Detection of a peritumoral pseudocapsule in patients with renal cell carcinoma undergoing robot-assisted partial nephrectomy using enhanced MDCT

Characteristics of peritumoral pseudocapsule in small renal cell carcinoma and its influencing factors

BACKGROUND

The aim of this study was to investigate the peritumoral pseudocapsule (PC) status and identify the factors influencing PC status in small renal cell carcinoma (RCCs).

METHODS

A total of 147 patients with small RCC (≤4 cm) who had undergone tumor enucleation (TE) were assigned into three groups according to PC status: complete PC, PC absence, and PC invasion. Computed tomography (CT) imaging and clinicopathological features were compared among the three groups. Univariate and multivariate analyses were performed to identify factors associated with incomplete PC.

RESULTS

The number of patients with complete PC, PC absence, and PC invasion was 87 (59%), 20 (14%), and 40 (27%), respectively. Compared with the other two groups, tumors with complete PC were most common in clear cell RCC (CCRCC) and showed a hyperenhancement pattern (92%) and clear boundary (63%) on CT scanning images (p < 0.001). PC absence was most common in female patients (50%), whereas PC invasion was more common in male patients (85%) (p = 0.017). The tumor diameter in the PC absence group (2.24 ± 0.93 cm) was shorter compared with that of the complete PC group (2.88 ± 0.76 cm) and PC invasion group (3.16 ± 0.64 cm) (p < 0.001). Univariate and multivariate analysis showed that hypoenhancement pattern, unclear boundary, and non-CCRCC subtype were independent risk factors of incomplete PC.

CONCLUSIONS

Hypoenhancement pattern, unclear boundary, and non-CCRCC subtype were significant predictors of incomplete PC in small RCCs. It remains to be established whether TE is an appropriate procedure for patients with incomplete PC.

Imaging Features of Renal Masses to Select Optimal Candidates for Tumor Enucleation Partial Nephrectomy

PURPOSE OF REVIEW

The goal of this paper was to critically evaluate preoperative findings that optimally select candidates for renal tumor enucleation partial nephrectomy.

RECENT FINDINGS

Tumor enucleation has been widely accepted as a management option for patients with chronic kidney disease, hereditary renal cell carcinoma, or multifocal disease. Recent evidence suggests safety and efficacy in the management of routine small renal masses. With recent advances in imaging, the literature for ruling out aggressive renal cell carcinoma and selection for tumor enucleation is robust. As the incidence of renal cell carcinoma rises, partial nephrectomy continues to be the mainstay of treatment for localized renal cell carcinoma. Tumor enucleation maximizes preservation of renal parenchyma without hindering oncologic outcomes. It is important to recognize key tumor radiologic findings which urologists may use to optimize patient selection for tumor enucleation.

Sports Medical Image Modeling of Injury Prevention in Dance Learning and Sports Training

In order to effectively prevent injuries in dance learning and sports training, this paper proposes a method based on sports medical image modeling. This method solves the problem of injury prevention in dance learning by studying the association analysis algorithm, medical image information system, and CT technology and analyzing the role of data mining technology in the medical image information system. The experimental results show that the average prediction error of CT and US is about 5%, which can be considered that the model can predict accurately. The error of MR is as high as 28.2%, and the prediction is relatively inaccurate. Conclusion. the model can effectively prevent the injury in training.

Surgical and functional outcomes of robot-assisted laparoscopic partial nephrectomy for renal cell carcinoma in adolescents and young adults: a propensity score matching study

BACKGROUND

Cancer development in adolescents and young adults (AYAs) has elicited recent interest. We investigated the surgical and functional outcomes of robot-assisted laparoscopic partial nephrectomy (RAPN) for renal cell carcinoma (RCC) in AYAs.

METHODS

We retrospectively reviewed the medical records of 1023 patients with clinical stage I RCC who underwent RAPN before January 2021. Patients were divided into two groups: AYAs (aged 18-39 years) and non-AYAs (aged 40-89 years). The trifecta criteria, defined as a negative surgical margin, no perioperative complications (Clavien-Dindo grade > 2), and preserved postoperative renal function (1-year postoperative estimated glomerular filtration rate > 90% of baseline), were used to compare outcomes. We performed 1:1 propensity-score matching on the patient cohort.

RESULTS

There were initially 125 and 898 patients in the AYAs and non-AYAs groups, respectively, and 108 patients were included in each group after propensity score matching. There were no significant differences in surgical factors (operation time, clamping ischemia time, estimated blood loss, length of hospital stay, surgical complication rate) or renal function in the early postoperative period. The mean postoperative renal function was better (p = 0.0200) and the decrease in estimated glomerular filtration rate was lower (p = 0.0026) in AYAs than in non-AYAs 12 months postoperatively. The trifecta achievement rates in the AYAs and non-AYAs groups were significantly different (67.6% and 53.7%, respectively, p = 0.0220).

CONCLUSION

Although there was no difference in surgical burden between the groups, the estimated glomerular filtration rate was better preserved in AYAs than in non-AYAs at 6 and 12 months post-RAPN.

Comparison of surgical outcomes between enucleation and standard resection in robot-assisted partial nephrectomy for completely endophytic renal tumors through a 1:1 propensity score-matched analysis

OBJECTIVE

Robot-assisted laparoscopic partial nephrectomy (RAPN) for completely endophytic renal tumors is challenging because of the tumor complexity. The enucleation technique is an ideal resection method to maximally preserve the renal parenchyma. In the present study, we investigated the surgical outcomes of RAPN for completely endophytic renal tumors and compared them between the enucleation and standard resection techniques.

METHODS

One-hundred-and-forty-four patients who underwent RAPN for completely endophytic tumors were the subjects of this study. The subjects were divided into two groups according to the surface-intermediate-margin (SIB) score: enucleation group (SIB score 0-2) and standard resection group (SIB score 3-5). To minimize selection bias between the two surgical methods, patient variables such as age, sex, body mass index, American Society of Anesthesiologists score, tumor size, RENAL NS, and preoperative renal function were adjusted using 1:1 propensity score matching.

RESULTS

Of the 144 patients, 72 were assigned to the enucleation group and 72 to the standard resection group. After matching, 45 patients were included in each group. The mean tumor size was 26-27 mm and the mean RENAL NS score was 9.0-9.1, after matching. The enucleation group showed significantly better preservation of the estimated glomerular filtration rate (eGFR) in the early postoperative period (-4.9% vs. -16%, p = 0.0005) and at 6-12 months after surgery (-4.9% vs. -9.2%, p = 0.0327) than the standard resection group. In addition, a shorter operation time (140 vs. 167 min, p = 0.0028) was observed in the enucleation group. Other outcomes including estimated blood loss, positive surgical margin rate, incidence rate of complications, and length of hospital stay were not significantly different between the two groups.

CONCLUSION

The enucleation technique showed better surgical outcomes for completely endophytic renal tumors in terms of preservation of renal function and operation time than the standard resection technique.

No Detection of Pseudocapsule of Tumor-Parenchyma Interface on Multidetector Computed Tomography (MDCT) Images: Clinical Significance and Histological Reflections in Renal Cell Carcinoma

Objective

Pseudocapsule (PS) of tumor-parenchyma interface (TPI) can be detected by MDCT (ctPS) in renal cell carcinoma (RCC) with exceptions. We aim to study the prognostic implications and histological reflections of no detection of ctPS in RCC.

Patients and Methods

A total of 210 RCC patients who had MDCT examination and received nephrectomy in our institution were included in the analysis. Absence or presence of ctPS was recognized, and its associations with overall survival (OS) and progression-free survival (PFS), pathological PS (pPS) and vasculature were studied.

Results

A total of 172 (81.9%) patients were recognized to have a ctPS and 38 (18.1%) had no detection of it. They had comparable histology, stage, grade, and necrosis. Patients without a ctPS had significantly shortened overall survival (OS, p = 0.001) and progression-free survival (PFS, p <0.001), the significance of which persisted in multivariable analysis (OS, HR 3.104, p = 0.003; PFS, HR 3.313, p = 0.001). Nearly all tumors (34/38, 89.4%) without a ctPS actually had a pPS being detected and incompleteness of pPS was also irrelevant (p = 0.739). Compared with ctPS presence, those without a ctPS had significantly thinned pPS (0.36 vs 0.43 mm, p = 0.005). In clear-cell histology, those without a ctPS also contained increased vascular density and cross-sectional area of vessels with long diameter ≥200 um in the pPS layer (p = 0.005 and 0.011) and increased vascular density in the 500 um layer outside pPS (p = 0.017).

Conclusion

Absence of ctPS on MDCT significantly increases the risk of adverse clinical outcome in RCC. It is the reflection of a thinner pPS and enriched vasculature of TPI rather than absence of pPS itself.