1
|
Ayoub E, Kutchukian S, Bigot P, Dinh A, Gondran-Tellier B, Robin H, Françot M, de Vergie S, Rigaud J, Chapuis M, Brureau L, Jousseaume C, Karray O, Kosseifi FT, Borojeni S, Descazeaud A, Asare HJ, Gaullier M, Poussot B, Tricard T, Baboudjian M, Lechevallier É, Delpech PO, Ducousso H, Bernardeau S, Bruyère F, Vallée M. Asymptomatic bacteriuria prior to partial and radical nephrectomy: To screen or not to screen? Results from the national and multicenter TOCUS database. World J Urol 2024; 42:179. [PMID: 38507063 DOI: 10.1007/s00345-024-04853-1] [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] [Received: 11/15/2023] [Accepted: 02/06/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION In the era of increased bacterial resistance, the main strategy is to reduce the prescription of antibiotics when possible. Nowadays, it is highly recommended to screen for asymptomatic bacteriuria (ABU), prior to urological surgery with potential mucosal breach or urine exposure. Screening and treating urinary colonization is a strategy widely adopted before radical and partial nephrectomy but without any evidence. Our main end point in this study is to analyze the relationship between preoperative urine culture and the risk of postoperative febrile urinary tract infection (UTI) or surgical-site infection (SSI) in partial or radical nephrectomy patients. METHODS We conducted a multicenter retrospective cohort study between January 2016 and January 2023 in 11 French tertiary referral hospitals (TOCUS database). We collected the data for 269 patients including several pre-, intra-, and post-operative variables that could potentially increase the risk of postoperative UTI and SSI including preoperative urinary culture results. RESULTS The incidence rate of postoperative UTI and SSI was 8.9% in our study. After conducting a logistic multivariate analysis, a propensity score matching analysis, and a subgroup analysis, we found no significant correlation between the urine culture and the postoperative UTI risk [OR = 1.2 (0.5-2.7) (p = 0.7)]. Only the postoperative non-infectious complications were related to a higher risk of postoperative UTI [OR = 12 (4-37), p < 0.001)]. CONCLUSION Our research shows that screening and treating for ABU prior to radical or partial nephrectomy seems to be unnecessary to prevent postoperative UTI and SSI.
Collapse
Affiliation(s)
- Elias Ayoub
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France.
| | - Stessy Kutchukian
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Pierre Bigot
- Département d'urologie Centre Hospitalier Universitaire, Angers, France
| | - Aurélien Dinh
- Service de maladies infectieuses, Centre Hospitalier Universitaire, R. Poincaré, APHP, GarchesUniversité Versailles Paris Saclay, IHU PROMETHEUS, Paris, France
- Membre du comité d'infectiologie de l'Association Française d'Urologie (CIAFU), Paris, France
| | - Bastien Gondran-Tellier
- Département d'urologie Centre Hospitalier Universitaire, Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Humphrey Robin
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Marc Françot
- Département d'urologie Centre Hospitalier Universitaire, Nantes, France
| | | | - Jérôme Rigaud
- Département d'urologie Centre Hospitalier Universitaire, Nantes, France
| | - Mathilde Chapuis
- Département d'urologie Centre Hospitalier Universitaire, Guadeloupe, France
| | - Laurent Brureau
- Département d'urologie Centre Hospitalier Universitaire, Guadeloupe, France
| | - Camille Jousseaume
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Omar Karray
- Département d'urologie Centre Hospitalier, Pontoise, France
| | - Fares T Kosseifi
- Département d'urologie Centre Hospitalier Universitaire, Paris Saint Joseph, France
| | - Shahed Borojeni
- Département d'urologie Centre Hospitalier Universitaire, Paris Saint Joseph, France
| | | | - Harrison-Junior Asare
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Maxime Gaullier
- Département d'urologie Centre Hospitalier Universitaire, Strasbourg, France
| | - Baptiste Poussot
- Département d'urologie Centre Hospitalier Universitaire, Strasbourg, France
| | - Thibault Tricard
- Département d'urologie Centre Hospitalier Universitaire, Strasbourg, France
| | - Michael Baboudjian
- Département d'urologie Centre Hospitalier Universitaire, Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Éric Lechevallier
- Département d'urologie Centre Hospitalier Universitaire, Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Pierre-Olivier Delpech
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Héloïse Ducousso
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Simon Bernardeau
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France
| | - Franck Bruyère
- Membre du comité d'infectiologie de l'Association Française d'Urologie (CIAFU), Paris, France
- Département d'urologie Centre Hospitalier Universitaire, Tours, France
| | - Maxime Vallée
- Département d'urologie et de transplantation rénale, Centre Hospitalier Universitaire, 2 rue de la Milétrie, 86000, Poitiers, France
- Membre du comité d'infectiologie de l'Association Française d'Urologie (CIAFU), Paris, France
- Université de Poitiers, unité INSERM U1070, PHAR2, 86000, Poitiers, France
| |
Collapse
|
2
|
Bic A, Mazeaud C, Salleron J, Bannay A, Balkau B, Larose C, Hubert J, Eschwège P. Complications after partial nephrectomy: robotics overcomes open surgery and laparoscopy: the PMSI French national database. BMC Urol 2023; 23:146. [PMID: 37715175 PMCID: PMC10502976 DOI: 10.1186/s12894-023-01322-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023] Open
Abstract
PURPOSE To evaluate three partial nephrectomies (PN) procedures: open (OPN), standard laparoscopy (LPN), and robot-assisted laparoscopy (RAPN), for the risk of initial complications and rehospitalization for two years after the surgery. MATERIALS AND METHODS From the French national hospital database (PMSI-MCO), every hospitalization in French hospitals for renal tumor PN in 2016-2017 were extracted. Complications were documented from the initial hospitalization and any rehospitalization over two years. Chi-square and ANOVA tests compared the frequency of complications and length of initial hospitalization between the three surgical procedures. Relative risks (RR) and 95% confidence intervals were computed. RESULTS The 9119 initial hospitalizations included 4035 OPN, 1709 LPN, and 1900 RAPN; 1475 were excluded as the laparoscopic procedure performed was not determined. The average length of hospitalization was 8.1, 6.2, and 4.5 days for OPN, LPN, and RAPN, respectively. Compared to OPN, there were fewer complications at the time of initial hospitalization for the mini-invasive procedures: 29% for OPN vs. 20% for LPN (0.70 [0.63;0.78]) and 12% for RAPN (RR=0.43, 95%CI [0.38;0.49]). For RAPN compared to LPN, there were fewer haemorrhages (RR=0.55 [0.43;0.72]), anemia (0.69 {0.48;0.98]), and sepsis (0.51 [0.36;0.71]); during follow up, there were fewer urinary tract infections (0.64 [0.45;0.91]) but more infectious lung diseases (1.69 [1.03;2.76]). Over the two-year postoperative period, RAPN was associated with fewer acute renal failures (RR=0.73 [0.55;0.98]), renal abscesses (0.41 [0.23;0.74]), parietal complications (0.69 [0.52;0.92]) and urinary tract infections (0.54 [0.40;0.73]) than for OPN. CONCLUSIONS Conservative renal surgery is associated with postoperative morbidity related to the surgical procedure fashion. Mini-invasive procedures, especially robot-assisted surgery, had fewer complications and shorter hospital lengths of stay.
Collapse
Affiliation(s)
- Antoine Bic
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France.
- Department of Urology, Nancy University Hospital, Avenue de Bourgogne, Vandoeuvre Cedex, 54511, France.
| | - Charles Mazeaud
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France
| | - Julia Salleron
- Département de Biostatistiques, Institut de Cancérologie de Lorraine, 6 avenue de Bourgogne CS 30519, Vandoeuvre-lès-Nancy Cedex, 54519, France
| | - Aurélie Bannay
- Service d'Évaluation et Information Médicales, CHRU Nancy, Nancy, France
| | - Beverley Balkau
- Épidémiologie Clinique, Centre de Recherche en Épidémiologie et Santé des Populations, Institut National de la Santé et de la Recherche Médicale U1018, Université Paris-Saclay, USVQ, Université Paris-Sud, Villejuif, F-94807, France
| | - Clément Larose
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France
| | - Jacques Hubert
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France
| | - Pascal Eschwège
- Service d'Urologie CHRU Nancy, Site Brabois, Nancy, 54000, France
| |
Collapse
|
3
|
Das H, Fudge T, Hernandez B, McGregor TB, Kirkpatrick IDC, Kaushik D, Mansour AM, Svatek RS, Liss MA, Gelfond J, Pruthi DK. Volumetric Analysis of Renal Masses as Predictors of Partial Nephrectomy Outcomes. J Endourol 2023; 37:673-680. [PMID: 37166349 DOI: 10.1089/end.2022.0558] [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: 05/12/2023] Open
Abstract
Objective: To examine the role of endophytic tumor volume (TV) assessment (endophycity) on perioperative partial nephrectomy (PN) outcomes. Patients and Methods: Retrospective review of 212 consecutive laparoscopic and open partial nephrectomies from single institution using preoperative imaging and 1-year follow-up. Demographics, comorbidities, RENAL nephrometry scores, and all peri- and postoperative outcomes were recorded. Volumetric analysis performed using imaging software, independently assessed by two blinded radiologists. Univariate and multivariate statistical analysis were completed to assess predictive value of endophycity for all clinically meaningful outcomes. Results: Among those undergoing minimally invasive surgery (MIS), lower tumor endophycity was associated with higher likelihood of trifecta outcome (negative surgical margin, <10% decline in estimated glomerular filtration rate, the absence of complications) irrespective of max tumor size. For MIS, estimated blood loss increased with greater tumor endophycity regardless of tumor size. Among those who underwent open partial nephrectomy, lower tumor endophycity was associated with trifecta outcomes for tumors >4 cm only. On multivariate analysis with log-scaled odds ratios (OR), tumor endophycity and total kidney volume had the strongest correlation with tumor-related complications (OR = 3.23, 2.66). The analysis identified that tumor endophycity and TV on imaging were inversely correlated with of trifecta outcomes (OR = 0.53 for both covariates). Conclusions: Volumetric assessment of tumor endophycity performed well in identifying PN outcomes. As automated imaging software improves, volumetric analysis may prove to be a useful adjunct in preoperative planning and patient counseling.
Collapse
Affiliation(s)
- Hrishikesh Das
- Department of Urology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Thomas Fudge
- Department of Diagnostic Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brian Hernandez
- Department of Biostatistics, University of Texas Health San Antonio, San Antonio, Texas, USA
| | | | - Iain D C Kirkpatrick
- Department of Diagnostic Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dharam Kaushik
- Department of Urology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Ahmed M Mansour
- Department of Urology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Robert S Svatek
- Department of Urology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Michael A Liss
- Department of Urology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Jonathan Gelfond
- Department of Biostatistics, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Deepak K Pruthi
- Department of Urology, University of Texas Health San Antonio, San Antonio, Texas, USA
| |
Collapse
|
4
|
El-Asmar JM, Ayoub CH, Kfoury P, Abou-Mrad A, El-Hajj A. Surgical Complications Requiring Reoperation in Open Versus Minimally Invasive Radical Nephrectomy: A Contemporary Analysis of the National Surgical Quality Improvement Program. World J Surg 2023; 47:856-862. [PMID: 36587175 DOI: 10.1007/s00268-022-06869-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND To explore reoperation rates for different radical nephrectomy (RN) approaches that are experiencing a shift from open radical nephrectomy (ORN) toward minimally invasive surgery (MIS), we aimed to compare reoperation rates along with their culprit etiologies between the different types of surgical approaches for RN. METHODS The national surgical quality improvement program dataset was used to select patients who underwent RN between the years 2012-2019. A 1:1 propensity score matched analysis was used. Reoperation rates and causes were then compared between open and MIS approach. RESULTS The propensity matched cohort included 15,294 patients. Reoperation rates due to large bowel injury (0.01 vs. 0.14%), vascular injury (0.07 vs. 0.22%), and other abdominal (0.5 vs. 0.77%) were more common in ORN as compared to MIS (MIS vs. ORN, respectively, p < 0.034). Reoperation due to hernia (0.14 vs. 0.03%) was more common in MIS as compared to ORN (p = 0.027). No difference was seen for small bowel injury and incision/wound debridement. General reoperation (1.61 vs. 2.22%) and mortality (0.57 vs. 1.47%) were also more common in ORN as compared to MIS (p < 0.008). CONCLUSION Reoperation due to large bowel injury, vascular injury, and other abdominal was more likely to occur in ORN. Whereas reoperation due to hernia was more likely to occur in MIS. Surgical approach was an independent risk factor for immediate and early reoperation rates in RN patients. These results could be used to counsel patients pre-operatively on possible surgical approaches and complications.
Collapse
Affiliation(s)
- Jose M El-Asmar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon
| | - Christian Habib Ayoub
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon
| | - Peter Kfoury
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Anthony Abou-Mrad
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Albert El-Hajj
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El Solh, PO BOX: 11-0236, Beirut, 1107 2020, Lebanon.
| |
Collapse
|
5
|
Patient Factors Impacting Perioperative Outcomes for T1b-T2 Localized Renal Cell Carcinoma May Guide Decision for Partial versus Radical Nephrectomy. J Clin Med 2022; 12:jcm12010175. [PMID: 36614976 PMCID: PMC9821707 DOI: 10.3390/jcm12010175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 12/28/2022] Open
Abstract
There remains debate surrounding partial (PN) versus radical nephrectomy (RN) for T1b-T2 renal cell carcinoma (RCC). PN offers nephron-sparing benefits but involves increased perioperative complications. RN putatively maximizes oncologic benefit with complex tumors. We analyzed newly available nephrectomy-specific NSQIP data to elucidate predictors of perioperative outcomes in localized T1b-T2 RCC. We identified 2094 patients undergoing nephrectomy between 2019-2020. Captured variables include surgical procedure and approach, staging, comorbidities, prophylaxis, peri-operative complications, reoperations, and readmissions. 816 patients received PN while 1278 received RN. Reoperation rates were comparable; however, PN patients more commonly experienced 30-day readmissions (7.0% vs. 4.7%, p = 0.026), bleeds (9.19% vs. 5.56%, p = 0.001), renal failure requiring dialysis (1.23% vs. 0.31%, p = 0.013) and urine leak or fistulae (1.10% vs. 0.31%, p = 0.025). Infectious, pulmonary, cardiac, and venothromboembolic event rates were comparable. Robotic surgery reduced occurrence of various complications, readmissions, and reoperations. PN remained predictive of all four complications upon multivariable adjustment. Several comorbidities were predictive of complications including bleeds and readmissions. This population-based cohort explicates perioperative outcomes following nephrectomy for pT1b-T2 RCC. Significant associations between PN, patient-specific factors, and complications were identified. Risk stratification may inform management to improve post-operative quality of life (QOL) and RCC outcomes.
Collapse
|
6
|
Adem RY, Hassen SM, Abdulaziz M, Ahmed AI, Jemberie AM, Gebeyehu YT, Sedeta AM, Gebrehiwot FG, Abebe E, Berhe T. Clinical Profile and Outcome of Patients Operated on for Renal Cell Carcinoma: Experience from a Tertiary Care Center in a Developing Country. Res Rep Urol 2022; 14:389-397. [DOI: 10.2147/rru.s376720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
|
7
|
Fang L, Li H, Zhang T, Liu R, Zhang T, Bi L, Xie D, Wang Y, Yu D. Analysis of predictors of adherent perinephric fat and its impact on perioperative outcomes in laparoscopic partial nephrectomy: a retrospective case-control study. World J Surg Oncol 2021; 19:319. [PMID: 34732206 PMCID: PMC8567560 DOI: 10.1186/s12957-021-02429-6] [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: 05/06/2021] [Accepted: 10/23/2021] [Indexed: 12/12/2022] Open
Abstract
Background Adherent perinephric fat (APF), characterized by inflammatory fat surrounding the kidney, can limit the isolation of renal tumors and increase the operative difficulty in laparoscopic partial nephrectomy (LPN). The aim of this study was to investigate the predictors of APF and its impact on perioperative outcomes during LPN. Methods A total of 215 consecutive patients undergoing LPN for renal cell carcinoma (RCC) from January 2017 to June 2019 at our institute were included. We divided these patients into two groups according to the presence of APF. Radiographic data were retrospectively collected from preoperative cross-sectional imaging. The perioperative clinical parameters were compared between the two groups. Univariate and multivariate analyses were performed to evaluate the predictive factors of APF. Results APF was identified in 41 patients (19.1%) at the time of LPN. Univariate analysis demonstrated that APF was significantly correlated with the male gender (P = 0.001), higher body mass index (P = 0.002), lower preoperative estimated glomerular filtration rate (P = 0.004), greater posterior perinephric fat thickness (P< 0.001), greater perinephric stranding (P< 0.001), and higher Mayo Adhesive Probability (MAP) score (P< 0.001). The MAP score (P< 0.001) was the only variable that remained an independent predictor for APF in multivariate analysis. We found that patients with APF had longer operative times (P< 0.001), warm ischemia times (P = 0.001), and greater estimated blood loss (P = 0.003) than those without APF. However, there were no significant differences in surgical approach, transfusion rate, length of postoperative stay, complication rate, or surgical margin between the two groups. Conclusions Several specific clinical and radiographic factors including the MAP score can predict APF. The presence of APF is associated with an increased operative time, warm ischemia time, and greater estimated blood loss but has no impact on other perioperative outcomes in LPN. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02429-6.
Collapse
Affiliation(s)
- Lu Fang
- Department of Urology, The Second Hospital of Anhui Medical University, 678 FuRong Road, Hefei, 230601, Anhui Province, China
| | - Huan Li
- Department of Radiology, The Second Hospital of Anhui Medical University, 678 FuRong Road, Hefei, 230601, Anhui Province, China
| | - Tao Zhang
- Department of Urology, The Second Hospital of Anhui Medical University, 678 FuRong Road, Hefei, 230601, Anhui Province, China
| | - Rui Liu
- Department of Urology, The Second Hospital of Anhui Medical University, 678 FuRong Road, Hefei, 230601, Anhui Province, China
| | - Taotao Zhang
- Department of Urology, The Second Hospital of Anhui Medical University, 678 FuRong Road, Hefei, 230601, Anhui Province, China
| | - Liangkuan Bi
- Department of Urology, The Second Hospital of Anhui Medical University, 678 FuRong Road, Hefei, 230601, Anhui Province, China
| | - Dongdong Xie
- Department of Urology, The Second Hospital of Anhui Medical University, 678 FuRong Road, Hefei, 230601, Anhui Province, China
| | - Yi Wang
- Department of Urology, The Second Hospital of Anhui Medical University, 678 FuRong Road, Hefei, 230601, Anhui Province, China
| | - Dexin Yu
- Department of Urology, The Second Hospital of Anhui Medical University, 678 FuRong Road, Hefei, 230601, Anhui Province, China.
| |
Collapse
|
8
|
Howard JM, Nandy K, Woldu SL, Margulis V. Demographic Factors Associated With Non-Guideline-Based Treatment of Kidney Cancer in the United States. JAMA Netw Open 2021; 4:e2112813. [PMID: 34106265 PMCID: PMC8190623 DOI: 10.1001/jamanetworkopen.2021.12813] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/06/2021] [Indexed: 01/20/2023] Open
Abstract
Importance Significant demographic disparities have been found to exist in the delivery of health care. Demographic factors associated with clinical decision-making in kidney cancer have not been thoroughly studied. Objective To determine whether demographic factors, including sex and race/ethnicity, are associated with receipt of non-guideline-based treatment for kidney cancer. Design, Setting, and Participants This retrospective cohort study was conducted using data from the National Cancer Database for the years 2010 through 2017. Included patients were individuals aged 30 to 70 years with localized (ie, cT1-2, N0, M0) kidney cancer and no major medical comorbidities (ie, Charlson-Deyo Comorbidity Index score of 0 or 1) treated at Commission on Cancer-accredited health care institutions in the United States. Data were analyzed from November 2020 through March 2021. Exposures Demographic factors, including sex, race/ethnicity, and insurance status. Main Outcomes and Measures Receipt of non-guideline-based treatment (undertreatment or overtreatment) for kidney cancer, as defined by accepted clinical guidelines, was determined. Results Among 158 445 patients treated for localized kidney cancer, 99 563 (62.8%) were men, 120 001 individuals (75.7%) were White, and 91 218 individuals (57.6%) had private insurance. The median (interquartile range) age was 58 (50-64) years. Of the study population, 48 544 individuals (30.6%) received non-guideline-based treatment. Female sex was associated with lower adjusted odds of undertreatment (odds ratio [OR], 0.82; 95% CI, 0.77-0.88; P < .001) and higher adjusted odds of overtreatment (OR, 1.27; 95% CI, 1.24-1.30; P < .001) compared with male sex. Compared with White patients, Black and Hispanic patients had higher adjusted odds of undertreatment (Black patients: OR, 1.42; 95% CI, 1.29-1.55; P < .001; Hispanic patients: OR, 1.20; 95% CI, 1.06-1.36; P = .004) and overtreatment (Black patients: OR, 1.09; 95% CI, 1.05-1.13; P < .001; Hispanic patients: OR, 1.06; 95% CI, 1.01-1.11, P = .01). Individuals who were uninsured, compared with those who had insurance, had statistically significantly higher adjusted odds of undertreatment (OR, 2.63; 95% CI, 2.29-3.01; P < .001) and lower adjusted odds of overtreatment (OR, 0.72; 95% CI, 0.67-0.77; P < .001). Conclusions and Relevance This study found that there were significant disparities in treatment decision-making for patients with kidney cancer, with increased rates of non-guideline-based treatment for women and Black and Hispanic patients. These findings suggest that further research into the mechanisms underlying these disparities is warranted and that clinical and policy decision-making should take these disparities into account.
Collapse
Affiliation(s)
- Jeffrey M. Howard
- Department of Urology, University of Texas Southwestern Medical Center, Dallas
| | - Karabi Nandy
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas
| | - Solomon L. Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas
| |
Collapse
|
9
|
Falagario UG, Veccia A, Cormio L, Simeone C, Carbonara U, Crocerossa F, Antonelli A, Porpiglia F, Carrieri G, Autorino R. Nomogram predicting 30-day mortality after nephrectomy in the contemporary era: Results from the SEER database. Int J Urol 2020; 28:309-314. [PMID: 33319434 DOI: 10.1111/iju.14461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 11/09/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To assess contemporary 30-day mortality rates after partial and radical nephrectomy in USA, and to develop a predictive model of 30-day mortality. METHODS We relied on the National Cancer Institute Surveillance, Epidemiology and End Results database. A multivariable logistic regression analysis was fitted to predict 30-day mortality. A nomogram was built based on the coefficients of the logit function. Internal validation was carried out using the leave-one-out cross-validation. Calibration was graphically investigated. RESULTS A total of 102 146 patients who underwent partial nephrectomy (n = 36 425; 35.7%) or radical nephrectomy (n = 65 721; 64.3%) between 2005 and 2015 were included in the analysis. The median age at diagnosis was 62 years. A total of 11 921 (11.7%) patients were African American. The clinical stage was T1-T2 in 79 452 (77.8%), T3 in 16 141 (15.8%) and T4/T1-4-M1 in 6553 (6.4%) patients. Overall, 497 deaths occurred during the initial 30 days after nephrectomy (0.49% 30-day mortality rate). Stratified by type of surgery, the 30-day mortality rate was 0.16% for partial nephrectomy and 0.67% for radical nephrectomy. At univariate analyses, age, tumor size, stage and surgical procedure emerged as predictors of 30-day mortality (all P < 0.001). All of these covariates were included in the multivariable logistic regression model. The area under the curve after leave-one-out cross-validation was 0.808 (95% confidence interval 0.788-0.828), and the model showed good calibration in the range of predicted probability <10%. CONCLUSIONS Contemporary rates of 30-day mortality in patients undergoing radical or partial nephrectomy are very low. Age and tumor stage are key determinants of 30-day mortality. We present a predictive model that provides individual probabilities of 30-day mortality after nephrectomy, and it can be used for patient counseling prior surgery.
Collapse
Affiliation(s)
- Ugo Giovanni Falagario
- Division of Urology, Virginia Commonwealth University Health, Richmond, Virginia, USA.,Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Alessandro Veccia
- Division of Urology, Virginia Commonwealth University Health, Richmond, Virginia, USA.,Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Luigi Cormio
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Brescia, Italy
| | - Umberto Carbonara
- Division of Urology, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Fabio Crocerossa
- Division of Urology, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | | | | | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University Health, Richmond, Virginia, USA
| |
Collapse
|
10
|
Lee RA, Strauss D, Kutikov A. Role of minimally invasive partial nephrectomy in the management of renal mass. Transl Androl Urol 2020; 9:3140-3148. [PMID: 33457286 PMCID: PMC7807341 DOI: 10.21037/tau.2019.12.24] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Partial nephrectomy is recommended for surgical management of small renal masses (SRM), or lesions ≤7 cm. The decision for surgical intervention involves a balanced patient assessment. Minimally invasive approach, which includes laparoscopic and robotic techniques, has shown to have improved blood loss, length of hospitalization, and post-operative pain while maintaining oncologic efficacy when compared to an open approach. Transperitoneal approach is preferred at most centers; however, retroperitoneoscopic minimally invasive surgery (MIS) partial nephrectomy expertise is essential for comprehensive kidney cancer care. With advances in surgical technology and deep penetration of robotics into surgical training and practice, robotic partial nephrectomy has become the modality of choice in modern clinical practice. This review discusses the indications and outcomes for various minimally invasive approaches of partial nephrectomy.
Collapse
Affiliation(s)
- Randall A Lee
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - David Strauss
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Alexander Kutikov
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| |
Collapse
|
11
|
Grant SR, Lei X, Hess KR, Smith GL, Matin SF, Wood CG, Nguyen Q, Frank SJ, Anscher MS, Smith BD, Karam JA, Tang C. Stereotactic Body Radiation Therapy for the Definitive Treatment of Early Stage Kidney Cancer: A Survival Comparison With Surgery, Tumor Ablation, and Observation. Adv Radiat Oncol 2020; 5:495-502. [PMID: 32529146 PMCID: PMC7276675 DOI: 10.1016/j.adro.2020.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/04/2019] [Accepted: 01/06/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose Partial nephrectomy is the preferred definitive treatment for early stage kidney cancer, with tumor ablative techniques or active surveillance reserved for patients not undergoing surgery. Stereotactic body radiation therapy (SBRT) has emerged as a potential noninvasive alternative for patients with early stage kidney cancer not amenable to surgery, with early reports suggesting excellent rates of local control and limited toxicity. Methods and Materials The national cancer database from 2004 to 2014 was queried for patients who received a diagnosis of T1N0M0 kidney cancer. Treatments were categorized as surgery (partial or total nephrectomy), tumor ablation (cryoablation or thermal ablation), SBRT (radiation therapy in 5 fractions or less to a total biological effective dose [BED10] of 72 or more), or observation. A propensity score was generated by multinomial logistic regression. A Cox proportional hazards model was fit to determine association between overall survival and treatment group with propensity score adjustments for patient, demographic, and treatment characteristics. Results A total of 165,298 received surgery, 17,196 underwent tumor ablation, 104 underwent SBRT, and 18,241 were observed. Median follow-up was 51 months. On multivariable analysis, surgery, tumor ablation, and SBRT were associated with a decreased risk of death compared with observation, with hazard ratios of 0.25 (95% confidence interval, 0.24-0.26, P < .001), 0.36 (0.35-0.38, P < .001), and 0.56 (0.39-0.79, P < .001), respectively. When stratifying by BED10 and compared with observation, hazard ratio for risk of death for patients treated with SBRT to a BED10 ≥100 (n = 62) and a BED10 <100 (n = 42) was 0.34 (0.19-0.60, P < .001) and 0.90 (0.58-1.4, P = .64), respectively. Conclusions In this population-based cohort, patients undergoing high-dose SBRT (BED10 ≥100) for early stage kidney cancer demonstrated longer survival compared with patients undergoing observation. This may be a promising noninvasive treatment option for nonsurgical candidates with prospective efficacy and safety assessments meriting study in future clinical trials.
Collapse
Affiliation(s)
- Stephen R Grant
- Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Xiudong Lei
- Health Service Research, MD Anderson Cancer Center, Houston, Texas
| | - Kenneth R Hess
- Biostatistics, MD Anderson Cancer Center, Houston, Texas
| | - Grace L Smith
- Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | | | | | - Quynh Nguyen
- Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Steven J Frank
- Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | | | | | - Jose A Karam
- Urology, MD Anderson Cancer Center, Houston, Texas
| | - Chad Tang
- Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
12
|
Bravi CA, Larcher A, Capitanio U, Mari A, Antonelli A, Artibani W, Barale M, Bertini R, Bove P, Brunocilla E, Da Pozzo L, Di Maida F, Fiori C, Gontero P, Li Marzi V, Longo N, Mirone V, Montanari E, Porpiglia F, Schiavina R, Schips L, Simeone C, Siracusano S, Terrone C, Trombetta C, Volpe A, Montorsi F, Ficarra V, Carini M, Minervini A. Perioperative Outcomes of Open, Laparoscopic, and Robotic Partial Nephrectomy: A Prospective Multicenter Observational Study (The RECORd 2 Project). Eur Urol Focus 2019; 7:390-396. [PMID: 31727523 DOI: 10.1016/j.euf.2019.10.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/24/2019] [Accepted: 10/17/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Partial nephrectomy (PN) has a non-negligible perioperative morbidity. Comparative evidence of the available surgical techniques is limited. OBJECTIVE To compare the perioperative outcomes of open, laparoscopic, and robotic PN. METHODS Data of 2331 patients treated with PN for cT1 renal tumors were extracted from the RECORd2 database, a prospective multicenter project. Multivariable regression models assessed the relationship between surgical technique and surgical margins, warm ischemia time, postoperative complications, and acute kidney injury (AKI). The probability of achieving a modified trifecta (negative margins, warm ischemia time <25min, and no Clavien-Dindo ≥2 complications) was examined for each surgical approach. RESULTS Minimally invasive techniques had lower rate of Clavien-Dindo ≥2 complications than that of open surgery (odds ratio [OR] for robotic surgery: 0.27; 95% confidence interval [95% CI]: 0.15-0.47, p< 0.0001; OR for laparoscopy: 0.52; 95% CI: 0.34-0.78; p= 0.002). The probability of receiving ischemia was highest for robotic PN (p< 0.001). Among on-clamp PN, laparoscopy had longer ischemia than open (estimate: 1.09; 95% CI: -0.00 to 2.18; p= 0.050) and robotic (estimate: 1.36; 95% CI: 0.31-2.40; p= 0.011) surgery. When compared with open PN, the risk of AKI was roughly halved for patients treated by robotic and laparoscopic surgery (both p< 0.0001). Positive margins rate did not differ between the groups (all p≥ 0.1). The likelihood to achieve a modified trifecta was not affected by surgical technique in the overall population (all p≥ 0.075). In Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score < 10 lesions, robotic surgery had higher probability of achieving a modified trifecta than open PN (OR: 1.66; 95% CI: 1.09-2.53; p= 0.018) and laparoscopy (OR: 1.34; 95% CI: 0.94-1.90; p= 0.11). CONCLUSIONS In PADUA<10 renal tumors, robotic PN allows for higher rates of trifecta than open and laparoscopic surgeries. The impact of surgical technique on perioperative outcomes of PN might be limited in more complex lesions. PATIENT SUMMARY We evaluated the association between surgical technique and perioperative outcomes of partial nephrectomy. In less complex (Preoperative Aspects and Dimensions Used for an Anatomical [PADUA] score < 10) lesions, robotic PN allows for higher rates of trifecta when compared with other surgical techniques.
Collapse
Affiliation(s)
- Carlo Andrea Bravi
- Unit of Urology, Division of Experimental Oncology, URI-Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, URI-Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, URI-Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Mari
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Alessandro Antonelli
- Department of Urology, Ospedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Walter Artibani
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Maurizio Barale
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Roberto Bertini
- Unit of Urology, Division of Experimental Oncology, URI-Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierluigi Bove
- Department of Urology, University Hospital of Tor Vergata, Rome, Italy
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Luigi Da Pozzo
- Department of Urology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fabrizio Di Maida
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Vincenzo Li Marzi
- Department of Urology, University of Florence, Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
| | - Nicola Longo
- Department of Urology, University Federico II, Naples, Italy
| | - Vincenzo Mirone
- Department of Urology, University Federico II, Naples, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Luigi Schips
- Department of Urology, SS Hospital. Annunziata, Chieti, Italy
| | - Claudio Simeone
- Department of Urology, Ospedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Salvatore Siracusano
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Carlo Terrone
- Department of Urology, University of Genova, Genova, Italy
| | - Carlo Trombetta
- U.C.O. Clinica Urologica, Università degli Studi di Trieste, Trieste, Italy
| | - Alessandro Volpe
- Department of Urology, Maggiore della Carità Hospital, Novara, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, URI-Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Ficarra
- Department of Human and Paediatric Pathology, Gaetano Barresi, Urologic Section, University of Messina, Messina, Italy
| | - Marco Carini
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy.
| |
Collapse
|
13
|
Khalil MI, Ubeda J, Soehner T, Bhandari NR, Payakachat N, Davis R, Raheem OA, Kamel MH. Contemporary Perioperative Morbidity and Mortality Rates of Minimally Invasive vs Open Partial Nephrectomy in Obese Patients with Kidney Cancer. J Endourol 2019; 33:920-927. [PMID: 31333072 DOI: 10.1089/end.2019.0310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: To compare early postoperative morbidity and mortality rates in obese patients (body mass index ≥30 kg/m2) who underwent minimally invasive partial nephrectomy (MIPN) vs open partial nephrectomy (OPN), utilizing the National Surgical Quality Improvement Program (NSQIP) database. Materials and Methods: The NSQIP database was queried to identify obese patients who underwent either MIPN or OPN between 2008 and 2016. Patient demographics, comorbidities, operative time (OT), length of stay (LOS), and 30-day postoperative complications, readmissions, and mortality rates were recorded and compared between the two groups. Multivariable logistic regression analysis was used to determine the adjusted odds of early postoperative complications in MIPN vs OPN. Results: A total of 6041 obese MIPN patients and 3064 obese OPN patients were identified. Mean OT (minutes ± standard deviation) was longer for MIPN vs OPN (197.2 ± 71.0 vs 189.6 ± 82.4, p < 0.001), while mean LOS (3.8 ± 2.8 days vs 5.8 ± 3.5 days, p < 0.001) and 30-day complications (8.5% vs 19.8%, p < 0.001) were lower. No difference in 30-day postoperative mortality rates between MIPN (0.4%) and OPN (0.5%) was observed (p = 0.426). In the adjusted analysis, the odds of any complication within 30 days in the MIPN group were 61% lower, blood transfusion 73% lower, pneumonia 38% lower, sepsis 70% lower, acute renal failure 64% lower, superficial surgical site infection 40% lower, and reoperation 47% lower, compared with OPN patients. Conclusions: When compared with OPN in obese patients, the likelihood of 30-day postoperative morbidity was significantly lower in MIPN patients. However, the odds of 30-day mortality rates were similar between the groups.
Collapse
Affiliation(s)
- Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Joel Ubeda
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Thomas Soehner
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Naleen Raj Bhandari
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Omer A Raheem
- Department of Urology, Tulane University, New Orleans, Louisiana
| | - Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Urology, Ain Shams University, Cairo, Egypt
| |
Collapse
|
14
|
Examining and Understanding Value: The Cost of Preoperative Characteristics, Intraoperative Variables and Postoperative Complications of Minimally Invasive Partial Nephrectomy. UROLOGY PRACTICE 2019. [DOI: 10.1016/j.urpr.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
15
|
Pereira JF, Pareek G, Mueller-Leonhard C, Zhang Z, Amin A, Mega A, Tucci C, Golijanin D, Gershman B. The Perioperative Morbidity of Transurethral Resection of Bladder Tumor: Implications for Quality Improvement. Urology 2019; 125:131-137. [DOI: 10.1016/j.urology.2018.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/07/2018] [Accepted: 10/12/2018] [Indexed: 11/30/2022]
|
16
|
Impact of Perioperative Blood Transfusions on the Outcomes of Patients Undergoing Kidney Cancer Surgery: A Systematic Review and Pooled Analysis. Clin Genitourin Cancer 2019; 17:e72-e79. [DOI: 10.1016/j.clgc.2018.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/31/2018] [Accepted: 09/16/2018] [Indexed: 12/27/2022]
|
17
|
Sperling CD, Xia L, Berger IB, Shin MH, Strother MC, Guzzo TJ. Obesity and 30-Day Outcomes Following Minimally Invasive Nephrectomy. Urology 2018; 121:104-111. [DOI: 10.1016/j.urology.2018.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/23/2018] [Accepted: 08/01/2018] [Indexed: 12/23/2022]
|
18
|
Arnold Anele U, Autorino R. Editorial Comment on: Perioperative Morbidity of Open Versus Minimally Invasive Partial Nephrectomy: A Contemporary Analysis of the National Surgical Quality Improvement Program by Pereira et al. J Endourol 2017; 32:124. [PMID: 29239209 DOI: 10.1089/end.2017.0885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|