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Kinnear N, Kucheria A, Warner R, Brodie A, Adshead J. Achieving trifecta outcomes in robotic-assisted partial nephrectomy within a fellowship training centre. J Robot Surg 2024; 18:275. [PMID: 38954074 DOI: 10.1007/s11701-024-01941-7] [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: 02/17/2024] [Accepted: 04/04/2024] [Indexed: 07/04/2024]
Abstract
To assess the robotic-assisted partial nephrectomy (RAPN) trifecta rate within a fellowship program. Patients undergoing RAPN 01/01/2010-01/07/2023 were enrolled from a prospectively maintained database. All cases were performed jointly with surgical fellows, except when privately insured. Patients were excluded if they were converted to open or radical nephrectomy. The primary outcome was achieving the 'trifecta' of negative surgical margins, no complications < 30 days post-operatively and warm ischaemia time (WIT) < 25 min. The secondary outcomes were factors associated with trifecta success. Ethics approval was obtained. In the enrolment period, 355 patients underwent intended RAPN, of whom seven were excluded due to conversion to conversion to radical nephrectomy (6 patients) or conversion to open (one). Amongst the 348 eligible patients, median age was 60 years, 115 (33%) were female and 19 were private patients. WIT was < 25 min for 324/337 patients (96%), surgical margins were negative in 325 (93%), 294 (84%) were complication-free at 30 days and 301/320 (94%) had a < 30% decline in estimated glomerular filtration rate at 3-6 months postoperatively. Subsequently, trifecta outcomes were achieved in 253/337 (75%) patients. Comparing with patients without those with trifecta success were similar in all thirteen measured patients and tumour factors. In a teaching hospital, with a fellowship training programme, trifecta outcome is achievable for most RAPN patients, and at a rate comparable to international standards. Fellowship centres should monitor their outcomes to ensure high patient outcomes are maintained alongside training requirements.
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Affiliation(s)
- Ned Kinnear
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK.
- Flinders Medical Centre, Adelaide, Australia.
| | | | - Ross Warner
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK
| | - Andrew Brodie
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK
| | - James Adshead
- Lister Hospital, Coreys Mill Ln, Stevenage, SG1 4AB, UK
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2
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Zhang X, Sun Q, Qi Y, Chen Y, Xiong Y, Xi W, Miao Z, Li X, Quan X, Lin J. Associations between R.E.N.A.L. nephrometry score and survival outcomes in renal tumours. Jpn J Clin Oncol 2024; 54:339-345. [PMID: 38117949 DOI: 10.1093/jjco/hyad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/29/2023] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVE The radius-exophytic/endophytic-nearness-anterior/posterior-location nephrometry score could be used to predict surgical outcomes and renal tumour aggressiveness. We aimed to analyse its associations with survival outcomes. METHODS We included 1368 patients with sporadic, unilateral and non-metastatic renal tumours who received curative nephrectomy in Zhongshan Hospital from January 2009 to September 2019. Radius-exophytic/endophytic-nearness-anterior/posterior-location nephrometry scores were assigned by three urologists based on preoperative CT/MRI scans. Correlations between parameters or sum of radius-exophytic/endophytic-nearness-anterior/posterior-location nephrometry scores, overall survival and recurrence-free survival were analysed by Kaplan-Meier analyses and the multivariate Cox regression model. We further compared survival outcomes between patients who received partial nephrectomy and patients who received radical nephrectomy. RESULTS We observed statistically significant associations between all components of radius-exophytic/endophytic-nearness-anterior/posterior-location nephrometry scores and oncologic outcomes, including R (radius) (overall survival, P < 0.001; recurrence-free survival , P < 0.001), E (exophytic/endophytic) (overall survival, P = 0.003; recurrence-free survival, P < 0.001), N (nearness) (overall survival, P = 0.063; recurrence-free survival, P < 0.001), A (anterior/posterior) (overall survival, P < 0.001; recurrence-free survival, P = 0.005), L (location) (overall survival, P = 0.008; recurrence-free survival, P < 0.001) and suffix 'h' (overall survival, P = 0.237; recurrence-free survival, P = 0.034). Kaplan-Meier curves of overall survival and recurrence-free survival rates were significantly different when stratified by radius-exophytic/endophytic-nearness-anterior/posterior-location nephrometry score complexity group (overall survival, P < 0.001; recurrence-free survival, P < 0.001). After adjusting for tumour stage and grade, radius-exophytic/endophytic-nearness-anterior/posterior-location nephrometry score as continuous variables was an adverse independent risk factor for survival outcomes [P = 0.027, hazard ratio (95% confidence interval) = 1.151 (1.016-1.303)] and recurrence-free survival [P < 0.001, hazard ratio (95% confidence interval) = 1.299 (1.125-1.501)]. For tumours with radius-exophytic/endophytic-nearness-anterior/posterior-location nephrometry scores of 4 and 5, partial nephrectomy showed a survival benefit than radical nephrectomy. CONCLUSION Both components and complexity groups of the radius-exophytic/endophytic-nearness-anterior/posterior-location nephrometry score are associated with survival outcomes in renal tumour patients.
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Affiliation(s)
- Xue Zhang
- Department of Radiology, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Qi Sun
- Department of Pathology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
- Department of Pathology, Xiamen Clinical Research Center for Cancer Therapy, Xiamen, China
| | - Yangyang Qi
- Department of Immunology and Microbiology, Shanghai Jiao Tong University College of Basic Medical Sciences, Shanghai Institute of Immunology, Shanghai, China
| | - Yanyun Chen
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ying Xiong
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Xi
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhongchang Miao
- Department of Radiology, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xiaoxia Li
- Department of Radiology, Zhongshan Hospital(Xiamen), Fudan University, Xiamen, China
- Department of Radiology, Xiamen Clinical Research Center for Cancer Therapy, Xiamen, China
| | - Xiaoling Quan
- Department of Pathology, Hexi University Affiliated Zhangye People's Hospital, China
| | - Jinglai Lin
- Department of Urology, Zhongshan Hospital(Xiamen), Fudan University, Xiamen, China
- Department of Urology, Xiamen Clinical Research Center for Cancer Therapy, Xiamen, China
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3
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Razdan S, Ucpinar B, Badani KK. Response to D. Agarwal et al. Urology 2024; 183:305. [PMID: 37898321 DOI: 10.1016/j.urology.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/30/2023]
Affiliation(s)
- Shirin Razdan
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY.
| | - Burak Ucpinar
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Ketan K Badani
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY
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Zhang Y, Sun Z, Ma H, Wang C, Zhang W, Liu J, Li M, Zhang Y, Guo H, Ba X. Prediction of Fuhrman nuclear grade for clear cell renal carcinoma by a multi-information fusion model that incorporates CT-based features of tumor and serum tumor associated material. J Cancer Res Clin Oncol 2023; 149:15855-15865. [PMID: 37672076 DOI: 10.1007/s00432-023-05353-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE Prediction of Fuhrman nuclear grade is crucial for making informed herapeutic decisions in clear cell renal cell carcinoma (ccRCC). The current study aimed to develop a multi-information fusion model utilizing computed tomography (CT)-based features of tumors and preoperative biochemical parameters to predict the Fuhrman nuclear grade of ccRCC in a non-invasive manner. METHODS 218 ccRCC patients confirmed by histopathology were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent predictors and establish a model for predicting the Fuhrman grade in ccRCC. The predictive performance of the model was evaluated using receiver operating characteristic (ROC) curves, calibration, the 10-fold cross-validation method, bootstrapping, the Hosmer-Lemeshow test, and decision curve analysis (DCA). RESULTS R.E.N.A.L. Nephrometry Score (RNS) and serum tumor associated material (TAM) were identified as independent predictors for Fuhrman grade of ccRCC through multivariate logistic regression. The areas under the ROC curve (AUC) for the multi-information fusion model composed of the above two factors was 0.810, higher than that of the RNS (AUC 0.694) or TAM (AUC 0.764) alone. The calibration curve and Hosmer-Lemeshow test showed the integrated model had a good fitting degree. The 10-fold cross-validation method (AUC 0.806) and bootstrap test (AUC 0.811) showed the good stability of the model. DCA demonstrated that the model had superior clinical utility. CONCLUSION A multi-information fusion model based on CT features of tumor and routine biochemical indicators, can predict the Fuhrman grade of ccRCC using a non-invasive approach. This model holds promise for assisting clinicians in devising personalized management strategies.
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Affiliation(s)
- Yumei Zhang
- Department of Radiology, Laishan Branch of Yantai Yuhuangding Hospital, Yantai, 264000, Shandong, China
| | - Zehua Sun
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, 264000, Shandong, China
| | - Heng Ma
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, 264000, Shandong, China
| | - Chenchen Wang
- Department of Radiology, Laishan Branch of Yantai Yuhuangding Hospital, Yantai, 264000, Shandong, China
| | - Wei Zhang
- Department of Radiology, Yantai Penglai People's Hospital, Yantai, 265600, Shandong, China
| | - Jing Liu
- Department of Pathology, Yantai Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, 264000, Shandong, China
| | - Min Li
- Department of Radiology, Yantai Hospital of Traditional Chinese Medicine, Yantai, 264000, Shandong, China
| | - Yuxia Zhang
- Department of Obstetrics and Gynecology, Yanzhou Hospital of TCM, Yanzhou, 272100, Shandong, China
| | - Hao Guo
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, 264000, Shandong, China.
| | - Xinru Ba
- Department of Radiology, Yantaishan Hospital, Yantai, 264000, Shandong, China.
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5
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Berry JM, Hill H, Vetter JM, Bhayani SB, Henning GM, Pickersgill NA, Sivaraman A, Figenshau RS, Kim EH. Single-port vs multi-port robot-assisted renal surgery: analysis of perioperative outcomes for excision of high and low complexity renal masses. J Robot Surg 2023; 17:2149-2155. [PMID: 37256454 PMCID: PMC10230457 DOI: 10.1007/s11701-023-01637-4] [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: 05/13/2023] [Accepted: 05/26/2023] [Indexed: 06/01/2023]
Abstract
There is emerging but limited data assessing single-port (SP) robot-assisted surgery as an alternative to multi-port (MP) platforms. We compared perioperative outcomes between SP and MP robot-assisted approaches for excision of high and low complexity renal masses. Retrospective chart review was performed for patients undergoing robot-assisted partial or radical nephrectomy using the SP surgical system (n = 23) at our institution between November 2019 and November 2021. Renal masses were categorized as high complexity (7+) or low complexity (4-6) using the R.E.N.A.L. nephrometry scoring system. Adjusting for baseline characteristics, patients were matched using a prospectively maintained MP database in a 2:1 (MP:SP) ratio. For high complexity tumors (n = 12), SP surgery was associated with a significantly longer operative time compared to MP (248.4 vs 188.1 min, p = 0.02) but a significantly shorter length of stay (1.9 vs 2.8 days, p = 0.02). For low complexity tumors (n = 11), operative time (177.7 vs 161.4 min, p = 0.53), estimated blood loss (69.6.0 vs 142.0 mL, p = 0.62), and length of stay (1.6 vs 1.8 days, p = 0.528) were comparable between SP and MP approaches. Increasing nephrometry score was associated with a greater relative increase in operative time for SP compared to MP renal surgery (p = 0.07) using best of fit linear modeling. SP robot-assisted partial and radical nephrectomy is safe and feasible for low complexity renal masses. For high complexity renal masses, the SP system is associated with a significantly longer operative time compared to the MP technique. Careful consideration should be given when selecting patients for SP robot-assisted kidney surgery.
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Affiliation(s)
- James M Berry
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA.
| | - Hayden Hill
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Joel M Vetter
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Sam B Bhayani
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Grant M Henning
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Nicholas A Pickersgill
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Arjun Sivaraman
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - R Sherburne Figenshau
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Eric H Kim
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA.
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Licari LC, Bologna E, Proietti F, Flammia RS, Bove AM, D'annunzio S, Tuderti G, Leonardo C. Exploring the Applications of Indocyanine Green in Robot-Assisted Urological Surgery: A Comprehensive Review of Fluorescence-Guided Techniques. SENSORS (BASEL, SWITZERLAND) 2023; 23:5497. [PMID: 37420664 DOI: 10.3390/s23125497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 07/09/2023]
Abstract
This comprehensive review aims to explore the applications of indocyanine green (ICG) in robot-assisted urological surgery through a detailed examination of fluorescence-guided techniques. An extensive literature search was conducted in PubMed/MEDLINE, EMBASE and Scopus, using keywords such as "indocyanine green," "ICG", "NIRF", "Near Infrared Fluorescence", "robot-assisted", and "urology". Additional suitable articles were collected by manually cross-referencing the bibliography of previously selected papers. The integration of the Firefly® technology in the Da Vinci® robotic system has opened new avenues for the advancement and exploration of different urological procedures. ICG is a fluorophore widely used in near-infrared fluorescence-guided techniques. The synergistic combination of intraoperative support, safety profiles and widespread availability comprises an additional asset that empowers ICG-guided robotic surgery. This overview of the current state of the art illustrates the potential advantages and broad applications of combining ICG-fluorescence guidance with robotic-assisted urological surgery.
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Affiliation(s)
- Leslie Claire Licari
- Urology Unit, Department of Maternal-Child and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Eugenio Bologna
- Urology Unit, Department of Maternal-Child and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Flavia Proietti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Rocco Simone Flammia
- Urology Unit, Department of Maternal-Child and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Alfredo Maria Bove
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Simone D'annunzio
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Costantino Leonardo
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
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7
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Filipas DK, Yu H, Spink C, Rink M, Riechardt S, Gild P, Marks P, Fisch M, Dahlem R, Meyer CP, Vetterlein MW. Nephrometry and cumulative morbidity after partial nephrectomy: A standardized assessment of complications in the context of PADUA and R.E.N.A.L. scores. Urol Oncol 2023; 41:51.e1-51.e11. [PMID: 36283929 DOI: 10.1016/j.urolonc.2022.09.014] [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: 05/06/2022] [Revised: 07/09/2022] [Accepted: 09/22/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nephrometry scores aid in clinical decision-making, yet evidence is scarce regarding their impact on cumulative morbidity following partial nephrectomy (PN). PATIENTS AND METHODS Retrospective, monocentric study of 122 patients with suspicious renal masses undergoing open or robot-assisted PN between January 2019 and August 2020. Morbidity assessment followed European Association of Urology guidelines on complication reporting. 30-d complications were extracted using a PN-specific catalog, were graded by the Clavien-Dindo classification (CDC), and Comprehensive Complication Index (CCI®) values were calculated. The impact of nephrometry on cumulative morbidity was evaluated by (1) comparing morbidity estimates between Preoperative Aspects and Dimensions Used for an Anatomical (PADUA)/R.E.N.A.L. complexity groups, (2) by Pearson's correlation between nephrometry scores and CCI®, and (3) by multivariable regression models using any 30-d complication and 30-d CCI® as endpoints. RESULTS Of 122 patients, 101 (83%) underwent open and 21 (17%) robot-assisted PN. Median PADUA and R.E.N.A.L. scores were 9 (interquartile range, IQR 8-10) and 8 (IQR 6-9), respectively. Of 218 complications in 92 patients (75%), the majority was classified as minor (CDC grade ≤IIIa). Median 30-d CCI® was 8.7 (IQR 0.50-15). There was a small positive correlation between PADUA or R.E.N.A.L. score with CCI® (all P ≤ 0.026), explaining 4.7% and 4.1% of the variation in CCI®, respectively. After adjustment, nephrometry scores were associated with any 30-d complication and the CCI® (all P ≤ 0.011). PADUA and R.E.N.A.L. high complexity tumors were positively associated with both morbidity endpoints compared to low complexity tumors (all P ≤ 0.041). CONCLUSIONS At a referral center, PN may be safely performed, even if morbidity assessment follows a strict protocol. Nephrometry risk classification does only marginally translate into clinical relevant differences regarding short-term complications. Thus, nephron-sparing surgery should not be withheld from patients with high complexity renal masses.
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Affiliation(s)
- Dejan K Filipas
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hang Yu
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Clemens Spink
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Riechardt
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Gild
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Phillip Marks
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian P Meyer
- Department of Urology, Ruhr-University Bochum, Campus OWL, Herford, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Faiella E, Calabrese A, Santucci D, Corti R, Cionfoli N, Pusceddu C, de Felice C, Bozzini G, Mazzoleni F, Muraca RM, Moramarco LP, Venturini M, Quaretti P. Green Tattoo Pre-Operative Renal Embolization for Robotic-Assisted and Laparoscopic Partial Nephrectomy: A Practical Proof of a New Technique. J Clin Med 2022; 11:jcm11226816. [PMID: 36431293 PMCID: PMC9693545 DOI: 10.3390/jcm11226816] [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: 10/04/2022] [Revised: 11/03/2022] [Accepted: 11/13/2022] [Indexed: 11/19/2022] Open
Abstract
(1) Background: Our aim is to describe a new mixed indocyanine-non-adhesive liquid embolic agent (Onyx-18) pre-operative renal embolization technique for assisted-robotic and laparoscopic partial nephrectomy with near-infra-red fluorescence imaging. (2) Methods: Thirteen patients with biopsy-proven renal tumors underwent pre-operative mixed indocyanine-ethylene vinyl alcohol (EVOH) embolization (Green-embo) between June 2021 and August 2022. All pre-operative embolizations were performed with a super selective stop-flow technique using a balloon microcatheter to deliver an indocyanine-EVOH mixture into tertiary order arterial branch feeders and the intra-lesional vascular supply. Efficacy (evaluated as complete embolization, correct tumor mapping on infra-red fluorescence imaging and clamp-off surgery) and safety (evaluated as complication rate and functional outcomes) were primary goals. Clinical and pathological data were also collected. (3) Results: Two male and eleven female patients (mean age 72 years) received pre-operative Green-embo. The median tumor size was 29 mm (range 15-50 mm). Histopathology identified renal cell carcinoma (RCC) in 9 of the 13 (69%) patients, oncocytoma in 3 of the 13 (23%) patients and sarcomatoid RCC in 1 of the 13 (8%) patients. Lesions were equally distributed between polar, meso-renal, endo- and exophytic locations. Complete embolization was achieved in all the procedures. A correct green mapping was identified during all infra-red fluorescence imaging. All patients were discharged on the second day after the surgery. The median blood loss was 145 cc (10-300 cc). No significant differences were observed in serum creatinine levels before and after the embolization procedures. (4) Conclusions: The Green-tattoo technique based on a mixed indocyanine-non-adhesive liquid embolic agent (Onyx-18) is a safe and effective pre-operative embolization technique. The main advantages are the excellent lesion mapping for fluorescence imaging, reduction in surgical time, and definitive, complete and immediate tumor devascularization based on the deep Onyx-18 penetration, leading to a very low intra-operative blood loss.
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Affiliation(s)
- Eliodoro Faiella
- Department of Radiology, Sant’Anna Hospital, Via Ravona, San Fermo della Battaglia, 22042 Como, Italy
- Correspondence: ; Tel.: +39-331-455-7202
| | - Alessandro Calabrese
- Department of Radiological Sciences, Oncology and Pathology, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161 Rome, Italy
| | - Domiziana Santucci
- Department of Radiology, Sant’Anna Hospital, Via Ravona, San Fermo della Battaglia, 22042 Como, Italy
- Unit of Computer Systems and Bioinformatics, Department of Engineering, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Riccardo Corti
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Nicola Cionfoli
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Claudio Pusceddu
- Regional Referral Center for Oncologic Disease, Department of Oncological and Interventional Radiology, Businco Hospital, A.O. Brotzu, 09100 Cagliari, Italy
| | - Carlo de Felice
- Department of Radiological Sciences, Oncology and Pathology, Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 105, 00161 Rome, Italy
| | - Giorgio Bozzini
- Department of Radiology, Sant’Anna Hospital, Via Ravona, San Fermo della Battaglia, 22042 Como, Italy
| | - Federica Mazzoleni
- Department of Radiology, Sant’Anna Hospital, Via Ravona, San Fermo della Battaglia, 22042 Como, Italy
| | - Rosa Maria Muraca
- Department of Radiology, Sant’Anna Hospital, Via Ravona, San Fermo della Battaglia, 22042 Como, Italy
| | - Lorenzo Paolo Moramarco
- Department of Radiology, Sant’Anna Hospital, Via Ravona, San Fermo della Battaglia, 22042 Como, Italy
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, 21100 Varese, Italy
| | - Pietro Quaretti
- Unit of Interventional Radiology, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
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9
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Yamazaki M, Takayama T, Fujita A, Kikuchi T, Kamimura T, Myoga H, Mayumi S, Yazaki K, Katano S, Komatsubara M, Kamei J, Sugihara T, Ando S, Fujimura T. 3D printed kidney model could be an important educational tool for residents. Asian J Endosc Surg 2022; 16:197-202. [PMID: 36254752 DOI: 10.1111/ases.13136] [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: 07/20/2022] [Revised: 09/19/2022] [Accepted: 10/03/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This study aimed to evaluate whether it is useful for junior physicians to use a three-dimensional (3D) kidney model when evaluating the R.E.N.A.L. nephrometry score. MATERIALS AND METHODS An expert and four urology residents retrospectively evaluated the R.E.N.A.L. nephrometry scores of 64 renal tumors (62 patients) that underwent robot-assisted partial nephrectomy at our hospital. The expert evaluated 64 R.E.N.A.L. nephrometry scores with computed tomography (CT), whereas four residents evaluated 32 cases using CT alone and the other 32 cases using CT and a 3D kidney model. The consistency between the expert and residents was assessed by Cohen's kappa score. Patient-specific 3D kidney models were created in a gird style using a 3D printer based on CT or magnetic resonance imaging of the patient. RESULTS For all four residents, the accuracy of the overall R.E.N.A.L. nephrometry score was significantly higher with the 3D model and CT than with CT alone (P < .001). Regarding the individual components of the R.E.N.A.L. nephrometry score, the accuracy rates of "E," "N," "A," and "L" scores were higher with the 3D model and CT than with the CT alone (P = .020-.089). CONCLUSION Patient-specific 3D-printed kidney models could improve the resident's understanding of the renal tumor complexity and could be an important educational tool for residents.
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Affiliation(s)
- Masahiro Yamazaki
- Department of Urology, Jichi Medical University, Shimotuke City, Japan
| | - Tatsuya Takayama
- Department of Urology, International University of Health and Welfare Hospital, Nasushiobara-shi, Japan
| | - Akifumi Fujita
- Department of Radiology, Jichi Medical University, Shimotuke City, Japan
| | - Tomohiro Kikuchi
- Department of Radiology, Jichi Medical University, Shimotuke City, Japan
| | - Tomoki Kamimura
- Department of Radiology, Jichi Medical University, Shimotuke City, Japan
| | - Hiroaki Myoga
- Department of Urology, Jichi Medical University, Shimotuke City, Japan
| | - Shozaburo Mayumi
- Department of Urology, Jichi Medical University, Shimotuke City, Japan
| | - Kai Yazaki
- Department of Urology, Jichi Medical University, Shimotuke City, Japan
| | - Saki Katano
- Department of Urology, Jichi Medical University, Shimotuke City, Japan
| | - Maiko Komatsubara
- Department of Urology, Jichi Medical University, Shimotuke City, Japan
| | - Jun Kamei
- Department of Urology, Jichi Medical University, Shimotuke City, Japan
| | - Toru Sugihara
- Department of Urology, Jichi Medical University, Shimotuke City, Japan
| | - Satoshi Ando
- Department of Urology, Jichi Medical University, Shimotuke City, Japan
| | - Tetsuya Fujimura
- Department of Urology, Jichi Medical University, Shimotuke City, Japan
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10
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Deng X, Liu X, Hu B, Jiang M, Zhu K, Nie J, Liu T, Chen L, Deng W, Fu B, Xiong S. Pathological diagnostic nomograms for predicting malignant histology and unfavorable pathology in patients with endophytic renal tumor. Front Oncol 2022; 12:964048. [PMID: 36212405 PMCID: PMC9532530 DOI: 10.3389/fonc.2022.964048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo develop and validate nomograms for pre-treatment prediction of malignant histology (MH) and unfavorable pathology (UP) in patients with endophytic renal tumors (ERTs).MethodsWe retrospectively reviewed the clinical information of 3245 patients with ERTs accepted surgical treatment in our center. Eventually, 333 eligible patients were included and randomly enrolled into training and testing sets in a ratio of 7:3. We performed univariable and multivariable logistic regression analyses to determine the independent risk factors of MH and UP in the training set and developed the pathological diagnostic models of MH and UP. The optimal model was used to construct a nomogram for MH and UP. The area under the receiver operating characteristics (ROC) curves (AUC), calibration curves and decision curve analyses (DCA) were used to evaluate the predictive performance of models.ResultsOverall, 172 patients with MH and 50 patients with UP were enrolled in the training set; and 74 patients with MH and 21 patients with UP were enrolled in the validation set. Sex, neutrophil-to-lymphocyte ratio (NLR), R score, N score and R.E.N.A.L. score were the independent predictors of MH; and BMI, NLR, tumor size and R score were the independent predictors of UP. Single-variable and multiple-variable models were constructed based on these independent predictors. Among these predictive models, the malignant histology-risk nomogram consisted of sex, NLR, R score and N score and the unfavorable pathology-risk nomogram consisted of BMI, NLR and R score performed an optimal predictive performance, which reflected in the highest AUC (0.842 and 0.808, respectively), the favorable calibration curves and the best clinical net benefit. In addition, if demographic characteristics and laboratory tests were excluded from the nomograms, only the components of the R.E.N.A.L. Nephrometry Score system were included to predict MH and UP, the AUC decreased to 0.781 and 0.660, respectively (P=0.001 and 0.013, respectively).ConclusionIn our study, the pathological diagnostic models for predicting malignant and aggressive histological features for patients with ERTs showed outstanding predictive performance and convenience. The use of the models can greatly assist urologists in individualizing the management of their patients.
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Affiliation(s)
- Xinxi Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Urology, Jiu Jiang NO.1 People’s Hospital, Jiujiang, China
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Bing Hu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Ming Jiang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Ke Zhu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Jianqiang Nie
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Taobin Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Wen Deng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
- *Correspondence: Situ Xiong, ; Bin Fu,
| | - Situ Xiong
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Institute of Urology, Nanchang, China
- *Correspondence: Situ Xiong, ; Bin Fu,
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11
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Bianchi L, Schiavina R, Bortolani B, Cercenelli L, Gaudiano C, Mottaran A, Droghetti M, Chessa F, Boschi S, Molinaroli E, Balestrazzi E, Costa F, Rustici A, Carpani G, Piazza P, Cappelli A, Bertaccini A, Golfieri R, Marcelli E, Brunocilla E. Novel Volumetric and Morphological Parameters Derived from Three-dimensional Virtual Modeling to Improve Comprehension of Tumor's Anatomy in Patients with Renal Cancer. Eur Urol Focus 2022; 8:1300-1308. [PMID: 34429273 DOI: 10.1016/j.euf.2021.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/22/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Three-dimensional (3D) models improve the comprehension of renal anatomy. OBJECTIVE To evaluate the impact of novel 3D-derived parameters, to predict surgical outcomes after robot-assisted partial nephrectomy (RAPN). DESIGN, SETTING, AND PARTICIPANTS Sixty-nine patients with cT1-T2 renal mass scheduled for RAPN were included. Three-dimensional virtual modeling was achieved from computed tomography. The following volumetric and morphological 3D parameters were calculated: VT (volume of the tumor); VT/VK (ratio between tumor volume and kidney volume); CSA3D (ie, contact surface area); UCS3D (contact to the urinary collecting system); Tumor-Artery3D: tumor's blood supply by tertiary segmental arteries (score = 1), secondary segmental artery (score = 2), or primary segmental/main renal artery (scoren = 3); ST (tumor's sphericity); ConvT (tumor's convexity); and Endophyticity3D (ratio between the CSA3D and the global tumor surface). INTERVENTION RAPN with a 3D model. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Three-dimensional parameters were compared between patients with and without complications. Univariate logistic regression was used to predict overall complications and type of clamping; linear regression was used to predict operative time, warm ischemia time, and estimated blood loss. RESULTS AND LIMITATIONS Overall, 11 (15%) individuals experienced overall complications (7.2% had Clavien ≥3 complications). Patients with urinary collecting system (UCS) involvement at 3D model (UCS3D = 2), tumor with blood supply by primary or secondary segmentary arteries (Tumor-Artery3D = 1 and 2), and high Endophyticity3D values had significantly higher rates of overall complications (all p ≤ 0.03). At univariate analysis, UCS3D, Tumor-Artery3D, and Endophyticity3D are significantly associated with overall complications; CSA3D and Endophyticity3D were associated with warm ischemia time; and CSA3D was associated with selective clamping (all p ≤ 0.03). Sample size and the lack of interobserver variability are the main limits. CONCLUSIONS Three-dimensional modeling provides novel volumetric and morphological parameters to predict surgical outcomes after RAPN. PATIENT SUMMARY Novel morphological and volumetric parameters can be derived from a three-dimensional model to describe surgical complexity of renal mass and to predict surgical outcomes after robot-assisted partial nephrectomy.
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Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy.
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Barbara Bortolani
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Laura Cercenelli
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Caterian Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angelo Mottaran
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Francesco Chessa
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Sara Boschi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Enrico Molinaroli
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Eleonora Balestrazzi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Francesco Costa
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Arianna Rustici
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giulia Carpani
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Bertaccini
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Emanuela Marcelli
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli studi di Bologna, Bologna, Italy
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12
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Dubeux V, Zanier JFC, Chantong CGC, Carrerette F, Gabrich PN, Damiâo R. Nephrometry scoring systems: their importance for the planning of nephron-sparing surgery and the relationships among them. Radiol Bras 2022; 55:242-252. [PMID: 35983342 PMCID: PMC9380606 DOI: 10.1590/0100-3984.2021.0166] [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] [Received: 11/16/2021] [Accepted: 02/18/2022] [Indexed: 11/23/2022] Open
Abstract
In recent years, the development of new imaging techniques and scoring systems have improved the diagnosis and management of small renal masses. Imaging-based nephrometry scoring systems play an interesting role in the planning of nephron-sparing surgery, providing surgeons with the information necessary to determine the complexity of the renal mass, to deliver the appropriate postoperative care, and to predict adverse outcomes. The aim of this study was to review nephrometry scoring systems, evaluating their characteristics and the relationships among them. The urology and radiology communities should decide which nephrometry scoring system will prevail and be used in daily practice.
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Affiliation(s)
- Victor Dubeux
- Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro (HUPE-UERJ), Brazil
| | | | | | - Fabricio Carrerette
- Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro (HUPE-UERJ), Brazil
| | - Pedro Nicolau Gabrich
- Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro (HUPE-UERJ), Brazil
| | - Ronaldo Damiâo
- Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro (HUPE-UERJ), Brazil
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13
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Combination of holographic imaging with robotic partial nephrectomy for renal hilar tumor treatment. Int Urol Nephrol 2022; 54:1837-1844. [PMID: 35568753 DOI: 10.1007/s11255-022-03228-y] [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: 02/16/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To evaluate the clinical value of the holographic imaging technology in combination with robotic-assisted partial nephrectomy (RAPN) for renal hilar tumor treatment. PATIENTS AND METHODS From Dec. 2018 to Dec. 2021, patients diagnosed with renal hilar tumor were included in this retrospective study. Before the surgery, the engineers established the holographic image models based on the enhanced CT data. The models were used in patient consultation, pre-surgery planning and surgery simulation. During the RAPN, the navigation was achieved by real-time overlapping of the holographic images on the robotic surgery endoscopic views. The navigation technique helped the surgeon to identify the important anatomic structures such as tumor, renal vein, renal artery, and pelvis. RESULTS There were total of eight patients with renal hilar tumor who underwent RAPN combined with holographic imaging technique. The mean age was 57.3 years, the median ASA score was 2. The mean tumor size was 42.4 mm and the median RENAL Nephrometry score was 9.5. The clinical stages were cT1a (37.5%) and cT1b (62.5%). All the procedures were performed uneventfully by one surgeon. The mean operative time was 144.3 min, and the mean warm ischemia time was 27.9 min. The mean estimated blood loss was 86.3 ml. There was no conversion to open surgery or radical nephrectomy. There were no Clavien-Dindo ≥ 3 perioperative complications. CONCLUSIONS Using the holographic imaging technique, the pre-surgery planning, simulation of renal arterial clamp and excision of the tumor, and intraoperative navigation were feasible and helpful in facilitating RAPN.
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14
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Sharma G, Shah M, Ahluwalia P, Dasgupta P, Challacombe BJ, Bhandari M, Ahlawat R, Rawal S, Buffi NM, Sivaraman A, Porter JR, Rogers C, Mottrie A, Abaza R, Rha KH, Moon D, Thyavihally YB, Parekh DJ, Capitanio U, Maes KK, Porpiglia F, Turkeri L, Gautam G. Perioperative outcomes following robot-assisted partial nephrectomy for complex renal masses: A Vattikuti Collective Quality Initiative database study. Indian J Urol 2022; 38:288-295. [PMID: 36568454 PMCID: PMC9787447 DOI: 10.4103/iju.iju_154_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/27/2022] [Accepted: 09/29/2022] [Indexed: 12/27/2022] Open
Abstract
Introduction Outcomes of robot-assisted partial nephrectomy (RAPN) depend on tumor complexity, surgeon experience and patient profile among other variables. We aimed to study the perioperative outcomes of RAPN for patients with complex renal masses using the Vattikuti Collective Quality Initiative (VCQI) database that allowed evaluation of multinational data. Methods From the VCQI, we extracted data for all the patients who underwent RAPN with preoperative aspects and dimensions used for an anatomical (PADUA) score of ≥10. Multivariate logistic regression was conducted to ascertain predictors of trifecta (absence of complications, negative surgical margins, and warm ischemia times [WIT] <25 min or zero ischemia) outcomes. Results Of 3,801 patients, 514 with PADUA scores ≥10 were included. The median operative time, WIT, and blood loss were 173 (range 45-546) min, 21 (range 0-55) min, and 150 (range 50-3500) ml, respectively. Intraoperative complications and blood transfusions were reported in 2.1% and 6%, respectively. In 8.8% of the patients, postoperative complications were noted, and surgical margins were positive in 10.3% of the patients. Trifecta could be achieved in 60.7% of patients. Clinical tumor size, duration of surgery, WIT, and complication rates were significantly higher in the group with a high (12 or 13) PADUA score while the trifecta was significantly lower in this group (48.4%). On multivariate analysis, surgical approach (retroperitoneal vs. transperitoneal) and high PADUA score (12/13) were identified as predictors of the trifecta outcomes. Conclusion RAPN may be a reasonable surgical option for patients with complex renal masses with acceptable perioperative outcomes.
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Affiliation(s)
- Gopal Sharma
- Department of Urologic Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Milap Shah
- Department of Urologic Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Puneet Ahluwalia
- Department of Urologic Oncology, Max Institute of Cancer Care, New Delhi, India
| | - Prokar Dasgupta
- King's Health Partners, Faculty of Life Sciences and Medicine, King's College, London, UK
| | | | - Mahendra Bhandari
- Vattikuti Foundation, Henry Ford Hospital, Detroit, MI, Washington, USA
| | - Rajesh Ahlawat
- Department of Urology, Medanta – The Medicity Hospital, New Delhi, India
| | - Sudhir Rawal
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Nicolo M. Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | | | - Craig Rogers
- Department of Urology, Henry Ford Hospital, Detroit, MI, Washington, USA
| | | | - Ronney Abaza
- Central Ohio Urology Group, Mount Carmel St. Ann's Hospital, OH, USA
| | - Khoon Ho Rha
- Department of Urology, Yonsei University Health System, Seoul, South Korea
| | - Daniel Moon
- Department of Urology, Royal Melbourne Clinical School, Peter MacCallum Hospital, University of Melbourne, Melbourne, Australia
| | | | - Dipen J. Parekh
- Department of Urology, University of Miami Health System, Miami, FL, USA
| | - Umberto Capitanio
- Department of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, MI, Washington, USA
| | - Kris K. Maes
- Center for Robotics and Minimally Invasive Surgery, Hospital Da Luz, Luz Sáude, Portugal
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital of Orbassano, Turin, Italy
| | - Levent Turkeri
- Department of Urology, Altuzinade Hospital, Acıbadem M.A. Aydınlar University, Istanbul, Turkey
| | - Gagan Gautam
- Department of Urologic Oncology, Max Institute of Cancer Care, New Delhi, India,
E-mail:
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15
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Bianchi L, Chessa F, Piazza P, Ercolino A, Mottaran A, Recenti D, Serra C, Gaudiano C, Cappelli A, Modestino F, Golfieri R, Bertaccini A, Marcelli E, Porreca A, Celia A, Schiavina R. Percutaneous ablation or minimally invasive partial nephrectomy for cT1a renal masses? A propensity score-matched analysis. Int J Urol 2021; 29:222-228. [PMID: 34894001 DOI: 10.1111/iju.14758] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/03/2021] [Accepted: 11/08/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Local tumor ablation to treat small renal mass is increasing. The aim of the present study was to compare oncologic outcomes among patients with T1 renal mass treated with partial nephrectomy and local tumor ablation. METHODS To reduce the inherent differences between patients undergoing laparoscopic or robot-assisted partial nephrectomy (n = 405) and local tumor ablation (n = 137), we used a 1:1 propensity score-matched analysis. Local tumor ablation consisted of radiofrequency ablation and cryoablation. Disease-free survival, overall survival and other causes mortality-free survival rates were estimated using the Kaplan-Meier method. Multivariable logistic regression and competing-risk regression models were used to identify predictors of complications, recurrence and other causes mortality, respectively. RESULTS Partial nephrectomy had higher disease-free survival estimates, as compared with local tumor ablation (92.8% vs 80.4% at 5 years, P = 0.02), with no significant difference between radiofrequency ablation and cryoablation (P = 0.9). Ablation showed comparable overall survival estimates to partial nephrectomy (91% vs 95.8% at 5 years, P = 0.6). The 5-year recurrence rates were 7.9% versus 23.8% for patients aged ≤70 years, and 2.5% versus 11.9% for patients aged >70 years treated with partial nephrectomy and ablation, respectively; the 5-year other causes mortality rates were 0% and 2.2% for patients treated with partial nephrectomy and ablation aged ≤70 years, and 3% versus 10.9% for patients aged >70 years treated with partial nephrectomy and ablation, respectively. At multivariable analysis, ablation was associated with fewer complications (odds ratio 0.41; P = 0.01). At competing risks analysis, age (hazard ratio 0.96) and ablation (hazard ratio 4.56) were independent predictors of disease recurrence (all P ≤ 0.008). CONCLUSIONS Local tumor ablation showed a higher risk of recurrence and lower risk of complications compared with partial nephrectomy, with comparable overall survival rates.
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Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Francesco Chessa
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Amelio Ercolino
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angelo Mottaran
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Dario Recenti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carla Serra
- Interventional Ultrasound Unit, Department of Organ Failure and Transplantations, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Modestino
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Bertaccini
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Emanuela Marcelli
- Department of Experimental, Diagnostic and Specialty Medicine, Laboratory of Bioengineering, University of Bologna, Bologna, Italy
| | - Angelo Porreca
- Department of Urology, Veneto Institute of Oncology, Padua, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
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16
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Psutka SP, Gulati R, Jewett MAS, Fadaak K, Finelli A, Legere L, Morgan TM, Pierorazio PM, Allaf ME, Herrin J, Lohse CM, Houston Thompson R, Boorjian SA, Atwell TD, Schmit GD, Costello BA, Shah ND, Leibovich BC. A Clinical Decision Aid to Support Personalized Treatment Selection for Patients with Clinical T1 Renal Masses: Results from a Multi-institutional Competing-risks Analysis. Eur Urol 2021; 81:576-585. [PMID: 34862099 DOI: 10.1016/j.eururo.2021.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/28/2021] [Accepted: 11/01/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Personalized treatment for clinical T1 renal cortical masses (RCMs) should take into account competing risks related to tumor and patient characteristics. OBJECTIVE To develop treatment-specific prediction models for cancer-specific mortality (CSM), other-cause mortality (OCM), and 90-d Clavien grade ≥3 complications across radical nephrectomy (RN), partial nephrectomy (PN), thermal ablation (TA), and active surveillance (AS). DESIGN, SETTING, AND PARTICIPANTS Pretreatment clinical and radiological features were collected for consecutive adult patients treated with initial RN, PN, TA, or AS for RCMs at four high-volume referral centers (2000-2019). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Prediction models used competing-risks regression for CSM and OCM and logistic regression for 90-d Clavien grade ≥3 complications. Performance was assessed using bootstrap validation. RESULTS AND LIMITATIONS The cohort comprised 5300 patients treated with RN (n = 1277), PN (n = 2967), TA (n = 476), or AS (n = 580). Over median follow-up of 5.2 yr (interquartile range 2.5-8.7), there were 117 CSM, 607 OCM, and 198 complication events. The C index for the predictive models was 0.80 for CSM, 0.77 for OCM, and 0.64 for complications. Predictions from the fitted models are provided in an online calculator (https://small-renal-mass-risk-calculator.fredhutch.org). To illustrate, a hypothetical 74-yr-old male with a 4.5-cm RCM, body mass index of 32 kg/m2, estimated glomerular filtration rate of 50 ml/min, Eastern Cooperative Oncology Group performance status of 3, and Charlson comorbidity index of 3 has predicted 5-yr CSM of 2.9-5.6% across treatments, but 5-yr OCM of 29% and risk of 90-d Clavien grade 3-5 complications of 1.9% for RN, 5.8% for PN, and 3.6% for TA. Limitations include selection bias, heterogeneity in practice across treatment sites and the study time period, and lack of control for surgeon/hospital volume. CONCLUSIONS We present a risk calculator incorporating pretreatment features to estimate treatment-specific competing risks of mortality and complications for use during shared decision-making and personalized treatment selection for RCMs. PATIENT SUMMARY We present a risk calculator that generates personalized estimates of the risks of death from cancer or other causes and of complications for surgical, ablation, and surveillance treatment options for patients with stage 1 kidney tumors.
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Affiliation(s)
- Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA.
| | - Roman Gulati
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center and University Health Network, University of Toronto, Toronto, Canada
| | - Kamel Fadaak
- Department of Urology, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Antonio Finelli
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center and University Health Network, University of Toronto, Toronto, Canada
| | - Laura Legere
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center and University Health Network, University of Toronto, Toronto, Canada
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Phillip M Pierorazio
- Department of Urology, Brady Urological Institute, Department of Urology at Johns Hopkins, Baltimore, MD, USA
| | - Mohamad E Allaf
- Department of Urology, Brady Urological Institute, Department of Urology at Johns Hopkins, Baltimore, MD, USA
| | - Jeph Herrin
- Division of Cardiology, Yale School of Medicine, New Haven, CT, USA; Health Research & Educational Trust, Chicago, IL, USA
| | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Grant D Schmit
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Nilay D Shah
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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17
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Rosiello G, Piazza P, Puliatti S, Mazzone E, Amato M, Tames V, Farinha R, De Groote R, Berquin C, Develtere D, Sinatti C, Larcher A, Capitanio U, D'Hondt F, Schatteman P, Briganti A, Montorsi F, De Naeyer G, Mottrie A. Simplified PADUA renal (SPARE) nephrometry score validation and long-term outcomes after robot-assisted partial nephrectomy. Urol Oncol 2021; 40:65.e1-65.e9. [PMID: 34824015 DOI: 10.1016/j.urolonc.2021.09.021] [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: 06/16/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND International guidelines suggest the use of anatomic scores to predict surgical outcomes after partial nephrectomy (PN). We aimed at validating the use of Simplified PADUA Renal (SPARE) nephrometry score in robot-assisted PN (RAPN). MATERIALS AND METHODS Three hundred and sixty-eight consecutive RAPN patients were included. Primary endpoints were overall complications, postoperative acute kidney injury (AKI) and TRIFECTA achievement. Secondary endpoint was estimated glomerular filtration rate (eGFR) decrease at last follow-up. Multivariable logistic and linear regression models were used. RESULTS Of 368 patients, 229 (62%) vs. 116 (31%) vs. 23 (6.2%) harboured low- vs. intermediate- vs. high-risk renal mass, according to SPARE classification. SPARE score predicted higher risk of overall complications (Odds ratio [OR]: 1.23, 95%CI 1.09-1.39; P < 0.001), and postoperative AKI (OR: 1.20, 95%CI 1.08-1.35; P < 0.01). Moreover, SPARE score was associated with lower TRIFECTA achievement (OR: 0.89, 95%CI 0.81-0.98; P = 0.02). Predicted accuracy was 0.643, 0.614 and 0.613, respectively. After a median follow-up of 40 (IQR: 21-66) months, eGFR decrease ranged from -7% in low-risk to -17% in high-risk SPARE. CONCLUSIONS SPARE scoring system predicts surgical success in RAPN patients. Moreover, SPARE score is associated with eGFR decrease at long-term follow-up. Thus, the adoption of SPARE score to objectively assess tumor complexity prior to RAPN may be preferable.
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Affiliation(s)
- Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium.
| | - Pietro Piazza
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Bologna, Bologna, Italy
| | - Stefano Puliatti
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Elio Mazzone
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Amato
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Victor Tames
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, Bellvitge University Hospital, Barcelona, Spain
| | - Rui Farinha
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Camille Berquin
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Dries Develtere
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Celine Sinatti
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alessandro Larcher
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Capitanio
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Frederiek D'Hondt
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Peter Schatteman
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
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18
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Mitre AI. The potential threats and benefits of nephron-sparing surgery can be predicted by any available score system. Int Braz J Urol 2021; 48:120-121. [PMID: 34735087 PMCID: PMC8691247 DOI: 10.1590/s1677-5538.ibju.2021.0424.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Anuar Ibrahim Mitre
- Divisão de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brasil
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19
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Kobayashi S, Shiota M. Editorial Comment to Endoscopic laser treatment for urine leakage caused by an isolated calyx after robot-assisted partial nephrectomy. IJU Case Rep 2021; 4:346. [PMID: 34755051 PMCID: PMC8560454 DOI: 10.1002/iju5.12349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/01/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Satoshi Kobayashi
- Department of RadiologyBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Masaki Shiota
- Department of UrologyGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
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20
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Bianchi L, Schiavina R, Bortolani B, Cercenelli L, Gaudiano C, Carpani G, Rustici A, Droghetti M, Mottaran A, Boschi S, Salvador M, Chessa F, Cochetti G, Golfieri R, Bertaccini A, Marcelli E. Interpreting nephrometry scores with three-dimensional virtual modelling for better planning of robotic partial nephrectomy and predicting complications. Urol Oncol 2021; 39:836.e1-836.e9. [PMID: 34535356 DOI: 10.1016/j.urolonc.2021.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/08/2021] [Accepted: 07/26/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE 3D models are increasingly used as additional preoperative tools for renal surgery. We aim to evaluate the impact of 3D renal models in the assessment of PADUA, RENAL, Contact Surface Area (CSA) and Arterial Based Complexity (ABC) for the prediction of complications after Robot assisted Partial Nephrectomy (RAPN). METHODS AND MATERIALS Overall, 57 patients with T1 and 1 patient with T2 renal mass referred to RAPN, were prospectively enrolled. 3D virtual modelling was obtained from 2D computed tomography (CT). Two radiologists recorded PADUA2D, RENAL2D, CSA2D and ABC2D by evaluation of 2D images; two bioengineers recorded PADUA3D, RENAL3D, CSA3D and ABC3D by evaluation of the 3D model, using MeshMixer software. To evaluate the concordance between 2D and 3D nephrometry scores, Cohen's j coefficient was calculated. Receiver-operating characteristic (ROC) curves were generated to evaluate the accuracy of 3D and 2D nephrometry scores to predict overall complications. Finally, the impact of 3D model on clamping approach during RAPN was compared to 2D imaging. RESULTS PADUA3D, RENAL3D, CSA3D and ABC3D scores had a significant different distribution compared to PADUA2D, RENAL2D, CSA2D and ABC2D (all p≤0.03). 2D nephrometry scores may be unchanged, reduced or increased after assessment by 3D models: CSA3D, PADUA3D, RENAL3D and ABC3D were reduced in14%, 26%, 29% and 16% and increased in 16%, 36%, 38% and 29% of cases, respectively. At ROC curve analysis, PADUA3D, RENAL3D and ABC3D showed were significantly better accuracy to predict complications compared to PADUA2D, RENAL2D and ABC2D. PADUA3D (OR: 1.66), RENAL3D (OR: 1.69) and ABC3D (OR: 2.44) revealed a significant correlation with postoperative complications (all P ≤0.03). CONCLUSION Nephrometry scores calculated via 3D models predict complications after RAPN with higher accuracy than conventional 2D imaging.
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Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy.
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Barbara Bortolani
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Laura Cercenelli
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Caterina Gaudiano
- Division of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giulia Carpani
- Division of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Arianna Rustici
- Division of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angelo Mottaran
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Sara Boschi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marco Salvador
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Chessa
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, University of Perugi, Perugia, Italy
| | - Rita Golfieri
- Università degli Studi di Bologna, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; Division of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Bertaccini
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Emanuela Marcelli
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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21
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Piazza P, Bianchi L, Giampaoli M, Droghetti M, Casablanca C, Ercolino A, Beretta C, Recenti D, Balestrazzi E, Puliatti S, Rosiello G, Amato M, Romagnoli D, D'Agostino D, Gaudiano C, Golfieri R, Porreca A, Mottrie A, Schiavina R. Short Time Delay Between Previous Prostate Biopsy for Prostate Cancer Assessment and Holmium Laser Enucleation of the Prostate Correlates with Worse Perioperative Outcomes. Eur Urol Focus 2021; 8:563-571. [PMID: 33858812 DOI: 10.1016/j.euf.2021.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/08/2021] [Accepted: 04/04/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND No data are available regarding the impact of time between a previous transrectal prostate biopsy (PB) and holmium laser enucleation of the prostate (HoLEP) on perioperative outcomes. OBJECTIVE To evaluate the impact of time from PB to HoLEP on perioperative outcomes. DESIGN, SETTING, AND PARTICIPANTS A total of 172 consecutive patients treated with HoLEP within 12 mo of a single previous transrectal PB at two tertiary centers were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were stratified into two groups according to the median time from PB to HoLEP (namely, ≤6 and >6 mo). The primary outcome was intraoperative complications. Multivariate logistic regressions were used to identify the predictors of intraoperative complications. Linear regressions were used to test the association between the time from PB to HoLEP and intraoperative complications, enucleation efficiency, and enucleation time. RESULTS AND LIMITATIONS In total, 93 (54%) and 79 (46%) patients had PB ≤ 6 and >6 mo before HoLEP, respectively. Patients in PB ≤ 6 mo group experienced higher rates of intraoperative complications than those in PB > 6 mo group (14% vs 2.6%, p = 0.04). At multivariable analysis, time between PB and HoLEP was an independent predictor of intraoperative complications (odds ratio: 0.74; 95% confidence interval: 0.6-0.9; p = 0.006). Finally, the risk of intraoperative complications reduced by 1.5%, efficiency of enucleation increased by 4.1%, and enucleation time reduced by 1.7 min for each month passed from PB to HoLEP (all p ≤ 0.006). Selection of patients with only one previous PB represents the main limitation. CONCLUSIONS The time from PB to HoLEP of ≤6 mo is associated with a higher risk of intraoperative complications, lower enucleation efficacy, and longer enucleation time. PATIENT SUMMARY Patients with a prostate biopsy (PB) ≤6 mo before holmium laser enucleation of the prostate (HoLEP) had significantly worse outcomes than those with a PB > 6 mo before HoLEP.
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Affiliation(s)
- Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy; ORSI Academy, Melle, Belgium
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy.
| | - Marco Giampaoli
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Carlo Casablanca
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Amelio Ercolino
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Carlo Beretta
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Dario Recenti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Eleonora Balestrazzi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Stefano Puliatti
- ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Amato
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rita Golfieri
- Università degli Studi di Bologna, Bologna, Italy; Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angelo Porreca
- Department of Urology, Veneto Institute of Oncology IOV - IRCCS, 35128 Padua, Italy
| | | | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
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22
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Crockett MG, Giona S, Whiting D, Whitehurst L, Agag A, Malki M, Hussain M, Barber NJ. Nephrometry scores: a validation of three systems for peri-operative outcomes in retroperitoneal robot-assisted partial nephrectomy. BJU Int 2021; 128:36-45. [PMID: 33001563 DOI: 10.1111/bju.15262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To externally validate the RENAL, PADUA and SPARE nephrometry scoring systems for use in retroperitoneal robot-assisted partial nephrectomy (RAPN). MATERIALS AND METHODS Nephrometry scores were calculated for 322 consecutive patients receiving retroperitoneal RAPN at a tertiary referral centre from 2017. Patients with multiple tumours were excluded. Scores were correlated with peri-operative outcomes, including the trifecta (warm ischaemia time <25 min, no peri-operative complications and a negative surgical margin), both as continuous and categorical variables. Comparisons were performed using Spearman correlation and ability to predict the trifecta was assessed using binomial logistical regression. RESULTS All three scoring systems correlated significantly with the main variables (operating time, warm ischaemia time and estimated blood loss), both as continuous and categorical variables. Only PADUA and SPARE were able to predict achievement of the trifecta (PADUA area under the curve [AUC] 0.623, 95% confidence interval [CI] 0.559-0.668; SPARE AUC 0.612, 95% CI 0.548-0.677). CONCLUSION This study validates the RENAL, PADUA and SPARE scoring systems to predict key intra-operative outcomes in retroperitoneal RAPN. Only PADUA and SPARE were able to predict achievement of the trifecta. As a simplified version of the PADUA scoring system with comparable outcomes, we recommend using the SPARE system.
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Affiliation(s)
- Matthew G Crockett
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
| | - Simone Giona
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
| | - Danielle Whiting
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
| | - Lily Whitehurst
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
| | - Ayman Agag
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
| | - Manar Malki
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
| | - Muddassar Hussain
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
| | - Neil J Barber
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Frimley, Camberley, UK
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23
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Rizzo M, Piasentin A, Rebez G, Giannarini G, Umari P, Sachs C, Celia A, Pavan N, Balestrieri L, Artuso G, Bertolotto M, Trombetta C, Liguori G. Percutaneous cryoablation for high-complexity renal masses: complications, functional and oncological outcomes. Minerva Urol Nephrol 2021; 73:518-524. [PMID: 33769011 DOI: 10.23736/s2724-6051.21.04015-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND During the past two decades cryoablation (CA) has become a therapeutic option for the management of localized cT1 renal masses in comorbid patients. We analyzed the mid-term functional and oncological outcomes of CA in the treatment of cT1 renal masses which were classified as high-complexity masses according to the PADUA system. METHODS A total of 299 patients underwent percutaneous CA between November 2007 and December 2018 in 4 institutions for cT1N0M0 renal masses. All patients with high-complexity (PADUA≥10) renal tumors were included. Technical failure of CA was considered an exclusion criterion. RESULTS Inclusion criteria were met by 45 patients. Median Charlson Comorbidity Index (CCI) was 6.0 (IQR: 5.0-7.0), median age was 74 years (IQR: 64.5-79.5). Seven Clavien 1 and 1 Clavien 2 procedure-related complications were reported. Median eGFR at baseline was 64.3mL/min (IQR: 52.0-82.3) while at the 1-year follow-up was 61.4 mL/min (IQR: 44.0-74.5). The median follow-up was 32 months (IQR: 13.25-47.5). Local recurrences were detected in 6 patients; 3 of them underwent re-cryoablation while the others started active surveillance. Median time to recurrence was 17.5 months (IQR: 7.8-27.3). Cancer-specific survival and metastasis-free survival were 100%, while overall survival was 86.7%. CONCLUSIONS CA proved to be a valuable therapeutic option for the management of patients with cT1 high-complexity PADUA≥10 renal tumors as it provides a low rate of procedural morbidity and good preservation of renal function. However, these results are counterbalanced by a recurrence rate that appears to be higher than those reported on surgically treated patients.
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Affiliation(s)
- Michele Rizzo
- Department of Urology, Surgery and Health Science, University of Trieste, Trieste, Italy -
| | - Andrea Piasentin
- Department of Urology, Surgery and Health Science, University of Trieste, Trieste, Italy
| | - Giacomo Rebez
- Department of Urology, Surgery and Health Science, University of Trieste, Trieste, Italy
| | - Gianluca Giannarini
- Department of Urology, Santa Maria della Misericordia Hospital, Udine, Italy
| | - Paolo Umari
- Department of Surgery, Clinic of Urology, University of Eastern Piedmont, Novara, Italy
| | - Camilla Sachs
- Department of Radiology, University of Trieste, Trieste, Italy
| | - Antonio Celia
- ULSS 7 Pedemontana, Bassano del Grappa, Vicenza, Italy
| | - Nicola Pavan
- Department of Urology, Surgery and Health Science, University of Trieste, Trieste, Italy
| | | | - Giorgio Artuso
- Department of Urology, ULSS 3 Serenissima, Dolo, Venezia, Italy
| | | | - Carlo Trombetta
- Department of Urology, Surgery and Health Science, University of Trieste, Trieste, Italy
| | - Giovanni Liguori
- Department of Urology, Surgery and Health Science, University of Trieste, Trieste, Italy
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24
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Piazza P, Oliveira Paludo AD, Puliatti S, Rosiello G, Farinha R, Amato M, Schiavina R, Brunocilla E, Berquin C, De Groote R, Thielman L, Mottrie A, De Naeyer G. Bilateral kidney metastases from adenoid cystic carcinoma of lung: a case report and literature review. CEN Case Rep 2021; 10:468-472. [PMID: 33686592 DOI: 10.1007/s13730-021-00589-8] [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: 12/17/2020] [Accepted: 02/24/2021] [Indexed: 10/22/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) is a rare malignant tumor, usually arising from salivary glands and rarely found in other locations. ACC is characterized by asymptomatic course, slow growth pattern, perineural invasion and high incidence of late metastasis. Renal localization of metastasis is rare. Only 12 cases of renal metastasis were published and, to our best knowledge, no case of bilateral metastasis to the kidney has ever been reported. We present a case of a 58 years old woman with bilateral renal metastasis from ACC of the right lung after fourteen years from lobectomy and radiotherapy for the primary presentation. The patient underwent bilateral robot-assisted partial nephrectomy in a two-stage approach. Despite its rare incidence and slow growth, ACC metastasis may simulate primary papillary renal carcinoma and occur many years after primary treatment. Therefore, lifelong follow-up, including abdominal imaging, is recommended.
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Affiliation(s)
- Pietro Piazza
- Department of Urology, Onze-Lieve-Vrouw Hospital, Moorselbaan 164, 9300, Aalst, Belgium. .,Division of Urology, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy. .,ORSI Academy, Melle, Belgium.
| | - Artur de Oliveira Paludo
- Department of Urology, Onze-Lieve-Vrouw Hospital, Moorselbaan 164, 9300, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Stefano Puliatti
- ORSI Academy, Melle, Belgium.,Urology Department, Università di Modena e Reggio Emilia, Modena, Italy
| | - Giuseppe Rosiello
- Department of Urology, Onze-Lieve-Vrouw Hospital, Moorselbaan 164, 9300, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Rui Farinha
- Department of Urology, Onze-Lieve-Vrouw Hospital, Moorselbaan 164, 9300, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Marco Amato
- Department of Urology, Onze-Lieve-Vrouw Hospital, Moorselbaan 164, 9300, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Urology Department, Università di Modena e Reggio Emilia, Modena, Italy
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Camille Berquin
- Department of Urology, Onze-Lieve-Vrouw Hospital, Moorselbaan 164, 9300, Aalst, Belgium
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouw Hospital, Moorselbaan 164, 9300, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | | | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouw Hospital, Moorselbaan 164, 9300, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouw Hospital, Moorselbaan 164, 9300, Aalst, Belgium
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25
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Nishimura K, Sawada Y, Sugihara N, Funaki K, Koyama K, Noda T, Fukumoto T, Miura N, Miyauchi Y, Kikugawa T, Saika T. A low RENAL Nephrometry Score can avoid the need for the intraoperative insertion of a ureteral catheter in robot-assisted partial nephrectomy. World J Surg Oncol 2021; 19:40. [PMID: 33541337 PMCID: PMC7863492 DOI: 10.1186/s12957-021-02146-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/25/2021] [Indexed: 12/16/2022] Open
Abstract
Background Intraoperative urinary collecting system entry (CSE) in robot-assisted partial nephrectomy (RAPN) may cause postoperative urinary leakage and extend the hospitalization. Therefore, identifying and firmly closing the entry sites are important for preventing postoperative urine leakage. In RAPN cases expected to require CSE, we insert a ureteral catheter and inject dye into the renal pelvis to identify the entry sites. We retrospectively analyzed the factors associated with intraoperative CSE in RAPN and explored the indications of intraoperative ureteral catheter indwelling in RAPN. Methods Of 104 Japanese patients who underwent RAPN at our institution from August 2016 to March 2020, 101 were analyzed. The patients were classified into CSE and non-CSE groups. The patients’ background characteristics, RENAL Nephrometry Score (RNS), and surgical outcomes were analyzed. Results Intraoperative CSE was observed in 41 patients (41%). The CSE group had a significantly longer operative time, console time, ischemic time, and hospital stay than the non-CSE group. In a multivariable analysis, the N-score (odds ratio [OR] = 3.9, P < 0.05) and RNS total score excluding the L-score (OR = 3.1, P < 0.05) were associated with CSE. In a logistic regression analysis, CSE showed a moderate correlation with the RNS total score excluding the L-score (AUC 0.848, cut-off 5, sensitivity 0.83, specificity 0.73). Conclusion A ureteral catheter should not be placed in patients with an RNS total score (excluding the L-score) of ≤ 4.
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Affiliation(s)
- Kenichi Nishimura
- Department of Urology, Ehime University Graduate school of Medicine, Shitsukawa, Toon, Matsuyama, Ehime, 791-0295, Japan.
| | - Yuichiro Sawada
- Department of Urology, Ehime University Graduate school of Medicine, Shitsukawa, Toon, Matsuyama, Ehime, 791-0295, Japan
| | - Naoya Sugihara
- Department of Urology, Ehime University Graduate school of Medicine, Shitsukawa, Toon, Matsuyama, Ehime, 791-0295, Japan
| | - Keisuke Funaki
- Department of Urology, Ehime University Graduate school of Medicine, Shitsukawa, Toon, Matsuyama, Ehime, 791-0295, Japan
| | - Kanae Koyama
- Department of Urology, Ehime University Graduate school of Medicine, Shitsukawa, Toon, Matsuyama, Ehime, 791-0295, Japan
| | - Terutaka Noda
- Department of Urology, Ehime University Graduate school of Medicine, Shitsukawa, Toon, Matsuyama, Ehime, 791-0295, Japan
| | - Tetsuya Fukumoto
- Department of Urology, Ehime University Graduate school of Medicine, Shitsukawa, Toon, Matsuyama, Ehime, 791-0295, Japan
| | - Noriyoshi Miura
- Department of Urology, Ehime University Graduate school of Medicine, Shitsukawa, Toon, Matsuyama, Ehime, 791-0295, Japan
| | - Yuki Miyauchi
- Department of Urology, Ehime University Graduate school of Medicine, Shitsukawa, Toon, Matsuyama, Ehime, 791-0295, Japan
| | - Tadahiko Kikugawa
- Department of Urology, Ehime University Graduate school of Medicine, Shitsukawa, Toon, Matsuyama, Ehime, 791-0295, Japan
| | - Takashi Saika
- Department of Urology, Ehime University Graduate school of Medicine, Shitsukawa, Toon, Matsuyama, Ehime, 791-0295, Japan
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26
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Juvet TS, Thompson RH, Potretzke AM. Robot-assisted partial nephrectomy is safe and effective for complex renal masses when performed by experienced surgeons. Transl Androl Urol 2021; 9:2474-2478. [PMID: 33457219 PMCID: PMC7807336 DOI: 10.21037/tau-20-865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Tristan S Juvet
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
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27
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Sharma G, Tyagi S, Mavuduru R, Bora GS, Sharma AP, Devana SK, Gorsi U, Kakkar N, Singh SK. External validation of SPARE nephrometery score in predicting overall complications, trifecta and pentafecta outcomes following robot-assisted partial nephrectomy. Minerva Urol Nephrol 2021; 74:63-71. [PMID: 33439569 DOI: 10.23736/s2724-6051.20.03972-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND There is an ongoing need and search for a simple yet accurate nephrometry scoring system for predicting the postoperative outcomes after partial nephrectomy (PN). Simplified PADUA Renal (SPARE) Nephrometry Scoring System, a simplified version of Preoperative Aspects and Dimensions Used for an Anatomical Classification (PADUA) has been proposed as a predictor of postoperative complications following PN recently. However, this score has never been externally validated and assessed as a predictor of trifecta and pentafecta outcomes of PN. In the current study, we applied the SPARE scoring system to our robot-assisted PN cohort (RAPN). METHODS Prospectively maintained data of patients, who underwent RAPN from November 2014 to December 2018, was abstracted. Imaging was analyzed to calculate SPARE and RENAL nephrometry scores (RNS) by two urologists, independently. SPARE was compared with complications, trifecta outcomes, pentafecta outcomes, and RENAL nephrometry scoring (RNS). RESULTS Data of 201 RAPN patients were analyzed. The mean SPARE score was 3 (range 0-11). One hundred thirteen patients were classified as low risk, 64 as intermediate risk, and 24 as high risks. On multivariate analysis SPARE score alone predicted complications (OR=1.37, P=0.014) and trifecta outcomes (OR=0.75, P=0.000) while age (OR=0.96, P=0.042), preoperative eGFR (OR=0.97, P=0.001) and SPARE scores (OR=0.81, P=0.016) were predictors for pentafecta outcomes. Receiver operated curve (ROC) analysis between SPARE and RNS in predicting the complications; trifecta and pentafecta outcomes had a comparable area under the curve. CONCLUSIONS Our study validates the SPARE nephrometry scoring system in predicting postoperative complications, trifecta, and pentafecta outcomes in a RAPN cohort. The predictive accuracy of SPARE is similar to RNS.
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Affiliation(s)
- Gopal Sharma
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shantanu Tyagi
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravimohan Mavuduru
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Girdhar S Bora
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India -
| | - Aditya P Sharma
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudheer K Devana
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shrawan K Singh
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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28
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Seetharam Bhat KR, Moschovas MC, Onol FF, Rogers T, Roof S, Patel VR, Schatloff O. Robotic renal and adrenal oncologic surgery: A contemporary review. Asian J Urol 2021; 8:89-99. [PMID: 33569275 PMCID: PMC7859360 DOI: 10.1016/j.ajur.2020.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/30/2020] [Accepted: 04/22/2020] [Indexed: 01/20/2023] Open
Abstract
Robot-assisted surgery has evolved over time. Radical nephrectomy with inferior vena cava thrombectomy is feasible and safe for level I, II and III thrombus in high volume centers. Though it is feasible for level IV thrombus, this procedure needs a multi-departmental co-operation. However, the safety of robot-assisted procedures in this subset is still unknown. Robot-assisted partial nephrectomy has been universally approved and found oncologically safe. Robotic adrenalectomy has been increasingly utilized for select cases, especially in bilateral tumors and for retroperitoneal adrenalectomy.
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Affiliation(s)
| | | | - Fikret Fatih Onol
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Travis Rogers
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Shannon Roof
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Vipul R. Patel
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
| | - Oscar Schatloff
- Global Robotics Institute, AdventHealth Celebration Health, Celebration, FL, USA
- Sudmedica Health, Chile
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29
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Lin V, Mai HC, Wu CH, Lin YY, Kuo WT, Lee YH, Li RC, Wu R. Using R.E.N.A.L. nephrometry and preoperative aspects and dimensions employed for anatomical classification to evaluate perioperative outcomes of renal tumors greater than 4 cm in patients who underwent minimally invasive partial nephrectomy in a single center. UROLOGICAL SCIENCE 2021. [DOI: 10.4103/uros.uros_78_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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30
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Tokas T, Avgeris M, Leotsakos I, Nagele U, Gözen AS. Impact of three-dimensional vision in laparoscopic partial nephrectomy for renal tumors. Turk J Urol 2020; 47:144-150. [PMID: 33337319 DOI: 10.5152/tud.2020.20439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare three-dimensional (3D) with standard two-dimensional (2D) laparoscopic partial nephrectomy (LPN) with respect to intra- and postoperative outcomes. MATERIAL AND METHODS Data from 112 patients who underwent transperitoneal LPN from 2012 to 2014 by a single experienced surgeon were collected. Sixty patients (group 1) underwent conventional 2D LPN and 52 patients (group 2) 3D LPN. Perioperative patient, procedure, and tumor data were recorded. The follow-up period was 1-5 years. RESULTS The two groups had similar patient age (p=0.834) and body mass index (p=0.141). The total laparoscopy time (LT) was shorter in group 2 (119.0 vs. 106.0 min; p=0.009). Warm ischemia times (WITs) were also shorter in group 2 (11.5 vs. 10.0 min; p=0.032). The estimated blood loss (EBL) (350.0 vs. 250.0 mL; p<0.001) and hemoglobin (Hb) decrease (1.55 vs. 1.35 g/dL; p=0.536) were lower in the 3D LPN group. Creatinine (0 vs. 0 g/dL; p=0.610) increase and estimated glomerular filtration rate (eGFR) decrease (0 vs. 0 mL/min/1.73 m2; p=0.553) did not demonstrate statistically significant differences. Duration of hospitalization (7 vs. 7 days; p=0.099) and complication rates (p=0.559) were similar between the two groups. CONCLUSION The new-generation 3D laparoscope has a great impact on significant LPN intraoperative parameters, mainly LT, WIT, and EBL. Hb decrease is also in favor of 3D vision, although not dramatically altered. Therefore, 3D LPN appears to be superior to conventional 2D LPNs.
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Affiliation(s)
- Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria.,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group
| | - Margaritis Avgeris
- Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Athens, Athens, Greece
| | - Ioannis Leotsakos
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria.,Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria.,Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group
| | - Ali Serdar Gözen
- Department of Urology, SLK-Kliniken, University of Heidelberg, Heilbronn, Germany
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31
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Bianchi L, Mineo Bianchi F, Chessa F, Barbaresi U, Casablanca C, Piazza P, Mottaran A, Droghetti M, Roveroni C, Balestrazzi E, Gentile G, Gaudiano C, Bertaccini A, Marcelli E, Porreca A, DE Concilio B, Serra C, Celia A, Brunocilla E, Schiavina R. Percutaneous tumor ablation versus partial nephrectomy for small renal mass: the impact of histologic variant and tumor size. Minerva Urol Nephrol 2020; 73:581-590. [PMID: 33256358 DOI: 10.23736/s2724-6051.20.03983-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The aim, of this study was to investigate recurrence rates in patients with T1 renal cell carcinoma (RCC) undergone partial nephrectomy (PN), radiofrequency ablation (RFA) or cryoablation (Cryo). METHODS We retrospectively evaluated data from 665 (81.4%), 68 (8.3%) and 83 (10.3%) patients who underwent PN, RFA and Cryo, respectively. Kaplan-Meier curves depict recurrence-free survival (RFS) rates in the overall population and after stratifying according to tumor's histology (namely, clear cell RCC and non-clear RCC) and size (namely <2 cm and 2-4 cm). Multivariable Cox regression model was used to identify predictors of recurrence. Cumulative-incidence plots evaluated disease recurrence and other causes of mortality (OCM). RESULTS Patients referred to PN experienced higher RFS rate compared to those treated with RFA and Cryo at 60-month in the overall population (96.4% vs. 79.4% vs. 87.8%), in patients with clear cell RCC (93.3% vs. 75% vs. 80.4%) and in those with tumor of 2-4 cm (97.3% vs. 78% and 84.4%; all P≤0.01). In patients with non-clear cell RCC and with tumor <2cm, PN showed higher RFS rate at 60-month as compared to RFA (97.9% vs. 84.4% and 95.1% vs. 78.1%, respectively: all P≤0.02). At multi-variate analysis, ablative techniques (RFA [HR=4.03] and Cryo [HR=3.86]) were independent predictors of recurrence (all P<0.03). At competing risks analysis, recurrence rate and OCM were 7.3% and 1.3% vs. 25% and 7.2% vs. 19.9% and 19.9% for PN, RFA and Cryo, respectively. CONCLUSIONS PN and Cryo showed similar RFS rates in patients with non-clear cell RCC and with renal mass <2cm.
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Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy - .,University of Bologna, Bologna, Italy -
| | - Federico Mineo Bianchi
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Francesco Chessa
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Umberto Barbaresi
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Carlo Casablanca
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Pietro Piazza
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Angelo Mottaran
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Carlo Roveroni
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Eleonora Balestrazzi
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Giorgio Gentile
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Caterina Gaudiano
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Alessandro Bertaccini
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | | | - Angelo Porreca
- Department of Radiology, IRCCS University Hospital of Bologna, Bologna, Italy
| | | | - Carla Serra
- Unit of Interventional Ultrasound, Department of Organ Failure and Transplantations, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Eugenio Brunocilla
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
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32
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Arora S, Bronkema C, Porter JR, Mottrie A, Dasgupta P, Challacombe B, Rha KH, Ahlawat RK, Capitanio U, Yuvaraja TB, Rawal S, Moon DA, Sivaraman A, Maes KK, Porpiglia F, Gautam G, Turkeri L, Bhandari M, Jeong W, Menon M, Rogers CG, Abdollah F. Omission of Cortical Renorrhaphy During Robotic Partial Nephrectomy: A Vattikuti Collective Quality Initiative Database Analysis. Urology 2020; 146:125-132. [DOI: 10.1016/j.urology.2020.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/24/2020] [Accepted: 09/03/2020] [Indexed: 01/20/2023]
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33
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The impact of intraoperative bleeding on the risk of chronic kidney disease after nephron-sparing surgery. World J Urol 2020; 39:2553-2558. [PMID: 33123741 DOI: 10.1007/s00345-020-03504-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The current literature regarding the effect of blood loss (eBL) after nephron-sparing surgery (NSS) on long-term renal function is scarce. We tested the effect of eBL on the risk of developing chronic kidney disease (CKD) after NSS. METHODS Within an institutional prospectively maintained database, we identified 215 patients treated with NSS for cT1N0M0 renal mass at one European high-volume center. Multivariable logistic regression models tested the effect of eBL on the risk of developing CKD, after accounting for surgical complexity, individual clinical characteristics, and surgical experience. Multivariable linear regression models identified predictors of eBL. RESULTS After a median follow-up of 36 months, 55 (25.6%) patients experienced CKD after surgery. At multivariable analyses, eBL independently predicted higher risk of CKD after NSS (odds ratio [OR]: 1.16; 95% confidence intervals [CI] 1.04-1.30; p < 0.01). Specifically, the relationship between eBL and probability of CKD emerged as nonlinear, with a plateau from 0 to 500 mL of eBL and an increase afterward. When multivariable linear regression analyses investigated predictors of eBL, hypertension (Est: 127, 95% CI 12-242; p = 0.03), clinical size (Est: 47, 95% CI 7-87; p = 0.02), and PADUA score (Est: 42; 95% CI 4-80 p = 0.03) achieved independent predictor status for higher intraoperative eBL. Conversely, surgical experience was associated with lower eBL (p = 0.01). CONCLUSIONS Intraoperative bleeding is independently associated with the risk of developing CKD after surgery, even after adjustment for well-known predictors of renal failure and tumor complexity. Hence, strategies aimed at maximally reducing such adverse events deserve special consideration.
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34
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Rocco B, Sighinolfi MC, Menezes AD, Eissa A, Inzillo R, Sandri M, Puliatti S, Turri F, Ciarlariello S, Amato M, De Carne C, Sarchi L, Bozzini G, Bianchi G, Micali S. Three-dimensional virtual reconstruction with DocDo, a novel interactive tool to score renal mass complexity. BJU Int 2020; 125:761-762. [PMID: 32160392 DOI: 10.1111/bju.15049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Bernardo Rocco
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Ahmed Eissa
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy.,Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Raffaele Inzillo
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Sandri
- Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Stefano Puliatti
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Filippo Turri
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Marco Amato
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Cosimo De Carne
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Sarchi
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giampaolo Bianchi
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
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Schiavina R, Bianchi L, Chessa F, Barbaresi U, Cercenelli L, Lodi S, Gaudiano C, Bortolani B, Angiolini A, Bianchi FM, Ercolino A, Casablanca C, Molinaroli E, Porreca A, Golfieri R, Diciotti S, Marcelli E, Brunocilla E. Augmented Reality to Guide Selective Clamping and Tumor Dissection During Robot-assisted Partial Nephrectomy: A Preliminary Experience. Clin Genitourin Cancer 2020; 19:e149-e155. [PMID: 33060033 DOI: 10.1016/j.clgc.2020.09.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Riccardo Schiavina
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia; Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Lorenzo Bianchi
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia; Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy.
| | - Francesco Chessa
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia; Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Umberto Barbaresi
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Laura Cercenelli
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Simone Lodi
- Department of Electrical, Electronic, and Information Engineering, "Guglielmo Marconi," University of Bologna, Bologna, Italy
| | - Caterina Gaudiano
- Radiology Unit, Department of Diagnostic Medicine and Prevention, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Barbara Bortolani
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy
| | - Andrea Angiolini
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Federico Mineo Bianchi
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Amelio Ercolino
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Carlo Casablanca
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Enrico Molinaroli
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia
| | - Angelo Porreca
- Department of Urology, Abano Terme Hospital, Padua, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Diagnostic Medicine and Prevention, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering, "Guglielmo Marconi," University of Bologna, Bologna, Italy
| | - Emanuela Marcelli
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italia; Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
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Huang CP, Chang CH, Wu HC, Yang CR, Hsieh PF, Chen GH, Hsiao PJ, Chang YH, Wang YP, Wang YD. External validation of the Simplified PADUA REnal (SPARE) nephrometry system in predicting surgical outcomes after partial nephrectomy. BMC Urol 2020; 20:146. [PMID: 32917159 PMCID: PMC7488659 DOI: 10.1186/s12894-020-00702-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 08/21/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Pentafecta is a major goal in the era of partial nephrectomy (PN). Simplified PADUA REnal (SPARE) nephrometry system was developed to evaluate the complexity of tumor. However, the predictive ability in pentafecta of SPARE system is yet to be determined. The aim of this study was to externally validate the applicability of SPARE nephrometry system in predicting pentafecta achievement after partial nephrectomy, and to examine inter-observer concordance. METHODS We retrospectively reviewed data of 207 consecutive patients who underwent PN between January 2012 and August 2018 at a tertiary referral center. We obtained SPARE, R.E.N.A.L., and PADUA scores and evaluated correlations among the nephrometries and surgical outcomes including pentafecta by Spearman test. Logistic regression analysis was used to identify independent predictors of pentafecta outcomes. We compared the nephrometries to determine the predictive ability of achieving pentafecta using receiver operating characteristic curve analysis. Fleiss' generalized kappa was used to assessed interobserver variation in the SPARE system. RESULTS Based on the SPARE system, 120, 74, and 13 patients were stratified into low-risk, intermediate-risk, and high-risk groups, respectively. Regarding the individual components of pentafecta, there were significant differences in the complication rate (p = 0.03), ischemia time (p < 0.001), and percent change of eGFR (p < 0.001) among the three risk groups. In addition, higher tumor complexity was significantly associated with a lower achievement rate of pentafecta (p = 0.01). In Spearman correlation tests, SPARE nephrometry was correlated with ischemia time (ρ:0.37, p < 0.001), operative time (ρ:0.28, p < 0.001), complication rate (ρ:0.34, p < 0.001), percent change of eGFR (ρ:0.34, p < 0.001), and progression of chronic kidney disease stage (ρ:0.17, p = 0.02). Multivariate analysis revealed that SPARE significantly affected pentafecta (OR: 0.67, p < 0.001). In ROC curve analysis, SPARE showed fair predictive ability in the achievement pentafecta (AUC: 0.71). The predictive ability of pentafecta was similar between nephrometries (SPARE vs. R.E.N.A.L., p = 0.78; SPARE vs. PADUA, p = 0.66). The interobserver concordance of SPARE was excellent (Kappa: 0.82, p = 0.03). CONCLUSIONS SPARE system was a predictive factor of surgical outcomes after PN. This refined nephrometry had similar predictive abilities for pentafecta achievement compared with R.E.N.A.L. and PADUA.
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Affiliation(s)
- Chi-Ping Huang
- Department of Urology, China Medical University Hospital, No. 2, Yu-De Rd., Taichung City, Taiwan (R.O.C.).,School of Medicine, China Medical University, No. 91, Xueshi Rd., North Dist., Taichung City, 404, Taiwan (R.O.C.)
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University Hospital, No. 2, Yu-De Rd., Taichung City, Taiwan (R.O.C.).,School of Medicine, China Medical University, No. 91, Xueshi Rd., North Dist., Taichung City, 404, Taiwan (R.O.C.)
| | - Hsi-Chin Wu
- School of Medicine, China Medical University, No. 91, Xueshi Rd., North Dist., Taichung City, 404, Taiwan (R.O.C.).,Department of Urology, China Medical University Beigang Hospital, No. 123, Xinde Rd., Beigang Township, Yunlin County, 651, Taiwan (R.O.C.)
| | - Che-Rei Yang
- Department of Urology, China Medical University Hospital, No. 2, Yu-De Rd., Taichung City, Taiwan (R.O.C.)
| | - Po-Fan Hsieh
- Department of Urology, China Medical University Hospital, No. 2, Yu-De Rd., Taichung City, Taiwan (R.O.C.).,School of Medicine, China Medical University, No. 91, Xueshi Rd., North Dist., Taichung City, 404, Taiwan (R.O.C.)
| | - Guang-Heng Chen
- Department of Urology, China Medical University Hsinchu Hospital, No. 199, Sec. 1, Xinglong Rd., Zhubei City, Hsinchu County, 302, Taiwan (R.O.C.)
| | - Po-Jen Hsiao
- Department of Urology, China Medical University Hospital, No. 2, Yu-De Rd., Taichung City, Taiwan (R.O.C.).,Department of Urology, China Medical University Hsinchu Hospital, No. 199, Sec. 1, Xinglong Rd., Zhubei City, Hsinchu County, 302, Taiwan (R.O.C.)
| | - Yi-Huei Chang
- Department of Urology, China Medical University Hospital, No. 2, Yu-De Rd., Taichung City, Taiwan (R.O.C.)
| | - Yu-Ping Wang
- Department of Radiology, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist., Taichung City, 407, Taiwan (R.O.C.)
| | - Yu-De Wang
- Department of Urology, China Medical University Hospital, No. 2, Yu-De Rd., Taichung City, Taiwan (R.O.C.).
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Mari A, Tellini R, Porpiglia F, Antonelli A, Schiavina R, Amparore D, Bertini R, Brunocilla E, Capitanio U, Checcucci E, Da Pozzo L, Di Maida F, Fiori C, Francavilla S, Furlan M, Gontero P, Longo N, Roscigno M, Simeone C, Siracusano S, Ficarra V, Carini M, Minervini A. Perioperative and Mid-term Oncological and Functional Outcomes After Partial Nephrectomy for Complex (PADUA Score ≥10) Renal Tumors: A Prospective Multicenter Observational Study (the RECORD2 Project). Eur Urol Focus 2020; 7:1371-1379. [PMID: 32811779 DOI: 10.1016/j.euf.2020.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/12/2020] [Accepted: 07/24/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Partial nephrectomy (PN) for complex renal masses has a non-negligible risk of perioperative complications. Furthermore, late functional and oncological outcomes of patients submitted to these challenging surgeries still remain to be determined. OBJECTIVES To report the perioperative and mid-term oncological and functional outcomes of PN for complex masses (Preoperative Aspects and Dimensions Used for an Anatomical [PADUA] score≥10) in a large multicenter prospective observational study. DESIGN, SETTING, AND PARTICIPANTS We prospectively evaluated patients treated with PN for complex renal tumors at 26 urological centers (Registry of Conservative and Radical Surgery for Cortical Renal Tumor Disease [RECORD2] project). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariate logistic regression analyses explored the predictors of surgical complications. Multivariable Cox regression analyses estimated the hazard of renal function loss and disease recurrence. Kaplan-Meier estimates assessed the probability of survival. RESULTS AND LIMITATIONS In total, 410 patients who underwent PN for complex masses were evaluated. Clinical T1b and T2 tumors accounted for 43.2% and 9.8% of the cases. Overall, 45.9%, 18.8%, and 35.4% of patients underwent open, laparoscopic, and robotic PN, respectively. Intraoperative complications occurred in 15 (3.6%) patients, while postoperative surgical complications were recorded in 76 (18.5%) patients. At multivariable analysis, preoperative hemoglobin (odds ratio [OR]: 0.67; p<0.001) and open (OR: 3.91; p<0.001) versus robotic surgical approach were found to be the only predictors of surgical complications. An estimated glomerular filtration rate drop of >25% from baseline was observed in 30.2% and 17.6% of patients at 1st month and 2 yr after surgery, respectively. Two-year recurrence-free survival was 97.1%; positive surgical margins (hazard ratio [HR]: 3.35; p=0.009), nucleolar grading (HR: 5.61; p<0.001), and tumor stage (HR: 2.62; p=0.05) were associated with recurrence. CONCLUSIONS In a large series, PN for complex renal masses was a safe technique with an acceptable rate of perioperative complications and excellent mid-term oncological and functional results. PATIENT SUMMARY In this study, we evaluated peri- and postoperative outcomes of patients treated with partial nephrectomy for complex renal masses. Open surgery was associated with higher complications than the robotic approach. Some histological features were found to be associated with disease recurrence.
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Affiliation(s)
- Andrea Mari
- Department of Urology, University of Florence, Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Riccardo Tellini
- Department of Urology, University of Florence, Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Alessandro Antonelli
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, 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
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, 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
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, 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
| | - Simone Francavilla
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Maria Furlan
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Nicola Longo
- Department of Urology, University Federico II of Naples, Naples, Italy
| | - Marco Roscigno
- Department of Urology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Claudio Simeone
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Salvatore Siracusano
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, 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.
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Zeuschner P, Meyer I, Siemer S, Stoeckle M, Wagenpfeil G, Wagenpfeil S, Saar M, Janssen M. Three Different Learning Curves Have an Independent Impact on Perioperative Outcomes After Robotic Partial Nephrectomy: A Comparative Analysis. Ann Surg Oncol 2020; 28:1254-1261. [PMID: 32710272 PMCID: PMC7801306 DOI: 10.1245/s10434-020-08856-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/15/2020] [Indexed: 01/20/2023]
Abstract
Background Robot-assisted partial nephrectomy (RAPN) has become widely accepted, but its different underlying types of learning curves have not been comparatively analyzed to date. This study aimed to determine and compare the impact that the learning curve of the department, the console surgeon, and the bedside assistant as well as patient-related factors has on the perioperative outcomes of RAPN. Methods The study retrospectively analyzed 500 consecutive transperitoneal RAPNs (2007–2018) performed in a tertiary referral center by 7 surgeons and 37 bedside assistants. Patient characteristics and surgical data were obtained. Experience (EXP) was defined as the current number of RAPNs performed by the department, the surgeon, and the assistant. As the primary outcome, the impact of EXP and patient-related factors on perioperative outcomes were analyzed and compared. As the secondary outcome, a cutoff between “experienced” and “inexperienced” was defined. Correlation and regression analysis, receiver operating characteristic curve analysis, Fisher’s exact test, and the Mann–Whitney U test were performed, with p values lower than 0.05 denoting significance. Results The EXP of the department, the surgeon, and the assistant each has a major influence on perioperative outcome in RAPN irrespective of patient-related factors. Perioperative outcomes improve significantly with EXP greater than 100 for the department, EXP greater than 35 for the surgeon, and EXP greater than 15 for the assistant. Conclusions The perioperative results of RAPN are influenced by three different types of learning curves including those for the surgical department, the console surgeon, and the assistant. The influence of the bedside assistant clearly has been underestimated to date because it has a significant impact on the perioperative outcomes of RAPN. Electronic supplementary material The online version of this article (10.1245/s10434-020-08856-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Irmengard Meyer
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Stefan Siemer
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Michael Stoeckle
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Gudrun Wagenpfeil
- Department of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg/Saar, Germany
| | - Stefan Wagenpfeil
- Department of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg/Saar, Germany
| | - Matthias Saar
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Martin Janssen
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany. .,Department of Urology and Pediatric Urology, University Hospital of Munster, Münster, Germany.
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Weprin S, Falagario U, Veccia A, Nandanan N, Emerson D, Ovanez C, Albuquerque EV, Zukovski EB, Clayton R, Hampton L, Autorino R. Simplified PADUA Renal (SPARE) Nephrometry Scoring System: External Validation, Interobserver Variability, and Comparison with RENAL and PADUA in a Single-center Robotic Partial Nephrectomy Series. Eur Urol Focus 2020; 7:591-597. [PMID: 32591285 DOI: 10.1016/j.euf.2020.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/21/2020] [Accepted: 05/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The RENAL (radius [R], exophytic/endophytic [E], nearness to collecting system/sinus [N], anterior/posterior [A], and location relative to polar lines [L]) and the PADUA (preoperative aspects and dimensions used for an anatomical classification) scores help in quantifying tumor complexity. However, nephrometry scoring systems have low interobserver variability. To simplify and improve score reproducibility, a new Simplified PADUA Renal (SPARE) scoring system was introduced. OBJECTIVE To externally validate the SPARE nephrometry scoring system and to determine its interobserver variability. DESIGN, SETTING, AND PARTICIPANTS A total of 202 patients were included in the analysis. We performed a retrospective analysis of robot-assisted partial nephrectomy (RAPN) cases for a single renal mass performed at a single academic institution during the period 2008-2018. For each renal mass, PADUA, RENAL, and SPARE nephrometry scores were calculated. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Three urology residents (URs), two urology attendings (UAs), two radiology residents (RRs), and one radiology attending (RA) retrospectively reviewed computed tomography scans blinded to clinical outcomes. The accuracy of the SPARE nephrometry score in the prediction of any complication (Clavien grade ≥1) was compared with other scoring systems in a univariable and a multivariate fashion. The area under the curve (AUC) and kappa statistics were used to assess interobserver variability of the SPARE score. RESULTS AND LIMITATIONS The SPARE score was not inferior to the PADUA and RENAL scores (AUC 0.61, 0.59, and 0.57, respectively, p = 0.43). Patients with intermediate to high SPARE scores had longer operative time (158 vs 135 min, p = 0.10) and a higher rate of complications (28% vs 14%, p = 0.012). Univariable analysis predicting overall complications showed that RRs performed slightly better than URs and UAs using the SPARE score. Interobserver agreement was 84% between an RA and an RR (kappa 0.42), 85% between an RA and a UA (kappa 0.39), and 85% between an RA and a UR (kappa 0.45). CONCLUSIONS These findings confirm that the SPARE nephrometry scoring system is a reproducible and easy tool offering overall fair interobserver agreement regardless of years of training or type of practice, while maintaining the predictive capabilities of more established nephrometry scores. PATIENT SUMMARY In this study, a novel and simple classification system was assessed using a sample of cases from our institution to define surgical complexity renal masses detected on radiological imaging. Our findings suggest that this tool can be useful in clinical practice to facilitate the characterization of renal masses and predict the complications of surgical treatment.
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Affiliation(s)
- Samuel Weprin
- Division of Urology, VCU Health System, Richmond, VA, USA
| | - Ugo Falagario
- Division of Urology, VCU Health System, Richmond, VA, USA; Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Alessandro Veccia
- Division of Urology, VCU Health System, Richmond, VA, 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
| | | | - Dow Emerson
- Department of Radiology, VCU Health, Richmond, VA, USA
| | | | - Emanuel V Albuquerque
- Division of Urology, VCU Health System, Richmond, VA, USA; Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, São Paulo, Brazil
| | | | - Ryan Clayton
- Department of Radiology, VCU Health, Richmond, VA, USA
| | - Lance Hampton
- Division of Urology, VCU Health System, Richmond, VA, USA
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Shi N, Zu F, Shan Y, Chen S, Xu B, Du M, Chen M. The value of renal score in both determining surgical strategies and predicting complications for renal cell carcinoma: A systematic review and meta-analysis. Cancer Med 2020; 9:3944-3953. [PMID: 32281277 PMCID: PMC7286475 DOI: 10.1002/cam4.2993] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/29/2020] [Accepted: 02/29/2020] [Indexed: 01/20/2023] Open
Abstract
Objectives Radical nephrectomy (RN) was the standard treatment for renal cell carcinoma (RCC). However, recent studies have found that partial nephrectomy (PN) could achieve similar effects as radical nephrectomy, and has the advantages of less bleeding and shorter hospital stay. The choice of surgical strategies has become a concern of clinicians, which could be guided by renal score introduced by Kutikov et al Therefore, we conducted this meta‐analysis to clarify the value of renal score of determining surgical strategies and predicting complications. Methods The keywords “RENAL score,” “renal nephrometry score,” or “nephrometry score” were used to retrieve electronic databases for relevant literature up to Feb 2020, including PubMed, Web of Science, and the Cochrane library. Surgical strategies and complications are outcome measures. Risk ratio (RR) with 95% confidence intervals (CI) is applied to assess the effect size. Results A total of 20 studies met the selection criteria for meta‐analysis. There was significant difference in RN operation rate for each subgroup (low‐moderate: RR = 3.50, 95% Cl = 2.60‐4.71, P < .001; low‐high: RR = 6.29, 95% Cl = 4.40‐9.00, P < .001; moderate‐high: RR = 1.80, 95% Cl = 1.39‐2.32, P < .001).The overall incidence of complications from high renal score group was significantly higher than that in low renal score group (low‐moderate: RR = 1.32, 95% Cl = 1.03‐1.69, P = .026; low‐high: RR = 2.45, 95% Cl = 1.48‐4.07, P = .001; moderate‐high: RR = 1.75, 95% Cl = 1.17‐2.61, P = .007). Conclusions This meta‐analysis indicated that renal score is an efficient tool for determining surgical strategies and predicting complications in PN. More prospective research is essential to verify the predictive value of renal score.
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Affiliation(s)
- Naipeng Shi
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Feng Zu
- Department of Urology, Funing People's Hospital, Yancheng, Jiangsu, China
| | - Yong Shan
- Department of Urology, The Second People's Hospital of Taizhou, Taizhou, Jiangsu, China
| | - Shuqiu Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Bin Xu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Mulong Du
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
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Veccia A, Antonelli A, Uzzo RG, Novara G, Kutikov A, Ficarra V, Simeone C, Mirone V, Hampton LJ, Derweesh I, Porpiglia F, Autorino R. Predictive Value of Nephrometry Scores in Nephron-sparing Surgery: A Systematic Review and Meta-analysis. Eur Urol Focus 2019; 6:490-504. [PMID: 31776071 DOI: 10.1016/j.euf.2019.11.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/17/2019] [Accepted: 11/03/2019] [Indexed: 01/20/2023]
Abstract
CONTEXT Over the last decade, several nephrometry scores (NSs) have been introduced with the aim of facilitating preoperative decision making, planning, and counseling in the field of nephron-sparing surgery. However, their predictive role remains controversial. OBJECTIVE To describe currently available nephrometry scores and to determine their predictive role for different outcomes by performing a systematic review and meta-analysis of the literature. EVIDENCE ACQUISITION PubMed, Embase®, and Web of Science were screened to identify eligible studies. Identification and selection of the reports were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A pooled analysis of NS predictive role of intraoperative, postoperative, oncological, and functional outcomes was performed. Odds ratio was considered the effect size. All the analyses were performed using Stata 15.0, and statistical significance was set at p≤ 0.05. EVIDENCE SYNTHESIS Overall, 51 studies meeting our inclusion criteria were identified and considered for the analysis. Except for one prospective randomized trial, all the studies were retrospective. All the studies were found to be of intermediate quality, except for one of high quality. Most studies assessed the predictive role of the Radius-Exophytic/Endophytic-Nearness-Anterior/Posterior-Location (RENAL) and Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) scores, mostly regarding complications after nephron-sparing surgery. RENAL was an independent predictor of an on-clamp procedure (p< 0.001). Mayo Adhesive Probability score was related to adhesive perinephric fat (p= 0.005). Continuous and high-complexity RENAL scores were predictors of warm ischemia time (WIT; p= 0.006 and p< 0.001, respectively). Continuous (p< 0.001) and high-complexity (p< 0.001) PADUA scores were related to WIT. Continuous and high-complexity RENAL scores were predictors of overall complications (p= 0.002 and p< 0.001, respectively). PADUA score was related to complications both as continuous (p< 0.001) and as a categorical value (p< 0.002). The RENAL scores R=3 (p= 0.008), E=2 (p= 0.039), and hilar location (p= 0.006) were predictors of histological malignancy. Continuous and categorical RENAL scores were independent predictors of an estimated glomerular filtration rate (eGFR) increase (p= 0.006 and p< 0.001, respectively). The Diameter-Axial-Polar score (p= 0.018) and Peritumoral Artery Scoring System (PASS; p= 0.02) were also independent predictors. CONCLUSIONS The literature regarding nephrometry scoring systems is sparse, and mostly focused on RENAL and PADUA, which are easy to calculate and have a good correlation with most outcomes. Renal Pelvic Score is the best predictor of pelvicalyceal entry/repair and urine leak, whereas Surgical Approach Renal Ranking and PASS strongly predict surgical approach and renal function variation, respectively. Other nephrometry scores based on mathematical models are limited by their complexity, and they lack evidence supporting their predictive value. PATIENT SUMMARY We reviewed the medical literature regarding the use and value of so-called "nephrometry scores," which are scoring systems based on radiological imaging and made to grade the complexity of a renal tumor. We analyzed whether these scoring systems can predict some of the outcomes of patients undergoing surgical removal of renal tumors.
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Affiliation(s)
- Alessandro Veccia
- Division of Urology, VCU Health System, Richmond, VA, USA; Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Italy
| | - Alessandro Antonelli
- Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Italy
| | - Robert G Uzzo
- Division of Urology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Giacomo Novara
- Department of Oncologic, Surgical and Gastrointestinal Sciences, Urologic Unit, University of Padua, Italy
| | | | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Italy
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia, Italy
| | - Vincenzo Mirone
- Department of Urology, Federico II University, Naples, Italy
| | | | - Ithaar Derweesh
- Department of Urology, UCSD Health System, La Jolla, CA, USA
| | - Francesco Porpiglia
- Division of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
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Cheaib JG, Pierorazio PM. How Does Treatment Uncertainty Factor into Decisions to Place Patients on Active Surveillance for Kidney Cancer? Eur Urol Focus 2019; 5:946-948. [DOI: 10.1016/j.euf.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/26/2019] [Accepted: 07/08/2019] [Indexed: 01/30/2023]
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Bianchi L, Schiavina R, Borghesi M, Chessa F, Casablanca C, Angiolini A, Ercolino A, Pultrone CV, Mineo Bianchi F, Barbaresi U, Piazza P, Manferrari F, Bertaccini A, Fiorentino M, Ferro M, Porreca A, Marcelli E, Brunocilla E. Which patients with clinical localized renal mass would achieve the trifecta after partial nephrectomy? The impact of surgical technique. MINERVA UROL NEFROL 2019; 72:339-349. [PMID: 31619030 DOI: 10.23736/s0393-2249.19.03485-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND To develop a clinical nomogram aimed to predict the achievement of trifecta in patients treated with open, laparoscopic and robotic partial nephrectomy (PN) for localized renal masses (<cT2). METHODS We retrospectively evaluated 482 consecutive patients who underwent PN with open (OPN: 243), laparoscopic (LPN: 156) and robotic (RAPN: 83) approach for T1 renal mass at single tertiary center. Trifecta was defined as follows: warm ischemia time (WIT) <20 min and no positive surgical margins (PSM) and no postoperative complications. First, we compared clinical, pathologic and perioperative outcomes within the three surgical approaches. Second, multivariable logistic regression was performed to identify the independent predictors of the trifecta's achievement. Finally, regression-based coefficients were used to develop a nomogram predicting the likelihood to achieve the trifecta and 200 bootstrap resamples were used for internal validation. RESULTS The three cohorts were comparable in terms of demographics and clinical characteristics. Trifecta has been achieved in 49%, 50.6% and 69.9% of patients undergoing OPN, LPN and RAPN, respectively (P=0.003). At multivariable analyses, American Anesthesiologists Score (ASA) score 3-4 (Odd Ratio [OR]: 0.63; P=0.02), urinary collecting system (UCS) involvement (OR 0.56; P=0.02) and surgical approach (LPN and OPN vs. RAPN: OR: 0.39 and 0.38, respectively; P=0.001) were independent predictors of trifecta's achievement. A nomogram based on covariates included in the multivariable model demonstrated bootstrap-corrected predictive accuracy of 63%. CONCLUSIONS ASA Score, UCS involvement and the surgical technique were independent predictors of trifecta outcome. Our nomogram could facilitate the preoperative counselling and to choose the best surgical approach for PN.
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Affiliation(s)
- Lorenzo Bianchi
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy - .,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy -
| | - Riccardo Schiavina
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Marco Borghesi
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Francesco Chessa
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Carlo Casablanca
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Andrea Angiolini
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Amelio Ercolino
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Cristian V Pultrone
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Federico Mineo Bianchi
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Umberto Barbaresi
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Pietro Piazza
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Fabio Manferrari
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Alessandro Bertaccini
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Michelangelo Fiorentino
- Laboratory of Oncologic Molecular Pathology, Sant'Orsola-Malpighi Teaching Hospital, University of Bologna, Bologna, Italy
| | | | - Angelo Porreca
- Department of Urology, Abano Terme Hospital, Padua, Italy
| | - Emanuela Marcelli
- Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy.,Laboratory of Oncologic Molecular Pathology, Sant'Orsola-Malpighi Teaching Hospital, University of Bologna, Bologna, Italy.,Istituto Europeo di Urologia, Milan, Italy.,Department of Urology, Abano Terme Hospital, Padua, Italy.,Laboratory of Bioengineering, Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.,Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy
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Ficarra V, Porpiglia F, Crestani A, Minervini A, Antonelli A, Longo N, Novara G, Giannarini G, Fiori C, Simeone C, Carini M, Mirone V. The Simplified PADUA REnal (SPARE) nephrometry system: a novel classification of parenchymal renal tumours suitable for partial nephrectomy. BJU Int 2019; 124:621-628. [PMID: 30963680 DOI: 10.1111/bju.14772] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To simplify the original Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) classification of renal tumours, generating a new system able to predict equally or better the risk of overall complications in patients undergoing partial nephrectomy (PN); and to test if the addition of the contact surface area (CSA) parameter improves the accuracy of the original PADUA and new Simplified PADUA REnal (SPARE) nephrometry classification systems. PATIENTS AND METHODS We analysed the clinical records of 531 patients who underwent PN (open, laparoscopic and robot-assisted) for renal tumours at five tertiary academic referral centres from January 2014 to December 2016. The ability of each variable included in the PADUA classification to predict overall complications was tested using binary logistic regression analysis. The variables that were not statistically significant were excluded from the SPARE classification. In addition to the original PADUA and SPARE systems, another two models were generated adding tumour CSA. Receiver operating characteristic curve analysis was used to compare the ability of the four different models to predict overall complications. Binary logistic regression was used to perform both univariable and multivariable analyses looking for predictors of postoperative complications. Linear regression analysis was used to identify independent predictors of absolute change in estimated glomerular filtration rate (eGFR; ACE). RESULTS The SPARE nephrometry score system including: (i) rim location, (ii) renal sinus involvement, (iii) exophytic rate, and (iv) tumour dimension; showed equal performance in comparison with the original PADUA score (area under the curve [AUC] 0.657 vs 0.664). Adding tumour CSA to the original PADUA (AUC 0.661) or to the SPARE (AUC 0.658) scores did not increase the accuracy of either system to predict overall complications. The SPARE system (odds ratio 1.2, 95% confidence interval 1.1-1.3) was an independent predictor of postoperative overall complications. Age (P < 0.001), body mass index (P < 0.001), Charlson Comorbidity Index (P = 0.02), preoperative eGFR (P < 0.001), and tumour CSA (P = 0.005) were independent predictors of ACE. Limitations include the retrospective design and the lack of central imaging review. CONCLUSIONS The new SPARE score is comprised of only four variables instead of the original six and its accuracy to predict overall complications is similar to that of the original PADUA score. Addition of tumour CSA was not associated with an increase in prognostic accuracy. The SPARE system could replace the original PADUA score to evaluate the complexity of tumours suitable for PN.
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Affiliation(s)
- Vincenzo Ficarra
- Department of Human and Pediatric Pathology 'Gaetano Barresi', Urologic Section, University of Messina, Messina, Italy
| | - Francesco Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital Orbassano, University of Turin, Turin, Italy
| | | | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessandro Antonelli
- Urology Unit, ASST, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Nicola Longo
- Department of Urology, University Federico II of Naples, Napoli, Italy
| | - Giacomo Novara
- Urologic Unit, Department of Oncologic, Surgical and Gastrointestinal Sciences, University of Padua, Padua, Italy
| | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Cristian Fiori
- Division of Urology, San Luigi Gonzaga Hospital Orbassano, University of Turin, Turin, Italy
| | - Claudio Simeone
- Urology Unit, ASST, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Vincenzo Mirone
- Department of Urology, University Federico II of Naples, Napoli, Italy
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Porpiglia F, Amparore D, Checcucci E, Manfredi M, Stura I, Migliaretti G, Autorino R, Ficarra V, Fiori C. Three-dimensional virtual imaging of renal tumours: a new tool to improve the accuracy of nephrometry scores. BJU Int 2019; 124:945-954. [PMID: 31390140 DOI: 10.1111/bju.14894] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To apply the standard PADUA and RENAL nephrometry score variables to three-dimensional (3D) virtual models (VMs) produced from standard bi-dimensional imaging, thereby creating three-dimensional (3D)-based (PADUA and RENAL) nephrometry scores/categories for the reclassification of the surgical complexity of renal masses, and to compare the new 3D nephrometry score/category with the standard 2D-based nephrometry score/category, in order to evaluate their predictive role for postoperative complications. MATERIALS AND METHODS All patients with localized renal tumours scheduled for minimally invasive partial nephrectomy (PN) between September 2016 and September 2018 underwent 3D and 2D nephrometry score/category assessments preoperatively. After nephrometry score/category evaluation, all the patients underwent surgery. Chi-squared tests were used to evaluate the individual patients' grouping on the basis of the imaging tool (3D VMs and 2D imaging) used to assess the nephrometry score/category, while Cohen's κ coefficient was used to test the concordance between classifications. Receiver-operating characteristic curves were produced to evaluate the sensitivity and specificity of the 3D nephrometry score/category vs the 2D nephrometry score/category in predicting the occurrence of postoperative complications. A general linear model was used to perform multivariable analyses to identify predictors of overall and major postoperative complications. RESULTS A total of 101 patients were included in the study. The evaluation of PADUA and RENAL nephrometry scores via 3D VMs showed a downgrading in comparison with the same scores evaluated with 2D imaging in 48.5% and 52.4% of the cases. Similar results were obtained for nephrometry categories (29.7% and 30.7% for PADUA risk and RENAL complexity categories, respectively). The 3D nephrometry score/category demonstrated better accuracy than the 2D nephrometry score/category in predicting overall and major postoperative complications (differences in areas under the curve for each nephrometry score/category were statistically significant comparing the 3D VMs with 2D imaging assessment). Multivariable analyses confirmed 3D PADUA/RENAL nephrometry category as the only independent predictors of overall (P = 0.007; P = 0.003) and major postoperative complications (P = 0.03; P = 0.003). CONCLUSIONS In the present study, we showed that 3D VMs were more precise than 2D standard imaging in evaluating the surgical complexity of renal masses according to nephrometry score/category. This was attributable to a better perception of tumour depth and its relationships with intrarenal structures using the 3D VM, as confirmed by the higher accuracy of the 3D VM in predicting postoperative complications.
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Affiliation(s)
- Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano (Turin), Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano (Turin), Italy
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano (Turin), Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano (Turin), Italy
| | - Ilaria Stura
- Department of Public Health and Paediatric Sciences, School of Medicine, University of Turin, Orbassano (Turin), Italy
| | - Giuseppe Migliaretti
- Department of Public Health and Paediatric Sciences, School of Medicine, University of Turin, Orbassano (Turin), Italy
| | | | - Vincenzo Ficarra
- Urological Section, Department of Human and Paediatric Pathology, University of Messina, Messina, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano (Turin), Italy
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Zinssius D, Jünemann KP, Geiger F, Hamann C, Seiler F, Osmonov D. [Evaluation of the Padua and R.E.N.A.L. scores regarding their validity and implication in the perioperative management during partial nephrectomy]. Aktuelle Urol 2019; 53:423-430. [PMID: 31242516 DOI: 10.1055/a-0888-7234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Due to the rapid development of minimally-invasive surgery, there is a broader indication for surgical preservation of renal tissue. Current research suggests that, apart from the size of the tumour, its exact anatomical position should be considered when seeking optimal surgical treatment for individual patients. Therefore, numerous nephrometry scores have emerged, the Padua score and the R.E.N.A.L. score being most commonly used. Based on our patient population, we aimed to shed light on the question which score is best suited to assess the feasibility of nephron-sparing surgery and which can predict complications most accurately. PATIENTS AND METHODS This study included 117 patients treated with partial nephrectomy at the University Hospital in Kiel (UKSH, Campus Kiel) between 2014 and 2017. The imaging results (computed tomography and magnetic resonance tomography) were retrospectively evaluated according to the Padua and R.E.N.A.L. score criteria. In some cases, radical nephrectomy became necessary despite the planned partial nephrectomy. We evaluated group differences regarding both nephrometry scores in these cases and the cases without radical nephrectomy. Then we performed correlation analyses regarding score outcome, operation time as well as perioperative, postoperative and overall complications. RESULTS The tumours requiring treatment by radical nephrectomy (10 out of 117) had significantly higher scores only when the R.E.N.A.L. score was applied (mean difference 1.059, p < 0.05). Both the Padua and the R.E.N.A.L. score were positive correlated with operation time (R.E.N.A.L. score: correlation coefficient 0.284, p < 0.05, Padua score: coefficient 0.312, p < 0.05) as well as perioperative, postoperative and overall complications (R.E.N.A.L. score: coefficient 0.216, p < 0.05, Padua score: coefficient 0.192, p < 0.05). CONCLUSION Each of the examined scores can be used to assess the risk of partial nephrectomy. For our patients, the preoperative application of the R.E.N.A.L. score would have been advantageous. Preoperative nephrometry scores are a useful tool and should be applied in addition to the surgeon's subjective evaluation. There is a lack of prospective studies investigating this issue.
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Affiliation(s)
- Daniel Zinssius
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Urologie und Kinderurologie, Kiel
| | - Klaus-Peter Jünemann
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Urologie und Kinderurologie, Kiel
| | - Friedemann Geiger
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Institut für medizinische Psychologie und medizinische Soziologie, Kiel
| | - Claudius Hamann
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Urologie und Kinderurologie, Kiel
| | - Felix Seiler
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Urologie und Kinderurologie, Kiel
| | - Daniar Osmonov
- Universitätsklinikum Schleswig-Holstein Campus Kiel, Klinik für Urologie und Kinderurologie, Kiel
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Simone G, Tuderti G, Anceschi U, Ferriero M, Costantini M, Minisola F, Vallati G, Pizzi G, Guaglianone S, Misuraca L, Gallucci M. “Ride the Green Light”: Indocyanine Green–marked Off-clamp Robotic Partial Nephrectomy for Totally Endophytic Renal Masses. Eur Urol 2019; 75:1008-1014. [DOI: 10.1016/j.eururo.2018.09.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/10/2018] [Indexed: 01/20/2023]
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Swavely NR, Anele UA, Porpiglia F, Mir MC, Hampton LJ, Autorino R. Optimization of renal function preservation during robotic partial nephrectomy. Ther Adv Urol 2019; 11:1756287218815819. [PMID: 30671138 PMCID: PMC6329014 DOI: 10.1177/1756287218815819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/06/2018] [Indexed: 01/20/2023] Open
Abstract
Over the past few years, the role of robotic-assisted partial nephrectomy (RPN) has exponentially grown. Multiple recognized factors contribute to postoperative renal function in patients undergoing RPN. The aim of this review is to identify these potential factors, and to evaluate strategies that may help optimize the goal of renal function preservation. A nonsystematic literature review was performed to retrieve the most recent evidence on factors contributing to renal function post-RPN. Analyzed elements include baseline factors (tumor complexity and patient characteristics), intraoperative (surgical) factors (control of the renal hilum and type of ischemia, resection technique, renorrhaphy technique), and pharmacotherapeutics. In conclusion, the advantages of robotic surgery in the setting of partial nephrectomy (PN) are becoming well established. Maximal preservation of renal function remains a priority goal of the procedure, and it is influenced by a plethora of factors. Adequate patient selection using radiomics, control of comorbidities, utilization of evidence-based intraoperative techniques/strategies, and postoperative care are key components of postoperative preservation of renal function. Further investigations regarding these factors and their effects on long-term renal function are necessary and will continue to aid in guiding appropriate patient care.
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Affiliation(s)
- Natalie R Swavely
- Department of Surgery, VCU Health, Richmond, VA, USA Department of Surgery, McGuire VA Medical Center, Richmond, VA, USA
| | - Uzoma A Anele
- Department of Surgery, VCU Health, Richmond, VA, USA Department of Surgery, McGuire VA Medical Center, Richmond, VA, USA
| | | | - Maria C Mir
- Instituto Valenciano de Oncologia Foundation, Valencia, Spain
| | - Lance J Hampton
- Department of Surgery, VCU Health, Richmond, VA, USA Department of Surgery, McGuire VA Medical Center, Richmond, VA, USA
| | - Riccardo Autorino
- VCU Health and Division of Urology, Department of Surgery, McGuire VA Medical Center, 1200 East Broad St, Richmond, VA 23249, USA
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Cacciamani GE, Gill T, Medina L, Ashrafi A, Winter M, Sotelo R, Artibani W, Gill IS. Impact of Host Factors on Robotic Partial Nephrectomy Outcomes: Comprehensive Systematic Review and Meta-Analysis. J Urol 2018; 200:716-730. [DOI: 10.1016/j.juro.2018.04.079] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Giovanni E. Cacciamani
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Urology, University of Verona, Verona, Italy
| | - Tania Gill
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Luis Medina
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Akbar Ashrafi
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Matthew Winter
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Renè Sotelo
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Inderbir S. Gill
- USC Institute of Urology & Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
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Robotic versus open partial nephrectomy for highly complex renal masses: Comparison of perioperative, functional, and oncological outcomes. Urol Oncol 2018; 36:471.e1-471.e9. [DOI: 10.1016/j.urolonc.2018.06.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 06/20/2018] [Accepted: 06/27/2018] [Indexed: 01/20/2023]
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