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Ferriero M, Ragusa A, Mastroianni R, Tuderti G, Costantini M, Anceschi U, Misuraca L, Brassetti A, Guaglianone S, Bove AM, Leonardo C, Gallucci M, Papalia R, Simone G. Long-Term Oncologic Outcomes of Off-Clamp Robotic Partial Nephrectomy for Cystic Renal Tumors: A Propensity Score Matched-Pair Comparison of Cystic versus Pure Clear Cell Carcinoma. Curr Oncol 2024; 31:2985-2993. [PMID: 38920711 PMCID: PMC11203107 DOI: 10.3390/curroncol31060227] [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: 03/23/2024] [Revised: 05/04/2024] [Accepted: 05/13/2024] [Indexed: 06/27/2024] Open
Abstract
Few data are available on survival outcomes of partial nephrectomy performed for cystic renal tumors. We present the first long-term oncological outcomes of cystic (cystRCC) versus pure clear cell renal cell carcinoma (ccRCC) in a propensity score-matched (PSM) analysis. Our "renal cancer" prospectively maintained database was queried for "cystRCC" or "ccRCC" and "off-clamp robotic partial nephrectomy" (off-C RPN). The two groups were compared for age, gender, tumor size, pT stage, and Fuhrman grade. A 1:3 PSM analysis was applied to reduce covariate imbalance to <10% and two homogeneous populations were generated. Student t- and Chi-square tests were used for continuous and categorical variables, respectively. Ten-year oncological outcomes were compared between the two cohorts using log-rank test. Univariable Cox regression analysis was used to identify predictors of disease progression after RPN. Out of 859 off-C RPNs included, 85 cases were cystRCC and 774 were ccRCC at histologic evaluation. After applying the PSM analysis, two cohorts were selected, including 64 cystRCC and 170 ccRCC. Comparable 10-year cancer-specific survival probability (95.3% versus 100%, p = 0.146) was found between the two cohorts. Conversely, 10-year disease-free survival probability (DFS) was less favorable for pure ccRCC than cystRCC (66.69% versus 90.1%, p = 0.035). At univariable regression analysis, ccRCC histology was the only independent predictor of DFS probability (HR 2.96 95% CI 1.03-8.47, p = 0.044). At the 10-year evaluation, cystRCC showed favorable oncological outcomes after off-C RPN. Pure clear cell variant histology displayed a higher rate of disease recurrence than cystic lesions.
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Affiliation(s)
- Mariaconsiglia Ferriero
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (R.M.); (G.T.); (M.C.); (U.A.); (L.M.); (A.B.); (S.G.); (A.M.B.); (C.L.); (M.G.); (G.S.)
| | - Alberto Ragusa
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (R.P.)
| | - Riccardo Mastroianni
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (R.M.); (G.T.); (M.C.); (U.A.); (L.M.); (A.B.); (S.G.); (A.M.B.); (C.L.); (M.G.); (G.S.)
| | - Gabriele Tuderti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (R.M.); (G.T.); (M.C.); (U.A.); (L.M.); (A.B.); (S.G.); (A.M.B.); (C.L.); (M.G.); (G.S.)
| | - Manuela Costantini
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (R.M.); (G.T.); (M.C.); (U.A.); (L.M.); (A.B.); (S.G.); (A.M.B.); (C.L.); (M.G.); (G.S.)
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (R.M.); (G.T.); (M.C.); (U.A.); (L.M.); (A.B.); (S.G.); (A.M.B.); (C.L.); (M.G.); (G.S.)
| | - Leonardo Misuraca
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (R.M.); (G.T.); (M.C.); (U.A.); (L.M.); (A.B.); (S.G.); (A.M.B.); (C.L.); (M.G.); (G.S.)
| | - Aldo Brassetti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (R.M.); (G.T.); (M.C.); (U.A.); (L.M.); (A.B.); (S.G.); (A.M.B.); (C.L.); (M.G.); (G.S.)
| | - Salvatore Guaglianone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (R.M.); (G.T.); (M.C.); (U.A.); (L.M.); (A.B.); (S.G.); (A.M.B.); (C.L.); (M.G.); (G.S.)
| | - Alfredo Maria Bove
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (R.M.); (G.T.); (M.C.); (U.A.); (L.M.); (A.B.); (S.G.); (A.M.B.); (C.L.); (M.G.); (G.S.)
| | - Costantino Leonardo
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (R.M.); (G.T.); (M.C.); (U.A.); (L.M.); (A.B.); (S.G.); (A.M.B.); (C.L.); (M.G.); (G.S.)
| | - Michele Gallucci
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (R.M.); (G.T.); (M.C.); (U.A.); (L.M.); (A.B.); (S.G.); (A.M.B.); (C.L.); (M.G.); (G.S.)
| | - Rocco Papalia
- Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.R.); (R.P.)
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (R.M.); (G.T.); (M.C.); (U.A.); (L.M.); (A.B.); (S.G.); (A.M.B.); (C.L.); (M.G.); (G.S.)
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Wang L, Deng JY, Li KP, Yin S, Zhu PY. Perioperative and oncological outcomes of robot-assisted laparoscopic partial nephrectomy for cystic and solid renal masses: Evidence from controlled trials. Asian J Surg 2024; 47:16-24. [PMID: 37597984 DOI: 10.1016/j.asjsur.2023.08.048] [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: 05/18/2023] [Accepted: 08/06/2023] [Indexed: 08/21/2023] Open
Abstract
To evaluate the outcomes of robot-assisted partial nephrectomy (RAPN) for solid and cystic renal tumors. We systematically searched the Cochrane Library, PubMed, EMBASE, and Scopus databases up to March 2023. Review Manager 5.4 performed a pooled analysis of the data for random effects. Besides, sensitivity and subgroup analyses to explore heterogeneity, Newcastle-Ottawa scale, and GRADE to evaluate study quality and level of evidence. Five observational studies comprising 1353 patients (Cystic tumor: 183; Solid tumor: 1083) were included in this study. Compared to solid masses, cystic masses were associated with fewer major complications (odds ratio [OR] = 2.2; 95% confidence intervals [CI] = 1.17 to 4.13; p = 0.01). Additionally, no significant differences were observed between the two groups in terms of operative time, warm ischemia time, blood loss, hospital stay, intraoperative complications, postoperative complications, transfusion rate, postoperative estimated glomerular filtration rate (eGFR), eGFR preservation, positive surgical margin (PSM), recurrence, overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS) and trifecta achievement. RAPN can be performed in cystic renal tumors with perioperative, functional, and oncologic outcomes like those achievable in solid tumors. However, our findings need further validation in a large-sample prospective randomized study.
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Affiliation(s)
- Li Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jing-Ya Deng
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Kun-Peng Li
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Shan Yin
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ping-Yu Zhu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
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Yang W, Yang L, Mao S, Liu D, Wang L. Analysis of the effect of nursing care based on action research method on the prevention of postoperative lymphedema in breast cancer patients. Medicine (Baltimore) 2023; 102:e36743. [PMID: 38206748 PMCID: PMC10754543 DOI: 10.1097/md.0000000000036743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024] Open
Abstract
RATIONALE In recent times, the pervasive adoption of the action research method has garnered substantial attention both domestically and internationally. Its integration has traversed various domains of nursing research, nursing education, and nursing practice, yielding commendable outcomes. However, a notable gap persists, as this method remains untapped in the realm of nursing care concerning the prevention of postoperative lymphedema in breast cancer patients. DIAGNOSIS To employ the action research methodology in the context of patients undergoing axillary lymph node dissection surgery for breast cancer, aiming to investigate its impact on mitigating postoperative lymphedema and assessing its influence on the patient's quality of life, as well as levels of anxiety and depression postoperatively. INTERVENTION The study focused on breast cancer patients admitted to our hospital from January 2022 to December 2022. Among them, 44 patients from January to June constituted the control group, while 44 patients from July to December comprised the observation group. Conventional nursing measures were applied to the control group, whereas the observation group received nursing interventions rooted in the action research method. A comparative analysis was conducted between the 2 groups, assessing the incidence of postoperative lymphedema, daily life ability, as well as levels of anxiety and depression. OUTCOMES The prevalence of edema was notably reduced in the observation group (20.93%) compared to the control group (42.22%), with a statistically significant difference. Throughout the study, patients in both groups exhibited increased Barthel Index Scale scores from the study's initiation, and the scores for the observation group surpassed those of the control group, reaching statistical significance (P < .05). Furthermore, by the study's conclusion, anxiety and depression scores for patients in both groups were diminished compared to the study's commencement, and the observation group demonstrated significantly lower scores in anxiety and depression compared to the control group (P < .05). LESSONS The implementation of nursing care grounded in the action research methodology exhibits a capacity to diminish both the occurrence and intensity of postoperative lymphedema in breast cancer patients. Concurrently, it enhances the patients' daily life functionality and mitigates symptoms of anxiety and depression.
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Affiliation(s)
- Weijuan Yang
- Breast Surgery Department, Jiangsu Province Hospital, and the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li Yang
- Breast Surgery Department, Jiangsu Province Hospital, and the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuangwei Mao
- Breast Surgery Department, Jiangsu Province Hospital, and the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dandan Liu
- Breast Surgery Department, Jiangsu Province Hospital, and the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lili Wang
- Breast Surgery Department, Jiangsu Province Hospital, and the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Chen XB, Li YG, Wu T, Du ZB, Tan CL, Zhang Q, Yu XD. Perioperative, oncologic, and functional outcomes of robot-assisted partial nephrectomy for special types of renal tumors (hilar, endophytic, or cystic): an evidence-based analysis of comparative outcomes. Front Oncol 2023; 13:1178592. [PMID: 37152053 PMCID: PMC10157041 DOI: 10.3389/fonc.2023.1178592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/05/2023] [Indexed: 05/09/2023] Open
Abstract
Purpose This study aims to perform a pooled analysis to compare the outcomes of robot-assisted partial nephrectomy (RAPN) between complex tumors (hilar, endophytic, or cystic) and non-complex tumors (nonhilar, exophytic, or solid) and evaluate the effects of renal tumor complexity on outcomes in patients undergoing RAPN. Methods Four databases were systematically searched, including Science, PubMed, Web of Science, and Cochrane Library, to identify relevant studies published in English up to December 2022. Review Manager 5.4 was used for statistical analyses and calculations. The study was registered with PROSPERO (Registration number: CRD42023394792). Results In total, 14 comparative trials, including 3758 patients were enrolled. Compared to non-complex tumors, complex tumors were associated with a significantly longer warm ischemia time (WMD 3.67 min, 95% CI 1.78, 5.57; p = 0.0001), more blood loss (WMD 22.84 mL, 95% CI 2.31, 43.37; p = 0.03), and a higher rate of major complications (OR 2.35, 95% CI 1.50, 3.67; p = 0.0002). However, no statistically significant differences were found between the two groups in operative time, length of stay, transfusion rates, conversion to open nephrectomy and radical nephrectomy rates, estimated glomerular filtration rate (eGFR) decline, intraoperative complication, overall complication, positive surgical margins (PSM), local recurrence, and trifecta achievement. Conclusions RAPN can be a safe and effective procedure for complex tumors (hilar, endophytic, or cystic) and provides comparable functional and oncologic outcomes to non-complex tumors. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=394792, identifier CRD42023394792.
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Affiliation(s)
- Xiao-bin Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yu-gen Li
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Tao Wu
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Zhong-bo Du
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Chun-lin Tan
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Qiang Zhang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xiao-dong Yu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China
- *Correspondence: Xiao-dong Yu,
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Grossmann NC, Mischo A, Rupp NJ, Hermanns T. Peritoneal carcinomatosis of a cystic papillary renal cell carcinoma following intraoperative cyst rupture during partial nephrectomy: A case report and review of the literature. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2022. [DOI: 10.1016/j.cpccr.2022.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Vartolomei MD, Remzi M, Fajkovic H, Shariat SF. Robot-Assisted Partial Nephrectomy Mid-Term Oncologic Outcomes: A Systematic Review. J Clin Med 2022; 11:jcm11206165. [PMID: 36294486 PMCID: PMC9605111 DOI: 10.3390/jcm11206165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/03/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Robot-assisted partial nephrectomy (RAPN) is used more and more in present days as a therapy option for surgical treatment of cT1 renal masses. Current guidelines equally recommend open (OPN), laparoscopic (LPN), or robotic partial nephrectomy (PN). The aim of this review was to analyze the most representative RAPN series in terms of reported oncological outcomes. (2) Methods: A systematic search of Webofscience, PUBMED, Clinicaltrials.gov was performed on 1 August 2022. Studies were considered eligible if they: included patients with renal cell carcinoma (RCC) stage T1, were prospective, used randomized clinical trials (RCT) or retrospective studies, had patients undergo RAPN with a minimum follow-up of 48 months. (3) Results: Reported positive surgical margin rates were from 0 to 10.5%. Local recurrence occurred in up to 3.6% of patients. Distant metastases were reported in up to 6.4% of patients. 5-year cancer free survival (CFS) estimates rates ranged from 86.4% to 98.4%. 5-year cancer specific survival (CSS) estimates rates ranged from 90.1% to 100%, and 5-year overall survival (OS) estimates rated ranged from 82.6% to 97.9%. (4) Conclusions: Data coming from retrospective and prospective series shows very good oncologic outcomes after RAPN. Up to now, 10-year survival outcomes were not reported. Taken together, RAPN deliver similar oncologic performance to OPN and LPN.
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Affiliation(s)
- Mihai Dorin Vartolomei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Institution Organizing University Doctoral Studies IOSUD, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania
- Correspondence:
| | - Mesut Remzi
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Harun Fajkovic
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow 119992, Russia
- Department of Urology, Weill Cornell Medical College, New York, NY 14853, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA
- Karl Landsteiner Institute of Urology and Andrology, 1090 Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, 15006 Prague, Czech Republic
- Hourani Center for Applied Scientific Research, Al Ahlizza Amman University, Amman 19328, Jordan
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A clinical investigation of recurrence and lost follow-up after renal cell carcinoma surgery: a single-center, long-term, large cohort, retrospective study. Int J Clin Oncol 2022; 27:1467-1476. [PMID: 35767079 DOI: 10.1007/s10147-022-02204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/05/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Late recurrence of renal cell carcinoma (RCC) is observed in some postoperative patients. In addition, some of these patients are lost to long-term postoperative follow-up. We reviewed the treatment results and prognosis of postoperative patients with RCC at Chiba University Hospital, with the aim of clarifying the proportion and background of patients lost to follow-up. METHODS This retrospective study included 1176 RCC patients who underwent radical or/and partial nephrectomy. Overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), and lost follow-up free survival (LFFS) were evaluated and the risk factors for LFFS identified. RESULTS The median RFS for stage II and II cases was 188.3 and 104.0 months, respectively. Even in stage I, recurrence was observed in about 20% of patients 20 years after surgery. The Kaplan-Meier curve for LFFS showed a linear descent over time, with 50% of patients lost to follow-up within 25 years. Older age (≥ 62 years), histological type (clear cell RCC), and no recurrence were significant risk factors for lost follow-up. CONCLUSIONS Long-term follow-up is necessary after RCC surgery because late recurrence cases are not uncommon. We believe that lifelong follow-up with imaging studies is recommended for postoperative RCC patients. Early detection of recurrence in postoperative patients is a very important issue, and it may be worthwhile for improving the prognosis of postoperative patients to focus on patients lost to follow-up who may have been overlooked.
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Surgical outcomes of robot-assisted laparoscopic partial nephrectomy for cystic renal cell carcinoma. J Robot Surg 2021; 16:649-654. [PMID: 34342799 DOI: 10.1007/s11701-021-01292-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
To compare the surgical outcomes of robot-assisted partial nephrectomy (RAPN) between patients with cystic renal cell carcinoma (cRCC) and those with solid RCC (sRCC). We retrospectively analyzed 1065 patients who underwent RAPN between 2013 and 2020 for a pathological diagnosis of RCC. Patients were divided into two groups: cRCC and sRCC. cRCC was diagnosed according to the Bosniak classification system. To minimize selection bias between the two groups, patient variables (patient characteristics) and tumor factors (such as size and complexity) were adjusted using 1:1 propensity score matching. Of the 1065 patients, 94 (9%) were diagnosed with cRCC. Bosniak categories of IIF, III, and IV were noted in 4 (4.2%), 31 (33%), and 59 (63%) patients, respectively. After matching, 83 patients each were assigned to the cRCC and sRCC groups. The operation time in cRCC tended to be longer than in sRCC but not significantly different (164 vs. 150 min, P = 0.0767). Other surgical outcomes, such as change in estimated glomerular filtration rate ( - 5.2 vs. - 7.2%, P = 0.1577), perioperative complications (14.5 vs. 15.7%, P = 0.9225), estimated blood loss (62 vs. 58 mL, P = 0.5613), or negative surgical margin status (100 vs 99%, P = 0.236), were not significantly different between the two groups. During the follow-up period of about 2 years, one and two patients showed recurrence in the cRCC and sRCC groups, respectively. The surgical outcomes of RAPN were similar between cRCC and sRCC, demonstrating the feasibility of RAPN for cRCC.
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