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Morris LK, Altahan A, Gandhi J, Mays J, Giri U, Fleming M, Martin MG. Impact of margin status on survival after radical nephrectomy for renal cell carcinoma. J Surg Oncol 2020; 123:687-692. [PMID: 33333591 DOI: 10.1002/jso.26321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/12/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Data about the impact of surgical margin positivity on patient outcomes following radical nephrectomy (RN) for renal cell carcinoma (RCC) is limited. We evaluate the effect of positive surgical margins (PSMs) on relapse-free survival (RFS) and overall survival (OS.) METHODS: Clinicopathologic data of patients who underwent RN for RCC was analyzed based on margin status. χ2 and Student t test were used to compare groups. Cox regression analysis was used for the analysis. Kaplan-Meier method was used for survival curves. RESULTS A total of 485 patients who underwent RN for RCC were analyzed. Most patients with T1/T2 stage had NSM. Most patients with T4 had PSM. T3 patients were split between the two groups. Analysis of the T3 group showed shorter RFS in the PSM group at 3 years (hazard ratio [HR]: 4.3, p = .01), and 5 years (HR: 4.3, p = .01.) OS analysis showed worse OS in PSM but not statistically significant. There was a significant association between PSM and laterality (p = .023) and histologic type (p = .025.) CONCLUSIONS: PSM was associated with shorter RFS after RN in T3 RCC patients. There was a trend towards worse OS in the PSM group, but it did not reach statistical significance. Laterality and histologic type were associated with surgical margin status.
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Affiliation(s)
- Lindsay K Morris
- College of Medicine (Medical School), University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Alaa Altahan
- Department of Hematology and Oncology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jatin Gandhi
- Department of Pathology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - John Mays
- College of Medicine (Medical School), University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Upama Giri
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Martin Fleming
- Department of Surgical Oncology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mike G Martin
- Medical Oncology Division, West Cancer Center Research & Institute, Germantown, Tennessee, USA
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Wang B, Tian Y, Peng Y, Ban Y, Shan G, Tan X, Tang X, Luo G, Sun Z. Comparative Study of Retroperitoneal Laparoscopic Versus Open Ipsilateral Nephrectomy After Percutaneous Nephrostomy: A Multicenter Analysis. J Laparoendosc Adv Surg Tech A 2020; 30:520-524. [PMID: 32027216 DOI: 10.1089/lap.2019.0746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose: To investigate the feasibility of retroperitoneal laparoscopic ipsilateral nephrectomy of a benign nonfunctional kidney after percutaneous nephrostomy, and to compare this method with open surgery. Materials and Methods: Data from 70 patients who underwent simple nephrectomy from January 2014 to October 2018 at three large centers were retrospectively analyzed. All patients underwent percutaneous nephrostomy because of renal or ureteral calculi with severe hydronephrosis or pyonephrosis. Simple nephrectomy was performed via retroperitoneal laparoscopic surgery (retroperitoneal laparoscopic group; n = 33) or open surgery (open group; n = 37). The retroperitoneal laparoscopic and open groups were compared regarding preoperative variables (age, sex, location of surgery, hypertension, diabetes, BMI, preoperative serum creatinine level, American Society of Anesthesiologists (ASA) grade, fistula duration, fistula size, number of fistulae, and urinary tract infection), and perioperative variables (operation time, intraoperative blood loss, postoperative drainage volume, catheter indwelling time, gastrointestinal function recovery time, duration of bedrest, duration of postoperative hospitalization, postoperative hemoglobin decline, perioperative transfusion, and postoperative complications). Results: The retroperitoneal laparoscopic group included more patients with hydronephrosis, while the open group included more patients with pyonephrosis. There were no significant differences between the two groups in age (P = .813), sex (P = .729), location of surgery (P = .345), hypertension (P = .271), diabetes (P = .394), BMI (P = .798), preoperative serum creatinine level (P = .826), ASA grade (P = .820), fistula duration (P = .108), fistula size (P = .958), number of fistulae (P = .925), urinary tract infection (P = .111), or operative time (P = .851). The retroperitoneal laparoscopic group had significantly lesser intraoperative blood loss (P = .007), postoperative drainage volume (P = .008), shorter catheter indwelling time (P = .002), gastrointestinal function recovery time (P < .001), duration of bedrest (P < .001), and duration of postoperative hospitalization (P < .001), and lesser postoperative hemoglobin decline (P = .035) compared with the open group. Conclusions: Retroperitoneal laparoscopic ipsilateral nephrectomy is feasible for a benign nonfunctional kidney after percutaneous nephrostomy. The surgical method should be selected based on the surgeon's experience and the specific situation of the patient.
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Affiliation(s)
- Bo Wang
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China
| | - Ye Tian
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China
| | - Yue Peng
- Department of Nephrology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, P.R. China
| | - Yong Ban
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China
| | - Gang Shan
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China
| | - Xianyu Tan
- Department of Orthopedics, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, P.R. China
| | - Xiaohu Tang
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China
| | - Guangheng Luo
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China
| | - Zhaolin Sun
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, P.R. China
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Liu G, Ma Y, Wang S, Han X, Gao D. Laparoscopic Versus Open Radical Nephrectomy for Renal Cell Carcinoma: a Systematic Review and Meta-Analysis. Transl Oncol 2017; 10:501-510. [PMID: 28550770 PMCID: PMC5447386 DOI: 10.1016/j.tranon.2017.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The aim of this study is to summarize and quantify the current evidence on the therapeutic efficacy of laparoscopic radical nephrectomy (LRN) compared with open radical nephrectomy (ORN) in patients with renal cell carcinoma (RCC) in a meta-analysis. METHODS Data were collected by searching Pubmed, Embase, Web of Science, and ScienceDirect for reports published up to September 26, 2016. Studies that reported data on comparisons of therapeutic efficacy of LRN and ORN were included. The fixed-effects model was used in this meta-analysis if there was no evidence of heterogeneity; otherwise, the random-effects model was used. RESULTS Thirty-seven articles were included in the meta-analysis. The meta-analysis showed that the overall mortality was significantly lower in the LRN group than that in the ORN group (odds ratio [OR] =0.77, 95% confidence interval [CI]: 0.62-0.95). However, there was no statistically significant difference in cancer-specific mortality (OR=0.77, 95% CI: 0.55-1.07), local tumor recurrence (OR=0.86, 95% CI: 0.65-1.14), and intraoperative complications (OR=1.27, 95% CI: 0.83-1.94). The risk of postoperative complications was significantly lower in the LRN group (OR=0.71, 95% CI: 0.65-0.78). In addition, LRN has been shown to offer superior perioperative results to ORN, including shorter hospital stay days, time to start oral intake, and convalescence time, and less estimated blood loss, blood transfusion rate, and anesthetic consumption. CONCLUSION LRN was associated with better surgical outcomes as assessed by overall mortality and postoperative complications compared with ORN. LRN has also been shown to offer superior perioperative results to ORN.
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Affiliation(s)
- Gang Liu
- Department of Urology, Affiliated Hospital of Weifang Medical University
| | - Yulei Ma
- Department of Urology, Affiliated Hospital of Weifang Medical University
| | - Shouhua Wang
- Department of Urology, Affiliated Hospital of Weifang Medical University.
| | - Xiancheng Han
- Department of Urology, Affiliated Hospital of Weifang Medical University
| | - Dianjun Gao
- Department of Urology, Affiliated Hospital of Weifang Medical University
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Shen H, Tu R, Li W, He G, Huang W, Qin Z, Wang C, Yu S. Comparison of the Clinical Efficacy of Retroperitoneal Laparoscopic Partial Nephrectomy and Radical Nephrectomy for Treating Small Renal Cell Carcinoma: Case Report and Literature Review. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017; 18:e23912. [PMID: 28182157 PMCID: PMC5287050 DOI: 10.5812/ircmj.23912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 06/30/2015] [Accepted: 07/23/2015] [Indexed: 01/17/2023]
Abstract
Background Renal cell carcinoma (RCC) is a common malignancy of the urinary system with high rates of morbidity and mortality. Objectives This study aimed to investigate and analyze the clinical efficacy of retroperitoneal laparoscopic partial nephrectomy and laparoscopic radical nephrectomy for the treatment of small RCC. Methods In this retrospective study of 45 patients with small RCC, the patients were divided into two treatment groups: Group A (retroperitoneal laparoscopic partial nephrectomy, 25 cases) and Group B (retroperitoneal laparoscopic radical nephrectomy, 20 cases). Results There were no statistically significant differences in the operative time, amount of intraoperative blood loss, length of hospital stay, preoperative creatinine level, postoperative creatinine level after 24 hours, and survival rate after 1, 2, and 3 years between the two groups (P > 0.05). Conclusions There were no significant differences in the survival rates and short-term postoperative complications between the laparoscopic partial nephrectomy group and the laparoscopic radical nephrectomy group for small RCC, but the former was slightly more effective.
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Affiliation(s)
- Hongfeng Shen
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Ruisha Tu
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Wei Li
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Geng He
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Wei Huang
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Zhenchang Qin
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Chongfeng Wang
- Department of Urology, 187 Hospital of PLA, Hainan, China
| | - Shuyong Yu
- Department of Urology, 187 Hospital of PLA, Hainan, China
- Corresponding Author: Shuyong Yu, Department of Urology, 187 Hospital of PLA, Hainan, China. Tel: +86-13876769088, Fax: +86-13876769088, E-mail:
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Chung JH, Lee SW, Lee KS, Cho WY, Kim TH. Safety of en bloc ligation of the renal hilum during laparoscopic radical nephrectomy for renal cell carcinoma: a randomized controlled trial. J Laparoendosc Adv Surg Tech A 2013; 23:489-94. [PMID: 23621831 DOI: 10.1089/lap.2012.0444] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIM To evaluate the safety of en bloc stapler ligation of the renal vascular pedicle during laparoscopic radical nephrectomy for renal cell carcinoma. SUBJECTS AND METHODS Clinical data were collected prospectively from 70 patients who underwent either en bloc stapling of the renal hilum (n=35) (Group A) or the separate ligation method (n=35) (Group B) to treat renal cell carcinoma. To evaluate the incidence of arteriovenous fistula (AVF), blood pressure and heart rate were measured, and abdominal auscultation was performed at 1 month, 3 months, 6 months, and 12 months post-surgery. Abdominal computed tomography was also performed at 6 and 12 months post-surgery. In addition, preoperative characteristics and postoperative outcomes (such as operation time and estimated blood loss [EBL]) were examined. RESULTS Both operation time and EBL were lower for Group A: operative time, Group A versus Group B, 60.26±10.94 minutes versus 67.51±10.49 minutes (P=.007); EBL, Group A versus Group B, 33.53±13.46 mL versus 49.14±32.21 mL (P=.011). No statistically significant differences were noted in either of the postoperative variables (blood pressure and heart rate), and there was no clinical evidence of bruit or AVF at 12 months post-surgery. CONCLUSIONS No AVF was observed after en bloc ligation upon clinical follow-up or on radiological evaluation.
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Affiliation(s)
- Jae Hoon Chung
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
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Kwon SY, Bae JJ, Lee JG, Choi SH, Kim BS, Yoo ES, Kwon TG, Kim TH. Obesity is an adverse factor on laparoscopic radical nephrectomy for t2 but not t1 renal cell carcinoma. Korean J Urol 2011; 52:538-42. [PMID: 21927700 PMCID: PMC3162219 DOI: 10.4111/kju.2011.52.8.538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 07/08/2011] [Indexed: 11/18/2022] Open
Abstract
Purpose Laparoscopic radical nephrectomy (LRN) is more challenging with increases in body mass index (BMI). Several recent studies have shown, however, that LRN can be safely performed even in obese patients. The influence of obesity on the perioperative outcomes of LRN has not been well elucidated for large renal tumors (>7 cm), however. We estimated the impact of obesity on LRN for stage T1 and T2 renal cell carcinoma (RCC). Materials and Methods From January 2004 to March 2011, 266 patients underwent LRN (T1: 195, T2: 71). These patients were subdivided into the following two groups according to BMI: the nonobese group (BMI less than 25 kg/m2) and the obese group (BMI greater than 25 kg/m2). Perioperative outcomes were retrospectively compared between these two groups in T1 and T2 RCC patients. Results There were no significant differences in perioperative outcomes between the obese and nonobese groups of T1 RCC patients. However, in T2 RCC patients, operative time and complication rate were significantly increased in the obese group. Conclusions Our results suggest that LRN can be safely performed in Korean patients with T1 RCC regardless of obesity. In T2 RCC patients, however, LRN may become more difficult with increasing BMI considering a longer operation time as well as a higher complication rate. We suggest that LRN for obese patients with T2 RCC be carefully considered.
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Affiliation(s)
- Se Yun Kwon
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
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7
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Jeong W, Rha KH, Kim HH, Byun SS, Kwon TG, Seo IY, Sung GT, Jeon SH, Jeong YB, Hong SH. Comparison of Laparoscopic Radical Nephrectomy and Open Radical Nephrectomy for Pathologic Stage T1 and T2 Renal Cell Carcinoma With Clear Cell Histologic Features: A Multi-institutional Study. Urology 2011; 77:819-24. [DOI: 10.1016/j.urology.2010.06.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 05/13/2010] [Accepted: 06/06/2010] [Indexed: 11/26/2022]
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8
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Conradie MC, Urry RJ, Naidoo D, Mahmood K, Jogiat Z, Alsharef M, Mierzwinski R. Advantages of en bloc hilar ligation during laparoscopic extirpative renal surgery. J Endourol 2009; 23:1503-7. [PMID: 19673656 DOI: 10.1089/end.2009.0380] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE By evaluating the technical challenges encountered during 123 laparoscopic nephrectomies, we have been able to modify the surgical technique to allow general urologists to effectively perform the procedure with minimal complications. DESIGN AND METHOD A retrospective chart review was performed on 123 patients who consecutively underwent laparoscopic nephrectomy or nephroureterectomy. Using a modified dissection approach to the hilum and en bloc ligation of the renal pedicle with a vascular stapler, a new standard of laparoscopic nephrectomy was developed at our institution. In 30 cases, the conventional technique was used, whereas in 93 cases the en bloc technique was used. Operating time, blood loss, transfusion requirements, intra- and postoperative complications, and the incidence of arteriovenous fistula (AVF) were documented. Follow-up included serial clinical evaluation and computed tomography angiogram at 3 months and repeated at 3-monthly intervals where indicated. RESULTS Operative and postoperative parameters were improved in the en bloc group compared with the conventional group. In the en bloc group, the average operating time was 56 minutes and the average blood loss was 32 mL. No patients required a blood transfusion and only two cases required conversion to open nephrectomy. No late vascular complications related to this method were observed with a mean follow-up of 28 months. There were no perioperative deaths. Postoperative complications were self-limiting and no patients developed postnephrectomy AVF. CONCLUSION The results of using the en bloc ligation technique for laparoscopic nephrectomy have been favorable in terms of operating time, risk to the patient, and surgeon's surgical preference. The risk of AVF formation after en bloc ligation of the renal pedicle and ligation by the conventional method appears to be equal based on the clinical follow-up and radiological evaluation. Therefore, long-term radiological follow-up is not mandatory in most cases.
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Affiliation(s)
- Marius C Conradie
- Department of Urology, Greys Hospital, Pietermaritzburg, South Africa.
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9
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Krebs RK, Andreoni C, Khalil W, Ortiz V. Contemporary Different Patterns of Indications and Outcomes for the Surgical Management of Renal Tumors in an Academic Center. J Endourol 2009; 23:1903-7. [DOI: 10.1089/end.2009.0405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rodrigo K. Krebs
- Division of Urology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Cassio Andreoni
- Division of Urology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Walid Khalil
- Division of Urology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Valdemar Ortiz
- Division of Urology, Federal University of Sao Paulo, Sao Paulo, Brazil
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Yoo KH, Lee HL, Chang SG, Jeon SH. Renal Function Outcomes in Patients Undergoing Open or Laparoscopic Radical Nephrectomy. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.6.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Koo Han Yoo
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyung-Lae Lee
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung-Goo Chang
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seung Hyun Jeon
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
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Colombo JR, Haber GP, Jelovsek JE, Lane B, Novick AC, Gill IS. Seven years after laparoscopic radical nephrectomy: oncologic and renal functional outcomes. Urology 2008; 71:1149-54. [PMID: 18313111 DOI: 10.1016/j.urology.2007.11.081] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 10/15/2007] [Accepted: 11/15/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare the long-term oncologic and renal function outcomes in patients undergoing laparoscopic (LRN) versus open radical nephrectomy (ORN). METHODS The medical records of 116 patients undergoing radical nephrectomy for pathologically confirmed renal cell carcinoma before January 2000 were reviewed. Of these 116 patients, 63 underwent LRN and 53 ORN. The oncologic and renal functional data were obtained from the patient charts, radiographic reports, and direct telephone calls to the patients or their families. RESULTS The median follow-up was 65 months (range 19 to 92) in the LRN group and 76 months (range 8 to 105) in the ORN group. LRN was successfully completed in all patients without open conversion. The mean tumor size was 5.4 cm in the LRN group and 6.4 cm in the ORN group (P = 0.007). The 5-year overall survival (78% versus 84%, respectively; P = 0.24), cancer-specific survival (91% versus 93%, respectively; P = 0.75), and recurrence-free survival (91% versus 93%, respectively; P = 0.75) rates were similar between the LRN and ORN groups. At 7 years, the overall survival (72% versus 84%; P = 0.24), cancer-specific survival (91% versus 93%; P = 0.75), and recurrence-free survival (91% versus 93%; P = 0.75) rates were also comparable. No port site recurrence was noted in the laparoscopic group. The long-term renal function outcomes were similar in the LRN and ORN groups, with serum creatinine increasing by 33% and 25%, and the estimated creatinine clearance decreasing by 31% and 23% from baseline, respectively. Chronic renal insufficiency developed in 4% of patients in each group. CONCLUSIONS The results of our study have shown that LRN and ORN have comparable long-term oncologic and renal functional outcomes.
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Affiliation(s)
- Jose R Colombo
- Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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12
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Challacombe B, Sahai A, Murphy D, Dasgupta P. Laparoscopic retroperitoneal nephrectomy for giant hydronephrosis: when simple nephrectomy isn't simple. J Endourol 2007; 21:437-40. [PMID: 17451339 DOI: 10.1089/end.2006.0246] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Retroperitoneoscopic nephrectomy (RN) for giant hydronephrosis (GH) is regarded as a more challenging procedure than RN for small nonfunctioning kidneys (SNFK). We describe specific technical modifications to facilitate surgery in the GH group and compare outcomes in the two groups. PATIENTS AND METHODS Data were collected in a prospective fashion on all patients undergoing upper urinary-tract laparoscopy at a single institution. Eleven patients (eight women, three men; mean age 41 years) underwent RN for GH. The etiologies were congenital ureteropelvic junction obstruction in 10 and obstruction secondary to endometriosis in 1. Technical modifications to facilitate surgery included initial fingerplasty, balloon dissection in two directions, initial intact dissection, subsequent pelvic puncture and aspiration, and extracorporeal retraction if required. The results were compared with those of a matched group of 19 patients who had RN for SNFK. RESULTS All procedures were completed without open conversion. In the GH group, the mean operating time was 126 minutes (range 65-240 minutes) and the estimated blood loss 101 mL (range 5-450 mL). No patient required transfusion, and the mean length of the hospital stay was 2.9 days (range 1.5-6 days). In the group undergoing RN for SNFK, the mean operating time was 116 minutes (range 55-270 minutes), the estimated blood loss 46 mL (range 5-400 mL), and the mean length of stay 2.8 days (range 1-5 days). In the GH group, the estimated blood loss was significantly greater (P = 0.042), and the operative time was longer, although this difference did not reach statistical significance. CONCLUSION An RN for GH is not as simple as laparoscopic simple nephrectomy for other benign lesions. Operative duration and blood loss are greater. Technical modifications have been vital to our success with this procedure.
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Affiliation(s)
- Ben Challacombe
- Department of Urology, Guy's Hospital and GKT School of Medicine, London, UK
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13
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Colombo JR, Haber GP, Aron M, Cocuzza M, Colombo R, Kaouk J, Gill IS. Oncological outcomes of laparoscopic radical nephrectomy for renal cancer. Clinics (Sao Paulo) 2007; 62:251-6. [PMID: 17589664 DOI: 10.1590/s1807-59322007000300008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Accepted: 12/26/2006] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To report the 5-year oncological outcomes of patients undergoing laparoscopic radical nephrectomy for renal cancer compared to a cohort of patients undergoing open radical nephrectomy. METHODS We retrospectively analyzed the data of 88 patients undergoing radical nephrectomy for renal cell carcinoma prior to January 2000. Of these, 45 patients underwent laparoscopic radical nephrectomy, and 43 patients underwent open radical nephrectomy. Inclusion criteria comprised clinically organ-confined tumors of 15 cm or less in size without concomitant lymphadenopathy or vena cava thrombus. Oncological follow-up data were obtained from charts, radiological reports, and phone calls to patients or their families, and were calculated from the date of surgery to the date of last appointment with physician or date of death. RESULTS All laparoscopic procedures were completed without open conversion. On comparing the laparoscopic radical nephrectomy and open radical nephrectomy groups, mean tumor size was 5. 8 vs 6.2 cm (P = . 44), mean blood loss was 183 vs 461 mL (P = . 004), and mean operative time was 2.8 vs 3.7 hrs (P < . 001). Over a mean follow-up of 5 years in the laparoscopic radical nephrectomy group and 6 years in the open radical nephrectomy group, the overall survival was 81% vs 79% (P = . 47), and cancer-specific survival was 90% vs 92% (P = . 70) , respectively. CONCLUSIONS Laparoscopic radical nephrectomy for renal cancer confers equivalent 5-year oncological outcomes to those of open surgery.
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Affiliation(s)
- Jose R Colombo
- Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Kouba E, Smith A, McRackan D, Wallen EM, Pruthi RS. Watchful waiting for solid renal masses: insight into the natural history and results of delayed intervention. J Urol 2007; 177:466-70; discussion 470. [PMID: 17222611 DOI: 10.1016/j.juro.2006.09.064] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE We describe the short-term outcomes of patients whose renal masses were managed expectantly (ie watchful waiting) to provide insight into the natural history of small renal tumors. Additionally, this study examined the effects of delayed intervention in patients who required intervention after a period of expectant management. MATERIALS AND METHODS A total of 43 patients with 46 renal masses underwent planned expectant management of enhancing solid or cystic (Bosniak IV) renal masses. A subset of these patients (13) who underwent eventual intervention was also examined. Outcomes with regard to age, gender, growth rate, subsequent interventions and clinical followup are reported. RESULTS At a mean followup of 36 months 74% of patients had tumor growth with a mean (median) growth rate of 0.70 (0.35) cm per year. None of the patients had significant symptoms, disease progression or cancer specific death. There were 4 patients (10%) who died of other causes. The 13 patients undergoing eventual intervention were younger than those who did not undergo intervention (56 vs 72 years, respectively, p = 0.0006). Patients undergoing eventual intervention tended to have a higher tumor growth rate than those on continued observation (0.90 vs 0.61 cm per year, respectively, p = 0.1486). In patients undergoing eventual intervention 12 of 14 (87%) tumors were renal cell carcinoma. All were stage pT1, and 12 of 13 patients were alive after a mean followup of 41 months (1 patient died of other causes 30 months after surgery). No patient had up-staging of disease secondary to delay. CONCLUSIONS Watchful waiting for renal masses is a reasonable option for appropriately selected patients, especially those with competing comorbidities. Delayed intervention does not appear to adversely impact pathological outcomes.
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Affiliation(s)
- Erik Kouba
- Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
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Kouba E, Smith AM, Derksen JE, Gunn K, Wallen E, Pruthi RS. Efficacy and Safety of En Bloc Ligation of Renal Hilum During Laparoscopic Nephrectomy. Urology 2007; 69:226-9. [PMID: 17275073 DOI: 10.1016/j.urology.2006.09.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 07/15/2006] [Accepted: 09/21/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the feasibility, efficacy, and safety of en bloc ligation of the renal hilum with titanium vascular staplers during laparoscopic nephrectomy. En bloc ligation of the renal hilum has historically been associated with the very rare complication of arteriovenous fistula (AVF) formation, primarily in inflammatory renal pathologic features. Currently, no evidence exists of AVF development in human nephrectomies after ligating the hilum en bloc with titanium staplers. METHODS A total of 161 consecutive patients underwent planned laparoscopic radical nephrectomy or nephroureterectomy. A retrospective review was performed to evaluate the operative variables, including the method of hilar ligation, estimated blood loss, and final pathologic findings. The additional postoperative outcomes of diastolic blood pressure, heart rate, and other cardiovascular sequelae were evaluated. RESULTS Of the 161 patients, 90 underwent en bloc hilar ligation and 71 underwent individual hilar vessel ligation with the stapler. The blood loss and open conversion rate trended lower in the en bloc group. Postoperatively, no differences were found in blood pressure or heart rate between the two groups, and no instances of bruits or other clinical evidence of AVF were found after mean follow-up of 34 months. CONCLUSIONS This series found no evidence of AVF or other adverse clinical events in patients undergoing en bloc ligation of the renal hilum and laparoscopic nephrectomy. En bloc ligation may provide for more secure, expeditious control of the hilum without an increased operative time or the added potential of vascular injury that can be associated with the individual dissection of the vessels.
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Affiliation(s)
- Erik Kouba
- Division of Urologic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
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Colombo JR, Haber GP, Rubinstein M, Gill IS. Laparoscopic surgery in urological oncology: brief overview. Int Braz J Urol 2006; 32:504-12. [PMID: 17081318 DOI: 10.1590/s1677-55382006000500002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2006] [Indexed: 11/22/2022] Open
Abstract
The authors report the experience of a high-volume center with laparoscopic surgery in urological oncology, as well as a review of other relevant series. Laparoscopic outcomes in the treatment of adrenal, kidney, upper tract transitional cell carcinoma, bladder, prostate, and testicular malignancy are described in this review. Specific considerations as complications and port-site recurrence are also addressed. The authors concluded that the intermediate-term oncological data is encouraging and comparable to open surgery.
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Affiliation(s)
- Jose R Colombo
- Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Bibliography. Current world literature. Minimally invasive surgery in urology. Curr Opin Urol 2006; 16:112-7. [PMID: 16479214 DOI: 10.1097/01.mou.0000193398.85092.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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LiteratureWatch. J Endourol 2005; 19:1045-62. [PMID: 16253079 DOI: 10.1089/end.2005.19.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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