43, versus radical nephrectomy). In a parallel analysis of patients with normal or near-normal preoperative kidney function (eGFR≥60 ml/min per 1.73 m2), partial nephrectomy was also associated with a significantly lower relative risk of incident CKD stage 3b or higher (hazard ratio, 0.15; 95% CI, 0.11 to 0.19, versus radical nephrectomy) in propensity score-matched cohorts. Competing risk regression models produced consistent results. Finally, patients treated with a partial nephrectomy had reduced risk of mortality (hazard ratio, 0.55; 95% CI, 0.49 to 0.62). In conclusion, compared with radical nephrectomy, partial nephrectomy was associated with a marked reduction in the incidence of clinically significant CKD and with enhanced survival. Postoperative decline in kidney function occurred mainly in the first year after surgery and appeared stable over time.
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Affiliation(s)
- John T Leppert
- Departments of Urology, .,Division of Urology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and.,Stanford Kidney Cancer Research Program, Department of Urology, Stanford University, Stanford, California.,Medicine, and
| | | | | | - Benjamin I Chung
- Departments of Urology.,Stanford Kidney Cancer Research Program, Department of Urology, Stanford University, Stanford, California
| | - Geoffrey A Sonn
- Departments of Urology.,Stanford Kidney Cancer Research Program, Department of Urology, Stanford University, Stanford, California
| | - Eila C Skinner
- Departments of Urology.,Stanford Kidney Cancer Research Program, Department of Urology, Stanford University, Stanford, California
| | - Todd H Wagner
- Division of Urology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and.,Stanford Kidney Cancer Research Program, Department of Urology, Stanford University, Stanford, California.,Surgery, Stanford University School of Medicine, Stanford, California
| | - Glenn M Chertow
- Stanford Kidney Cancer Research Program, Department of Urology, Stanford University, Stanford, California.,Medicine, and
| | - James D Brooks
- Departments of Urology.,Stanford Kidney Cancer Research Program, Department of Urology, Stanford University, Stanford, California
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Partial Versus Total Nephrectomy: Indications, Limitations, and Advantages. Urol Oncol 2017. [DOI: 10.1007/978-3-319-42603-7_62-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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