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Flammia RS, Anceschi U, Tuderti G, Di Maida F, Grosso AA, Lambertini L, Mari A, Mastroianni R, Bove A, Capitanio U, Amparore D, Lee J, Pandolfo SD, Fiori C, Minervini A, Porpiglia F, Eun D, Autorino R, Leonardo C, Simone G. Development and internal validation of a nomogram predicting 3-year chronic kidney disease upstaging following robot-assisted partial nephrectomy. Int Urol Nephrol 2024; 56:913-921. [PMID: 37848745 DOI: 10.1007/s11255-023-03832-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Aim of the present study was to develop and validate a nomogram to accurately predict the risk of chronic kidney disease (CKD) upstaging at 3 years in patients undergoing robot-assisted partial nephrectomy (RAPN). METHODS A multi-institutional database was queried to identify patients treated with RAPN for localized renal tumor (cT1-cT2, cN0, cM0). Significant CKD upstaging (sCKD-upstaging) was defined as development of newly onset CKD stage 3a, 3b, and 4/5. Model accuracy was calculated according to Harrell C-index. Subsequently, internal validation using bootstrapping and calibration was performed. Then nomogram was depicted to graphically calculate the 3-year sCKD-upstaging risk. Finally, regression tree analysis identified potential cut-offs in nomogram-derived probability. Based on this cut-off, four risk classes were derived with Kaplan-Meier analysis tested this classification. RESULTS Overall, 965 patients were identified. At Kaplan-Meier analysis, 3-year sCKD-upstaging rate was 21.4%. The model included baseline (estimated glomerular filtration rate) eGFR, solitary kidney status, multiple lesions, R.E.N.A.L. nephrometry score, clamping technique, and postoperative acute kidney injury (AKI). The model accurately predicted 3-year sCKD-upstaging (C-index 84%). Based on identified nomogram cut-offs (7 vs 16 vs 26%), a statistically significant increase in sCKD-upstaging rates between low vs intermediate favorable vs intermediate unfavorable vs high-risk patients (1.3 vs 9.2 vs 22 vs 54.2%, respectively, p < 0.001) was observed. CONCLUSION Herein we introduce a novel nomogram that can accurately predict the risk of sCKD-upstaging at 3 years. Based on this nomogram, it is possible to identify four risk categories. If externally validated, this nomogram may represent a useful tool to improve patient counseling and management.
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Affiliation(s)
- Rocco Simone Flammia
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy.
| | - Umberto Anceschi
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Antonio Andrea Grosso
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Luca Lambertini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Alfredo Bove
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Umberto Capitanio
- Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Jennifer Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Daniel Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Costantino Leonardo
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
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Shi X, Yu Y, Ye T, Yu G, Xu B, Zhang Z, Wang S, Liu Z, Chen K, Wang S, Li H. Initial Experience with Hybrid Partial Nephrectomy with Ultrasound-guided Balloon Catheter Occlusion of the Renal Artery for Recurrent Renal Tumors. EUR UROL SUPPL 2024; 60:47-53. [PMID: 38333046 PMCID: PMC10850398 DOI: 10.1016/j.euros.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/10/2024] Open
Abstract
Repeat partial nephrectomy (PN) is an effective treatment in improving the prognosis for patients with recurrent renal cancer after initial PN. However, salvage PN (sPN) is inevitably associated with a higher rate of complications, largely because of intraperitoneal adhesions and fibrosis. Here we describe three initial cases for which recurrent renal tumors were treated with a novel minimally invasive approach, namely Ultrasound-guided Renal Artery Balloon catheter Occluded Hybrid Partial Nephrectomy (UBo-HPN).With laparoscopic ultrasound (LUS) guiding a Fogarty catheter to occlude the arterial blood supply, dissection of the renal hilum and most of the abdominal cavity can be avoided. UBo-HPN was successfully performed in three patients. One case of postoperative fever (Clavien-Dindo grade II) occurred, with no other complications. The mean operative time was 106 min, with a mean warm ischemia time of 21 min. UBo-HPN may be considered a safe and effective alternative for sPN, with a minimally invasive surgical footprint and better surgical outcomes.
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Affiliation(s)
- Xu Shi
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Yu
- Department of Ultrasound, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tianrun Ye
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology of Hubei Province, Wuhan, China
| | - Gan Yu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology of Hubei Province, Wuhan, China
| | - Bin Xu
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Zongbiao Zhang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology of Hubei Province, Wuhan, China
| | - Shen Wang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology of Hubei Province, Wuhan, China
| | - Zheng Liu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology of Hubei Province, Wuhan, China
| | - Ke Chen
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology of Hubei Province, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology of Hubei Province, Wuhan, China
| | - Heng Li
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology of Hubei Province, Wuhan, China
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Di Maida F, Grosso AA, Campi R, Lambertini L, Gallo ML, Cadenar A, Salamone V, Coco S, Paganelli D, Tuccio A, Masieri L, Minervini A. Redo Partial Nephrectomy for Local Recurrence After Previous Nephron-sparing Surgery. Surgical Insights and Oncologic Results from a High-volume Robotic Center. EUR UROL SUPPL 2023; 57:84-90. [PMID: 37810278 PMCID: PMC10551832 DOI: 10.1016/j.euros.2023.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Background The role of redo partial nephrectomy (PN) for recurrent renal cell carcinoma (RCC) is still overlooked. Objective To report our experience of salvage PN for local recurrence after previous nephron-sparing surgery (NSS). Design setting and participants We prospectively gathered data from patients treated with robotic redo PN for locally recurrent RCC after previous NSS from January 2017 to January 2023. The type of surgical resection technique was assigned to the pathologic specimen according to the surface-intermediate-base (SIB) score. Surgical procedure Redo PN was performed by using the Si Da Vinci robotic platform. Measurements Operative time, warm ischemia time, and intra- and postoperative complications were recorded. The severity of postoperative complications and tumor stage were evaluated. Results and limitations Overall, 26 patients entered the study. The median clinical diameter was 3.5 (interquartile range [IQR] 2.2-4.9) cm and the median Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score was 8 (IQR 7-9). In 14 (53.8%) cases, recurrence was at the level of previous tumor resection bed. The median operative time was 177 (IQR 148-200) min, and hilar clamping was performed in 14 (53.8%) cases with a median warm ischemia time of 16 (14.5-22) min. Pure enucleation (SIB score 0-1), hybrid enucleation (SIB score 2), and pure enucleoresection (SIB score 3) were recorded in 13 (50%), eight (30.8%), and five (19.2%) cases, respectively. The totality of recurrent RCC far from previous tumor resection bed received a SIB score of 0-1, while in 57.1% and 35.8% of recurrent RCC on previous tumor resection a hybrid enucleation and a pure enucleoresection were performed, respectively. At a median follow-up of 37 (IQR 16-45) mo, five (19%) patients experienced disease recurrence, being local and systemic in three (11.5%) and two (7.7%) patients, respectively. Conclusions Our study highlights the feasibility and safety of redo PN for the treatment of locally recurrent RCCs after NSS, either on previous tumor resection bed or elsewhere in the kidney. Patient summary Robotic redo partial nephrectomy is a challenging procedure. The surgeon needs to tailor the surgical strategy and tumor resection technique case by case, given the heterogeneity of clinical scenarios and the need to achieve maximal functional preservation while ensuring oncologic efficacy.
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Affiliation(s)
- Fabrizio Di Maida
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio Andrea Grosso
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Luca Lambertini
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Maria Lucia Gallo
- Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Anna Cadenar
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Vincenzo Salamone
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Simone Coco
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Daniele Paganelli
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Agostino Tuccio
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Masieri
- Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
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Masterson JM, Zhao H, Taich L, Naser‐Tavakolian A, Johnson H, Najjar R, Kim IK, Gupta A. Robotic bilateral nephrectomy for large polycystic kidney disease. BJUI COMPASS 2023; 4:701-708. [PMID: 37818019 PMCID: PMC10560624 DOI: 10.1002/bco2.263] [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: 02/02/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 10/12/2023] Open
Abstract
Objective This study aims to describe our technique and review our experience with synchronous robotic bilateral nephrectomy for large kidneys in ADPKD with the da Vinci XI and da Vinci Single Port platforms (Intuitive Surgical, Sunnyvale, CA). Materials and Methods We performed a retrospective review of all robotic bilateral nephrectomy cases from January 2020 to present at a high-volume robotic single centre. Demographic data and perioperative details including preoperative CT scans, indication for nephrectomy and renal function were collected. We also collected post-op course data and final specimen data details. Results Fourteen cases were included. Patient demographics, indications for surgery and specimen data are outlined in Table 1. The largest kidney removed has a measurement of 32 cm in the largest dimension on preoperative imaging. Median operating time from incision to closure was 299 min (IQR 260, 339). Median estimated blood loss was 75 cc (IQR 50, 187.5). Two patients were transfused intraoperatively. Median pre- and post-operative Hgb was 11.0 and 9.6, respectively. Median length of stay was 3 days (IQR 2, 3.5). There were no intraoperative complications and no open conversions. Post-operative complications included one incisional hematoma and one superficial wound infection. One patient was admitted to the surgical ICU post operatively for ventilatory support. Two patients were readmitted within 30 days of surgery. Conclusion The robotic approach to bilateral native nephrectomy for ADPKD should be considered when native nephrectomies are indicated. The operative times and outcomes are favourable compared with prior series, and this technique works even for very large kidneys.
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Affiliation(s)
- John M. Masterson
- Division of UrologyCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Hanson Zhao
- Hoag UrologyHoag HospitalNewport BeachCaliforniaUSA
| | - Lior Taich
- Division of UrologyCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | | | - Hayley Johnson
- Division of UrologyCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Reiad Najjar
- Division of NephrologyCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Irene K. Kim
- Department of SurgeryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Amit Gupta
- Division of UrologyCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
- Beverly Hills UrologyBeverly HillsCaliforniaUSA
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Pandolfo SD, Cerrato C, Wu Z, Franco A, Del Giudice F, Sciarra A, Verze P, Lucarelli G, Imbimbo C, Perdonà S, Cherullo EE, Porpiglia F, Derweesh IH, Autorino R. A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications: Large tumors (cT2-T3), solitary kidney, completely endophytic, hilar, recurrent, and multiple renal tumors. Asian J Urol 2023; 10:390-406. [PMID: 38024426 PMCID: PMC10659988 DOI: 10.1016/j.ajur.2023.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/18/2023] [Accepted: 06/19/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Robot-assisted partial nephrectomy (RAPN) has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses. The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses, large tumors (cT2-T3), renal cell carcinoma in solitary kidney, recurrent tumors, completely endophytic and hilar masses, and simultaneous and multiple tumors. Methods A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers. The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered. The secondary endpoint was to evaluate the surgical and functional outcomes. Results After screening 1250 records, 43 full-text manuscripts were selected, comprising over 8500 patients. Twelve and thirteen studies reported data for endophytic and hilar renal masses, respectively. Five and three studies reported outcomes for cT2-T3 and solitary kidney patients, respectively. Four studies focused on redo-RAPN for recurrent tumors. Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney. Conclusion Over the past decade, evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown. Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes, the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result. Certainly, a higher likelihood of complication might be expected when facing extremely challenging cases. However, none of these indications should be considered per se an exclusion criterion for performing RAPN. Ultimately, a risk-adapted approach should be employed.
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Affiliation(s)
- Savio Domenico Pandolfo
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, “Federico II” University, Naples, Italy
| | - Clara Cerrato
- Department of Urology, University of Verona, Verona, Italy
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Department of Urology, Sant’ Andrea Hospital, La Sapienza University, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urologic Sciences, La Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urologic Sciences, La Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, “Federico II” University, Naples, Italy
| | - Sisto Perdonà
- Department Uro-Gynecology, IRCCS G. Pascale Foundation, Naples, Italy
| | | | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Ithaar H. Derweesh
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
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Autorino R. Robotic surgery in urology: Recent advances. Asian J Urol 2023; 10:385-387. [PMID: 38024432 PMCID: PMC10659975 DOI: 10.1016/j.ajur.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
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