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Baboudjian M, Gondran-Tellier B, Abdallah R, Lannes F, Sichez PC, Akiki A, Gaillet S, Toledano H, Delaporte V, Andre M, Karsenty G, Lechevallier E, Rossi D, Vidal V, Boissier R, Bastide C. Selective Trans-arterial Embolization of Iatrogenic Vascular Lesions Did Not Influence the Global Renal Function After Partial Nephrectomy. Urology 2020; 141:108-113. [PMID: 32283170 DOI: 10.1016/j.urology.2020.03.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/19/2020] [Accepted: 03/26/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the renal function outcomes after selective trans-arterial embolization (SAE) of iatrogenic vascular lesions (IVL), including pseudoaneurysm and arteriovenous fistula, following partial nephrectomy (PN). MATERIALS AND METHODS A multi-institutional study was conducted including consecutive patients who underwent PN between January 2009 and March 2019. Two surgical approaches were used: open and robot-assisted PN. Patients with SAE were identified and matched (1:2) with patients without IVL. The matching criteria were age, gender, Charlson score, creatinine clearance, RENAL score, and tumor size. The primary outcome was the evolution of global renal function at 6-months postoperatively. RESULTS A total of 493 consecutive PN (360 open PN and 133 robot-assisted PN) were included. IVL occurred in 17 cases (3.4%) without statistical difference according to the surgical approach (P = .78). Patients from embolization group were matched to 34 cases without postoperative IVL. Groups were comparable concerning clinical, tumor and surgical characteristics. The clinical success of SAE, defined as the absence of recourse to a second embolization or a total nephrectomy, was obtained in 16 (94.1%) cases. No minor or major complications were reported after SAE. The preoperative estimated glomerular filtration rate (eGFR) was similar between control group (93 [85-102] ml/min) and embolization group (95 [83-102] ml/min) (P = .99). Median (IQR) eGFR between control group (87 [72-95] ml/min) and embolization group (83 [76-93] ml/min) at a follow-up of 6 months showed no significant difference (P = .73). CONCLUSION IVL are rare complications of PN. SAE is an effective and minimally invasive management tool, with no deleterious effect on global renal function.
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Affiliation(s)
- Michael Baboudjian
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France.
| | - Bastien Gondran-Tellier
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Rony Abdallah
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Francois Lannes
- Aix-Marseille University, APHM, Nord Academic Hospital, Dept. of Urology, Marseille, France
| | - Pierre Clement Sichez
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Akram Akiki
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Sarah Gaillet
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Harry Toledano
- Aix-Marseille University, APHM, Nord Academic Hospital, Dept. of Urology, Marseille, France
| | - Veronique Delaporte
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Marc Andre
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Radiology and Medical imaging, Marseille, France
| | - Gilles Karsenty
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Eric Lechevallier
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Dominique Rossi
- Aix-Marseille University, APHM, Nord Academic Hospital, Dept. of Urology, Marseille, France
| | - Vincent Vidal
- Aix-Marseille University, APHM, La Timone Academic Hospital, Dept. of Radiology and Medical imaging, Marseille, France; European Center for Medical Imaging Research CERIMED/LIIE, Marseille, France
| | - Romain Boissier
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Cyrille Bastide
- Aix-Marseille University, APHM, Nord Academic Hospital, Dept. of Urology, Marseille, France
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Management of patients with renal mass lesions based on renal biopsy cytology results. Hum Pathol 2019; 85:270-278. [DOI: 10.1016/j.humpath.2018.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 11/22/2022]
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Zapala P, Dybowski B, Miazek N, Radziszewski P. Open partial nephrectomy for entirely intraparenchymal tumors: a matched case-control study of oncologic outcome and complication rate. Int Braz J Urol 2017; 43:209-215. [PMID: 28128905 PMCID: PMC5433358 DOI: 10.1590/s1677-5538.ibju.2016.0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/05/2017] [Indexed: 05/29/2023] Open
Abstract
Purpose To compare the oncologic and clinical outcomes for open partial nephrectomy (OPN) performed in patients with entirely intraparenchymal tumors versus case-matched controls, with exophytic lesions. Material and methods Patients having undergone OPN between 2007 and 2012 were investigated. Exclusion criteria included patients with a benign tumor, advanced malignancy, malignancies other than renal cell carcinoma, end-stage renal failure, or 3 or more co-existing chronic diseases. Individuals with tumors that were invisible at the renal surface were identified, and then matched with 2 controls chosen for tumor size, pathology, age, follow-up period, and presence of a solitary kidney. Oncological status, perioperative, and postoperative data were collected and compared between groups. Results 17 individuals with entirely endophytic RCC tumors and available oncologic status were identified. For five patients, only one suitable control could be identified, bringing the control group number to 29. All tumors were clear cell carcinomas staged at pT1a. Median tumor size was 25mm for endophytic lesions, and 27mm for exophytic masses (P=0.32). The operative period was extended by 20 minutes for intrarenal tumors (P=0.03), with one case of a positive surgical margin in each group (P=0.7). There were no significant differences in perioperative or postoperative complications. Median follow-up was 47 and 43 months for patients with endophytic and exophytic tumors respectively. Disease recurrence was recorded in one patient after endophytic tumor resection, and in four controls (P=0.4). Conclusions OPN shows equivalent safety and efficacy for both intrarenal RCC tumors and exophytic tumors of the same size and type.
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Affiliation(s)
- Piotr Zapala
- Department of Urology, Medical University of Warsaw, Poland
| | | | - Nina Miazek
- Department of Urology, Medical University of Warsaw, Poland
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Weisbach L, Aziz A, Fisch M, Riechardt S. [Renal cell carcinomas in childhood]. Urologe A 2017; 56:900-904. [PMID: 28600591 DOI: 10.1007/s00120-017-0420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Renal cell carcinoma is a rare childhood disease. However, it should be considered in the differential diagnosis in the detection of a renal mass. OBJECTIVES Incidence and mortality of renal cell carcinomas in childhood. Presentation of clinical symptoms, diagnostics, histology, therapy and course of the disease. PATIENTS AND METHODS Evaluation of our own prospective data of a small patient population of 8 patients, as well as discussion of the current literature on this tumor entity. RESULTS The average follow-up period was 27 months. Preoperative staging studies showed no metastases. The histologically primary predominant subtype was papillary renal cell carcinoma. Tumor stage and lymph node status were the most important prognostic factors in our study. CONCLUSIONS Renal cell carcinoma in childhood is a rare disease whose treatment is challenging and should be performed in an interdisciplinary team. Typical clinical symptoms, as in adults, are absent. The partial nephrectomy should be, if practicable, the surgical treatment of choice. The most important risk factors for survival are tumor stage and lymph node status. Data on adjuvant target therapy for metastatic disease in childhood are lacking. Further prospective, multicenter studies are necessary to generate more information on the biology and course of this disease and to obtain adjuvant treatment options in locally advanced disease.
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Affiliation(s)
- L Weisbach
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - A Aziz
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - M Fisch
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - S Riechardt
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
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Ezzat AEHH, Helmy A, Ibrahim AH. Nephron-sparing surgery for renal tumors. J Egypt Natl Canc Inst 2011; 23:61-6. [DOI: 10.1016/j.jnci.2011.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 05/07/2011] [Indexed: 11/28/2022] Open
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Gupta G, Grover S, Kumar S, Kekre NS. Role of open nephron sparing surgery in the era of minimal invasive surgery. Indian J Urol 2009; 25:508-15. [PMID: 19955678 PMCID: PMC2808657 DOI: 10.4103/0970-1591.57930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective : The study aims to review the current status of nephron sparing surgery - open partial nephrectomy (OPN) for renal cell carcinoma in the minimal invasive era. The literature search was done using National Library of Medicine database (PubMed). Results : Early experience with laparoscopic partial nephrectomy is promising. It has an inherent advantage of less operative time, decreased operative blood loss and a shorter hospital stay at the expense of prolonged ischemia and operative time. Complex scenarios for partial nephrectomy such as centrally located tumor, tumor in a solitary kidney, predominantly cystic tumor, and multifocal disease probably are managed best with an open technique. All these challenging situations have been addressed successfully by experienced laparoscopic surgeons, therefore these conditions are best considered relative rather than absolute contraindications for laparoscopic partial nephrectomy. Conclusions : Laparoscopic partial nephrectomy faces the problem of technical complexity and availability of expertise. Open partial nephrectomy continues to be the gold standard for nephron sparing surgery.
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Affiliation(s)
- Gaurav Gupta
- Department of Urology, Christian Medical College and Hospital, Vellore - 632004, Tamilnadu, India
| | - Sameer Grover
- Department of Urology, Christian Medical College and Hospital, Vellore - 632004, Tamilnadu, India
| | - Santosh Kumar
- Department of Urology, Christian Medical College and Hospital, Vellore - 632004, Tamilnadu, India
| | - Nitin S. Kekre
- Department of Urology, Christian Medical College and Hospital, Vellore - 632004, Tamilnadu, India
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Denzinger S, Ganzer R, Fink A, Wieland WF, Blana A. Open partial nephrectomy for imperative and elective indications Comparison of peri-operative data and long-term follow-up. ACTA ACUST UNITED AC 2009; 41:496-500. [PMID: 17853016 DOI: 10.1080/00365590701485970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To report the outcome of nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) with elective and imperative indications, with analysis of complications, renal function and long-term oncological follow-up. MATERIAL AND METHODS We analyzed 91 patients undergoing NSS for RCC, 26 with imperative and 65 with elective indications. Variables analyzed included patient age and gender, comorbidities per patient and preoperative renal function. Pathological features included tumor size, WHO 2002 stage and grade. Peri- and postoperative data included complication and re-intervention rates, tumor recurrence and the mortality rate. RESULTS RCC was found in 81.3% of cases in the imperative group and in 73.9% in the elective group. Median tumor size was 3.2 and 2.5 cm (p = 0.02) in the imperative and elective groups, respectively. Operation time was longer in the imperative group (p < 0.01). There was no difference between the two groups regarding intraoperative complication rate (p = 0.37), whereas postoperative complications occurred more frequently in the imperative group (p = 0.02). The median follow-up period was 48 months for both groups. Mean serum creatinine during follow-up was significantly higher in the imperative group (238.4 vs 97.2 Micromol/L). However, no patient required hemodialysis. There was no local recurrence or tumor-specific death in either group. CONCLUSIONS NSS for RCC is a reasonable treatment option for patients with an imperative indication as it prevents the need for hemodialysis as well as ensuring excellent oncological follow-up. A higher postoperative complication rate has to be balanced against improved quality of life.
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Affiliation(s)
- Stefan Denzinger
- Department of Urology, University of Regensburg, Krankenhaus St Josef, Regensburg, Germany
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Miranda EP, Ribeiro GP, Almeida DC, Scafuri AG. Percutaneous injection of fibrin glue resolves persistent nephrocutaneous fistula complicating colonic perforation after percutaneous nephrolithotripsy. Clinics (Sao Paulo) 2009; 64:711-3. [PMID: 19606250 PMCID: PMC2710447 DOI: 10.1590/s1807-59322009000700017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Gustavo Pinto Ribeiro
- Federal University of Vale do São Francisco, Faculty of Medicine - Petrolina/PE, Brazil.
, Tel: 55 85 3267.2950
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Affiliation(s)
- Mark Louie-Johnsun
- Department of Urology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
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Meeks JJ, Smith ND, Lesani OA, Nadler RB. Percutaneous Endoscopic Management of Persistent Urine Leak after Partial Nephrectomy. J Endourol 2008; 22:485-8. [DOI: 10.1089/end.2007.0281] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Joshua J. Meeks
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Norm D. Smith
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Omid A. Lesani
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Robert B. Nadler
- Section of Endourology, Laparoscopy and Stone Disease, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Cozar JM, Tallada M. Open partial nephrectomy in renal cancer: a feasible gold standard technique in all hospitals. Adv Urol 2008; 2008:916463. [PMID: 18769498 PMCID: PMC2522334 DOI: 10.1155/2008/916463] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 05/31/2008] [Indexed: 12/02/2022] Open
Abstract
Introduction. Partial nephrectomy (PN) is playing an increasingly important role in localized renal cell carcinoma (RCC) as a true alternative to radical nephrectomy. With the greater experience and expertise of surgical teams, it has become an alternative to radical nephrectomy in young patients when the tumor diameter is 4 cm or less in almost all hospitals since cancer-specific survival outcomes are similar to those obtained with radical nephrectomy. Materials and Methods. The authors comment on their own experience and review the literature, reporting current indications and outcomes including complications. The surgical technique of open partial nephrectomy is outlined. Conclusions. Nowadays, open PN is the gold standard technique to treat small renal masses, and all nonablative techniques must pass the test of time to be compared to PN. It is not ethical for patients to undergo radical surgery just because the urologists involved do not have adequate experience with PN. Patients should be involved in the final treatment decision and, when appropriate, referred to specialized centers with experience in open or laparoscopic partial nephrectomies.
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Affiliation(s)
- J M Cozar
- Department of Urology, Virgen de las Nieves University Hospital, Granada, Spain.
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12
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Nemr E, Azar G, Fakih F, Chalouhy E, Moukarzel M, Sarkis P, Khoury R, Ayoub N, Merhej S. [Partial nephrectomy for renal cancers larger than 4 cm]. Prog Urol 2007; 17:810-4. [PMID: 17633991 DOI: 10.1016/s1166-7087(07)92297-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the results in patients operated by partial nephrectomy (PN) and radical nephrectomy (RN) for renal cancers < 4 cm, between 4 and 7 cm and > 7 cm. MATERIALS AND METHODS Retrospective study including 107 patients operated for renal cancer between 1998 and 2004. Demographic characteristics, TNM stage, tumour diameter and type of surgery (PN vs RN) were recorded. The patients' current status was determined and a survival curve was constructed by the Kaplan-Meier method. RESULTS 35.2% patients were operated by PN and 64.8% were operated by RN. The mean follow-up was 45 months. No significant difference in recurrence-free survival rate was observed between patients operated by PN and RN for tumours < 4 cm (93.3% vs 92.3%, respectively, p = 0.243), or for tumours between 4 and 7 cm (100% vs 89.3%, respectively, p = 0.564) or for tumours > 7 cm (100% vs 85.5%, respectively, p = 0.218). CONCLUSION Partial nephrectomy is the standard treatment for tumours < 4 cm, but this study suggests that it is just as effective for tumours up to 7 cm in diameter. Although partial nephrectomy also appears to be a safe treatment for tumours > 7 cm, further studies based on a greater number of tumours in this size category with a longer follow-up are necessary.
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Affiliation(s)
- Elie Nemr
- Service d'Urologie, Centre Hospitalier Universitaire Hôtel-Dieu de France, Université Saint-Joseph, Beyrouth, Liban.
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Mathers MJ, Lazica DA, Klotz T, Sommer F, Roth S. [Secondary prevention after urological tumor diseases. Focusing on the kidneys, testes, and bladder]. Urologe A 2007; 46:636-41. [PMID: 17487469 DOI: 10.1007/s00120-007-1353-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
It is generally agreed upon that patients require a caring as well as careful medical follow-up after cancer treatment. The goal of secondary prevention is to recognize a recurrence at an early stage and to use the curative chance while the tumor mass is still small. There is evidence of a medically effective and successful follow-up for tumors of the testicle and the bladder. For quality reasons, these follow-up regimes should be adhered to for quality reasons. In other diseases, e.g., renal cell carcinoma, prospective randomized studies are missing which demonstrate the effectiveness of follow-ups. In these cases asymptomatic patients should be stratified to individualized follow-up care.
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Affiliation(s)
- M J Mathers
- Urologische Gemeinschaftspraxis, Kooperationspraxis der Klinik für Urologie und Kinderurologie, Klinikum Wuppertal, Universität Witten/Herdecke, Fastenrathstrasse 1, 42853 Remscheid, Germany.
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Gebauer B, Werk M, Lopez-Hänninen E, Felix R, Althaus P. Radiofrequency Ablation in Combination with Embolization in Metachronous Recurrent Renal Cancer in Solitary Kidney after Contralateral Tumor Nephrectomy. Cardiovasc Intervent Radiol 2007; 30:644-9. [PMID: 17436034 DOI: 10.1007/s00270-007-9012-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the feasibility and safety of minimally invasive, percutaneous techniques in metachronous recurrent renal cell cancers (RCCs) in solitary kidneys. METHODS In 4 patients, recurrent RCC was treated by radiofrequency ablation (RFA) (RITA, StarBurst) alone, and in 2 patients by RFA in combination with superselective transarterial particle-lipiodol embolization using 3 Fr microcatheters. RFA was guided by computed tomography in 5 patients, and by magnetic resonance imaging in 1 patient. Mean tumor diameter was 26.7 mm (range 10-45 mm). All interventions were technically successful; during follow-up 1 patient developed recurrent RCC, which was retreated by RFA after embolization. RESULTS No major peri- or postprocedural complications occurred. Changes in creatinine (pre- vs. post-intervention, 122 vs. 127 micromol/l) and calculated creatinine clearance (pre- vs. post-intervention, 78 vs. 73 ml/min) after ablation were minimal. CONCLUSION In single kidneys, percutaneous, minimally invasive techniques are safe and feasible. In large tumors, or where there are adjacent critical structures, we prefer a combination of embolization and thermal ablation (RFA).
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Affiliation(s)
- Bernhard Gebauer
- Department of Radiology, Charité, Universitätsmedizin Berlin Campus Virchow-Clinic, Augustenburger Platz 1, 13353, Berlin, Germany.
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Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Marechal JM, Klotz L, Skinner E, Keane T, Claessens I, Sylvester R. A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 2006; 51:1606-15. [PMID: 17140723 DOI: 10.1016/j.eururo.2006.11.013] [Citation(s) in RCA: 287] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 11/03/2006] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study compared the complications and the cancer control of elective nephron-sparing surgery (NSS) and radical nephrectomy (RN) in patients with a small (<or=5 cm), solitary, low-stage N0 M0 tumour suspicious for renal cell carcinoma (RCC) and a normal contralateral kidney. METHODS 541 patients were randomised in a prospective, multicentre, phase 3 trial to undergo NSS (n=268) or RN (n=273) together with a limited lymph node dissection. RESULTS This publication reports only on the complications reported for both surgical methods. The rate of perioperative blood loss<0.5l was slightly higher after RN (96.0% vs. 87.2%) and the rate of severe haemorrhage was slightly higher after NSS (3.1% vs. 1.2%). Ten patients (4.4%), all of whom were treated with NSS, developed urinary fistulas. Pleural damage (11.5% for NSS vs. 9.3% for RN) and spleen damage (0.4% for NSS and 0.4% for RN) were observed with similar rates in both groups. Postoperative computed tomography scanning abnormalities were seen in 5.8% of NSS and 2.0% of RN patients. Reoperation for complications was necessary in 4.4% of NSS and 2.4% of RN patients. CONCLUSIONS NSS for small, easily resectable, incidentally discovered RCC in the presence of a normal contralateral kidney can be performed safely with slightly higher complication rates than after RN. The oncologic results are eagerly awaited to confirm that NSS is an acceptable approach for small asymptomatic RCC.
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Affiliation(s)
- Hendrik Van Poppel
- Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Lesage K, Joniau S, Fransis K, Van Poppel H. Comparison between open partial and radical nephrectomy for renal tumours: perioperative outcome and health-related quality of life. Eur Urol 2006; 51:614-20. [PMID: 17097216 DOI: 10.1016/j.eururo.2006.10.040] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 10/19/2006] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare perioperative outcome and health-related quality of life (HRQOL) after open partial and radical nephrectomy for renal tumours. METHODS Literature search of Medline and additional references from non-Medline-indexed journals for documents concerning treatment of renal tumours, perioperative outcome, and HRQOL after radical and partial nephrectomy. RESULTS A total of 39 references were used of which 7 discussed complications, 3 included hospital costs and length of stay, and 7 each discussed renal function and QOL. No statistical difference was found concerning perioperative complications although there seems to be a trend towards a slightly higher complication rate after partial nephrectomy. No statistical difference was reported between the two procedures concerning hospital costs and length of stay. For postoperative renal function, a higher incidence of chronic renal failure was noted after radical nephrectomy. When considering the HRQOL a benefit was found after elective partial nephrectomy. In case of mandatory partial nephrectomy the fear of recurrence and the worry about having fewer than two normal kidneys were significantly higher. CONCLUSIONS Partial nephrectomy achieves a better HRQOL due to better preservation of renal function and overall quality of life. Considering perioperative outcome no statistical difference was found for hospital costs and length of stay. A trend towards a higher perioperative complication rate was found after partial nephrectomy.
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Affiliation(s)
- Karl Lesage
- Department of Urology, University Hospital Gasthuisberg, Leuven, Belgium
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Hepps D, Chernoff A. Risk of renal insufficiency in African-Americans after radical nephrectomy for kidney cancer. Urol Oncol 2006; 24:391-5. [PMID: 16962487 DOI: 10.1016/j.urolonc.2005.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Revised: 09/08/2005] [Accepted: 09/09/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE We conducted a retrospective review to evaluate the change in serum creatinine in an African-American population undergoing radical nephrectomy. MATERIALS AND METHODS Race, and preoperative and follow-up creatinine data were extracted from the medical records of all patients who underwent radical nephrectomy performed by a single surgeon. Patients were classified as African-American or black and non-African-American. The non-African-American group included Caucasian, Asian, and Hispanic patients. RESULTS A total of 22 African-American and 19 non-African-American patients were studied. Mean preoperative creatinine was 1.3 mg/dL in African-American patients and 1.1 in non-African-American patients (P = 0.07). Average follow-up creatinine was 1.7 in the African-Americans, with a mean change in creatinine of 0.4, compared to the non-African-Americans, in which mean follow-up creatinine was 1.3 (P = 0.004) with a mean change of 0.2 (P = 0.048). Average follow-up creatinine was higher in African-American hypertensive (2.0 mg/dl) compared with non-African-American hypertensive patients (1.4 mg/dl; P = 0.002). Average change in creatinine was also higher in African-American hypertensive versus non-African-American hypertensive patients (0.6 vs. 0.2 mg/dl, P = 0.048). There were no racial differences seen in normotensive cases. Average follow-up was 9.7 months for African-American and 11.6 months for non-African-American patients. CONCLUSIONS Our data indicate that race may be a significant risk factor for renal deterioration after radical nephrectomy.
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Affiliation(s)
- David Hepps
- Department of Urology (M/C 955), College of Medicine, University of Illinois at Chicago, Chicago, IL 60612-7316, USA
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18
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Cook A, Lorenzo AJ, Salle JLP, Bakhshi M, Cartwright LM, Bagi D, Farhat W, Khoury A. Pediatric renal cell carcinoma: single institution 25-year case series and initial experience with partial nephrectomy. J Urol 2006; 175:1456-60; discussion 1460. [PMID: 16516019 DOI: 10.1016/s0022-5347(05)00671-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Indexed: 12/26/2022]
Abstract
PURPOSE RCC represents less than 2% to 6% of pediatric renal tumors. Few reports of long-term outcomes exist. We sought to determine the presentation, treatment and outcome of patients at our institution. MATERIALS AND METHODS We retrospectively reviewed the age, mode of presentation, mode of treatment, histological subtype, tumor grade, stage and survival of all patients with RCC from 1980 to 2005. RESULTS A total of 15 patients were identified. Mean age at presentation was 7.9 years. Symptomatic presentations in nearly 75% of patients included gross hematuria, abdominal pain and polycythemia. The remaining 25% of cases were asymptomatic, and were identified by physical examination or incidentally on imaging. Surgical resection consisted of radical nephrectomy in 10 patients and partial nephrectomy in 5. Pathological analysis revealed papillary RCC in 8 patients and clear cell RCC in 7. Six patients had high stage disease. One patient with stage IV disease died 8 months postoperatively. The remaining 14 patients were alive at a mean followup of 4.9 years. All but 1 patient remain recurrence-free, including all of those who underwent nephron sparing surgery. CONCLUSIONS To our knowledge this single institution series is the first to include children treated with partial nephrectomy. Pediatric patients with RCC tend to be older and more likely to present symptomatically compared to the typical patient with Wilms tumor. Hematuria and abdominal pain were the most common presentations, and papillary RCC was proportionately more common in this series. Our initial experience suggests that equivalent cure rates can be expected from a nephron sparing approach in appropriately selected cases.
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Affiliation(s)
- Anthony Cook
- Division of Urology and Department of Pathology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
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19
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Joniau S, Vander Eeckt K, Van Poppel H. The indications for partial nephrectomy in the treatment of renal cell carcinoma. ACTA ACUST UNITED AC 2006; 3:198-205. [PMID: 16607368 DOI: 10.1038/ncpuro0458] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Accepted: 01/30/2006] [Indexed: 12/11/2022]
Abstract
Partial nephrectomy is performed more frequently for small, incidentally discovered, low-stage renal tumors. Importantly, one should distinguish the imperative indications for such surgery from the relative and elective indications, while taking contraindications to nephron-sparing surgery into account. The main advantage of partial nephrectomy over radical nephrectomy is the avoidance of renal insufficiency; the major disadvantages include the possibility of local recurrence and perioperative complications. In this article, the literature on nephron-sparing surgery was reviewed in order to put the management of renal cancer into a modern perspective.
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Affiliation(s)
- Steven Joniau
- Department of Urology, University Hospital Gasthuisberg, Leuven, Belgium
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20
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Mitchell RE, Gilbert SM, Murphy AM, Olsson CA, Benson MC, McKiernan JM. Partial nephrectomy and radical nephrectomy offer similar cancer outcomes in renal cortical tumors 4 cm or larger. Urology 2006; 67:260-4. [PMID: 16461075 DOI: 10.1016/j.urology.2005.08.057] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Revised: 07/29/2005] [Accepted: 08/25/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine whether the type of surgery (partial nephrectomy [PN] versus radical nephrectomy [RN]) has any effect on cancer outcome for renal cortical tumors 4 cm or larger. PN outcomes for large renal cortical tumors have been shown to be worse than outcomes for smaller tumors, but the upper limit of tumor diameter amenable to PN remains controversial. METHODS We identified 33 patients from the Columbia University Comprehensive Urologic Oncology Database who underwent PN between 1988 and 2004 for renal cortical tumors 4 cm or larger. Each was matched with 2 patients undergoing RN on the basis of the tumor diameter. A survival analysis was conducted using the Kaplan-Meier method, and any differences between the two groups were compared using the log-rank test. The Cox regression model was used to determine which variables affected survival. RESULTS The estimated 5-year recurrence-free survival rate was 93.5% for the PN group and 83.3% for the RN group (P = 0.471). The estimated 5-year disease-specific survival rate was 96.2% for the PN group and 97.8% for the RN group (P = 0.893). Only tumor diameter had an impact on recurrence-free survival in the univariate (P = 0.005) and multivariate (P = 0.008) Cox regression models. Surgical technique had no impact on disease recurrence. CONCLUSIONS The results of our study have shown that cancer outcomes after PN do not differ from outcomes after RN for tumors of 4 cm or greater in diameter. The upper limit of 4 cm appears to have been determined arbitrarily. It is no longer advisable to restrict PN to patients with tumors smaller than 4 cm in diameter.
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Affiliation(s)
- Robert E Mitchell
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York, USA
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21
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Hollenbeck BK, Taub DA, Miller DC, Dunn RL, Wei JT. Use of Nephrectomy at Select Medical Centers—A Case of Follow the Crowd? J Urol 2006; 175:670-4. [PMID: 16407022 DOI: 10.1016/s0022-5347(05)00146-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Indexed: 11/21/2022]
Abstract
PURPOSE Regionalization of high risk surgical procedures to larger, teaching hospitals has been suggested as a means to improve the quality of care. We determined the extent to which the regionalization of nephrectomy has occurred and describe the potential causes and implications of any observed regionalization. MATERIALS AND METHODS The Nationwide Inpatient Sample comprises a 20% sampling of hospital discharges in the United States yearly. Patients undergoing nephrectomy for kidney cancer between 1988 and 2002 were identified using International Classification of Disease, Ninth Revision, Clinical Modification codes. Regionalization was assessed using 6 structural hospital measures, including teaching status, urban location, discharge volume, nephrectomy volume, bed capacity and for-profit status. Adjusted models were developed to identify the significance of temporal trends in each regionalization measure. RESULTS We identified 66,621 patients undergoing nephrectomy during the study period. Compared to procedures performed between 1988 and 1990 the likelihood of undergoing nephrectomy at teaching, high nephrectomy volume and high throughput (all diagnoses) hospitals increased by 2.0 (CI 1.9 to 2.2), 7.4 (CI 7.1 to 7.7) and 2.2 times (CI 2.1 to 2.2), respectively, in 2000 to 2002. Conversely nephrectomy was less likely to be performed at for-profit hospitals (OR 0.5, CI 0.5 to 0.6). Patients were more likely to undergo partial nephrectomy at teaching, high volume, high throughput, urban hospitals. CONCLUSIONS Regionalization of nephrectomy to teaching and high volume (nephrectomy and all diagnoses) hospitals is currently under way. Although the implications are not entirely clear, this study provides further evidence for the crowding of complex surgical procedures into these institutions.
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Affiliation(s)
- Brent K Hollenbeck
- Department of Urology and the Division of Clinical Research, the University of Michigan, Ann Arbor, Michigan, USA.
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22
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Phillips CK, Taneja SS, Stifelman MD. Robot-assisted laparoscopic partial nephrectomy: the NYU technique. J Endourol 2005; 19:441-5; discussion 445. [PMID: 15910252 DOI: 10.1089/end.2005.19.441] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The introduction of the daVinci surgical system has changed the way both surgeon and patient view radical prostatectomy. We hypothesized that the same theoretical and tangible benefits may be realized when employing the system for partial nephrectomy. This paper reviews our technique of robot-assisted laparoscopic partial nephrectomy (RALPN) utilizing the daVinci surgical system. Intraoperative hilar clamping is utilized in all cases. With the daVinci system, the tumor is excised with cold scissors, biopsies are taken from the base for frozen-section study, sutures are placed at the base, Gelfoam/fibrin glue is activated in the defect, a Surgicel bolster is laid in the defect, and mattress sutures are placed prior to releasing the clamp. After performing 12 RALPNs, it appears this technique is safe, feasible, and reproducible both for small exophytic masses and for deeper lesions involving the collecting system. A RALPN requires two surgeons, both well versed in laparoscopic and robotic techniques.
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Affiliation(s)
- Courtney K Phillips
- Department of Urology, New York University School of Medicine, New York, New York 10016, USA
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Abstract
Diagnosis of tumor recurrence and of therapy-related side effects as well as psychological support are the main goals of a surveillance program of cancer patients. While the latter may represent a time-consuming effort, most diagnostic procedures are expensive. Whether we can efficiently detect tumor recurrence in renal cell carcinoma depends on various parameters of the recurrent disease (e.g., frequency, localization, or therapeutic options). Available data lend support to "lean" follow-up strategies in patients with renal cell carcinoma.
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Affiliation(s)
- T Ebert
- Urologische Belegabteilung, EuromedClinic, Fürth.
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Bradford TJ, Wolf JS. Percutaneous injection of fibrin glue for persistent nephrocutaneous fistula after partial nephrectomy. Urology 2005; 65:799. [PMID: 15833546 DOI: 10.1016/j.urology.2004.10.079] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2004] [Revised: 10/06/2004] [Accepted: 10/29/2004] [Indexed: 10/25/2022]
Abstract
We report a case of persistent urinary leak of nearly 4 months' duration after open surgical partial nephrectomy. The urinary leak was refractory to ureteral stenting, urethral catheter placement, and ureteroscopic fulguration. Fibrin glue was injected percutaneously under fluoroscopic guidance into the nephrocutaneous fistula tract, which resulted in its prompt and complete resolution.
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Abstract
Locally recurrent renal cell carcinoma (RCC) is 0-10% after nephron-sparing surgery, 2.5-4% after thermoablative interventions and 2-3% after (radical) nephrectomy. Risk-factors are: sporadic or hereditary origin, tumor size, multifocality, histologic phenotype and incomplete resection. To date, there are no significant differences in the incidence of locally recurrent tumors independently of whether open or laparoscopic techniques were preferred. Caution still has to be taken with the use of alternative tools for minimally invasive tumor ablation.Finally, no statistically proven standard therapy exists that would clearly provide a superior outcome for patients with an isolated local recurrence. However, meta-analyses strongly support the performance of a resection of the recurrence as the primary working principal.
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Affiliation(s)
- M Löhr
- Urologische Klinik, Klinikum Darmstadt
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Beitler JJ, Makara D, Silverman P, Lederman G. Definitive, High-Dose-Per-Fraction, Conformal, Stereotactic External Radiation for Renal Cell Carcinoma. Am J Clin Oncol 2004; 27:646-8. [PMID: 15577450 DOI: 10.1097/01.coc.0000145289.57705.07] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Localized renal cell carcinoma is conventionally treated surgically. Preoperative and adjuvant external radiation have not improved survival. However, renal cell cancer brain metastases, although radioresistant to conventional external radiation, have been responsive to radiosurgery. The following report was compiled with information from our experience using high-dose-per-fraction, conformal radiation delivered to patients who refused definitive surgery. MATERIALS AND METHODS Nine patients with nonmetastatic renal cell carcinomas were identified, 2 of which had bilateral renal cell cancers. Patients were treated definitively with 40 Gy in 5 fractions using conformal external radiation. RESULTS With a median follow up of 26.7 months, 4 of the 9 patients are alive. The survivors have a minimum follow up of 48 months. At presentation, all 4 of the survivors had tumors < or =3.4 cm in largest dimension, had clinically negative nodes, and presented no clinical evidence of penetration of Gerota fascia or renal vein extension. CONCLUSION High-dose-per-fraction, conformal external radiation may have a curative role for small, node-negative, organ-confined renal cell carcinomas.
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Affiliation(s)
- Jonathan J Beitler
- Department of Radiation Oncology, Staten Island University Hospital, Staten Island, New York, USA.
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Shah O, Taneja SS. Renal imaging: what the urologist wants to know. Magn Reson Imaging Clin N Am 2004; 12:387-402, v. [PMID: 15271361 DOI: 10.1016/j.mric.2004.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Preoperative imaging in renal surgery is of utmost importance in contemporary surgical practice. From a diagnostic standpoint, imaging discovers many renal tumors incidentally before they become symptomatic. These tumors often are amenable to partial renal resection or minimally invasive surgical approaches. In general, surgical interventions for renal abnormalities have evolved to a less invasive endourologic or laparoscopic approach. Selection of the appropriate surgical intervention for renal tumors, collecting system tumors, and hydronephrosis depends heavily on the anatomy of the renal pathology. Thus, renal imaging is crucial in clinical decision-making. This article reviews the contribution of imaging to the surgical management of renal tumors, upper tract urothelial tumors, and ureteropelvic junction obstruction.
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Affiliation(s)
- Ojas Shah
- Department of Urology, New York University School of Medicine, 150 East 32nd Street, 2nd Floor, New York, NY 10016, USA
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Kirkali Z, Van Poppel H. Developments in Organ Preserving Treatments for Renal Cell Cancer: Open Surgery. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.eursup.2004.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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