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Thiel DD, Winfield HN. State-of-the-art surgical management of renal cell carcinoma. Expert Rev Anticancer Ther 2014; 7:1285-94. [PMID: 17892429 DOI: 10.1586/14737140.7.9.1285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is a recognizable increase in the incidence of renal cell carcinoma and a parallel rise in the surgical management of renal cell carcinoma has occurred. However, recent literature shows that not all small, suspected renal cell carcinoma needs to be treated surgically, especially in elderly patients or those with multiple medical comorbidities. The surgical options for renal cell carcinoma have expanded from traditional open nephrectomy to partial nephrectomy and, at present, more recent outcomes data are available for the laparoscopic versions of these surgeries. Short-term results of thermal ablative technology (radiofrequency and cryoablation) show real promise as minimally invasive therapies. This review examines the most up-to-date outcomes and future directions of the surgical management of renal cell carcinoma.
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Affiliation(s)
- David D Thiel
- University of Iowa Hospitals & Clinics, 200 Hawkins Drive Iowa City, Iowa 52242, USA.
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Hung SF, Wang SM, Chung SD, Lai MK, Huang KH, Pu YS, Yu HJ, Huang CY. Long-term oncologic outcomes of hand-assisted retroperitoneoscopic radical nephrectomy to treat clinically localized renal cell carcinoma. J Formos Med Assoc 2012; 111:41-5. [PMID: 22333012 DOI: 10.1016/j.jfma.2012.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Revised: 04/06/2010] [Accepted: 10/12/2010] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND/PURPOSE To evaluate the long-term oncological outcomes of hand-assisted retroperitoneoscopic radical nephrectomy (HARRN) for treating clinically localized renal cell carcinoma. METHODS We retrospectively collected and analyzed the data and clinical outcomes of 46 patients who underwent HARRN and 50 patients who underwent conventional open radical nephrectomy (ORN) at our institution for clinical localized renal cell carcinoma (RCC). RESULTS The median follow-up period of the HARRN group was 56.5 months (range: 14.6-78.7 months); for the ORN group, the median follow-up period was 110.8 months (range: 15.5-123 months). Patient age, sex, body mass index, pathologic parameters, and classification based on the guidelines of the American Society of Anesthesiologists were not significantly different between the two groups. The HARRN group had a significantly longer operative time (218 minutes vs. 178 minutes, p = 0.003) and less blood loss (203 mL vs. 670 mL, p < 0.001). The complication rates of the ORN and HARRN groups were similar (8% and 4.3%, respectively, p = 0.46). No conversions to an open procedure or intraoperative mortality occurred in the HARRN group. The disease-free and disease-specific survival rates were comparable between the two groups. CONCLUSION The results of our study indicate that HARRN is a feasible, minimally invasive treatment for managing clinically organ-confined RCC with a good long-term oncological outcome.
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Affiliation(s)
- Shun-Fa Hung
- Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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Jeon SH, Kwon TG, Rha KH, Sung GT, Lee W, Lim JS, Jeong YB, Hong SH, Kim HH, Byun SS. Comparison of laparoscopic versus open radical nephrectomy for large renal tumors: a retrospective analysis of multi-center results. BJU Int 2010; 107:817-821. [DOI: 10.1111/j.1464-410x.2010.09688.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Park YH, Byun SS, Kang SH, Koh JS, Park HK, Paick SH, Seo YJ, Yoo TG, Jung H, Cho JS, Jeon SS, Choi Y, Park SK. Comparison of Hand-Assisted Laparoscopic Radical Nephrectomy with Open Radical Nephrectomy for pT1-2 Clear Cell Renal-Cell Carcinoma: A Multi-Institutional Study. J Endourol 2009; 23:1485-9. [DOI: 10.1089/end.2009.0375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yong Hyun Park
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, Seoul, Korea
| | - Jun Sung Koh
- Department of Urology, Holy Family Hospital, Bucheon, Korea
| | - Hyoung Keun Park
- Department of Urology, Dongguk University International Hospital, Goyang, Korea
| | - Sung Hyun Paick
- Department of Urology, Konkuk University Hospital, Seoul, Korea
| | - Young Jin Seo
- Department of Urology, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Tag Geun Yoo
- Department of Urology, Eulji General Hospital, Seoul, Korea
| | - Han Jung
- Department of Urology, Gachon University Gil Hospital, Incheon, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Seoul, Korea
| | - Yunhee Choi
- Division of Clinical Epidemiology, Medical Research Collaborating Center Seoul National University Hospital, Seoul, Korea
| | - Sue Kyung Park
- Division of Clinical Epidemiology, Medical Research Collaborating Center Seoul National University Hospital, Seoul, Korea
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Conley SP, Humphreys MR, Desai PJ, Castle EP, Dueck AC, Ferrigni RG, Andrews PE. Laparoscopic Radical Nephrectomy for Very Large Renal Tumors (≥10 cm): Is There a Size Limit? J Endourol 2009; 23:57-61. [DOI: 10.1089/end.2008.0263] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Affiliation(s)
- Leslie A Deane
- Department of Urology, University of California Irvine, UCI Medical Center, Orange, CA 92868, USA
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Hemal AK, Kumar A, Kumar R, Wadhwa P, Seth A, Gupta NP. Laparoscopic versus open radical nephrectomy for large renal tumors: a long-term prospective comparison. J Urol 2007; 177:862-6. [PMID: 17296361 DOI: 10.1016/j.juro.2006.10.053] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Indexed: 12/12/2022]
Abstract
PURPOSE The role of laparoscopy in the management of large renal tumors (more than 7 cm) is not clearly established. We prospectively evaluated the feasibility, safety and long-term results of laparoscopic radical nephrectomy for large renal tumors (T2N0M0) and compared the results with those of open radical nephrectomy. MATERIALS AND METHODS Between 1998 and 2006, 112 patients with clinical stage T2N0M0 renal carcinoma underwent radical nephrectomy at our institution. Clinical data were prospectively collected after categorizing the patients into group 1-41 with laparoscopy and group 2-71 with open surgery. The choice of procedure was nonrandomized and it depended on patient and surgeon preference and experience. RESULTS The 2 groups were contemporary and comparable in terms of age, body mass index and mean tumor size (9.9 and 10.1 cm, respectively). Concomitant adrenalectomy was performed in 14 patients (34%) in group 1 and in 29 (41%) in group 2. Limited (hilar) lymphadenectomy was performed in 30 patients (73%) in group 1 and in 58 (81%) in group 2. Group 1 patients experienced significantly less blood loss, and had a decreased analgesic requirement, shorter hospital stay and more rapid convalescence, although they required longer operative time (180.8 vs 165.3 minutes, p=0.029). The 2 groups were followed for a similar period (mean 51.4 vs 57.2 months) and there was no difference in 5-year survival data. There were no local or port site recurrences. CONCLUSIONS Laparoscopic radical nephrectomy for clinical stage T2 renal tumors is effective with the advantages of less blood loss, shorter hospital stay, decreased analgesic requirement and rapid recovery compared with open radical nephrectomy. Long-term results are also similar in the 2 groups of patients. Laparoscopic radical nephrectomy for large tumors is a technically difficult, challenging procedure and it should be attempted by surgeons with significant experience.
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Affiliation(s)
- A K Hemal
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
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Chung SD, Huang KH, Lai MK, Huang CY, Pu YS, Yu HJ, Chueh SC. Long-Term Follow-up of Hand-Assisted Laparoscopic Radical Nephrectomy for Organ-Confined Renal Cell Carcinoma. Urology 2007; 69:652-5. [PMID: 17445645 DOI: 10.1016/j.urology.2006.12.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2006] [Revised: 09/26/2006] [Accepted: 12/22/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the efficacy and long-term outcomes of hand-assisted laparoscopic radical nephrectomy (HALRN) in treating clinically localized renal cell carcinoma. METHODS We analyzed the data from 54 patients who underwent hand-assisted laparoscopic radical nephrectomy (HALRN) and 70 patients who underwent conventional open radical nephrectomy (ORN) in our institution from January 1998 to December 2002 for clinical Stage T1N0M0 or T2N0M0 renal cell carcinoma. The data were collected retrospectively by reviewing the medical records. All specimens were confirmed by pathologic examination. We compared the surgical results and long-term oncologic outcomes between the two groups. RESULTS The median follow-up period in the HALRN group was 44.5 months (range 16 to 73) and in the ORN group it was 68 months (range 43 to 93). Patient age, sex, body mass index, pathologic parameters, and American Society of Anesthesiologists classification were not significantly different between the two groups. The HALRN group had a significantly longer operative time (204 minutes versus 181 minutes, P = 0.03) and less blood loss (161 mL versus 630 mL, P <0.01). The complication rates for the ORN and HALRN groups were similar (10% and 7.4% respectively, P = 0.62). No conversions to an open procedure or intraoperative mortality occurred in the HALRN group. The average hospital stay, length of wound, and parenteral narcotic analgesic dose were significantly less in the HALRN group. The 5-year disease-free rate and disease-specific survival rate were comparable in the two groups. CONCLUSIONS The results of our study have shown that HALRN is a less-invasive technique with 5-year disease-free and disease-specific survival rates comparable to those after ORN in treating patients with clinically localized renal cell carcinoma.
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Affiliation(s)
- Shiu-Dong Chung
- Department of Urology, Far-Eastern Memorial Hospital, Ban Ciao, Taipei County, Taiwan
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Gutiérrez Sanz-Gadea C, Mus Malleu A, Briones Mardones G, Hidalgo Pardo F, Rebassa Llull M, Conde Santos G. [Hand-assisted laparoscopic nephrectomy]. Actas Urol Esp 2006; 30:698-706. [PMID: 17058615 DOI: 10.1016/s0210-4806(06)73520-3] [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: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES To present the number of cases of hand-assisted laparoscopic nephrectomy. This study evaluates our results and difficulties of starting a progresive programme of laparoscopy. MATERIAL AND METHOD Between november 2003 and november 2005, 35 hand-assisted laparoscopic nephrectomies were carried out, of a total of 45 laparoscopic nephrectomies. 22 radical nephrectomies, 3 simple nephrectomies and 10 nephroureterectomies. The average age of patients was 66 years (47-89). On average, they were overweight (IMC 28,3), with approximately 38% being obese. ASA 2.3 (1-4). The tumors measured 4.8cm on average, and 80% of these were T1. In 28.6% of the cases, they had previously undergone abdominal surgery. RESULTS One was undertaken in 2003, 17 in 2004, and 17 in 2005. The surgery time was 140 minutes, 130 minutes (80-210) in radical nephrectomies, 135 minutes (120-150) in simple nephrectomies and 163 minutes (80-240) in the nephroureterectomy. Patients began an oral diet 1.7 days later, and were able to get up 1.7 days later. In the case of obese patients, they began an oral diet 2.3 days later and were able to get up (2.4 days) later than those non obese cases. (1.5 and 1.4 days respectively). The average stay has been 5.8 days (3-15). The average stay of the cases without complications was 4.2 days and those that encountered complications 9.7 days. In no cases was there a need for a blood transfusion. In 11.4% we had major complications with an average stay of 11.7 days. In 5.7% of cases there were reconversions, and 5.7% of cases were reoperated. 17.1% had minor complications, with an average stay of 8.8 days CONCLUSIONS The advantage of hand-assisted nephrectomy is that it allows one to begin a laparoscopy, with a reduced learning time, and with satisfactory results, allowing the incorporation of laparoscopy surgery in hospitals with a reduced annual volume.
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Ross PL, Meng MV, Kane CJ. Laparoscopic approaches to renal malignancies. Curr Probl Cancer 2006; 30:168-93. [PMID: 16860165 DOI: 10.1016/j.currproblcancer.2006.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Philip L Ross
- Department of Urology, The UCSF Comprehensive Cancer Center Urology Section, University of California-San Francisco, San Francisco, CA, USA
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Pareek G, Hedican SP, Gee JR, Bruskewitz RC, Nakada SY. Meta-analysis of the complications of laparoscopic renal surgery: comparison of procedures and techniques. J Urol 2006; 175:1208-13. [PMID: 16515961 DOI: 10.1016/s0022-5347(05)00639-7] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Indexed: 02/02/2023]
Abstract
PURPOSE We performed a meta-analysis of the literature to define the current expectations of complications during laparoscopic renal surgery. MATERIALS AND METHODS References were searched in the MEDLINE database from 1995 to 2004 using the terms complications and laparoscopic nephrectomy. Inclusion criteria were any series with greater than 20 cases, patient age older than 16 years and any complications listed for certain procedures, including laparoscopic radical nephrectomy, HA laparoscopic radical nephrectomy, LPN, HALPN, laparoscopic donor nephrectomy, HA laparoscopic donor nephrectomy, laparoscopic simple nephrectomy, laparoscopic nephroureterectomy and retroperitoneal laparoscopic nephrectomy. A data extraction form was created to categorize major or minor complications. A 5 member panel adhered to the strict criteria and extracted data from articles that met inclusion criteria. Data were entered into a spreadsheet and a meta-analysis was performed. RESULTS Initial review identified 73 of 405 references that were acceptable for retrieval and data extraction, of which 56 met inclusion criteria. The overall major and minor complication rates of laparoscopic renal surgery were 9.5% and 1.9%, respectively. There was a significant difference between the major complication rates of LPN and HALPN (21.0% vs 3.3%, p <0.05). CONCLUSIONS Our results show that patients who undergo laparoscopic renal surgery may have an overall major complication rate of 9.5%. The highest major complication rate is associated with technically challenging LPN (21%). There appears to be a significantly higher wound complication rate associated with HA surgery in comparison to that of standard laparoscopy (1.9% vs 0.2%, p <0.05).
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Affiliation(s)
- Gyan Pareek
- Division of Urology, Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin, USA.
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Malaeb BS, Sherwood JB, Taylor GD, Duchene DA, Broder KJ, Koeneman KS. Hand-assisted laparoscopic nephrectomy for renal masses >9.5 cm: Series comparison with open radical nephrectomy. Urol Oncol 2005; 23:323-7. [PMID: 16144665 DOI: 10.1016/j.urolonc.2005.03.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Revised: 03/23/2005] [Accepted: 03/24/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the feasibility of hand-assisted laparoscopic nephrectomy (HALN) for large renal masses (stage T2, mean size 9.7 cm) and compare outcomes with a similar cohort undergoing open radical nephrectomy (ORN). METHODS A nonrandomized comparison of 19 consecutive patients who underwent nephrectomy for renal masses >or=7 cm was performed. The HALN group was compared to the ORN group regarding demographic parameters and perioperative data, including blood loss, operating time, narcotic usage, hematocrit change, return to standard oral intake, length of hospital stay, and complications. Data collected prospectively and statistics used 2-tailed t-test analysis. RESULTS Patients underwent either ORN (mean tumor size 12.3 cm) or HALN (mean tumor size 9.7cm). Tumors up to 14 cm (n = 2) and pT3b, with renal vein thrombosis (n = 2), could be safely excised with HALN. There were no differences between the HALN and ORN groups regarding any demographic parameter. Blood loss, operating time, length of stay, parenteral narcotic use, and time to tolerating regular diet were all less statistically significant in the HALN group as compared to the ORN group (P < 0.05). Tumors >15 cm necessitated ORN. CONCLUSIONS HALN is technically feasible even for tumors with mean size >9.5 cm. There is a significant advantage to HALN over ORN regarding the intraoperative and postoperative morbidity. Tumors >or=15 cm should, in most cases, be performed with an open approach.
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Affiliation(s)
- Bahaa S Malaeb
- Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA
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Shiraishi K, Eguchi S, Mohri J, Kamiryo Y. Hand-Assisted Laparoscopic Radical Nephrectomy. Surg Laparosc Endosc Percutan Tech 2005; 15:216-9. [PMID: 16082309 DOI: 10.1097/01.sle.0000174555.25167.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transperitoneal and retroperitoneal approaches have been introduced to perform hand-assisted laparoscopic radical nephrectomy. The efficacy and convalescence of both approaches were compared. Of 26 patients with renal cell carcinoma, 14 patients were treated by the transperitoneal approach and 12 by the retroperitoneal approach at the same institution. The mean operative time by transperitoneal approach was significantly shorter than retroperitoneal approach (236.4 and 280.0 minutes, respectively, P < 0.05), but there is a steeper learning in retroperitoneal approach. A significant increase in operative time was required with an increase in specimen weight (r = 0.591, P < 0.05). There were no differences in patient demographic, operative, and convalescence data between the both groups. Hand-assisted laparoscopic radical nephrectomy is safe by either the transperitoneal or the retroperitoneal approach. Making enough retroperitoneal space for the hand and instrument enables us to use the retroperitoneal approach readily. Patients with abundant fatty tissues around the kidney should be treated by the transperitoneal approach.
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Affiliation(s)
- Koji Shiraishi
- Department of Urology, Saiseikai Shimonoseki General Hospital, Shimonoseki, Yamaguchi, Japan.
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