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Campbell RA, Scovell J, Rathi N, Aram P, Yasuda Y, Krishnamurthi V, Eltemamy M, Goldfarb D, Wee A, Kaouk J, Weight C, Haber GP, Campbell SC. Partial Versus Radical Nephrectomy: Complexity of Decision-Making and Utility of AUA Guidelines. Clin Genitourin Cancer 2022; 20:501-509. [PMID: 35778335 DOI: 10.1016/j.clgc.2022.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/30/2022] [Accepted: 06/05/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The American-Urological-Association(AUA) Guidelines for renal cancer(2017) recommend consideration for radical-nephrectomy(RN) over partial(PN) whenever there is increased oncologic-risk; and RN should be prioritized if three other criteria are all also met: 1) increased tumor-complexity; 2) no preexisting chronic-kidney-disease/ proteinuria, and 3) normal contralateral kidney that will likely provide estimated glomerular-filtration-rate (eGFR) >45ml/min/1.73m2 even if RN is performed. Our objective was to assess the complexity of decision-making about RN/PN and utility of AUA Guidelines statements regarding this issue. PATIENTS AND METHODS Retrospective review of 267 consecutive RN/PN from 2019(100-RN/167-PN). High tumor-complexity was defined as R.E.N.A.L.≥9. Increased oncologic-risk was defined as tumor >7cm, locally-advanced or infiltrative-features on imaging, or high-risk pathology on biopsy, if obtained. New-baseline GFR after RN was estimated using global-GFR, split-renal-functioncontralateral, and presuming 25% renal-functional-compensation. RESULTS 163 patients(61%) fit scenarios that are well-defined in the Guidelines. Of these, 34 had strong indications for RN, and all had RN. Twelve of 129 patients(9.3%) underwent RN despite Guidelines generally favoring PN. The remaining 104 patients(39%) did not fit within situations where the Guidelines provide specific recommendations. In these patients, RN was often performed despite functional-considerations favoring PN due to overriding concerns about oncologic-risk and/or tumor-complexity. CONCLUSION Our data demonstrate complexity of decision-making about PN/RN as almost 40% of patients did not fit well-described AUA Guidelines descriptors. Compliance was generally strong although occasional overutilization of RN remains a concern in our series, and will be addressed with additional education. Further studies will be required to assess the generalizability of our findings in other institutions/settings.
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Affiliation(s)
- Rebecca A Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jason Scovell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Nityam Rathi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH
| | - Pedram Aram
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Yosuke Yasuda
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Mohamed Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - David Goldfarb
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Alvin Wee
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Christopher Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Junejo NN, Alkhateeb SS, Alrumayyan MF, Alkhatib KY, Alzahrani HM, Alotaibi MF, Alothman KI, Al-Hussain TO, Altaweel WM. Trends in the surgical management of renal cell carcinoma in a contemporary tertiary care setting. Urol Ann 2021; 13:111-118. [PMID: 34194135 PMCID: PMC8210727 DOI: 10.4103/ua.ua_151_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/21/2020] [Indexed: 11/04/2022] Open
Abstract
Background In the last three eras, the incidence of renal cell carcinoma (RCC) has increased, due to increased radiological studies. The expected 5-year survival rate has become better, associated with the identification of small size renal masses. However, this survival improvement may be secondary to improved surgical techniques and medical therapies for these malignancies. Objectives The objective was to report the trends of clinical presentation, peri-operative, oncological outcomes, and surgical management trends for RCCs over the period. Methods After Institutional Review Board approval, a retrospective study for adult patients was conducted, who presented with renal mass and were managed between 2008 and 2019. Variables, including demographics, perioperative and pathological outcomes analyzed using descriptive statistics for continuous variables reported as mean ± standard deviation and categorical variables values compared by Chi-square test. Survival Analysis calculated using the Kaplan-Meier method. The level of significance is set at P-value < 0.05. Results A total of 588 patients underwent surgical treatment for kidney cancer from January 2008 to January 2019. 237 (40.30%) were females and 351 (59.69%) males. The clinical presentation was higher as an incidental diagnosis of 58.67%. 71.25% of patients were from outside Riyadh city. Pathology was mostly clear cell RCC 61.22% and grade 2 (57.48%). Tumor size, surgery time, and length of hospital stay showed a significant difference between the three periods (both P > 0.05). Robotic surgery performed more than open (P < 0.0001). There was no significant difference in the survival time, when compared to patients by the regions and when compared by the primary tumors (Log-Rank P = 0.4821). Patients from the Riyadh region (median = 54.0) had a significantly higher recurrence time (Log-Rank P < 0.0001). Conclusion There was a rising trend in the incidence of RCC associated with comorbidities and incidental diagnosis. In our study period we found increase in the trend of minimal invasive approach. The size of the tumor, blood loss and operative time decreases over the period of time. The Robotic assisted nephrectomy approach has become increased over the period of time duration in present study.
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Affiliation(s)
- Noor Nabi Junejo
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
| | - Sultan Saud Alkhateeb
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
| | - Majed Faisal Alrumayyan
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | - Hassan Messfer Alzahrani
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Faihan Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
| | - Khalid Ibrahim Alothman
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Turki Omar Al-Hussain
- Alfaisal University, College of Medicine, Riyadh, Saudi Arabia.,Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Waleed Mohamed Altaweel
- Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
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Bajalia EM, Parikh KA, Haehn DA, Kahn AE, Ball CT, Thiel DD. Assessment of Advanced Perioperative Outcomes to Identify the True Learning Curve of Robotic-assisted Partial Nephrectomy. Urology 2020; 144:136-141. [PMID: 32619599 DOI: 10.1016/j.urology.2020.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To evaluate the learning curve of robotic-assisted partial nephrectomy as it pertains to operative time (OT) and advanced perioperative variables such as achievement of trifecta, postoperative complications, 30-day readmission rates (RR), warm ischemia time (WIT), and functional volume loss (FVL). METHODS We evaluated 418 consecutive robotic-assisted partial nephrectomy performed by a single surgeon between February 2008 and April 2019. Multivariable log-log regression models were used to evaluate the associations between case number and continuous outcomes (OT, WIT, and FVL). Multivariable logistic regression models were used to evaluate the association of case number with dichotomous outcomes (trifecta, postoperative complications, RR). RESULTS Among the 406 eligible patients included in the study, 252 (62.1%) were male, median age was 63 years (range, 22-84), and median body mass index was 29 kg/m2 (interquartile range 26-33). Surgeon experience was associated with shorter OT (-2.5% per 50% increase in case number; 95% confidence interval; P <.001) and plateaus around 77 cases performed. There was slight improvement with trifecta (odds ratio [per 50% increase in cases] = 1.08; 95% confidence interval) and the plateau was also at 77 cases, however, this was not statistically significant (P = .086). We did not find statistically significant associations of surgeon experience with FVL (P = .77), postoperative complications (P = .74), WIT (P = .73), or 30-day RR (P = .33). CONCLUSION There does not appear to be a relationship between surgical experience and grade 3 or higher postoperative complications, 30-day RR, WIT, or FVL. Trifecta outcomes and maximum OT performance appear to be optimized at approximately 77 cases.
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Affiliation(s)
| | | | | | - Amanda E Kahn
- Department of Urology, Mayo Clinic, Jacksonville, FL
| | - Colleen T Ball
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL
| | - David D Thiel
- Department of Urology, Mayo Clinic, Jacksonville, FL.
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Flegar L, Groeben C, Koch R, Baunacke M, Borkowetz A, Kraywinkel K, Thomas C, Huber J. Trends in Renal Tumor Surgery in the United States and Germany Between 2006 and 2014: Organ Preservation Rate Is Improving. Ann Surg Oncol 2019; 27:1920-1928. [DOI: 10.1245/s10434-019-08108-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Indexed: 12/19/2022]
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Cristea O, Warren J, Blew B, Rowe N. Transplanting kidneys from donors with small renal masses - a strategy to expand the donor pool. Can Urol Assoc J 2019; 14:E32-E38. [PMID: 31348749 DOI: 10.5489/cuaj.5926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Renal transplantation is the optimal treatment for end-stage renal disease, but organ demand continues to outstrip supply. The transplantation of kidneys from donors with small renal masses (SRMs) represents a potential avenue to expand the donor pool. We reviewed all published cases of transplants from donors with SRMs and we present followup data, best practices, and outline an actionable series of steps to guide the implementation of such transplants at individual centers. METHODS A detailed literature search of the MEDLINE/PubMed and SCOPUS databases was performed. Thirty unique data sets met inclusion criteria and described the transplantation of tumor-ectomized kidneys; nine data sets described the transplantation of contralateral kidneys from donors with SRMs. RESULTS A total of 147 tumorectomized kidneys have been transplanted. Pathology revealed 120 to be renal cell carcinomas (RCCs), of which 116 were stage T1a (0.3-4 cm). The mean followup time was 44.2 months (1-200). A single suspected tumor recurrence occurred in one patient nine years post-transplantation and it was managed with active surveillance. Twenty-seven kidneys have been transplanted from deceased donors with contralateral renal masses. Pathology revealed 25 to be RCCs, of which 19 were confirmed to be stage T1 (<7 cm). The mean followup time was 46.7 months (0.5-155). One recipient developed an RCC and underwent curative allograft nephrectomy. CONCLUSIONS Careful use of kidneys from donors with SRMs is feasible and safe, with an overall recurrence rate of less than 1.5%. The use of such kidneys could help alleviate the organ shortage crisis.
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Affiliation(s)
- Octav Cristea
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Jeff Warren
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Brian Blew
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Neal Rowe
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
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Vigneswaran HT, Dobbs RW, Huang J, Sofer LA, Halgrimson WR, Crivellaro S. Use of a Novel Articulating Laparoscopic Needle Driver for Partial nephrectomy: An Initial Experience. Urology 2019; 132:123-129. [PMID: 31310768 DOI: 10.1016/j.urology.2019.05.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To demonstrate the clinical feasibility of an articulated laparoscopic needle driver to assist in the performance of laparoscopic partial nephrectomy (LPN). Previous studies have demonstrated under-utilization of minimally invasive techniques for patients undergoing partial nephrectomy (PN). METHODS Consecutive patients with renal masses amenable to PN underwent LPN with an articulating laparoscopic needle driver. A consecutive cohort of patients who previously underwent robot assisted laparoscopic PN (RALPN) was selected as a comparison cohort. Preoperative, perioperative, and postoperative variables were retrospectively collected. RESULTS A total of 20 patients underwent PN with 10 patients assigned to each of the LPN and RALPN cohorts. Median R.E.N.A.L. nephrometry scores assigned to the LPN and RALPN cohorts were 7 and 6 respectively (P= .31). Median warm ischemia time for patients in the LPN and RALPN groups was 25.5 and 18.5 minutes respectively (P= .36). Median estimated blood loss for LPN and RALPN was 200 and 50 mL (P= .03). Median operative time for LPN and RALPN was 203 and 194 minutes respectively (P= .76). Median Length of stay after LPN and RALPN was similar (3.0 vs 2.5 nights, P= .26). Following LPN, 3 patients required blood transfusion as compared to 2 patients in the RALPN cohort (P= .61). CONCLUSION Our initial results demonstrated the clinical safety and feasibility of a new surgical device for performing LPN. Patients who underwent LPN with a novel articulating needle driver demonstrated equivalent results to RALPN across several key outcomes.
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Affiliation(s)
| | - Ryan W Dobbs
- Department of Urology, University of Illinois at Chicago, Chicago, IL
| | - Jason Huang
- Department of Urology, University of Illinois at Chicago, Chicago, IL
| | - Laurel A Sofer
- Department of Urology, University of Illinois at Chicago, Chicago, IL
| | | | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL
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National trends and economic impact of surgical treatment for benign kidney tumors. Urol Oncol 2019; 37:183.e9-183.e15. [DOI: 10.1016/j.urolonc.2018.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/19/2018] [Accepted: 11/19/2018] [Indexed: 12/15/2022]
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Marchioni M, Nazzani S, Preisser F, Bandini M, Tian Z, Kapoor A, Cindolo L, Primiceri G, Carmignani L, Briganti A, Montorsi F, Shariat SF, Schips L, Karakiewicz PI. The Effect of Institution Teaching Status on Perioperative Outcomes After Robotic Partial or Radical Nephrectomy. J Endourol 2018; 32:621-629. [DOI: 10.1089/end.2018.0025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Michele Marchioni
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Department of Urology, SS Annunziata Hospital, “G.D'Annunzio” University of Chieti, Chieti, Italy
| | - Sebastiano Nazzani
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Felix Preisser
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Marco Bandini
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, Canada
| | - Luca Cindolo
- Department of Urology, ASL Abruzzo 2, Chieti, Italy
| | - Giulia Primiceri
- Department of Urology, SS Annunziata Hospital, “G.D'Annunzio” University of Chieti, Chieti, Italy
| | - Luca Carmignani
- Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Luigi Schips
- Department of Urology, SS Annunziata Hospital, “G.D'Annunzio” University of Chieti, Chieti, Italy
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Department of Urology, University of Montreal Health Centre, Montreal, Canada
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Hora M, Eret V, Trávníček I, Procházková K, Pitra T, Dolejšová O, Hes O, Petersson F. Surgical treatment of kidney tumors - contemporary trends in clinical practice. Cent European J Urol 2016; 69:341-346. [PMID: 28127448 PMCID: PMC5260449 DOI: 10.5173/ceju.2016.845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/16/2016] [Accepted: 08/30/2016] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The aim of this article is to generally describe the roles of main surgical modalities in treatment of renal tumors, especially in the CT1a category in clinical practice. Surgical modalities include the following: laparoscopic or open resection (LR, OR) and laparoscopic or open nephrectomy (LN, ON). Representation of these methods has been changing over years due to improved operative skills and equipment and due to a shift of tumors to the lower T categories. MATERIAL AND METHODS The sources of data were surgeries performed for renal tumors at the institution of the main author during the period 2002 to III/2016, reaching a total of 2204 cases (546 ONs, 647 LNs, 668 ORs and 343 LRs). Patients indicated for percutaneous ablative therapy or active surveillance were not included. RESULTS During the whole period, the proportions of methods were: ONs 24.8%, LNs 29.4%, ORs 30.3%, LRs 15.6%. But during the years 2014 - III/2016, these changed to 12.6%:26.3%:31.6%:29.4% (in cT1a 1.7%:8.3%:37.8%:52.2%). Category cT1a constitutes in the years 2007 - III/2016 41.3%, in 2014 - III/2016 50.9%. CONCLUSIONS Resections and minimally invasive approaches are being performed more frequently and are the preferred methods in surgical treatment of kidney tumors. Resection is now indicated in about 60% of cases (open vs. laparoscopic resection are used nearly equally with a slight tendency for laparascopic predomination). In the cT1a category (amounting to approximately 50% of all surgically treated tumors), resection is possible in about 85-90% of cases.
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Affiliation(s)
- Milan Hora
- University Hospital, Department of Urology, Plzeň, Czech Republic
| | - Viktor Eret
- University Hospital, Department of Urology, Plzeň, Czech Republic
| | - Ivan Trávníček
- University Hospital, Department of Urology, Plzeň, Czech Republic
| | | | - Tomáš Pitra
- University Hospital, Department of Urology, Plzeň, Czech Republic
| | - Olga Dolejšová
- University Hospital, Department of Urology, Plzeň, Czech Republic
| | - Ondřej Hes
- University Hospital, Department of Pathology, Plzeň, Czech Republic
| | - Fredrik Petersson
- Department of Pathology, National University Health System, Singapore, Singapore
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