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Cataneo JL, Mathis SA, Bartelt K, Gelfond A, Arias-Serrato R, Patel PA. Developing the Aesthetic Postoperative Complication Score (APeCS) for Detecting Major Morbidity in Facial Aesthetic Surgery. Aesthet Surg J 2024; 44:463-469. [PMID: 38124347 DOI: 10.1093/asj/sjad379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Facial aesthetic surgery encompasses a variety of procedures with complication rates that are difficult to estimate due to a lack of published data. OBJECTIVES We sought to estimate major complication rates in patients undergoing facial aesthetic procedures and develop a risk assessment tool to stratify patients. METHODS We utilized the Tracking Operation and Outcomes for Plastic Surgeons (TOPS) database from 2003-2018. The analytic database included major facial aesthetic procedures. Univariate analysis and a backward stepwise multivariate regression model identified risk factors for major complications. Regression coefficients were utilized to create the score. Performance robustness was measured with area under receiver operating characteristic curves and sensitivity analyses. RESULTS A total of 38,569 patients were identified. The major complication rate was 1.2% (460). The regression model identified risk factors including over 3 concomitant surgeries, BMI ≥25, ASA class ≥2, current or former smoker status, and age ≥45 as the variables fit for risk prediction (n = 13,004; area under curve: 0.68, standard error: 0.013, [0.62-0.67]). Each of the 5 variables counted for 1 point, except over 3 concomitant surgeries counting for 2, giving a score range from 0 to 6. Sensitivity analysis showed the cutoff point of ≥3 to best balance sensitivity and specificity, 58% and 66%, respectively. At this cutoff, 65% of cases were correctly classified as having a major complication. CONCLUSIONS We developed an acceptable risk prediction score with a cutoff value of ≥3 associated with correctly classifying approximately 65% of those at risk for major morbidity when undergoing face and neck aesthetic surgery. LEVEL OF EVIDENCE: 3
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Lambertini L, Mari A, Sandulli A, Amparore D, Antonelli A, Barale M, Bove P, Brunocilla E, Capitanio U, DA Pozzo LF, DI Maida F, Grosso AA, Fiori C, Gontero P, Li Marzi V, Campi R, Longo N, Marchioni M, Montanari E, Montorsi F, Porpiglia F, Porreca A, Schiavina R, Simeone C, Siracusano S, Terrone C, Ficarra V, Minervini A. Minimally invasive transperitoneal partial versus radical nephrectomy in obese patients: perioperative and long-term functional outcomes from a large perspective contemporary series (RECORd2 project). Minerva Urol Nephrol 2024; 76:185-194. [PMID: 38742553 DOI: 10.23736/s2724-6051.24.05692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND The aim of this study is to evaluate the perioperative and long-term functional outcomes of laparoscopic (LPN) and robot-assisted partial nephrectomy (RAPN) in comparison to laparoscopic radical nephrectomy (LRN) in obese patients diagnosed with renal cell carcinoma. METHODS Clinical data of 4325 consecutive patients from The Italian REgistry of COnservative and Radical Surgery for cortical renal tumor Disease (RECORD 2 Project) were gathered. Only patients treated with transperitoneal LPN, RAPN, or LRN with Body Mass Index (BMI) ≥30 kg/m2, clinical T1 renal tumor and preoperative estimated glomerular filtration rate (eGFR) ≥60 mL/min, were included. Perioperative, and long-term functional outcomes were examined. RESULTS Overall, 388 patients were included, of these 123 (31.7%), 120 (30.9%) and 145 (37.4%) patients were treated with LRN, LPN, and RAPN, respectively. No significant difference was observed in preoperative characteristics. Overall, intra and postoperative complication rates were comparable among the groups. The LRN group had a significantly increased occurrence of acute kidney injury (AKI) compared to LPN and RAPN (40.6% vs. 15.3% vs. 7.6%, P=0.001). Laparoscopic RN showed a statistically significant higher renal function decline at 60-month follow-up assessment compared to LPN and RAPN. A significant renal function loss was recorded in 30.1% of patients treated with LRN compared to 16.7% and 10.3% of patients treated with LPN and RAPN (P=0.01). CONCLUSIONS In obese patients, both LPN and RAPN showcased comparable complication rates and higher renal function preservation than LRN. These findings highlighted the potential benefits of minimally invasive PN over radical surgery in the context of obese individuals.
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Affiliation(s)
- Luca Lambertini
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Alessandro Sandulli
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Alessandro Antonelli
- 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
| | - Pierluigi Bove
- Department of Urology, University Hospital of Tor Vergata, Rome, Italy
| | | | - Umberto Capitanio
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Luigi F DA Pozzo
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, University Vita-Salute San Raffaele, Milan, Italy
- Department of Urology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fabrizio DI Maida
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Antonio Andrea Grosso
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, 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
- Medicine and Surgery Department, University of Milano-Bicocca, Monza, Italy
| | - Riccardo Campi
- Medicine and Surgery Department, University of Milano-Bicocca, Monza, Italy
| | - Nicola Longo
- Department of Urology, Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | | | | | - Francesco Montorsi
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Angelo Porreca
- Department of Urology, Fondazione IRCCS Ca' Granda, Maggiore Polyclinic Hospital, University of Milan, Milan, Italy
- Veneto Institute of Oncology (IOV) IRCCS, Castelfranco Veneto, Treviso, Italy
| | | | - Claudio Simeone
- Department of Urology, Abano Terme Polyclinic, Abano Terme, Padua, Italy
| | - Salvatore Siracusano
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Carlo Terrone
- Department of Urology, Ospedali Civili, University of Brescia, Brescia, Italy
| | | | - Andrea Minervini
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy -
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Ong CSH, Law TYX, Mok A, Ho KSC, Wang Z, Chiong E, Tiong HY, Teoh JYC. The impact of body mass index on oncological and surgical outcomes of patients undergoing nephrectomy: a systematic review and meta-analysis. BJU Int 2023; 132:608-618. [PMID: 37401806 DOI: 10.1111/bju.16103] [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: 07/05/2023]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis to evaluate the impact of body mass index (BMI) on oncological (primary) and surgical (secondary) outcomes of patients who underwent nephrectomy, as obesity or high BMI is a known risk factor for renal cell carcinoma (RCC) and predictor of poorer outcomes. METHODS Studies were identified from four electronic databases from database inception to 2 June 2021, according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. The review protocol was registered in the International Prospective Register of Systematic Reviews with the identification number: CRD42021275124. RESULTS A total of 18 studies containing 13 865 patients were identified for the final meta-analysis. Regarding oncological outcomes, higher BMI predicted higher overall survival (BMI >25 vs BMI <25 kg/m2 : hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.58-0.85), cancer-specific survival (BMI >25 vs BMI <25 kg/m2 : HR 0.60, 95% CI 0.50-0.73; BMI 25-30 vs BMI <25 kg/m2 : HR 0.46, 95% CI 0.23-0.95; BMI >30 vs BMI <25 kg/m2 : HR 0.50, 95% CI 0.36-0.69), and recurrence-free survival rates (BMI >25 vs BMI <25 kg/m2 : HR 0.72, 95% CI 0.63-0.82; BMI 25-30 vs BMI <25 kg/m2 : HR 0.59, 95% CI 0.42-0.82). Those with a lower BMI fared better in surgical outcomes, such as operation time and warm ischaemic time, although the absolute difference was minimal and unlikely to be clinically significant. There was no difference between groups for length of hospital stay, intraoperative or postoperative complications, blood transfusion requirements, and conversion to open surgery. CONCLUSION Our study suggests that a higher BMI is associated with improved long-term oncological survival and similar perioperative outcomes as a lower BMI. More research into the underlying biological and physiological mechanisms will enable better understanding of the effect of BMI, beyond mere association, on post-nephrectomy outcomes.
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Affiliation(s)
- Chloe S H Ong
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore
| | - Terence Y X Law
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore
| | - Alex Mok
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Kenny S C Ho
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Ziting Wang
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore
| | - Edmund Chiong
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore
| | - Jeremy Y C Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
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Nakanishi Y, Hirose K, Yasujima R, Umino Y, Okubo N, Kataoka M, Yajima S, Masuda H. Impact of perinephric fat volume and the Mayo Adhesive Probability score on time to clamping in robot-assisted partial nephrectomy. J Robot Surg 2023:10.1007/s11701-023-01544-8. [PMID: 36788149 DOI: 10.1007/s11701-023-01544-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Abstract
The aim of this study is to evaluate the association of perinephric fat volume (PNFV) and the Mayo Adhesive Probability (MAP) score with time to clamping (TTC) in robot-assisted partial nephrectomy (RAPN). The study subjects consisted of 73 tumors in 72 patients who underwent transperitoneal RAPN at a single cancer center between February 2020 and July 2022. Clinical characteristics including R.E.N.A.L. nephrometry score, MAP score and PNFV were evaluated in a multivariate analysis in relation to TTC, which was classified into two groups based on median TTC. PNFV and MAP score were analyzed separately. PNFVs were measured by SYNAPSE VINCENT® by a single expert urologist. Median TTC was 67 (range: 36-119) min. Spearman's rank correlation analysis indicated that a significant correlation was observed between PNFV and MAP score with a value of 0.81 (p < 0.0001). Univariate analysis revealed that R.E.N.A.L. nephrometry score ≥ 7 (p = 0.036), posterior tumor location (p = 0.033), MAP score ≥ 3 (p = 0.02) and PNFV ≥ 250 ml (p = 0.02) were significant factors for prolonged TTC. In a multivariate analysis including PNFV (analysis 1), R.E.N.A.L. nephrometry score ≥ 7 (OR 3.54, p = 0.018) and PNFV ≥ 250cm3 (OR 3.94, p = 0.010) were independent factors for prolonged TTC. Similarly for MAP score (analysis 2), R.E.N.A.L. nephrometry score ≥ 7 (OR 3.54, p = 0.018) and MAP score ≥ 3 (OR 3.94, p = 0.010) were independent factors for prolonged TTC. Both MAP score and PNFV may have a significant impact on TTC.
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Affiliation(s)
- Yasukazu Nakanishi
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan.
| | - Kohei Hirose
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Rikuto Yasujima
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Yosuke Umino
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Naoya Okubo
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Madoka Kataoka
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Shugo Yajima
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Hitoshi Masuda
- Department of Urology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
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Selective renal artery clamp during robot assisted partial nephrectomy: The use of indocyanine green. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Mayor N, Sapre N, Sandford B, Challacombe B. Superior Mesenteric Artery Injury During Robot-assisted Laparoscopic Nephrectomy: A Robotic Nightmare. EUR UROL SUPPL 2022; 38:44-48. [PMID: 35243398 PMCID: PMC8885611 DOI: 10.1016/j.euros.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Major vascular injuries during robotic renal surgery are rare, but the close proximity of the superior mesenteric artery (SMA) to the left renal artery means that it is liable to iatrogenic injury with potentially catastrophic implications. In this review, we present a case of accidental SMA ligation during a robot-assisted laparoscopic nephrectomy for a 12-cm upper pole renal mass. Prompt recognition and early vascular surgical assistance with conversion to open surgery allowed a primary vascular anastomosis to be made. A computed tomography angiogram at 6 wk was normal. On review of the imaging, the left renal artery take-off was higher than the SMA, which represents an anatomical variant and may have contributed to the injury. The risk of accidental SMA ligation is highest in left-sided tumours and in larger medial tumours that lead to significant distortion of the anatomy. The anatomy of the renal artery can also vary greatly. Surgeons must be knowledgeable of common variations and meticulously review preoperative imaging for the number and course of renal vessels as well as the location of the SMA. In cases of significant bleeding, rapid conversion to open surgery and urgent vascular consultation are critical. Patient summary In this article, we describe an accidental injury to a major blood vessel (the superior mesenteric artery) during a left robotic radical nephrectomy (kidney removal) for a tumour. We discuss the anatomical relationships of the blood vessels of the small bowel and kidneys, and how to anticipate, recognise, and manage such accidental injuries.
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Affiliation(s)
- Nikhil Mayor
- Stokes Centre for Urology, Royal Surrey NHS Foundation Trust, Guildford, Surrey, UK
- Corresponding author. Stokes Centre for Urology, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, Surrey GU2 7XX, UK. Tel. +447812363513.
| | - Nikhil Sapre
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Becky Sandford
- Department of Vascular Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ben Challacombe
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Crocerossa F, Carbonara U, Cantiello F, Marchioni M, Ditonno P, Mir MC, Porpiglia F, Derweesh I, Hampton LJ, Damiano R, Autorino R. Robot-assisted Radical Nephrectomy: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol 2021; 80:428-439. [DOI: 10.1016/j.eururo.2020.10.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/23/2020] [Indexed: 12/21/2022]
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8
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Fernandez-Pello S, Verma N, Kuusk T, Berezowska A, Mumtaz F, Patki P, Tran M, Barod R, Bex A. Perioperative impact of body mass index on upper urinary tract and renal robot-assisted surgery: a single high-volume centre experience. J Robot Surg 2021; 16:611-619. [PMID: 34313951 DOI: 10.1007/s11701-021-01285-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022]
Abstract
To assess the impact of body mass index (BMI) on peri-operative outcomes of kidney and upper tract robot-assisted surgery. Medical audit of patients who underwent robot-assisted kidney and upper tract cancer surgery at a single institution between 2017 and 2019, categorized on BMI into obese patients with a BMI ≥ 30 kg/m2 and a control group with BMI < 25 kg/m2. Patient and tumour characteristics, surgery time, intraoperative blood loss, intraoperative adverse events (AE) according to the European Association of Urology Intraoperative Adverse Incidents Classification (EAUiaiC), conversion- to-open/radical rate as well as 30-day postoperative AE according to Clavien-Dindo (CD) and length of inpatient stay were analyzed. 366 patients were identified, 141 with a BMI < 25 (normal-weight) and 225 BMI ≥ 30 (obesity). There were no significant differences between the groups in terms of age, gender, comorbidities, tumour size, TNM stage and type of surgery. Obese patients had a higher estimated blood loss (198.05 ml), surgery time (171.75 min), intraoperative AE (all grades) (14.67%, 95% CI (0.10-0.19) as well as adherent perinephric fat (APF) (14.22%, 95% CI (0.09-0.19)) in contrast to the control group (86.85 ml, 148.29 min, 7.04% and 2.12%, respectively). Hospital stay, major intraoperative AE (≥ 3) and major postoperative AE (CD > 2) distributed equally between groups. Robotic kidney and upper tract surgery in obese patients showed an increase in surgery time and blood loss potentially related to APF. However, obesity was not associated with conversion to open surgery or radical nephrectomy in nephron-sparing procedures, length of stay, major intraoperative AE or postoperative complications.
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Affiliation(s)
- Sergio Fernandez-Pello
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Hampstead, London, UK.,Department of Urology, Cabueñes University Hospital, Gijón, Spain
| | - Neeta Verma
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Hampstead, London, UK
| | - Teele Kuusk
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Hampstead, London, UK.,Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Aleksandra Berezowska
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Hampstead, London, UK
| | - Faiz Mumtaz
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Hampstead, London, UK
| | - Prasad Patki
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Hampstead, London, UK
| | - Maxine Tran
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Hampstead, London, UK.,UCL Division of Surgery and Interventional Science, London, UK
| | - Ravi Barod
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Hampstead, London, UK
| | - Axel Bex
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Hampstead, London, UK. .,UCL Division of Surgery and Interventional Science, London, UK.
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Zhang J, Luo S, Zeng M, Wang D. Robot-assisted laparoscopic surgery combined with axitinib for renal cell carcinoma and inferior vena cava tumor thrombi in a patient with severe obesity and obstructive sleep apnea-hypopnea syndrome: A case report. Asian J Surg 2021; 44:781-782. [PMID: 33814254 DOI: 10.1016/j.asjsur.2021.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jindong Zhang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Shengjun Luo
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Menghua Zeng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Delin Wang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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