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Mendes G, Madanelo M, Vila F, Versos R, Teixeira BL, Rocha MA, Mesquita S, Marques-Monteiro M, Príncipe P, Ramires R, Lindoro J, Fraga A, Silva-Ramos M. Transperitoneal vs. Retroperitoneal Approach in Laparoscopic Partial Nephrectomy for Posterior Renal Tumors: A Retrospective, Multi-Center, Comparative Study. J Clin Med 2024; 13:701. [PMID: 38337397 PMCID: PMC10856370 DOI: 10.3390/jcm13030701] [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: 01/10/2024] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Purpose: The aim of our study is to compare the perioperative, functional, and oncological outcomes of laparoscopic transperitoneal partial nephrectomy (LTPN) and laparoscopic retroperitoneal partial nephrectomy (LRPN) for posterior cT1 renal tumors. Methods: We retrospectively collected data on all patients who consecutively underwent LTPN and LRPN for posterior cT1 renal tumors in three different centers from January 2015 to January 2023. Patients with a single, unilateral, cT1 renal mass, located in the posterior renal surface were included. Patients' data regarding perioperative, functional, and oncological outcomes were collected from medical records and statistically analyzed and compared. Results: A total of 128 patients was obtained, with 53 patients in the LPTN group and 75 patients in the LRPN group. Baseline characteristics were similar. Warm ischemia time (WIT) (18.8 vs. 22.6 min, p = 0.002) and immediate postoperative eGFR drop (-6.1 vs. -13.0 mL/min/1.73 m2, p = 0.047) were significantly lower in the LPTN group. Estimated blood loss (EBL) (100 vs. 150 mL, p = 0.043) was significantly lower in the LRPN group. All other perioperative and functional outcomes and complications were similar between the groups. The positive surgical margin (PSM) rate was lower in the LRPN group, although without statistical significance (7.2% vs. 13.5%, p = 0.258). Surgical success defined by Trifecta (WIT ≤ 25 min, no PSM, and no major postoperative complication) was similar between both approaches. Conclusions: LTPN has significantly shorter WIT and a significantly smaller drop in immediate eGFR when compared to LRPN for posterior renal tumors. On the other hand, LRPN has significantly less EBL than LTPN. LRPN demonstrated fewer PSMs than LTPN, albeit without statistical significance. In terms of overall surgical success, as defined by Trifecta, both approaches achieved similar results.
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Affiliation(s)
- Gonçalo Mendes
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Mariana Madanelo
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Fernando Vila
- Urology Department, Centro Hospitalar Tâmega e Sousa, 4564-007 Penafiel, Portugal; (F.V.); (J.L.)
| | - Rui Versos
- Urology Department, Hospital da Senhora da Oliveira—Guimarães, 4835-044 Guimarães, Portugal; (R.V.); (R.R.)
| | - Bernardo Lobão Teixeira
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Maria Alexandra Rocha
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Sofia Mesquita
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Miguel Marques-Monteiro
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Paulo Príncipe
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Ricardo Ramires
- Urology Department, Hospital da Senhora da Oliveira—Guimarães, 4835-044 Guimarães, Portugal; (R.V.); (R.R.)
| | - Joaquim Lindoro
- Urology Department, Centro Hospitalar Tâmega e Sousa, 4564-007 Penafiel, Portugal; (F.V.); (J.L.)
| | - Avelino Fraga
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
| | - Miguel Silva-Ramos
- Urology Department, Centro Hospitalar Universitário de Santo António, 4099-001 Porto, Portugal; (G.M.); (M.M.); (B.L.T.); (M.A.R.); (S.M.); (M.M.-M.); (P.P.); (A.F.)
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Lukas VA, Dutta R, Hemal AK, Tsivian M, Craven TE, Deebel NA, Thiel DD, Pathak RA. Impact of pre- and peri-operative risk factors on length of stay and hospital readmission following minimally-invasive partial nephrectomy. Asian J Urol 2024; 11:72-79. [PMID: 38312812 PMCID: PMC10837654 DOI: 10.1016/j.ajur.2022.06.004] [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: 10/20/2021] [Accepted: 06/05/2022] [Indexed: 11/23/2022] Open
Abstract
Objective We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre- and peri-operative variables associated with length of stay (LOS) greater than 3 days and readmission within 30 days. Methods Records from 2008 to 2018 for "laparoscopy, surgical; partial nephrectomy" for prolonged LOS and readmission cohorts were compiled. Univariate analysis with Chi-square, t-tests, and multivariable logistic regression analysis with odds ratios (ORs), p-values, and 95% confidence intervals assessed statistical associations. Results Totally, 20 306 records for LOS greater than 3 days and 15 854 for readmission within 30 days were available. Univariate and multivariable analysis exhibited similar results. For LOS greater than 3 days, undergoing non-elective surgery (OR=5.247), transfusion of greater than four units within 72 h prior to surgery (OR=5.072), pre-operative renal failure or dialysis (OR=2.941), and poor pre-operative functional status (OR=2.540) exhibited the strongest statistically significant associations. For hospital readmission within 30 days, loss in body weight greater than 10% in 6 months prior to surgery (OR=2.227) and bleeding disorders (OR=2.081) exhibited strongest statistically significant associations. Conclusion Multiple pre- and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data. Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection, optimization strategies, and patient education.
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Affiliation(s)
- Vanessa A. Lukas
- Brigham and Women's Hospital, Division of Urology, Department of Surgery, 75 Francis Street, Boston, MA, USA
| | - Rahul Dutta
- Atrium Health Wake Forest Baptist Medical Center, Department of Urology, 1 Medical Center Blvd, Winston-Salem, NC, USA
| | - Ashok K. Hemal
- Atrium Health Wake Forest Baptist Medical Center, Department of Urology, 1 Medical Center Blvd, Winston-Salem, NC, USA
| | - Matvey Tsivian
- Atrium Health Wake Forest Baptist Medical Center, Department of Urology, 1 Medical Center Blvd, Winston-Salem, NC, USA
| | - Timothy E. Craven
- Atrium Health Wake Forest Baptist Medical Center, Department of Urology, 1 Medical Center Blvd, Winston-Salem, NC, USA
| | - Nicholas A. Deebel
- Atrium Health Wake Forest Baptist Medical Center, Department of Urology, 1 Medical Center Blvd, Winston-Salem, NC, USA
| | - David D. Thiel
- Mayo Clinic Florida, Department of Urology, 4500 San Pablo Road, Jacksonville, FL, USA
| | - Ram Anil Pathak
- Mayo Clinic Florida, Department of Urology, 4500 San Pablo Road, Jacksonville, FL, USA
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Tsivian M, Bole R, Packiam VT, Boorjian SA, Thapa P, Frank I, Tollefson MK. The Association of Trainee Involvement in Radical Cystectomy With Perioperative and Oncologic Outcomes. Urology 2022; 165:128-133. [PMID: 35038487 DOI: 10.1016/j.urology.2022.01.003] [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: 08/17/2021] [Revised: 12/07/2021] [Accepted: 01/02/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the impact of trainee involvement in surgery on perioperative and oncological outcomes of patients undergoing radical cystectomy (RC). MATERIALS AND METHODS We reviewed the records of patients undergoing RC for urothelial carcinoma between 2000 and 2015 at our institution. Trainee level was categorized as fellow, chief, senior and junior residents. Demographic, perioperative and oncological outcomes were recorded and compared between the groups. Specifically, operative time, 30-day complications, severe complications (Clavien III-V) and oncological outcomes (overall, cancer-specific and recurrence-free survival) were assessed. RESULTS A total of 895 patients were included for study. On multivariable analysis, operative times were 30-40 minutes longer in procedures assisted by junior residents as compared to more senior trainees. Notably, trainee level was not associated with overall or severe complications on multivariable analyses. Similarly, trainee level was not associated with oncologic outcomes. CONCLUSION While cases assisted by junior residents had longer operative times, complication rates and oncological outcomes were comparable across trainee groups. Trainee level does not appear to have an impact on perioperative and oncological outcomes of RC for urothelial carcinoma.
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Affiliation(s)
| | - Raevti Bole
- Department of Urology, Mayo Clinic, Rochester, MN.
| | | | | | - Prabin Thapa
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN
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Ni Y, Yang X. A Systematic Review and Meta-Analysis of Comparison of Outcomes of Robot-Assisted versus Open Partial Nephrectomy in Clinical T1 Renal Cell Carcinoma Patients. Urol Int 2022; 106:757-767. [PMID: 35193139 PMCID: PMC9533437 DOI: 10.1159/000521881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/31/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Robot-assisted partial nephrectomy (RAPN) has been increasingly used for renal cell carcinoma in recent years. But the advantages of RARN over open partial nephrectomy (OPN) are still controversial. METHODS We searched the articles between 1997 and 2021 in PubMed, Web of Science, Cochrane Library, and EMbase databases. The parameters were perioperative outcomes including operating time (OT), warm ischemic time (WIT), estimated blood loss (EBL), positive surgical margin (PSM), preoperative and postoperative estimated glomerular filtration rate (eGFR), length of stay (LOS), and intraoperative and postoperative complications. Stata 13.0 software was used for the meta-analysis. RESULTS Seven studies with 2,646 patients (1,285 in RAPN vs. 1,361 in OPN) were included in the analysis. There were no significant differences in OT (WMD [95% confidence interval (CI)]: 0.14 [-0.33, 0.61], p = 0.570); WIT (WMD [95% CI]:0.28 [-0.13, 0.69], p = 0.187); PSM (odds ratio [OR] [95% CI]: 1.04 [0.37, 2.94], p = 0.944); preoperative eGFR (OR [95% CI]: 0.11 [-0.01, 0.23], p = 0.071); postoperative eGFR (OR [95% CI]: -0.11 [0.27, 0.04], p = 0.159); and intraoperative complications (OR [95% CI]: 0.13 [0.02, 1.04], p = 0.055) between 2 groups. But there were still less EBL (WMD [95% CI]: -0.67 [-1.07, -0.28], p = 0.001), shorter LOS (WMD [95% CI]: -1.09 [-1.86, -0.32], p = 0.005) and fewer postoperative complications (OR [95% CI]: 0.51 [0.38, 0.68], p = 0.000). CONCLUSIONS Compared with OPN, RAPN appears to achieve partly similar short-term functional outcomes. Meanwhile, some results are inconsistent with previous studies which seem to show that tumor type is also an important factor in comparison between RAPN and OPN, but the analysis is not carried out due to lack of complete data. Therefore, more high-quality random controlled trials are acquired.
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Affiliation(s)
- Yixiu Ni
- Department of Urology, the Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Xiaohua Yang
- Department of Urology, the Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
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Han J, Ahmadi H, Ladi-Seyedian SS, Clifford TG, Douglawi A, Xu W, Bazargani ST, Mingo S, Thangathurai D, Daneshmand S, Djaladat H. Safety and feasibility of urological procedures in Jehovah's Witness patients. Int J Urol 2021; 29:83-88. [PMID: 34642972 DOI: 10.1111/iju.14721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the safety and feasibility of urological transfusion-free surgeries in Jehovah's Witness patients. METHODS An institutional review board-approved, retrospective review of Jehovah's Witness patients who underwent urological transfusion-free surgeries between 2003 and 2019 was carried out. Surgeries were stratified into low, intermediate and high risk based on complexity, invasiveness and bleeding potential. Patient demographics, perioperative data and clinical outcomes are reported. RESULTS A total of 161 Jehovah's Witness patients (median age 63.4 years) underwent 171 transfusion-free surgeries, including 57 (33.3%) in low-, 82 (47.9%) in intermediate- and 32 (18.8%) in high-risk categories. The mean estimated blood loss increased with risk category at 48 mL (range 10-50 mL), 150 mL (range 50-200 mL) and 388 mL (range 137-500 mL), respectively (P < 0.001). Implementing blood augmentation and conservation techniques increased with each risk category (3.5% vs 29% vs 69%, respectively; P < 0.001). Average length of stay increased concordantly at 1.6 days (range 0-12 days), 2.9 days (range 1-13 days) and 5.6 days (range 2-12 days), respectively (P ≤ 0.001). However, there was no increase in complication rates and readmission rates attributed to bleeding among the risk categories at 30 days (P = 0.9 and 0.4, respectively) and 90 days (P = 0.7 and 0.7, respectively). CONCLUSIONS Transfusion free urological surgery can be safely carried out on Jehovah's Witness patients using contemporary perioperative optimization. Additionally, these techniques can be expanded for use in the general patient population to avoid short- and long-term consequences of perioperative blood transfusion.
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Affiliation(s)
- Jullet Han
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Hamed Ahmadi
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Seyedeh-Sanam Ladi-Seyedian
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Thomas G Clifford
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Antoin Douglawi
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Willem Xu
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Soroush T Bazargani
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Samuel Mingo
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Duraiyah Thangathurai
- Department of Anesthesia, Keck Medical Center, University of Southern California, Los Angeles, California, USA
| | - Siamak Daneshmand
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Hooman Djaladat
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
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Crocerossa F, Carbonara U, Cantiello F, Marchioni M, Ditonno P, Mir MC, Porpiglia F, Derweesh I, Hampton LJ, Damiano R, Autorino R. Robot-assisted Radical Nephrectomy: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol 2021; 80:428-439. [DOI: 10.1016/j.eururo.2020.10.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/23/2020] [Indexed: 12/21/2022]
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Simmons KL, Chandrapal JC, Wolf S, Rice HE, Tracy EE, Fitzgerald T, Pomann GM, Routh JC. Open versus minimally-invasive surgical techniques in pediatric renal tumors: A population-level analysis of in-hospital outcomes. J Pediatr Urol 2021; 17:534.e1-534.e7. [PMID: 33849794 PMCID: PMC8449787 DOI: 10.1016/j.jpurol.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/31/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Minimally-invasive surgery (MIS) has been adopted slowly in pediatric oncology. We attempted to describe contemporary national trends in MIS use; we hypothesized that adolescents (who are more likely to have relatively small renal cell carcinomas) would have a higher proportion of MIS than younger children (who are more likely to have relatively large Wilms tumors) and that this relationship would vary by region. OBJECTIVE To explore whether pediatric urologic oncology outcomes vary by patient age or by surgical technique. METHODS We queried the 1998-2014 National Inpatient Sample (NIS) and included encounters in children aged ≤ 18 y, ICD-9 diagnostic code for renal tumor, and procedure code for open or MIS partial or radical nephrectomy. All analyses used weighted descriptive statistics and outcomes are compared based on age group (</>10 y) or surgery type; Wald-Chi square test was used for differences in proportions and unadjusted weighted ANOVA was used to test for differences in means. RESULTS 9259 weighted encounters were included; 91% were <10 years old and 50.7% were female. MIS surgery accounted for 1.8% of encounters; there was a difference in proportions by age group (1% <9 y vs. 9.9% >9 y, p < 0.01). The proportion of surgery type was similar across regions within age groups, however. Complications occurred in 13.3% of encounters; mean inpatient length of stay was 8.9 days (SD: 0.3); mean cost was $ 34,457.68 (SD: $1197.00). There was no evidence of a difference between surgery type and proportion of post-operative complications, mean inpatient length of stay or mean inpatient cost. DISCUSSION The admission-based, retrospective design of NIS left us unable to assess long-term outcomes, repeated admissions, or to track a particular patient across time; this is particularly relevant for oncologic variables on interest such as tumor stage or event-free survival. We were similarly limited in evaluating the effect of pre-surgical referral patterns on patient distributions. CONCLUSION In this preliminary descriptive analysis, MIS techniques were infrequently used in children, but there was a higher proportion of MIS use among adolescents. There were similar proportions of surgery type across geographic regions within the United States. Whether this infrequent usage is appropriate is as yet unclear given the lack of Level I evidence regarding the relative merits of MIS and open surgery for pediatric and adolescent renal tumors.
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Affiliation(s)
- Kirsten L Simmons
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Jason C Chandrapal
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Steven Wolf
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Henry E Rice
- Division of Pediatric Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Elisabeth E Tracy
- Division of Pediatric Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Tamara Fitzgerald
- Division of Pediatric Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Gina-Maria Pomann
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Jonathan C Routh
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC, USA; Surgical Center for Outcomes Research, Duke University School of Medicine, Durham, NC, USA.
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Minimally Invasive Partial Nephrectomy in the Era of Robotic Surgery. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:167-172. [PMID: 34349591 PMCID: PMC8298083 DOI: 10.14744/semb.2020.33230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/08/2020] [Indexed: 11/21/2022]
Abstract
Objectives: The objectives of the study were to compare the operative features, complication rates, functional, and pathological outcomes of laparoscopic partial nephrectomy (LPN) and robotic-assisted partial nephrectomy (RPN). Methods: The demographics, perioperative, and follow-up data of patients who underwent partial nephrectomy between January 2007 and April 2020 with minimally invasive methods were retrospectively analyzed. Patients with minimum 3 months follow-up were enrolled in the present study. Perioperative and pathological outcomes were compared between the patients underwent LPN and RPN. Results: A total of 85 patients (65 LPN and 20 RPN) were included in the present study. The mean patient age at the time of surgery was 56.31±10.48 years. Female-to-male ratio was 30/55. Patients in the RPN group had higher R.E.N.A.L. and PADUA scores (p=0.039 and p=0.030, respectively). Median warm ischemia time, median operation time, median intraoperative estimated blood loss, mean post-operative hemoglobin change, and median hospitalization time were similar between groups (p=0.133, p=0.753, p=0.079, p=0.882, and p=0.473, respectively). Artery-only clamping rate was significantly higher in RPN group (p=0.033). The cost of RPN was significantly greater than LPN (p<0.001). Transfusion rates, post-operative complication rates, percent of estimated glomerular filtration rate change at the last follow-up, and trifecta achievement were similar between the groups (p=0.622, p=0.238, p=0.428, and p=0.349, respectively). Conclusion: In this series, similar perioperative and functional outcomes were achieved by RPN compared to LPN in more complex renal masses.
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Grimaud LW, Chen FV, Chang J, Ziogas A, Sfakianos J, Badani KK, Uchio E, Anton-Culver H, Gin G. Comparison of Perioperative Outcomes for Radical Nephrectomy Based on Surgical Approach for Masses Greater than 10cm. J Endourol 2021; 35:1785-1792. [PMID: 34148404 DOI: 10.1089/end.2020.1164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction and Objective Robotic-assisted radical nephrectomy (RRN) is increasingly utilized as an alternative to laparoscopic radical nephrectomy (LRN) but there are concerns over costs and objective benefit. In the setting of very large renal masses (>10 cm), comparison between techniques is limited and it is unclear whether a robotic approach confers any perioperative benefit over LRN or open radical nephrectomy (ORN). In this study, perioperative outcomes of RRN, LRN, and ORN for very large renal masses are compared. Methods Using the National Cancer Database, patients were identified who underwent radical nephrectomy for kidney tumors >10 cm diagnosed from 2010-2015. Patients were analyzed according to surgical approach. Perioperative outcomes, including conversion to open, length of stay, readmission rates, positive surgical margins, and 30 and 90-day mortality were compared among cohorts. Results A total of 9288 patients met inclusion criteria (RRN = 842, LRN = 2326, ORN = 6120). Compared to ORN, recipients of RRN or LRN had similar rates of 30-day readmission and 30- and 90-day mortality. Length of hospital stay was significantly shorter in RRN (-1.73 days ±0.19; p<0.0001) and LRN (-1.40 days ±0.12; p<0.0001) compared to ORN. LRN had a higher rate of conversion to open compared to RRN (OR 1.48; 95% CI 1.10-1.98; p=0.0087). Conversion to open from RRN or LRN added 1.3 additional days of inpatient stay. Over the study period, RRN use increased from 4.1% to 14.8%, LRN from 20.9% to 25.6%, while ORN use decreased from 75% to 59.6%. Conclusions Minimally invasive approaches are increasingly utilized in very large renal masses. RRN has lower rates of conversion to open but produces comparable perioperative outcomes to LRN. Minimally invasive approaches have a shorter length of inpatient stay but otherwise report similar surgical margin status, readmission rates, and mortality rates compared to open radical nephrectomy.
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Affiliation(s)
- Logan Wilson Grimaud
- University of California Irvine, 8788, Urology, 101 The City Drive South, Orange, California, United States, 92868;
| | - Felix V Chen
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Jenny Chang
- University of California Irvine, 8788, Medicine, 301 Med Surge II, Irvine, California, United States, 92697;
| | - Argyrios Ziogas
- University of California Irvine School of Medicine, 12219, Medicine, Irvine, California, United States;
| | - John Sfakianos
- Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States;
| | - Ketan K Badani
- Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States;
| | - Edward Uchio
- UCI Health, 14447, Urology, 333 City Blvd. West, Suite 2100, Orange, California, United States, 92868-3201;
| | - Hoda Anton-Culver
- University of California Irvine School of Medicine, 12219, Medicine , Irvine, California, United States;
| | - Greg Gin
- UCI, 8788, 333 City Blvd. West, Suite 2100, Orange, California, United States, 92868.,VA Medical Center Long Beach, 19974, Long Beach, California, United States, 90822-5201;
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Gupta K, Omil-Lima D, Sheyn D, Shoag J. Temporal improvements in renal surgery outcomes across surgical approaches. Int Urol Nephrol 2021; 53:1311-1316. [PMID: 33591487 DOI: 10.1007/s11255-021-02811-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/08/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate patient outcomes in a contemporary cohort of patients undergoing partial nephrectomy (PN) or radical nephrectomy (RN). METHODS The NSQIP database was used to identify patients undergoing PN or RN for renal neoplasms between 2010 and 2018. The SEER database was also queried to assess changes in tumor staging during the study period. Logistic regression was used to assess the independent relationship between surgery year and approach on postoperative complications. RESULTS Between 2010 and 2018, NSQIP captured 58,020 cases, including 26,745 (46%) PN and 31,275 (54%) RN. The proportion of PN increased annually, from 39.8% in 2010 to 48.7% in 2018. This rise in PN coincided with a decrease in the proportion of patients experiencing complications, irrespective of surgical approach (20.4% of total cases to 14.2% of total cases). While limited by a lack of information on tumor characteristics, multivariable analysis controlling for patient characteristics demonstrated that RN was associated with an increased risk of complications, OR 1.42 (95% CI 1.35-1.49). CONCLUSION Here, we report an 8.9% increase in the proportion of patients undergoing PN between 2010 and 2018, with no associated increase in perioperative morbidity/mortality. Given that there was no concurrent shift in stage or size of kidney tumors undergoing resection during the study period, these data therefore suggest markedly improved surgical technique and perioperative management nationally. Furthermore, the relative burden of complications has shifted from patients undergoing PN to those undergoing RN. Therefore PN, when technically feasible, should be increasingly considered.
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Affiliation(s)
- Karishma Gupta
- Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Danly Omil-Lima
- Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David Sheyn
- Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jonathan Shoag
- Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
- Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, USA
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11
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Falagario UG, Veccia A, Cormio L, Simeone C, Carbonara U, Crocerossa F, Antonelli A, Porpiglia F, Carrieri G, Autorino R. Nomogram predicting 30-day mortality after nephrectomy in the contemporary era: Results from the SEER database. Int J Urol 2020; 28:309-314. [PMID: 33319434 DOI: 10.1111/iju.14461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 11/09/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To assess contemporary 30-day mortality rates after partial and radical nephrectomy in USA, and to develop a predictive model of 30-day mortality. METHODS We relied on the National Cancer Institute Surveillance, Epidemiology and End Results database. A multivariable logistic regression analysis was fitted to predict 30-day mortality. A nomogram was built based on the coefficients of the logit function. Internal validation was carried out using the leave-one-out cross-validation. Calibration was graphically investigated. RESULTS A total of 102 146 patients who underwent partial nephrectomy (n = 36 425; 35.7%) or radical nephrectomy (n = 65 721; 64.3%) between 2005 and 2015 were included in the analysis. The median age at diagnosis was 62 years. A total of 11 921 (11.7%) patients were African American. The clinical stage was T1-T2 in 79 452 (77.8%), T3 in 16 141 (15.8%) and T4/T1-4-M1 in 6553 (6.4%) patients. Overall, 497 deaths occurred during the initial 30 days after nephrectomy (0.49% 30-day mortality rate). Stratified by type of surgery, the 30-day mortality rate was 0.16% for partial nephrectomy and 0.67% for radical nephrectomy. At univariate analyses, age, tumor size, stage and surgical procedure emerged as predictors of 30-day mortality (all P < 0.001). All of these covariates were included in the multivariable logistic regression model. The area under the curve after leave-one-out cross-validation was 0.808 (95% confidence interval 0.788-0.828), and the model showed good calibration in the range of predicted probability <10%. CONCLUSIONS Contemporary rates of 30-day mortality in patients undergoing radical or partial nephrectomy are very low. Age and tumor stage are key determinants of 30-day mortality. We present a predictive model that provides individual probabilities of 30-day mortality after nephrectomy, and it can be used for patient counseling prior surgery.
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Affiliation(s)
- Ugo Giovanni Falagario
- Division of Urology, Virginia Commonwealth University Health, Richmond, Virginia, USA.,Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Alessandro Veccia
- Division of Urology, Virginia Commonwealth University Health, Richmond, Virginia, USA.,Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Luigi Cormio
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Umberto Carbonara
- Division of Urology, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Fabio Crocerossa
- Division of Urology, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | | | | | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University Health, Richmond, Virginia, USA
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12
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Kara Ö, Maurice MJ, Mouracade P, Malkoc E, Dagenais J, Çapraz M, Chavali JS, Kara MY, Kaouk JH. Preoperative proteinuria is associated with increased rates of acute kidney injury after partial nephrectomy. Int Braz J Urol 2019; 45:932-940. [PMID: 31268640 PMCID: PMC6844339 DOI: 10.1590/s1677-5538.ibju.2018.0776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/13/2019] [Indexed: 01/05/2023] Open
Abstract
Purpose We investigated the association between preoperative proteinuria and early postoperative renal function after robotic partial nephrectomy (RPN). Patients and Methods We retrospectively reviewed 1121 consecutive RPN cases at a single academic center from 2006 to 2016. Patients without pre-existing CKD (eGFR≥60 mL/min/1.73m2) who had a urinalysis within 1-month prior to RPN were included. The cohort was categorized by the presence or absence of preoperative proteinuria (trace or greater (≥1+) urine dipstick), and groups were compared in terms of clinical and functional outcomes. The incidence of acute kidney injury (AKI) was assessed using RIFLE criteria. Univariate and multivariable models were used to identify factors associated with postoperative AKI. Results Of 947 patients, 97 (10.5%) had preoperative proteinuria. Characteristics associated with preoperative proteinuria included non-white race (p<0.01), preoperative diabetes (p<0.01) and hypertension (HTN) (p<0.01), higher ASA (p<0.01), higher BMI (p<0.01), and higher Charlson score (p<0.01). The incidence of AKI was higher in patients with preoperative proteinuria (10.3% vs. 4.6%, p=0.01). The median eGFR preservation measured within one month after surgery was lower (83.6% vs. 91%, p=0.04) in those with proteinuria; however, there were no significant differences by 3 months after surgery or last follow-up visit. Independent predictors of AKI were high BMI (p<0.01), longer ischemia time (p<0.01), and preoperative proteinuria (p=0.04). Conclusion Preoperative proteinuria by urine dipstick is an independent predictor of postoperative AKI after RPN. This test may be used to identify patients, especially those without overt CKD, who are at increased risk for developing AKI after RPN.
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Affiliation(s)
- Önder Kara
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.,Kocaeli University, Medical School, Kocaeli, Turkey
| | - Matthew J Maurice
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Pascal Mouracade
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ercan Malkoc
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Julien Dagenais
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jaya S Chavali
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jihad H Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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13
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Khalil MI, Ubeda J, Soehner T, Bhandari NR, Payakachat N, Davis R, Raheem OA, Kamel MH. Contemporary Perioperative Morbidity and Mortality Rates of Minimally Invasive vs Open Partial Nephrectomy in Obese Patients with Kidney Cancer. J Endourol 2019; 33:920-927. [PMID: 31333072 DOI: 10.1089/end.2019.0310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: To compare early postoperative morbidity and mortality rates in obese patients (body mass index ≥30 kg/m2) who underwent minimally invasive partial nephrectomy (MIPN) vs open partial nephrectomy (OPN), utilizing the National Surgical Quality Improvement Program (NSQIP) database. Materials and Methods: The NSQIP database was queried to identify obese patients who underwent either MIPN or OPN between 2008 and 2016. Patient demographics, comorbidities, operative time (OT), length of stay (LOS), and 30-day postoperative complications, readmissions, and mortality rates were recorded and compared between the two groups. Multivariable logistic regression analysis was used to determine the adjusted odds of early postoperative complications in MIPN vs OPN. Results: A total of 6041 obese MIPN patients and 3064 obese OPN patients were identified. Mean OT (minutes ± standard deviation) was longer for MIPN vs OPN (197.2 ± 71.0 vs 189.6 ± 82.4, p < 0.001), while mean LOS (3.8 ± 2.8 days vs 5.8 ± 3.5 days, p < 0.001) and 30-day complications (8.5% vs 19.8%, p < 0.001) were lower. No difference in 30-day postoperative mortality rates between MIPN (0.4%) and OPN (0.5%) was observed (p = 0.426). In the adjusted analysis, the odds of any complication within 30 days in the MIPN group were 61% lower, blood transfusion 73% lower, pneumonia 38% lower, sepsis 70% lower, acute renal failure 64% lower, superficial surgical site infection 40% lower, and reoperation 47% lower, compared with OPN patients. Conclusions: When compared with OPN in obese patients, the likelihood of 30-day postoperative morbidity was significantly lower in MIPN patients. However, the odds of 30-day mortality rates were similar between the groups.
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Affiliation(s)
- Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Joel Ubeda
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Thomas Soehner
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Naleen Raj Bhandari
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Omer A Raheem
- Department of Urology, Tulane University, New Orleans, Louisiana
| | - Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Urology, Ain Shams University, Cairo, Egypt
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14
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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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15
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Choi SY, Jung H, You D, Jeong IG, Song C, Hong B, Hong JH, Ahn H, Kim C. Robot‐assisted partial nephrectomy is associated with early recovery of renal function: Comparison of open, laparoscopic, and robot‐assisted partial nephrectomy using DTPA renal scintigraphy. J Surg Oncol 2019; 119:1016-1023. [DOI: 10.1002/jso.25429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/07/2019] [Accepted: 02/11/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Se Young Choi
- Department of Urology, Chung‐Ang University HospitalChung‐Ang University College of MedicineSeoul Korea
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Han Jung
- Department of UrologyGachon University College of MedicineSeongnam Korea
| | - Dalsan You
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Cheryn Song
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Choung‐Soo Kim
- Department of Urology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
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16
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Anele UA, Marchioni M, Yang B, Simone G, Uzzo RG, Lau C, Mir MC, Capitanio U, Porter J, Jacobsohn K, de Luyk N, Mari A, Chang K, Fiori C, Sulek J, Mottrie A, White W, Perdona S, Quarto G, Bindayi A, Ashrafi A, Schips L, Berardinelli F, Zhang C, Gallucci M, Ramirez-Backhaus M, Larcher A, Kilday P, Liao M, Langenstroer P, Dasgupta P, Challacombe B, Kutikov A, Minervini A, Rha KH, Sundaram CP, Hampton LJ, Porpiglia F, Aron M, Derweesh I, Autorino R. Robotic versus laparoscopic radical nephrectomy: a large multi-institutional analysis (ROSULA Collaborative Group). World J Urol 2019; 37:2439-2450. [DOI: 10.1007/s00345-019-02657-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/28/2019] [Indexed: 12/14/2022] Open
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17
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Hyde ER, Berger LU, Ramachandran N, Hughes-Hallett A, Pavithran NP, Tran MGB, Ourselin S, Bex A, Mumtaz FH. Interactive virtual 3D models of renal cancer patient anatomies alter partial nephrectomy surgical planning decisions and increase surgeon confidence compared to volume-rendered images. Int J Comput Assist Radiol Surg 2019; 14:723-732. [PMID: 30680601 PMCID: PMC6420910 DOI: 10.1007/s11548-019-01913-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/04/2019] [Indexed: 12/14/2022]
Abstract
Purpose To determine whether the interactive visualisation of patient-specific virtual 3D models of the renal anatomy influences the pre-operative decision-making process of urological surgeons for complex renal cancer operations. Methods Five historic renal cancer patient pre-operative computed tomography (CT) datasets were retrospectively selected based on RENAL nephrectomy score and variety of anatomy. Interactive virtual 3D models were generated for each dataset using image segmentation software and were made available for online visualisation and manipulation. Consultant urologists were invited to participate in the survey which consisted of CT and volume-rendered images (VRI) for the control arm, and CT with segmentation overlay and the virtual 3D model for the intervention arm. A questionnaire regarding anatomical structures, surgical approach, and confidence was administered. Results Twenty-five participants were recruited (54% response rate), with 19/25 having > 5 years of renal surgery experience. The median anatomical clarity score increased from 3 for the control to 5 for the intervention arm. A change in planned surgical approach was reported in 19% of cases. Virtual 3D models increased surgeon confidence in the surgical decisions in 4/5 patient datasets. There was a statistically significant improvement in surgeon opinion of the potential utility for decision-making purposes of virtual 3D models as compared to VRI at the multidisciplinary team meeting, theatre planning, and intra-operative stages. Conclusion The use of pre-operative interactive virtual 3D models for surgery planning influences surgical decision-making. Further studies are needed to investigate if the use of these models changes renal cancer surgery outcomes. Electronic supplementary material The online version of this article (10.1007/s11548-019-01913-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E R Hyde
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Innersight Labs Ltd, London, UK.
| | - L U Berger
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Innersight Labs Ltd, London, UK
| | - N Ramachandran
- Department of Radiology, UCLH NHS Foundation Trust, London, UK
| | - A Hughes-Hallett
- Specialist Centre for Kidney Cancer, Department of Urology, The Royal Free London NHS Foundation Trust, London, UK
| | - N P Pavithran
- Specialist Centre for Kidney Cancer, Department of Urology, The Royal Free London NHS Foundation Trust, London, UK
| | - M G B Tran
- Specialist Centre for Kidney Cancer, Department of Urology, The Royal Free London NHS Foundation Trust, London, UK
| | - S Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - A Bex
- Specialist Centre for Kidney Cancer, Department of Urology, The Royal Free London NHS Foundation Trust, London, UK
- University College London Division of Surgery and Interventional Science, London, UK
| | - F H Mumtaz
- Specialist Centre for Kidney Cancer, Department of Urology, The Royal Free London NHS Foundation Trust, London, UK
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18
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Berger I, Xia L, Wirtalla C, Guzzo TJ, Kelz RR. Early Discharge After Radical Nephrectomy: An Analysis of Complications and Readmissions. Clin Genitourin Cancer 2018; 17:e293-e305. [PMID: 30587406 DOI: 10.1016/j.clgc.2018.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 11/24/2018] [Accepted: 11/25/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Length of stay (LOS) is increasingly being viewed as a quality metric, and efforts to reduce LOS are present across most surgical subspecialties. However, data on whether reducing LOS is safe in patients who undergo radical nephrectomy (RN) are lacking. The purpose of this study was to assess whether early discharge after RN affects readmission rates and postdischarge complications using a national cohort of patients. PATIENTS AND METHODS The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who underwent RN from 2012 to 2015. Procedures were stratified as minimally invasive or open. Early discharge was defined as less than or equal to the procedure-specific 25th percentile for LOS. Multivariable analysis was used to identify factors associated with readmission and postdischarge complications. A sensitivity analysis excluded patients with a LOS >75th percentile. RESULTS A total of 11,429 patients were included. The 25th percentile for LOS was 2 days in the minimally invasive group and 3 days in the open group. In multivariable analysis, early discharge did not increase the risk of postdischarge complications (odds ratio, 0.88; 95% confidence interval, 0.71-1.08; P = .214) and decreased the risk of readmission (odds ratio, 0.72; 95% confidence interval, 0.59-0.87; P = .001). CONCLUSION Early discharge after RN does not increase the risk of postdischarge complications or readmission. With the appropriate patient selection, decreasing LOS might lead to decreased surgical costs and improved patient flow. This work provides a foundation for future research that might optimize perioperative care pathways to decrease LOS.
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Affiliation(s)
- Ian Berger
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Leilei Xia
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Christopher Wirtalla
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Rachel R Kelz
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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19
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Hsu RCJ, Barclay M, Loughran MA, Lyratzopoulos G, Gnanapragasam VJ, Armitage JN. Time trends in service provision and survival outcomes for patients with renal cancer treated by nephrectomy in England 2000-2010. BJU Int 2018; 122:599-609. [PMID: 29603575 PMCID: PMC6175431 DOI: 10.1111/bju.14217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe the temporal trends in nephrectomy practice and outcomes for English patients with renal cell carcinoma (RCC). PATIENTS AND METHODS Adult RCC nephrectomy patients treated between 2000 and 2010 were identified in the National Cancer Data Repository and Hospital Episode Statistics, and followed-up until date of death or 31 December 2015 (n = 30 763). We estimated the annual frequency for each nephrectomy type, the hospital and surgeon numbers and their case volumes. We analysed short-term surgical outcomes, as well as 1- and 5-year relative survivals. RESULTS Annual RCC nephrectomy number increased by 66% during the study period. Hospital number decreased by 24%, whilst the median annual hospital volume increased from 10 to 23 (P < 0.01). Surgeon number increased by 27% (P < 0.01), doubling the median consultant number per hospital. The proportion of minimally invasive surgery (MIS) nephrectomies rose from 1% to 46%, whilst the proportion of nephron-sparing surgeries (NSS) increased from 5% to 16%, with 29% of all T1 disease treated with partial nephrectomy in 2010 (P < 0.01). The 30-day mortality rate halved from 2.4% to 1.1% and 90-day mortality decreased from 4.9% to 2.6% (P < 0.01). The 1-year relative survival rate increased from 86.9% to 93.4%, whilst the 5-year relative survival rate rose from 68.2% to 81.2% (P < 0.01). Improvements were most notable in patients aged ≥65 years and those with T3 and T4 disease. CONCLUSIONS Surgical RCC management has changed considerably with nephrectomy centralisation and increased NSS and MIS. In parallel, we observed significant improvements in short- and long-term survival particularly for elderly patients and those with locally advanced disease.
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Affiliation(s)
- Ray C. J. Hsu
- Academic Urology GroupDepartment of SurgeryUniversity of CambridgeCambridgeUK
- Department of UrologyAddenbrooke's HospitalCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Matthew Barclay
- The Healthcare Improvement Studies (THIS) InstituteUniversity of CambridgeCambridgeUK
| | - Molly A. Loughran
- Transforming Cancer Services TeamNational Health ServiceLondonUK
- National Cancer Registration and Analysis ServicePublic Health EnglandLondonUK
| | - Georgios Lyratzopoulos
- The Healthcare Improvement Studies (THIS) InstituteUniversity of CambridgeCambridgeUK
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) GroupDepartment of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Vincent J. Gnanapragasam
- Academic Urology GroupDepartment of SurgeryUniversity of CambridgeCambridgeUK
- Department of UrologyAddenbrooke's HospitalCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - James N. Armitage
- Department of UrologyAddenbrooke's HospitalCambridge University Hospitals NHS Foundation TrustCambridgeUK
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20
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Omidele OO, Davoudzadeh N, Palese M. Trifecta Outcomes to Assess Learning Curve of Robotic Partial Nephrectomy. JSLS 2018; 22:JSLS.2017.00064. [PMID: 29472757 PMCID: PMC5809150 DOI: 10.4293/jsls.2017.00064] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background and Objectives: The learning curve for achieving desirable perioperative outcomes in robot-assisted partial nephrectomy (RAPN) has not been well studied. Information is available regarding “trifecta” outcomes of no complications, no positive margins, warm ischemia time (WIT) of ≤25 minutes, and a ≤15% decrease in postoperative glomerular filtration rate (GFR). This study was conducted to assess the impact of the learning curve on surgical outcomes in patients undergoing RAPN. Methods: We reviewed 131 consecutive patients who underwent RAPN by a single, fellowship-trained surgeon from October 2007 through June 2015. Patients were divided into 4 subgroups, and mean perioperative values were compared. The learning curve was evaluated as the time it took the surgeon to attain a trifecta outcome. Results: Means for the RENAL Nephrometry Score, procedure length, WIT, and estimated blood loss (EBL) were 5.3 ± 1.2, 172.1 ± 43.5 minutes, 22.7 ± 7.0 minutes, and 267.2 ± 341.8 mL, respectively. Significance was noted for differences in WIT (P = .50), postoperative creatinine (P = .006), postoperative estimated (e)GFR (P = .40), and percentage change in creatinine (P = .023). The learning curve for achieving positive outcomes was noted in >61–90 cases after 66–80 months of performing minimally invasive partial nephrectomy surgeries at a rate of 20 cases per year. Conclusion: RAPN is a safe, feasible procedure with slightly better surgical outcomes than laparoscopic partial nephrectomy (LPN). In the hands of an experienced surgeon, the learning curve for achieving trifecta outcomes can involve a significant number of cases over several years.
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Affiliation(s)
- Olamide O Omidele
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Natan Davoudzadeh
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
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Chang YH, Chang SW, Liu CY, Lin PH, Yu KJ, Pang ST, Chuang CK, Kan HC, Shao IH. Demographic characteristics and complications of open and minimally invasive surgeries for renal cell carcinoma: a population-based case-control study in Taiwan. Ther Clin Risk Manag 2018; 14:1235-1241. [PMID: 30038497 PMCID: PMC6049605 DOI: 10.2147/tcrm.s164592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Renal cell carcinoma (RCC) is one of the most lethal urological malignancies, and surgeries remain the mainstay for localized RCC. This study aimed to compare the selection of open surgery and minimally invasive kidney surgery for RCCs for the aspects of complication, medical costs, and patient preference. Materials and methods We conducted a population-based case-control study by using the National Health Insurance Research Database of Taiwan, which included data from 23 million Taiwanese residents. Patients newly diagnosed with RCC during 2006-2012 were included. We compared the general characteristics, underlying disease, complications, hospital stay, postoperative analgesic dosage, and medical costs between open group and minimally invasive group. Results A total of 3,172 patients who received radical nephrectomy (RN) or partial nephrectomy (PN) for RCC were included. The mean age was 61.1 years, with a male to female ratio of 1.88. In the minimally invasive groups, the mean hospital stay was significantly shorter than in open groups (12.4 days in open RN versus 10.3 days in minimally invasive RN, and 9.7 days in open PN versus 8.2 days in minimally invasive PN). There was no significant difference between the medical costs and the incidence of major bleeding complication between the open group and the minimally invasive group. Female patients and patients with higher monthly income were more likely to receive minimally invasive surgery. Conclusion During past decades, open RN has gradually been replaced by minimally invasive surgeries and PN. Compared to open surgeries, minimally invasive surgeries could lead to less postoperative pain and faster recovery. Economic status of the patients potentially hinders them from receiving minimally invasive surgeries, which may cost more.
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Affiliation(s)
- Ying-Hsu Chang
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chung-Yi Liu
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Po-Hung Lin
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Kai-Jie Yu
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - See-Tong Pang
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Cheng-Keng Chuang
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Hung-Cheng Kan
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - I-Hung Shao
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
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22
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Rude TL, Donin NM, Cohn MR, Meeks W, Gulig S, Patel SN, Wysock JS, Makarov DV, Bjurlin MA. Analysis of National Trends in Hospital Acquired Conditions Following Major Urologic Surgery Before and After Implementation of the Hospital Acquired Condition Reduction Program. Urology 2018; 119:79-84. [PMID: 29885778 DOI: 10.1016/j.urology.2018.04.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/16/2018] [Accepted: 04/20/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To define the rates of common hospital acquired conditions (HACs) in patients undergoing major urologic surgery over a period of time encompassing the implementation of the Hospital Acquired Condition Reduction program, and to evaluate whether implementation of the HAC reimbursement penalties in 2008 was associated with a change in the rate of HACs. METHODS Using American College of Surgeons National Surgical Quality Improvement Program data, we determined rates of HACs in patients undergoing major inpatient urologic surgery from 2005 to 2012. Rates were stratified by procedure type and approach (open vs laparoscopic and/or robotic). Multivariable logistic regression was used to determine the association between year of surgery and HACs. RESULTS We identified 39,257 patients undergoing major urologic surgery, of whom 2300 (5.9%) had at least one hospital acquired condition. Urinary tract infection (2.6%) was the most common, followed by surgical site infection (2.5%) and venous thrombotic events (0.7%). Multivariable logistic regression analysis demonstrated that open surgical approach, diabetes, congestive heart failure, chronic obstructive pulmonary disease, weight loss, and American Society of Anesthesiology class were among the variables associated with higher likelihood of HAC. We observed a nonsignificant secular trend of decreasing rates of HAC from 7.4% to 5.8% HACs during the study period, which encompassed the implementation of the Hospital Acquired Condition Reduction program. CONCLUSION HACs occurred at a rate of 5.9% after major urologic surgery, and are significantly affected by procedure type and patient health status. The rate of HAC appeared unaffected by National Reduction program in this cohort. Better understanding of the factors associated with HACs is critical in developing effective reduction programs.
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Affiliation(s)
- Tope L Rude
- Department of Urology, New York University School of Medicine, New York, NY
| | - Nicholas M Donin
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | | | - William Meeks
- Data Management and Statistical Services, American Urological Association, Linthicum, MD
| | - Scott Gulig
- Data Management and Statistical Services, American Urological Association, Linthicum, MD
| | | | - James S Wysock
- Department of Urology, New York University School of Medicine, New York, NY
| | - Danil V Makarov
- Department of Urology, New York University School of Medicine, New York, NY
| | - Marc A Bjurlin
- Department of Urology, New York University School of Medicine, New York, NY.
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23
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Harke NN, Mandel P, Witt JH, Wagner C, Panic A, Boy A, Roosen A, Ubrig B, Schneller A, Schiefelbein F, Wagener N, Honeck P, Schoen G, Hadaschik B, Michel MS, Kriegmair MC. Are there limits of robotic partial nephrectomy? TRIFECTA outcomes of open and robotic partial nephrectomy for completely endophytic renal tumors. J Surg Oncol 2018; 118:206-211. [PMID: 29878367 DOI: 10.1002/jso.25103] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/23/2018] [Indexed: 11/05/2022]
Abstract
BACKGROUND To compare the outcomes of robot-assisted (RAPN) and open partial nephrectomy (OPN) for completely endophytic renal tumors. METHODS Consecutive patients undergoing OPN or RAPN for entirely endophytic tumors in four high-volume centers between 2008 and 2016 were identified. Endophytic masses were identified based on sectional imaging. Patient characteristics and surgical outcome were compared using Mann-Whitney-U-test and chi-squared-tests. Uni- and multivariate analyses were performed to identify predictors of TRIFECTA achievement and excisional volume loss. RESULTS Out of 1128 patients, 10.9% (64) of RAPN and 13.9% (76) of OPN underwent surgery for entirely endophytic tumors. Operative time was longer for RAPN (169 vs 140 min, P = 0.03) while ischemia time was shorter (13 vs 18 min, P = 0.001). Complication rates were comparable (21% OPN vs 22% RAPN, P = 0.91) and TRIFECTA achievement was not different between the groups (68% OPN vs 75% RAPN, P = 0.39). In multivariate analyses type of surgery was not associated with TRIFECTA achievement or excisional volume loss. Here, only tumor complexity (OR 0.48, P = 0.001) and size (OR 1.01, P = 0.002) were independent predictors. CONCLUSION For entirely endophytic tumors, both RAPN and OPN offer good TRIFECTA achievement. This encourages the use of NSS even for these highly complex tumors using the surgeon's preferred approach.
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Affiliation(s)
- Nina N Harke
- Essen University Hospital, Urology, Essen, Germany
| | - Philipp Mandel
- University Hospital Frankfurt, Urology, Frankfurt, Germany
| | - Jorn H Witt
- St. Antonius-Hospital, Urology, Gronau, Germany
| | | | - Andrej Panic
- Essen University Hospital, Urology, Essen, Germany
| | - Anselm Boy
- Witten/Herdecke University, Urology, Bochum, Germany
| | | | | | | | | | - Nina Wagener
- University Medical Center Mannheim, Urology, Mannheim, Germany
| | - Patrick Honeck
- University Medical Center Mannheim, Urology, Mannheim, Germany
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24
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Monda SM, Weese JR, Anderson BG, Vetter JM, Venkatesh R, Du K, Andriole GL, Figenshau RS. Development and Validity of a Silicone Renal Tumor Model for Robotic Partial Nephrectomy Training. Urology 2018; 114:114-120. [PMID: 29421300 DOI: 10.1016/j.urology.2018.01.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/16/2018] [Accepted: 01/26/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To provide a training tool to address the technical challenges of robot-assisted laparoscopic partial nephrectomy, we created silicone renal tumor models using 3-dimensional printed molds of a patient's kidney with a mass. In this study, we assessed the face, content, and construct validity of these models. MATERIALS AND METHODS Surgeons of different training levels completed 4 simulations on silicone renal tumor models. Participants were surveyed on the usefulness and realism of the model as a training tool. Performance was measured using operation-specific metrics, self-reported operative demands (NASA Task Load Index [NASA TLX]), and blinded expert assessment (Global Evaluative Assessment of Robotic Surgeons [GEARS]). RESULTS Twenty-four participants included attending urologists, endourology fellows, urology residents, and medical students. Post-training surveys of expert participants yielded mean results of 79.2 on the realism of the model's overall feel and 90.2 on the model's overall usefulness for training. Renal artery clamp times and GEARS scores were significantly better in surgeons further in training (P ≤.005 and P ≤.025). Renal artery clamp times, preserved renal parenchyma, positive margins, NASA TLX, and GEARS scores were all found to improve across trials (P <.001, P = .025, P = .024, P ≤.020, and P ≤.006, respectively). CONCLUSION Face, content, and construct validity were demonstrated in the use of a silicone renal tumor model in a cohort of surgeons of different training levels. Expert participants deemed the model useful and realistic. Surgeons of higher training levels performed better than less experienced surgeons in various study metrics, and improvements within individuals were observed over sequential trials. Future studies should aim to assess model predictive validity, namely, the association between model performance improvements and improvements in live surgery.
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Affiliation(s)
- Steven M Monda
- Division of Urological Surgery, Washington University School of Medicine, St. Louis, MO; Saint Louis University School of Medicine, St. Louis, MO.
| | - Jonathan R Weese
- Division of Urological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Barrett G Anderson
- Division of Urological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Joel M Vetter
- Division of Urological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Ramakrishna Venkatesh
- Division of Urological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Kefu Du
- Division of Urological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Gerald L Andriole
- Division of Urological Surgery, Washington University School of Medicine, St. Louis, MO
| | - Robert S Figenshau
- Division of Urological Surgery, Washington University School of Medicine, St. Louis, MO
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25
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Pereira J, Renzulli J, Pareek G, Moreira D, Guo R, Zhang Z, Amin A, Mega A, Golijanin D, Gershman B. Perioperative Morbidity of Open Versus Minimally Invasive Partial Nephrectomy: A Contemporary Analysis of the National Surgical Quality Improvement Program. J Endourol 2018; 32:116-123. [PMID: 29121786 PMCID: PMC5824659 DOI: 10.1089/end.2017.0609] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES In recent years, there has been a shift to minimally invasive partial nephrectomy (MIPN) with the dissemination of robot-assisted technology. However, contemporary data on the comparative morbidity of open partial nephrectomy (OPN) and MIPN are lacking. We, therefore, evaluated the perioperative morbidity of OPN and MIPN using a contemporary national cohort. METHODS We identified 13,658 patients aged 18 to 89 who underwent PN from 2010 to 2015 in the National Surgical Quality Improvement Program (NSQIP) database, of whom 9018 (66.0%) underwent MIPN. The associations of MIPN with 30-day morbidity were evaluated using logistic regression, adjusted for patient features. RESULTS Median age at surgery was 60 (interquartile range [IQR] 51, 68) years. Overall, 30-day complications occurred in 6.7% of patients. Compared with OPN, MIPN was associated with lower rates of 30-day complications (4.9% vs 10.1%, p < 0.0001), perioperative blood transfusion (3.8% vs 12.5%, p < 0.0001), prolonged hospitalization (5.6% vs 23.4%, p < 0.0001), readmission (4.4% vs 7.8%, p < 0.0001), reoperation (1.8% vs 3.2%, p < 0.0001), and 30-day mortality (0.3% vs 0.6%, p = 0.001). On multivariable analysis, MIPN was independently associated with a reduced risk of 30-day complications (odds ratio [OR] 0.46, p < 0.0001), perioperative blood transfusion (OR 0.27, p < 0.0001), prolonged hospitalization (OR 0.19, p < 0.0001), readmission (OR 0.59, p < 0.0001), and reoperation (OR 0.57, p < 0.0001). Postoperative complications occurred predominantly early after surgery, whereas hospital readmissions and reoperation occurred at a consistent rate. CONCLUSIONS In this contemporary national cohort, MIPN was independently associated with reduced rates of 30-day complications, perioperative blood transfusion, prolonged hospitalization, hospital readmission, and reoperation, compared with OPN.
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Affiliation(s)
- Jorge Pereira
- Minimally Invasive Urology Institute, The Miriam Hospital, Providence, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, Rhode Island
| | - Joseph Renzulli
- Minimally Invasive Urology Institute, The Miriam Hospital, Providence, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, Rhode Island
| | - Gyan Pareek
- Minimally Invasive Urology Institute, The Miriam Hospital, Providence, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, Rhode Island
| | - Daniel Moreira
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois
| | - Ruiting Guo
- Department of Biostatistics, Brown University, Providence, Rhode Island
| | - Zheng Zhang
- Department of Biostatistics, Brown University, Providence, Rhode Island
| | - Ali Amin
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Pathology & Laboratory Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Anthony Mega
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Hematology/Oncology, The Miriam Hospital, Providence, Rhode Island
| | - Dragan Golijanin
- Minimally Invasive Urology Institute, The Miriam Hospital, Providence, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, Rhode Island
| | - Boris Gershman
- Minimally Invasive Urology Institute, The Miriam Hospital, Providence, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, Rhode Island
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26
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Fero K, Hamilton ZA, Bindayi A, Murphy JD, Derweesh IH. Utilization and quality outcomes of cT1a, cT1b and cT2a partial nephrectomy: analysis of the national cancer database. BJU Int 2017; 121:565-574. [DOI: 10.1111/bju.14055] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Katherine Fero
- Department ofUrology; University of California San Diego School of Medicine; La Jolla CA USA
| | - Zachary A. Hamilton
- Department ofUrology; University of California San Diego School of Medicine; La Jolla CA USA
| | - Ahmet Bindayi
- Department ofUrology; University of California San Diego School of Medicine; La Jolla CA USA
| | - James D. Murphy
- Department ofRadiation Medicine; University of California San Diego School of Medicine; La Jolla CA USA
| | - Ithaar H. Derweesh
- Department ofUrology; University of California San Diego School of Medicine; La Jolla CA USA
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27
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Xia L, Wang X, Xu T, Guzzo TJ. Systematic Review and Meta-Analysis of Comparative Studies Reporting Perioperative Outcomes of Robot-Assisted Partial Nephrectomy Versus Open Partial Nephrectomy. J Endourol 2017; 31:893-909. [DOI: 10.1089/end.2016.0351] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Leilei Xia
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Xianjin Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - Tianyuan Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
| | - Thomas J. Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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28
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Khandwala YS, Jeong IG, Kim JH, Han DH, Li S, Wang Y, Chang SL, Chung BI. The Impact of Surgeon Volume on Perioperative Outcomes and Cost for Patients Receiving Robotic Partial Nephrectomy. J Endourol 2017; 31:851-857. [DOI: 10.1089/end.2017.0207] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yash S. Khandwala
- Department of Urology, Stanford University Medical Center, Stanford, California
- San Diego School of Medicine, University of California, San Diego, California
| | - In Gab Jeong
- Department of Urology, Stanford University Medical Center, Stanford, California
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Heon Kim
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Deok Hyun Han
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Shufeng Li
- Department of Urology and Dermatology, Stanford University Medical Center, Stanford, California
| | - Ye Wang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Steven L. Chang
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin I. Chung
- Department of Urology, Stanford University Medical Center, Stanford, California
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29
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Diffusion of robotic-assisted laparoscopic technology across specialties: a national study from 2008 to 2013. Surg Endosc 2017; 32:1405-1413. [DOI: 10.1007/s00464-017-5822-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/03/2017] [Indexed: 12/26/2022]
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30
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Maurice MJ, Ramirez D, Kara Ö, Malkoç E, Nelson RJ, Fareed K, Stein RJ, Fergany AF, Kaouk JH. Optimum outcome achievement in partial nephrectomy for T1 renal masses: a contemporary analysis of open and robot-assisted cases. BJU Int 2017; 120:537-543. [DOI: 10.1111/bju.13888] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Matthew J. Maurice
- Department of Urology; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Daniel Ramirez
- Department of Urology; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Önder Kara
- Department of Urology; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Ercan Malkoç
- Department of Urology; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Ryan J. Nelson
- Department of Urology; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Khaled Fareed
- Department of Urology; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Robert J. Stein
- Department of Urology; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Amr F. Fergany
- Department of Urology; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Jihad H. Kaouk
- Department of Urology; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
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31
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Khene ZE, Peyronnet B, Bosquet E, Pradère B, Robert C, Fardoun T, Kammerer-Jacquet SF, Verhoest G, Rioux-Leclercq N, Mathieu R, Bensalah K. Does training of fellows affect peri-operative outcomes of robot-assisted partial nephrectomy? BJU Int 2017; 120:591-599. [DOI: 10.1111/bju.13901] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Benoit Peyronnet
- Department of Urology; Rennes University Hospital; Rennes France
| | - Elise Bosquet
- Department of Urology; Rennes University Hospital; Rennes France
| | - Benjamin Pradère
- Department of Urology; Rennes University Hospital; Rennes France
| | - Corentin Robert
- Department of Radiology; Rennes University Hospital; Rennes France
| | - Tarek Fardoun
- Department of Urology; Rennes University Hospital; Rennes France
| | | | - Grégory Verhoest
- Department of Urology; Rennes University Hospital; Rennes France
| | | | - Romain Mathieu
- Department of Urology; Rennes University Hospital; Rennes France
| | - Karim Bensalah
- Department of Urology; Rennes University Hospital; Rennes France
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32
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Minimally invasive vs open nephrectomy in the modern era: does approach matter? World J Urol 2017; 35:1557-1568. [PMID: 28477204 DOI: 10.1007/s00345-017-2040-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/17/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate if the widespread adoption of a minimally invasive approach to radical nephrectomy has affected short- and long-term patient outcomes in the modern era. METHODS A retrospective cohort study of patients who underwent radical nephrectomy from 2001 to 2012 was conducted using the US National Cancer Institute Surveillance Epidemiology and End Results (SEER) Program and Medicare insurance program database. Patients who underwent open surgery were compared to those who underwent minimally invasive surgery using propensity score matching. RESULTS 10,739 (85.9%) underwent open surgery and 1776 (14.1%) underwent minimally invasive surgery. Minimally invasive surgery increased from 18.4% from 2001-2004 to 43.5% from 2009 to 2012. After median follow-up of 57.1 months, minimally invasive radical nephrectomy conferred long-term oncologic efficacy in terms of overall (HR 0.84; 95% CI 0.75-0.95) survival and cancer-specific (HR 0.68; 95% CI 0.54-0.86) survival compared to open radical nephrectomy. Minimally invasive surgery was associated with lower risk of inpatient death [risk ratio (RR) 0.45 with 95% CI: (0.20-0.99), p = 0.04], deep vein thrombosis [RR: 0.35 (0.18-0.69), p = 0.002], respiratory complications [RR: 0.73 (0.60-0.89), p = 0.001], infectious complications [RR: 0.35 (0.14-0.90), p = 0.02], acute kidney injury [RR: 0.66 (0.52-0.84), p < 0.001], sepsis [RR: 0.55 (0.31-0.98), p = 0.04], prolonged length of stay (18.6 vs 30.0%, p < 0.001), and ICU admission (19.7 vs 26.3%, p < 0.001). Costs were similar between the two approaches (30-day costs $15,882 vs $15,564; p = 0.70). CONCLUSION After widespread adoption of minimally invasive approaches to radical nephrectomy across the United States, oncologic standards remain preserved with improved perioperative outcomes at no additional cost burden.
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33
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Fernando A, Fowler S, Van Hemelrijck M, O'Brien T. Who is at risk of death from nephrectomy? An analysis of thirty-day mortality after 21 380 nephrectomies in 3 years of the British Association of Urological Surgeons (BAUS) National Nephrectomy Audit. BJU Int 2017; 120:358-364. [DOI: 10.1111/bju.13842] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Archie Fernando
- British Association of Urological Surgeons; London UK
- Urology Centre; Guy's & St Thomas' NHS Foundation Trust; London UK
| | - Sarah Fowler
- Urology Centre; Guy's & St Thomas' NHS Foundation Trust; London UK
| | - Mieke Van Hemelrijck
- Division of Cancer Studies; Cancer Epidemiology Group; King's College London; London UK
| | - Tim O'Brien
- British Association of Urological Surgeons; London UK
- Urology Centre; Guy's & St Thomas' NHS Foundation Trust; London UK
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34
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Editorial Comment. Urology 2016; 100:156-157. [PMID: 27988153 DOI: 10.1016/j.urology.2016.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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35
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Malkoc E, Maurice MJ, Kara O, Ramirez D, Nelson RJ, Caputo PA, Mouracade P, Stein R, Kaouk JH. Robot-assisted approach improves surgical outcomes in obese patients undergoing partial nephrectomy. BJU Int 2016; 119:283-288. [DOI: 10.1111/bju.13675] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ercan Malkoc
- Department of Urology; Cleveland Clinic; Glickman Urological and Kidney Institute; Cleveland OH USA
- Urology Department; Sultan Abdulhamid Education and Training Hospital; University of Health Science; Istanbul Turkey
| | - Matthew J. Maurice
- Department of Urology; Cleveland Clinic; Glickman Urological and Kidney Institute; Cleveland OH USA
| | - Onder Kara
- Department of Urology; Cleveland Clinic; Glickman Urological and Kidney Institute; Cleveland OH USA
- Urology Department; Amasya University Medical School; Amasya Turkey
| | - Daniel Ramirez
- Department of Urology; Cleveland Clinic; Glickman Urological and Kidney Institute; Cleveland OH USA
| | - Ryan J. Nelson
- Department of Urology; Cleveland Clinic; Glickman Urological and Kidney Institute; Cleveland OH USA
| | - Peter A. Caputo
- Department of Urology; Cleveland Clinic; Glickman Urological and Kidney Institute; Cleveland OH USA
| | - Pascal Mouracade
- Department of Urology; Cleveland Clinic; Glickman Urological and Kidney Institute; Cleveland OH USA
| | - Robert Stein
- Department of Urology; Cleveland Clinic; Glickman Urological and Kidney Institute; Cleveland OH USA
| | - Jihad H. Kaouk
- Department of Urology; Cleveland Clinic; Glickman Urological and Kidney Institute; Cleveland OH USA
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Maurice MJ, Ramirez D, Nelson RJ, Caputo PA, Kara Ö, Malkoç E, Kaouk JH. Multiple Tumor Excisions in Ipsilateral Kidney Increase Complications After Partial Nephrectomy. J Endourol 2016; 30:1200-1206. [DOI: 10.1089/end.2016.0223] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Matthew J. Maurice
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Ramirez
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ryan J. Nelson
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Peter A. Caputo
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Önder Kara
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Urology, Amasya University Medical School, Amasya, Turkey
| | - Ercan Malkoç
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H. Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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Non-modifiable factors predict discharge quality after robotic partial nephrectomy. Int Urol Nephrol 2016; 49:37-41. [PMID: 27671904 DOI: 10.1007/s11255-016-1421-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To identify predictors of poor discharge quality after robotic partial nephrectomy (RPN) at a large academic center. METHODS We queried our institutional RPN database for consecutive patients treated between 2011 and 2015. The primary outcome was poor discharge quality, defined as length of stay >3 days and/or unplanned readmission. The association between patient, disease, and provider factors and overall discharge quality was assessed using univariate and multivariable analyses. RESULTS Of 791 cases, 219 (27.7 %) had poor discharge quality. On univariate analysis, factors associated with poor discharge quality were older age (p < .01), black race (p = .01), social insurance (p < .01), higher ASA score (p < .01), chronic kidney disease (p < .01), increased tumor size (p < .01), and higher tumor complexity (p = .01). Surgeon case volume did not predict discharge quality (p = .63). After adjustment for covariates on multivariable analysis, race (p = .01), ASA (p = .02), CKD (p < .01), tumor size (p = .02), and tumor complexity (p = .03) still predicted poor discharge quality. In particular, the odds of poor discharge quality were highest in the setting of CKD (OR 2.62, 95 % CI 1.72-4.01), black race (OR 2.17, 95 % CI 1.32-3.57), and higher ASA (OR 1.49, 95 % CI 1.07-2.08). CONCLUSIONS Non-modifiable patient and disease factors predict poor discharge quality after RPN. Risk adjustment for these factors will be important for determining future reimbursement for RPN providers.
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Ramirez D, Maurice MJ, Caputo PA, Nelson RJ, Kara Ö, Malkoç E, Kaouk JH. Predicting complications in partial nephrectomy for T1a tumours: does approach matter? BJU Int 2016; 118:940-945. [DOI: 10.1111/bju.13583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Daniel Ramirez
- Department of Urology; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Matthew J. Maurice
- Department of Urology; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Peter A. Caputo
- Department of Urology; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Ryan J. Nelson
- Department of Urology; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Önder Kara
- Department of Urology; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Ercan Malkoç
- Department of Urology; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Jihad H. Kaouk
- Department of Urology; Glickman Urological and Kidney Institute; Cleveland Clinic; Cleveland OH USA
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Bragayrac LAN, Abbotoy D, Attwood K, Darwiche F, Hoffmeyer J, Kauffman EC, Schwaab T. Outcomes of Minimal Invasive vs Open Radical Nephrectomy for the Treatment of Locally Advanced Renal-Cell Carcinoma. J Endourol 2016; 30:871-6. [DOI: 10.1089/end.2016.0082] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Daniel Abbotoy
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | - Kristopher Attwood
- Department of Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Buffalo, New York
| | - Fadi Darwiche
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | - Jan Hoffmeyer
- Otto von Guericke Universität Magdeburg, Magdeburg, Germany
| | - Eric C. Kauffman
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | - Thomas Schwaab
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
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Peyronnet B, Seisen T, Oger E, Vaessen C, Grassano Y, Benoit T, Carrouget J, Pradère B, Khene Z, Giwerc A, Mathieu R, Beauval JB, Nouhaud FX, Bigot P, Doumerc N, Bernhard JC, Mejean A, Patard JJ, Shariat S, Roupret M, Bensalah K. Comparison of 1800 Robotic and Open Partial Nephrectomies for Renal Tumors. Ann Surg Oncol 2016; 23:4277-4283. [DOI: 10.1245/s10434-016-5411-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Indexed: 01/20/2023]
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Bezinque A, Lane BR. Comparison of 1800 Robotic and Open Partial Nephrectomies for Renal Tumors. Ann Surg Oncol 2016; 23:4137-4138. [DOI: 10.1245/s10434-016-5413-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Indexed: 11/18/2022]
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Borgmann H, Reiss AK, Kurosch M, Filmann N, Frees S, Mager R, Tsaur I, Haferkamp A. R.E.N.A.L. Score Outperforms PADUA Score, C-Index and DAP Score for Outcome Prediction of Nephron Sparing Surgery in a Selected Cohort. J Urol 2016; 196:664-71. [PMID: 27091569 DOI: 10.1016/j.juro.2016.03.176] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE Several nephrometry scores have been proposed to predict perioperative outcomes in renal surgery. We evaluated which nephrometry score correlates best with the MIC (margin, ischemia and complications) score and quantitative perioperative outcomes in nephron sparing surgery. MATERIALS AND METHODS Data on 188 patients undergoing nephron sparing surgery were retrospectively investigated for patient, operative and tumor characteristics. Nephrometry scores, including R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, hilar tumor touching the main renal artery or vein and location relative to polar lines), PADUA (preoperative aspects and dimensions used for an anatomical), C-index (concordance index) and DAP (diameter-axial-polar), were measured on preoperative computerized tomography or magnetic resonance imaging and coded continuously and categorically. Parameters pertaining to tumor margin, ischemia and complications were recorded as binary scores and classified as MIC achievement. Operative time, estimated blood loss, warm ischemia time and hospital stay were recorded as quantitative perioperative outcomes. RESULTS The R.E.N.A.L. score correlated best with MIC and quantitative perioperative outcomes. The continuously coded R.E.N.A.L. score was predictive of MIC on univariate analysis (OR 0.75, 95% CI 0.58-0.97, p = 0.03) and it had the best predictive value on multivariate logistic regression analysis (OR 0.31, 95% CI 0.18-0.82, p = 0.03). The C-index but not the PADUA or the DAP score was predictive of MIC on univariate and multivariate logistic regression analysis. MIC achievement rates were significantly higher for low than for high complexity tumors as assessed by categorically coded R.E.N.A.L. score, C-index and DAP scores. Continuously coded R.E.N.A.L. and PADUA scores positively correlated with operative time, warm ischemia time and hospital stay. The C-index and the DAP score correlated with warm ischemia time. CONCLUSIONS Of 4 nephrometry scores the R.E.N.A.L. score correlated best with MIC achievement and quantitative perioperative outcomes of nephron sparing surgery.
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Affiliation(s)
- Hendrik Borgmann
- Department of Urology, University Hospital Mainz, Mainz, Germany.
| | - Ann-Kathrin Reiss
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Martin Kurosch
- Department of Urology, University Hospital Mainz, Mainz, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, University Hospital Frankfurt, Frankfurt, Germany
| | - Sebastian Frees
- Department of Urology, University Hospital Mainz, Mainz, Germany
| | - Rene Mager
- Department of Urology, University Hospital Mainz, Mainz, Germany
| | - Igor Tsaur
- Department of Urology, University Hospital Mainz, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology, University Hospital Mainz, Mainz, Germany
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Meyer CP, Hollis M, Cole AP, Hanske J, O‘Leary J, Gupta S, Löppenberg B, Zavaski ME, Sun M, Sammon JD, Kibel AS, Fisch M, Chun FK, Trinh QD. Complications Following Common Inpatient Urological Procedures: Temporal Trend Analysis from 2000 to 2010. Eur Urol Focus 2016; 2:3-9. [DOI: 10.1016/j.euf.2015.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 10/09/2015] [Accepted: 10/19/2015] [Indexed: 11/16/2022]
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45
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Husain FZ, Badani KK, Sfakianos JP, Mehrazin R. Emerging surgical treatments for renal cell carcinoma. Future Oncol 2016; 12:921-9. [PMID: 26892144 DOI: 10.2217/fon.15.362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Treatment of renal cell carcinoma has evolved considerably over the last few years. While total nephrectomy is necessary at times, nephron-sparing surgery, with a goal of renal function preservation, should always be considered. Although open partial nephrectomy is considered the gold standard approach for nephron-sparing surgery, laparoscopic- or robotic-assisted techniques allow urologists to perform renal surgery less invasively, with excellent long-term oncological outcomes. Cryotherapy and radiofrequency ablation are less invasive management approaches for carefully selected patients with small renal masses. Active surveillance should be considered in elderly or patients who are unfit for surgery. Ultimately, the method chosen for management of a renal mass is an informed decision made by the physician and patient.
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Affiliation(s)
- Fatima Z Husain
- Icahn School of Medicine at Mount Sinai, Department of Urology & Oncological Science, New York, NY, USA
| | - Ketan K Badani
- Icahn School of Medicine at Mount Sinai, Department of Urology & Oncological Science, New York, NY, USA
| | - John P Sfakianos
- Icahn School of Medicine at Mount Sinai, Department of Urology & Oncological Science, New York, NY, USA
| | - Reza Mehrazin
- Icahn School of Medicine at Mount Sinai, Department of Urology & Oncological Science, New York, NY, USA
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Tinay I, Gelpi-Hammerschmidt F, Leow JJ, Allard CB, Rodriguez D, Wang Y, Chung BI, Chang SL. Trends in utilisation, perioperative outcomes, and costs of nephroureterectomies in the management of upper tract urothelial carcinoma: a 10-year population-based analysis. BJU Int 2015; 117:954-60. [DOI: 10.1111/bju.13375] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ilker Tinay
- Division of Urology; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Urology; Marmara University School of Medicine; Istanbul Turkey
| | - Francisco Gelpi-Hammerschmidt
- Division of Urology; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Urology; Massachusetts General Hospital; Boston MA USA
| | - Jeffrey J. Leow
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Urology; Tan Tock Seng Hospital; Singapore
| | - Christopher B. Allard
- Division of Urology; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Department of Urology; Massachusetts General Hospital; Boston MA USA
| | - Dayron Rodriguez
- Department of Urology; Massachusetts General Hospital; Boston MA USA
| | - Ye Wang
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Benjamin I. Chung
- Department of Urology; Stanford University Medical Center; Stanford CA USA
| | - Steven L. Chang
- Division of Urology; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
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Knight BA, Potretzke AM, Larson JA, Bhayani SB. Comparing Expert Reported Outcomes to National Surgical Quality Improvement Program Risk Calculator-Predicted Outcomes: Do Reporting Standards Differ? J Endourol 2015; 29:1091-9. [DOI: 10.1089/end.2015.0178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- B. Alexander Knight
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Aaron M. Potretzke
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jeffrey A. Larson
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sam B. Bhayani
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri
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48
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Hanske J, Sanchez A, Schmid M, Meyer CP, Abdollah F, Feldman AS, Kibel AS, Sammon JD, Menon M, Eswara JR, Noldus J, Trinh QD. A Comparison of 30-Day Perioperative Outcomes in Open Versus Minimally Invasive Nephroureterectomy for Upper Tract Urothelial Carcinoma: Analysis of 896 Patients from the American College of Surgeons-National Surgical Quality Improvement Program Database. J Endourol 2015; 29:1052-8. [DOI: 10.1089/end.2015.0137] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Julian Hanske
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Alejandro Sanchez
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Marianne Schmid
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian P. Meyer
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Firas Abdollah
- Center for Outcomes Research, Analystics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Adam S. Feldman
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Adam S. Kibel
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jesse D. Sammon
- Center for Outcomes Research, Analystics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Mani Menon
- Center for Outcomes Research, Analystics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Jairam R. Eswara
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joachim Noldus
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Akca O, Zargar H, Attalla K, Brandao LF, Laydner H, Krishnan J, Stein RJ, Kaouk JH. Possible Detrimental Effects of Clamping Main Versus Segmental Renal Arteries for the Achievement of Renal Global Ischemia During Robot-Assisted Partial Nephrectomy. J Endourol 2015; 29:785-90. [DOI: 10.1089/end.2014.0834] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Oktay Akca
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Homayoun Zargar
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kyrollis Attalla
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Humberto Laydner
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jayram Krishnan
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert J. Stein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H. Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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50
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Morbidity of urologic surgical procedures: an analysis of rates, risk factors, and outcomes. Urology 2015; 85:552-9. [PMID: 25733265 DOI: 10.1016/j.urology.2014.11.034] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/03/2014] [Accepted: 11/11/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To quantify national complication rates, perioperative outcomes, and predictors for a broad range of urologic procedures to demonstrate background rates and discuss benchmarking. METHODS Urologic procedures from the National Surgical Quality Improvement Program (2006-2011) were analyzed to identify 30-day rates of 21 complications; outcomes (length of stay, reoperation, and death); and predictors including resident involvement for 18 specific procedures. Multivariate logistic regression models assessed predictors for any complication and for Clavien grade IV or V complication. RESULTS A total of 39,700 procedures were included with abdominopelvic operations more morbid than endoscopic, scrotal, incontinence, or prolapse procedures. Cystectomy had the highest morbidity (10.8 days length of stay and 3.2% mortality), with 56% experiencing any complication followed by nephrectomy (21%), retroperitoneal lymph node dissection (20%), and radical retropubic prostatectomy (19%). Transurethral resection of bladder tumor (11%) and transurethral resection of the prostate (10%) had the highest rates for endoscopic procedures. Older age, American Society of Anesthesiologists class, dependent functional status, acute kidney injury (odds ratio [OR], 2.70 [1.89-3.87]), and ≥5 units preoperative transfusion (OR, 4.44 [3.40-5.80]) were the strongest predictors of any complication. Higher ORs of similar predictors along with chronic obstructive pulmonary disorder (OR, 1.52 [1.21-1.92]) and steroid use (OR, 1.51 [1.07-2.14]) were associated with Clavien grade IV or V complication. Resident involvement increased odds of any complication (OR, 1.18 [1.09-1.29]), mostly for abdominopelvic and urogynecologic procedures, but not Clavien grade IV or V complication (P = .55). CONCLUSION Complication rates of urologic procedures based on the retrospective experience of few surgeons do not allow for appropriate benchmarking. Baseline rates and benchmarks derived from the National Surgical Quality Improvement Program may help hospitals better track deficient areas and improvements in quality of care. Many predictors were similar across procedures, although magnitudes differed, and resident trainees did not impact rates of serious complications (Clavien-Dindo grade IV or V).
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