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Zhang C, Wang Z, Jing T, Wei Y, Guo F, Zhang Z, Xiao C, Wang Y, Xu H, Wu X, Tang S, Yang B, Wang S, Xu B, Zhu Q, Xia D, Wang L. Robot-assisted single-port retroperitoneal partial nephrectomy with a novel purpose-built single-port robotic system with deformable surgical instruments. World J Urol 2024; 42:134. [PMID: 38478100 PMCID: PMC10937792 DOI: 10.1007/s00345-024-04827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/16/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To investigate the safety and feasibility of using a novel purpose-built single-port robotic system (the SHURUI Robotic Surgical System) with deformable surgical instruments to perform retroperitoneal single-port partial nephrectomy. MATERIALS AND METHODS A prospective study was conducted to recruit patients with a single renal tumor no more than 4 cm. Robot-assisted single-port partial nephrectomy was performed by using the novel purpose-built single-port robotic system with deformable surgical instruments. Patients' demographics, tumor characteristics, and perioperative parameters were recorded and analyzed. RESULTS Sixteen patients were recruited to the study. The median tumor size was 2.0 cm (IQR: 1.2-2.4 cm). The median R.E.N.A.L score was 6 (IQR: 4-4.5). In 3 cases, pure single-port surgery was carried out, and all the assistance was through the robotic port. Median docking time was 15.5 min (IQR: 14.25-22.25 min). Median operating time was 148.5 min (IQR: 178-238.5 min). Median console time was 107 min (IQR: 92.75-149.75 min). Median warm ischemic time was 26.5 min (IQR: 24.5-30 min). Median blood loss was 17.5 ml (IQR: 10-50 ml). CONCLUSIONS Retroperitoneal partial nephrectomy can be safely performed with this novel purpose-built single-port robotic system (SHURUI) with deformable surgical instruments. Further studies are needed to fully evaluate the role of this new platform.
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Affiliation(s)
- Chao Zhang
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Zheng Wang
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Taile Jing
- Department Urology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yong Wei
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China
| | - Fei Guo
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Zongqin Zhang
- Department Urology, The Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Chengwu Xiao
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Yang Wang
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Hong Xu
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Xiaofeng Wu
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Shouyan Tang
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Bo Yang
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Shuo Wang
- Department Urology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Bin Xu
- Department Urology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200125, China.
| | - Qingyi Zhu
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China.
| | - Dan Xia
- Department Urology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
| | - Linhui Wang
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China.
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2
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Brassetti A, Anceschi U, Bove AM, Prata F, Costantini M, Ferriero M, Mastroianni R, Misuraca L, Tuderti G, Torregiani G, Covotta M, Gallucci M, Simone G. Purely Off-Clamp Laparoscopic Partial Nephrectomy Stands the Test of Time: 15 Years Functional and Oncologic Outcomes from a Single Center Experience. Curr Oncol 2023; 30:1196-1205. [PMID: 36661741 PMCID: PMC9858317 DOI: 10.3390/curroncol30010092] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Nephron-sparing surgery represents the gold standard treatment for organ-confined renal tumors. We present 15-years of outcomes after off-clamp laparoscopic partial nephrectomy (ocLPN). METHODS a retrospective analysis was performed on patients who underwent ocLPN between May 2001 and December 2005. Baseline demographic, clinical, pathologic, surgical, functional and survival data were collected. The Kaplan-Meier method evaluated group-specific oncologic outcomes at 5, 10 and 15 years and the log rank test assessed differences between groups. The same analysis investigated the probabilities of developing a significant renal function impairment (sRFI) and achieving ROMeS. Cox analyses identified predictors of this latter tricomposite outcome. RESULTS We included 63 patients whose median tumor size was 3 cm (IQR:2-4). At 15 years, the chances of developing local recurrence, metachronous renal cancers or distant metastases were 2 ± 2%, 23 ± 6% and 17 ± 5%, respectively. Consequently, disease-free, cancer-specific and overall-survival probabilities were 68 ± 6%, 90 ± 4% and 72 ± 6%. MCRSS and UCISS well predicted oncologic outcomes. Overall, nine (14%) patients experienced an sRFI and 33 (52%) achieved ROMeS. Age (HR: 1.046; p = 0.033) and malignant histology (low-risk cancers HR: 3.233, p = 0.048) (intermediate/high risk cancers HR: 5.721, p = 0.023) were independent predictors of ROMeS non-achievement. CONCLUSIONS At 15 years from ocLPN, most of patients will experience both excellent functional and oncologic outcomes.
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Affiliation(s)
- Aldo Brassetti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Alfredo Maria Bove
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Francesco Prata
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Manuela Costantini
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | | | - Riccardo Mastroianni
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Giulia Torregiani
- Department of Anesthesiology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Marco Covotta
- Department of Anesthesiology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Michele Gallucci
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy
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3
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Carvalho JAM, Nunes P, Tavares-da-Silva E, Parada B, Jarimba R, Moreira P, Retroz E, Caetano R, Sousa V, Cipriano A, Figueiredo A. Impact of Positive Surgical Margins After Partial Nephrectomy. EUR UROL SUPPL 2020; 21:41-46. [PMID: 34337467 PMCID: PMC8317835 DOI: 10.1016/j.euros.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 01/27/2023] Open
Abstract
Background The impact of positive surgical margins (PSMs) after partial nephrectomy (PN) is controversial. Objective To evaluate the risk factors for a PSM and its impact on overall survival. Design, setting, and participants This is a retrospective study of 388 patients were submitted to PN between November 2005 and December 2016 in a single centre. Two groups were created: PSM and negative surgical margin (NSM) after PN. A p value of <0.05 was considered significant. Outcome measurements and statistical analysis Relationships with outcome were assessed using univariable and multivariable tests and log-rank analysis. Results and limitations The PSM rate was 3.8% (N = 16). The mean age at the time of surgery (PSM group: 64.1 ± 11.3 vs NSM group: 61.8 ± 12.8 yr, p = 0.5) and the mean radiological tumour size (4.0 ± 1.5 vs 3.4 ± 1.8 cm, p = 0.2) were similar. Lesion location (p = 0.3), surgical approach (p = 0.4), warm ischaemia time (p = 0.9), and surgery time (p = 0.06) had no association with PSM. However, higher surgeon experience was associated with a lower PSM incidence (2.6% if ≥30 PNs vs 9.6% if <30 PNs; p = 0.02). Higher operative blood loss (p = 0.02), higher-risk tumours (p = 0.03), and larger pathological size (p = 0.05) were associated with an increase in PSM. In the PSM group, recurrence rate (18.7% vs 4.2%, p = 0.007) and secondary total nephrectomy rate (25% vs 4.4%, p < 0.001) were higher. However, overall survival was similar. Multivariate analysis revealed that high-risk tumour (p = 0.05) and low experience (p = 0.03) could predict a PSM. Limitations include retrospective design and reduced follow-up time. Conclusions PSMs were mainly associated with high-risk pathological tumour (p = 0.05) and low-volume surgeon experience. Recurrence rate and need for total nephrectomy were higher in that group, but no impact on survival was noticed. Patient summary The impact of positive surgical margins (PSMs) after partial nephrectomy is a matter of debate. In this study, we found that PSMs were mainly associated with aggressive disease and low surgeon experience.
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Affiliation(s)
- João André Mendes Carvalho
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Pedro Nunes
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Edgar Tavares-da-Silva
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Belmiro Parada
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Roberto Jarimba
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal
| | - Pedro Moreira
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal
| | - Edson Retroz
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal
| | - Rui Caetano
- Department of Pathology, Coimbra University Hospital Center, Coimbra, Portugal
| | - Vítor Sousa
- Faculty of Medicine, Coimbra University, Coimbra, Portugal.,Department of Pathology, Coimbra University Hospital Center, Coimbra, Portugal
| | - Augusta Cipriano
- Faculty of Medicine, Coimbra University, Coimbra, Portugal.,Department of Pathology, Coimbra University Hospital Center, Coimbra, Portugal
| | - Arnaldo Figueiredo
- Department of Urology and Renal Transplantation, Coimbra University Hospital Center, Coimbra, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
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Zhang C, Guo F, Jing T, Wang F, Wang H, Ye C, Yang Y, Yang B. The margin strategy in laparoscopic partial nephrectomy with selective renal artery clamping: Anatomical basis, surgical technique and comparative outcomes. Asian J Surg 2019; 43:417-422. [PMID: 31253384 DOI: 10.1016/j.asjsur.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 04/14/2019] [Accepted: 06/11/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To evaluate the possibility and efficiency of a modified margin strategy in laparoscopic partial nephrectomy with selective renal artery clamping. METHODS Seventy-six cases of laparoscopic partial nephrectomy with segmental renal artery clamping in Shanghai Changhai Hospital between July 2014 and September 2017 were retrospectively reviewed. Relevant clinical data were recorded including baseline patient and tumor characteristics, and surgical outcomes (segmental artery mobilization time, operating time, warm ischemic time, estimated blood loss, complications, and so on). A comparative analysis between standard technique and margin strategy was performed. RESULTS In 38 cases, margin strategy to mobilize segmental artery was successfully performed. In the other 38 cases, the surgery was performed in traditional method. The use of new strategy led to a shortened segmental artery mobilization time (5 min vs 12 min, p < 0.001). There was no difference in terms of perioperative complications between the two techniques. CONCLUSIONS The margin strategy is a practical method in laparoscopic partial nephrectomy with selective renal artery clamping. It provides a simplified way of finding segmental arteries. Further studies are needed to confirm these preliminary findings.
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Affiliation(s)
- Chao Zhang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Fei Guo
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Taile Jing
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, China
| | - Fubo Wang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Huiqing Wang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Chen Ye
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Yue Yang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Bo Yang
- Department of Urology, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai, China.
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5
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Poletajew S, Zapała P, Kopczyński B, Białek L, Bender S, Mutrynowski T, Nowak M, Mróz J, Pędzisz G, Dybowski B, Radziszewski P. Surgical treatment for renal masses in the elderly: analysis of oncological, surgical and functional outcomes. Int Braz J Urol 2019; 45:531-540. [PMID: 30912889 PMCID: PMC6786112 DOI: 10.1590/s1677-5538.ibju.2018.0310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 01/06/2019] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Radical treatment in elderly patients with renal tumor remains debatable due to uncertainties regarding the risk of surgical complications, risk of end-stage renal disease (ESRD) and survival benefit. The aim of the study was to assess outcomes of radical treatment for renal cancer in elderly patients. MATERIALS AND METHODS This retrospective analysis enrolled 507 consecutive patients treated with partial or radical nephrectomy due to renal mass. Patients with upfront metastatic disease (n=46) and patients lost to follow-up (n=110) were excluded from the analysis. Surgical, functional (screen for ESRD development) and survival outcomes were analyzed in patients aged >75 years in comparison to younger individuals. RESULTS The analyzed group included 55 elderly patients and 296 younger controls. Within the cohort a total of 148 and 203 patients underwent radical and partial nephrectomies respectively. The rate of surgical complications, including grade >3 Clavien- Dindo complications, did not differ between groups (3.6% vs. 4.4%, p=0.63). Median length of hospital stay was equal in both groups (7 days). During a follow-up (median 51.9 months, no difference between groups), ESRD occurred in 3.4% of controls and was not reported in elderly group (p=0.37). Younger patients demonstrated a statistically significant advantage in both overall survival and cancer-specific survival over elderly patients (OS 94.6% vs. 87% p=0.036, CSS 97.3% vs. 89.1% p=0.0008). CONCLUSIONS Surgical treatment in elderly patients with renal tumor is as safe as in younger individuals and does not increase the risk of ESRD. However, cancer specific survival among these patients remains shorter than in younger patients.
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Affiliation(s)
| | - Piotr Zapała
- Department of Urology, Medical University of Warsaw, Warsaw, Poland
| | | | - Lukasz Białek
- Department of Urology, Medical University of Warsaw, Warsaw, Poland
| | - Sylwia Bender
- Department of Urology, Medical University of Warsaw, Warsaw, Poland
| | | | - Mateusz Nowak
- Department of Urology, Medical University of Warsaw, Warsaw, Poland
| | - Julia Mróz
- Department of Urology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Pędzisz
- Department of Urology, Medical University of Warsaw, Warsaw, Poland
| | - Bartosz Dybowski
- Department of Urology, Medical University of Warsaw, Warsaw, Poland
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6
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Cao DH, Liu LR, Fang Y, Tang P, Li T, Bai Y, Wang J, Wei Q. Simple tumor enucleation may not decrease oncologic outcomes for T1 renal cell carcinoma: A systematic review and meta-analysis. Urol Oncol 2017; 35:661.e15-661.e21. [DOI: 10.1016/j.urolonc.2017.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/27/2017] [Accepted: 07/10/2017] [Indexed: 02/06/2023]
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7
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Ng AM, Shah PH, Kavoussi LR. Laparoscopic Partial Nephrectomy: A Narrative Review and Comparison with Open and Robotic Partial Nephrectomy. J Endourol 2017; 31:976-984. [PMID: 28937805 DOI: 10.1089/end.2017.0063] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Kidney cancer ranks among the top 10 most prevalent cancers in Western society, ∼90% of which are renal cell carcinomas. There has been a paradigm shift in the management of small renal masses with strong emphasis now placed on nephron-sparing surgery and increased utilization of laparoscopic approaches to partial nephrectomy. In this review, the current state of laparoscopic partial nephrectomy (LPN) is discussed. EVIDENCE ACQUISITION The PubMed database was queried using the MeSH terms "laparoscopy" and "nephrectomy," as well as the search term "partial." A search was performed filtering for "clinical trial," "review," "humans", and "English." EVIDENCE SYNTHESIS Articles that discussed intraoperative techniques, functional and oncologic outcomes, and a comparison between robot-assisted partial nephrectomy and LPN were synthesized. CONCLUSION LPN reduces ischemia time, affords equivalent functional outcomes, oncologic outcomes, and equivalent complication rates compared with open partial nephrectomy. Future advances in laparoscopic technique and advancements in robotic technology offer potential to improve surgical and patient outcomes.
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Affiliation(s)
- Andrew M Ng
- Arthur Smith Institute of Urology , New Hyde Park, New York
| | - Paras H Shah
- Arthur Smith Institute of Urology , New Hyde Park, New York
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8
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Kang HW, Seo SP, Kim WT, Kim YJ, Yun SJ, Lee SC, Choi YD, Ha YS, Kim TH, Kwon TG, Byun SS, Jeh SU, Kim WJ. Impact of the ASA Physical Status Score on Adjuvant Chemotherapy Eligibility and Survival of Upper Tract Urothelial Carcinoma Patients: a Multicenter Study. J Korean Med Sci 2017; 32:335-342. [PMID: 28049247 PMCID: PMC5220002 DOI: 10.3346/jkms.2017.32.2.335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/16/2016] [Indexed: 11/24/2022] Open
Abstract
The aim of the present multi-institutional study was to assess the influence of the American Society of Anesthesiologists Physical Status (ASA-PS) classification on adjuvant chemotherapy eligibility and survival in a multi-institutional cohort of patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). We retrospectively reviewed data from 416 patients who underwent RNU for UTUC at four Korean institutions between 2001 and 2013. The ASA-PS classification was obtained from the anesthesia chart. Locally advanced UTUC was defined as ≥ pT3 and/or pN1 disease. The influence of ASA-PS score on survival was evaluated by Kaplan-Meier analyses and a multivariate Cox regression model. Patients with a higher ASA-PS class were less likely to be eligible for adjuvant chemotherapy in locally advanced UTUC (P = 0.016). Kaplan-Meier estimates showed that the high-risk ASA-PS group has a poorer overallsurvival (OS) and cancer-specific survival (CSS) compared to low risk ASA-PS groups in both the total and locally advanced UTUC cohorts. Based on multivariate Cox regression analysis, the high-risk ASA-PS category was an independent predictor for overall mortality (OM) (hazard ratio [HR], 1.919; 95% confidence interval [CI], 1.017-3.619; P = 0.044) and cancer-specific mortality (CSM) (HR, 2.120; 95% CI, 1.023-4.394; P = 0.043). In conclusion, high-risk ASA-PS score was independently associated with a lower survival rate in patients with UTUC after RNU. However, the influence of ASA-PS classification on survival was limited to locally advanced UTUC. The lower eligibility of patients in the high-risk ASA category for adjuvant chemotherapy may contribute to the lower survival rate in this group.
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Affiliation(s)
- Ho Won Kang
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sung Pil Seo
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Won Tae Kim
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yong June Kim
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seok Joong Yun
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sang Cheol Lee
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Young Deuk Choi
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Sok Ha
- Departments of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Tae Hwan Kim
- Departments of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Tae Gyun Kwon
- Departments of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seok Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Uk Jeh
- Department of Urology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Wun Jae Kim
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea.
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9
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Wang HK, Qin XJ, Ma CG, Shi GH, Zhang HL, Ye DW. Nephrometry score-guided off-clamp laparoscopic partial nephrectomy: patient selection and short-time functional results. World J Surg Oncol 2016; 14:163. [PMID: 27329038 PMCID: PMC4915104 DOI: 10.1186/s12957-016-0914-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 06/14/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Laparoscopic partial nephrectomy (LPN) is not a novel but a relatively technically challenging surgical procedure. Off-clamp LPN with zero ischemia can completely eliminate ischemic reperfusion injury to the kidney. The purpose of this study was to evaluate the safety and functional outcome of nephrometry score-guided off-clamp technique in LPN. METHODS A total of 44 patients underwent LPN between January 2015 and July 2015 for renal mass with radius, exophytic/endophytic, nearness to sinus, anterior/posterior location (RENAL) score 4 were enrolled. Twenty-two of them underwent off-clamp LPN with zero ischemia, and the other 22 received standard LPN with common renal artery clamp. Estimate blood loss (EBL), total operation time, resection time, renorrhaphy time, preoperative estimated glomerular filtration rate (eGFR), postoperative eGFR, eGFR change, and drainage after surgery were compared between these two groups using t test. RESULTS Patients' characteristics including gender, age, BMI, tumor size, and RENAL score were balanced between the two groups. Average EBL was more in the off-clamp group than in the on-clamp group (134.32 versus 70.23 ml, p = 0.001). Average eGFR change was less in the off-clamp group than in the on-clamp group (-1.56 versus -6.45, p < 0.001). Average drainage after surgery was 203.41 ml for the off-clamp group and 145.46 ml for the on-clamp group, p = 0.062. No urinary leakage and hematuria occurred in both groups. There were no statistical difference in total operation time, resection time, renorrhaphy time, preoperative eGFR, and postoperative eGFR between the two groups. CONCLUSIONS Off-clamp LPN is a safe and feasible approach to excise certain kidney tumors with RENAL score 4. This technique can better preserve kidney function without ischemic reperfusion injury.
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Affiliation(s)
- Hong-Kai Wang
- Department of Urology, Fudan University Shanghai Cancer Center, 270 Dong'an Rd (M), Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Xiao-Jian Qin
- Department of Urology, Fudan University Shanghai Cancer Center, 270 Dong'an Rd (M), Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Chun-Guang Ma
- Department of Urology, Fudan University Shanghai Cancer Center, 270 Dong'an Rd (M), Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Guo-Hai Shi
- Department of Urology, Fudan University Shanghai Cancer Center, 270 Dong'an Rd (M), Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Hai-Liang Zhang
- Department of Urology, Fudan University Shanghai Cancer Center, 270 Dong'an Rd (M), Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, 270 Dong'an Rd (M), Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
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10
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Achieving zero ischemia in minimally invasive partial nephrectomy surgery. Int J Surg 2015; 18:48-54. [DOI: 10.1016/j.ijsu.2015.04.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 03/24/2015] [Accepted: 04/11/2015] [Indexed: 12/17/2022]
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11
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Gordetsky J, Gorin MA, Canner J, Ball MW, Pierorazio PM, Allaf ME, Epstein JI. Frozen section during partial nephrectomy: does it predict positive margins? BJU Int 2015; 116:868-72. [DOI: 10.1111/bju.13011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jennifer Gordetsky
- Departments of Pathology and Urology; The University of Alabama; Birmingham AL USA
| | - Michael A. Gorin
- Department of Urology; The Johns Hopkins Hospital; Baltimore MD USA
| | - Joe Canner
- Department of Surgery; Center for Surgical Trials and Outcomes Research; The Johns Hopkins Hospital; Baltimore MD USA
| | - Mark W. Ball
- Department of Urology; The Johns Hopkins Hospital; Baltimore MD USA
| | | | - Mohamad E. Allaf
- Department of Urology; The Johns Hopkins Hospital; Baltimore MD USA
| | - Jonathan I. Epstein
- Department of Urology; The Johns Hopkins Hospital; Baltimore MD USA
- Department of Pathology; The Johns Hopkins Hospital; Baltimore MD USA
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