1
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French AFU Cancer Committee Guidelines - Update 2022-2024: management of kidney cancer. Prog Urol 2022; 32:1195-1274. [DOI: 10.1016/j.purol.2022.07.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
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2
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Differential changes in self-reported quality of life in elderly populations after diagnosis of a genitourinary malignancy. Urol Oncol 2022; 40:455.e1-455.e10. [DOI: 10.1016/j.urolonc.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/19/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022]
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3
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Jiang H, Zhou X, Zhan X, Li Y, Xiong Y, Long J, Li S, Liu X, Fu B. Clinical study of centrality index in predicting the postoperative pathological nuclear grade of clear cell renal cell carcinoma. Int Urol Nephrol 2022; 54:3117-3122. [PMID: 36030357 DOI: 10.1007/s11255-022-03349-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/20/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to investigate whether the centrality index score (C index) can be used to predict the histological nuclear grade of clear cell renal cell carcinoma (ccRCC) and guide the clinical treatment of this disease. METHODS This study included 194 patients with ccRCC who underwent renal surgery at our center between 2016 and 2020 and had complete computed tomography or computed tomography angiography (CT/CTA) data and C index. The relationship between the pathological grade of renal masses and the C index was evaluated. RESULTS In univariate analysis, the gender, body mass index (BMI), tumor size, or height from the center of the renal hilum to the maximum diameter of the tumor along the 90° vertical axis (in cm) is y. The horizontal distance from the reference point of the central axis of the renal hilum to the tumor center is x. The distance from the center of the kidney to the center of the tumor is c and the C index was significantly correlated with postoperative tumor grade (p < 0.05). Multivariate analysis showed that tumor size and C index were independent prognostic factors for the preoperative prediction of the pathological grade factor of ccRCC. The receiver operating characteristic curves of the multi-parameter regression model [0.9471, 95% confidence interval (95% CI) 0.9138-0.9803], C index (0.9324, 95% CI 0.8899-0.9748), and tumor size (0.9307, 95% CI 0.8951-0.9663) were compared. CONCLUSION Tumor size and C index were independent prognostic factors for high-grade pathology, and large tumors and small C index were associated with high-grade pathology. Therefore, the C index can help urologists make treatment decisions.
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Affiliation(s)
- Haoxin Jiang
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Xiangpeng Zhan
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Yu Li
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Yunqiang Xiong
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Jiahui Long
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Sheng Li
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Xiaoqiang Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, People's Republic of China.
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, People's Republic of China.
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4
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Zhang XM, Xu JD, Lv JM, Pan XW, Cao JW, Chu J, Cui XG. “Zero ischemia” laparoscopic partial nephrectomy by high-power GreenLight laser enucleation for renal carcinoma: A single-center experience. World J Clin Cases 2022; 10:5646-5654. [PMID: 35979100 PMCID: PMC9258349 DOI: 10.12998/wjcc.v10.i17.5646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic partial nephrectomy has been widely used in renal cell carcinoma treatment. The efficacy of GreenLight laser on Laparoscopic partial nephrectomy is still unknown.
AIM To present the first series of laparoscopic partial nephrectomy (LPN) by GreenLight laser enucleation without renal artery clamping. Due to the excellent coagulation and hemostatic properties of the laser, laser-assisted LPN (LLPN) makes it possible to perform a “zero ischemia” resection.
METHODS Fifteen patients with T1a exogenous renal tumors who received high-power GreenLight laser non-ischemic LPN in our hospital were retrospectively analyzed. All clinical information, surgical and post-operative data, complications, pathological and functional outcomes were analyzed.
RESULTS Surgery was successfully completed in all patients, and no open or radical nephrectomy was performed. The renal artery was not clamped, leading to no ischemic time. No blood transfusions were required, the average hemoglobin level ranged from 96.0 to 132.0 g/L and no postoperative complications occurred. The mean operation time was 104.3 ± 8.2 min. The postoperative removal of negative pressure drainage time ranged from 5.0 to 7.0 d, and the mean postoperative hospital stay was 6.5 ± 0.7 d. No serious complications occurred. Postoperative pathological results showed clear cell carcinoma in 12 patients, papillary renal cell carcinoma in 2 patients, and hamartoma in 1 patient. The mean creatinine level was 75.0 ± 0.8 μmol/L (range 61.0-90.4 μmol/L) at 1 mo after surgery, and there were no statistically significant differences compared with pre-operation (P > 0.05). The glomerular filtration rate ranged from 45.1 to 60.8 mL/min, with an average of 54.0 ± 5.0 mL/min, and these levels were not significantly different from those before surgery (P > 0.05).
CONCLUSION GreenLight laser has extraordinary cutting and sealing advantages when used for small renal tumors (exogenous tumors of stage T1a) during LPN. However, use of this technique can lead to the generation of excessive smoke.
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Affiliation(s)
- Xiang-Min Zhang
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200092, China
- Department of Urology, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China
| | - Ji-Dong Xu
- Department of Urology, Gongli Hospital of The Second Military Medical University, Shanghai 200135, China
| | - Jian-Min Lv
- Department of Urology, Shanghai The Seventh People's Hospital, Shanghai 200137, China
| | - Xiu-Wu Pan
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200092, China
| | - Jian-Wei Cao
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200092, China
| | - Jian Chu
- Department of Urology, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China
| | - Xin-Gang Cui
- Department of Urology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200092, China
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5
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Schmid FA, Bausch K, Wettstein MS, Feicke A, Weltzien B, Schmid DM, Strebel RT, Poyet C, Rupp NJ, Sulser T, Seifert HH, Hermanns T. Long-Term Oncological Efficacy of Retroperitoneoscopic Radical Nephrectomy of Localized Renal Cell Cancer pT1-3 (≤ 12cm). Clin Genitourin Cancer 2022; 20:e411-e418. [DOI: 10.1016/j.clgc.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 11/03/2022]
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6
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Junker T, Duus L, Rasmussen BSB, Azawi N, Lund L, Graumann O, Nørgaard B. Quality of life and complications after nephron-sparing treatment of renal cell carcinoma stage T1-a systematic review. Syst Rev 2022; 11:4. [PMID: 34983648 PMCID: PMC8725354 DOI: 10.1186/s13643-021-01868-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 12/08/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Despite the fact that nephron-sparing treatment is considered preferable from a surgical perspective patients' quality of life (QoL) following different types of nephron-sparing treatments remains unclear. PURPOSE To investigate the quality of life and complications after nephron-sparing treatment of renal cell carcinomas of stage T1. MATERIALS AND METHODS A systematic search of six databases was carried out. We included studies that reported the quality of life and complications in patients aged 18 years or older following nephron-sparing treatment of renal cell carcinoma stage T1. The quality assessment was performed using the Critical Appraisal Skills Programme (CASP) checklist for cohort studies and the CASP Randomized Controlled Trial Checklist. Data were analyzed using a narrative approach. RESULTS Eight studies were included, six of which investigated QoL after partial nephrectomy and two after ablation therapies. Seven studies reported complications. Three studies reported higher QoL scores after partial nephrectomy compared to radical nephrectomy. Two studies showed that QoL increased or returned to baseline levels up to 12 months following partial nephrectomy. One study reported a gradual increase in QoL after radiofrequency ablation, and one study reported that all patients recovered to baseline QoL following cryoablation. Across studies, we found a complication rate up to 20% after partial nephrectomy and up to 12.5% after ablation therapy. CONCLUSIONS The results of this systematic review suggest that nephron-sparing treatment appears to be superior or comparable to other treatment alternatives with regard to QoL outcomes. Additionally, based on the studies included in this review, partial nephrectomy appears to have a higher complication rate compared with ablation therapies. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020155594.
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Affiliation(s)
- Theresa Junker
- Department of Radiology, Odense University Hospital, Kløvervænget 10, Indgang 112, 5000, Odense C, Denmark. .,Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, Indgang 112, 5000, Odense C, Denmark.
| | - Louise Duus
- Department of Radiology, Odense University Hospital, Kløvervænget 10, Indgang 112, 5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, Indgang 112, 5000, Odense C, Denmark
| | - Benjamin S B Rasmussen
- Department of Radiology, Odense University Hospital, Kløvervænget 10, Indgang 112, 5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, Indgang 112, 5000, Odense C, Denmark
| | - Nessn Azawi
- Department of Urology, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Sygehusvej 10, 4000, Roskilde, Denmark
| | - Lars Lund
- Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, Indgang 112, 5000, Odense C, Denmark.,Department of Urology, Odense University Hospital, J. B. Winsløws Vej 4, Odense C, 5000, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Kløvervænget 10, Indgang 112, 5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Kløvervænget 10, Indgang 112, 5000, Odense C, Denmark
| | - Birgitte Nørgaard
- Department of Public Health, User Perspectives and Community-based Interventions, University of Southern Denmark, J.B. Winsløws Vej 9B, 5000, Odense C, Denmark
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7
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Shiozaki K, Kawanishi Y, Sasaki Y, Daizumoto K, Tsuda M, Izumi K, Kusuhara Y, Fukawa T, Yamamoto Y, Yamaguchi K, Takahashi M, Kanayama H. Clinical application of virtual imaging guided Robot-assisted partial nephrectomy. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:237-243. [DOI: 10.2152/jmi.69.237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Keito Shiozaki
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasuo Kawanishi
- Department of Urology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Yutaro Sasaki
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kei Daizumoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Megumi Tsuda
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kazuyoshi Izumi
- Department of Urology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Yoshito Kusuhara
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomoya Fukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasuyo Yamamoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kunihisa Yamaguchi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masayuki Takahashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hiroomi Kanayama
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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8
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Abstract
In addition to its established advantages, laparoscopic radical nephrectomy (RN) poses a unique set of challenges over traditional open surgery. In this study, we discuss preoperative considerations and detailed steps for laparoscopic RN. We review the transabdominal approach in detail, including patient positioning, equipment, and port placement in addition to the surgical steps. Intraoperative decisions such as adrenal management, renal preservation, and tumor identification are reviewed. Common complications of laparoscopic renal surgery are also summarized.
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Affiliation(s)
- David Mikhail
- Department of Urology, Lenox Hill Hospital, New York, New York, USA
| | - Aaron Tabibzadeh
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Arun Rai
- The Smith Institute for Urology, Lenox Hill Hospital, New York, New York, USA
| | - Lee Richstone
- The Smith Institute for Urology, Lenox Hill Hospital, New York, New York, USA
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9
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Darbas T, Forestier G, Leobon S, Pestre J, Jesus P, Lachatre D, Tubiana-Mathieu N, Descazeaud A, Deluche E. Impact of Body Composition in Overweight and Obese Patients With Localised Renal Cell Carcinoma. In Vivo 2021; 34:2873-2881. [PMID: 32871827 DOI: 10.21873/invivo.12115] [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: 06/02/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND/AIM To investigate the impact of body composition on morbidity and mortality at the initial diagnosis of localised renal cell carcinoma (RCC) in patients with overweight or obesity. PATIENTS AND METHODS Sarcopenia was defined using sex-specific cut-off points and other body composition parameters by median values with computed tomography imaging. RESULTS Among the 96 patients, 40 had sarcopenia (43.0%) at diagnosis. Body composition had no effect on morbidity and 5-year disease-free survival contrary to the classic factors (p<0.05). In the subgroup of obese patients, those with sarcopenia had a poor prognosis (p=0.04) but not in the population with overweight (p=0.9). CONCLUSION Sarcopenia was frequently associated with localised RCC at the initial diagnosis. Body composition did not affect morbidity or outcomes. BMI was involved in morbidity and there was paradoxically longer survival in the obesity group.
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Affiliation(s)
- Tiffany Darbas
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | - Geraud Forestier
- Department of Radiology, Limoges University Hospital, Limoges, France
| | - Sophie Leobon
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | - Julia Pestre
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | - Pierre Jesus
- Nutrition Unit, Limoges University Hospital, Limoges, France
| | - Denis Lachatre
- Department of Radiology, Limoges University Hospital, Limoges, France
| | | | | | - Elise Deluche
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
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10
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Stellato M, Santini D, Verzoni E, De Giorgi U, Pantano F, Casadei C, Fornarini G, Maruzzo M, Sbrana A, Di Lorenzo G, Soraru M, Naglieri E, Buti S, De Vivo R, Napolitano A, Vignani F, Mucciarini C, Grillone F, Roviello G, Di Napoli M, Procopio G. Impact of Previous Nephrectomy on Clinical Outcome of Metastatic Renal Carcinoma Treated With Immune-Oncology: A Real-World Study on Behalf of Meet-URO Group (MeetUro-7b). Front Oncol 2021; 11:682449. [PMID: 34168997 PMCID: PMC8217989 DOI: 10.3389/fonc.2021.682449] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/11/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Immune-Oncology (IO) improves Overall Survival (OS) in metastatic Renal Cell Carcinoma (mRCC). The prognostic impact of previous Cytoreductive Nephrectomy (CN) and radical nephrectomy (RN), with curative intent, in patients treated with IO is not well defined. The aim of our paper is to evaluate the impact of previous nephrectomy on outcome of mRCC patients treated with IO. METHODS 287 eligible patients were retrospectively collected from 16 Italian referral centers adhering to the MeetUro association. Patients treated with IO as second and third line were included, whereas patients treated with IO as first line were excluded. Kaplan-Meier method and log-rank test were performed to compare Progression Free Survival (PFS) and OS between groups. In our analysis, both CN and RN were included. The association between nephrectomy and other variables was analyzed in univariate and multivariate setting using the Cox proportional hazard model. RESULTS 246/287 (85.7%) patients had nephrectomy before IO treatment. Median PFS in patients who underwent nephrectomy (246/287) was 4.8 months (95%CI 3.9-5.7) vs 3.7 months (95%CI 1.9-5.5) in patients who did not it (HR log rank 0.78; 95%CI 0.53 to 1.15; p = 0.186). Median OS in patients who had previous nephrectomy (246/287) was 20.9 months (95%CI 17.6-24.1) vs 13 months (95%CI 7.7-18.2) in patients who did not it (HR log rank 0.504; 95%CI 0.337 to 0.755; p = 0.001). In the multivariate model, nephrectomy showed a significant association with OS (HR log rank 0.638; 95%CI 0.416 to 0.980), whereas gland metastases were still associated with better outcome in terms of both OS (HR log rank 0.487; 95%CI 0.279 to 0.852) and PFS (HR log rank 0.646; 95%CI 0.435 to 0.958). CONCLUSIONS IO treatment, in patients who had previously undergone nephrectomy, was associated with a better outcome in terms of OS. Further prospective trials would assess this issue in order to guide clinicians in real word practice.
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Affiliation(s)
- Marco Stellato
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Elena Verzoni
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Italy
| | - Francesco Pantano
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Chiara Casadei
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Italy
| | - Giuseppe Fornarini
- Onco-ematological Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marco Maruzzo
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Andrea Sbrana
- Department of Surgical, Medical and Molecular Pathology and Critical Area Medicine, University of Pisa, Pisa, Italy
| | | | - Mariella Soraru
- Oncology Unit, Camposampiero General Hospital, Padova, Italy
| | - Emanuele Naglieri
- Division of Medical Oncology, Istituto Tumori Bari Giovanni Paolo II—IRCCS, Bari, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Rocco De Vivo
- Department of Oncology, San Bortolo General Hospital, Vicenza, Italy
| | - Andrea Napolitano
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Claudia Mucciarini
- U.O. Medicina Oncologica, Ospedale Ramazzini, Carpi-AUSL Modena, Carpi, Italy
| | - Francesco Grillone
- Azienda Ospedaliero-Universitario “Mater Domini”, Policlinico of Catanzaro, Catanzaro, Italy
| | | | - Marilena Di Napoli
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Napoli, Italy
| | - Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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11
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Cinque A, Vago R, Trevisani F. Circulating RNA in Kidney Cancer: What We Know and What We Still Suppose. Genes (Basel) 2021; 12:835. [PMID: 34071652 PMCID: PMC8227397 DOI: 10.3390/genes12060835] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Renal cancer represents the 7th most common tumor worldwide, affecting 400,000 people annually. This malignancy, which is the third most frequent cancer among urological diseases, displays a completely different prognosis if the tumor is detected in the early stages or advance phases. Unfortunately, more than 50% of renal cancers are discovered incidentally, with a consistent percentage of cases where the tumor remains clinically silent till the metastatic process is established. In day-to-day clinical practice, no available predictive biomarkers exist, and the existent imaging diagnostic techniques harbor several gaps in terms of diagnosis and prognosis. In the last decade, many efforts have been reported to detect new predictive molecular biomarkers using liquid biopsies, which are less invasive in comparison to renal biopsy. However, until now, there has been no clear evidence that a liquid biopsy biomarker could be relevant to the creation of a precise and tailored medical management in these oncological patients, even though circulating RNA biomarkers remain among the most promising. Given the idea that liquid biopsies will play a future key role in the management of these patients, in the present review, we summarize the current state of circulating RNA (miRNA, lncRNAs, and circRNAs) as possible biomarkers of renal cancer presence and aggressiveness in patients.
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MESH Headings
- Animals
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/urine
- Carcinoma, Renal Cell/blood
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/pathology
- Carcinoma, Renal Cell/urine
- Circulating MicroRNA/blood
- Circulating MicroRNA/genetics
- Circulating MicroRNA/urine
- Extracellular Vesicles/genetics
- Extracellular Vesicles/metabolism
- Humans
- Kidney Neoplasms/blood
- Kidney Neoplasms/genetics
- Kidney Neoplasms/pathology
- Kidney Neoplasms/urine
- RNA, Long Noncoding/blood
- RNA, Long Noncoding/genetics
- RNA, Long Noncoding/urine
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Affiliation(s)
- Alessandra Cinque
- Urological Research Institute, San Raffaele Scientific Institute, 20132 Milano, Italy; (A.C.); (R.V.)
| | - Riccardo Vago
- Urological Research Institute, San Raffaele Scientific Institute, 20132 Milano, Italy; (A.C.); (R.V.)
- Department of Urology, Università Vita-Salute San Raffaele, 20132 Milano, Italy
| | - Francesco Trevisani
- Urological Research Institute, San Raffaele Scientific Institute, 20132 Milano, Italy; (A.C.); (R.V.)
- Unit of Urology, San Raffaele Scientific Institute, 20132 Milano, Italy
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12
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Abstract
Partial nephrectomy (PN) is increasingly considered the gold standard treatment for localized renal cell carcinomas (RCCs) where technically feasible. The advantage of nephron-sparing surgery lies in preservation of parenchyma and hence renal function. However, this advantage is counterbalanced with increased surgical risk. In recent years with the popularization of minimally invasive partial nephrectomy (laparoscopic and robotic), the contemporary role of open PN (OPN) has changed. OPN has several advantages, particularly in complex patients such as those with a solitary kidney, multi-focal tumors, and significant surgical history, as well as providing improved application of renoprotective measures. As such, it is a technique that remains relevant in current urology practice. In this article we discuss the evidence, indications, operative considerations and surgical technique, along with the role of OPN in contemporary nephron-sparing surgery.
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Affiliation(s)
- Ellen O'Connor
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Brennan Timm
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Australia.,North Eastern Urology, Heidelberg, Australia
| | - Nathan Lawrentschuk
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Joseph Ischia
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Australia
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13
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Kalapara AA, Frydenberg M. The role of open radical nephrectomy in contemporary management of renal cell carcinoma. Transl Androl Urol 2020; 9:3123-3139. [PMID: 33457285 PMCID: PMC7807349 DOI: 10.21037/tau-19-327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Radical nephrectomy (RN) remains a cornerstone of the management of localised renal cell carcinoma (RCC). RN involves the en bloc removal of the kidney along with perinephric fat enclosed within Gerota's fascia. Key principles of open RN include appropriate incision for adequate exposure, dissection and visualisation of the renal hilum, and early ligation of the renal artery and subsequently renal vein. Regional lymph node dissection (LND) facilitates local staging but its therapeutic role remains controversial. LND is recommended in patients with high risk clinically localised disease, but its benefit in low risk node-negative and clinically node-positive patients is unclear. Concomitant adrenalectomy should be reserved for patients with large tumours with radiographic evidence of adrenal involvement. Despite a recent downtrend in utilisation of open RN due to nephron-sparing and minimally invasive alternatives, there remains a vital role for open RN in the management of RCC in three domains. Firstly, open RN is important to the management of large, complex tumours which would be at high risk of complications if treated with partial nephrectomy (PN). Secondly, open RN plays a crucial role in cytoreductive nephrectomy (CN) for metastatic RCC, in which the laparoscopic approach achieves similar results but is associated with a high reoperation rate. Finally, open RN is the current standard of care in the management of inferior vena caval (IVC) tumour thrombus. Management of tumour thrombus requires a multidisciplinary approach and varies with cranial extent of thrombus. Higher level thrombus may require hepatic mobilisation and circulatory support, whilst the presence of bland thrombus may warrant post-operative filter insertion or ligation of the IVC.
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Affiliation(s)
| | - Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, Australia.,Cabrini Institute, Cabrini Health, Melbourne, Australia
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14
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Bensalah K, Bigot P, Albiges L, Bernhard J, Bodin T, Boissier R, Correas J, Gimel P, Hetet J, Long J, Nouhaud F, Ouzaïd I, Rioux-Leclercq N, Méjean A. Recommandations françaises du Comité de cancérologie de l’AFU – actualisation 2020–2022 : prise en charge du cancer du rein. Prog Urol 2020; 30:S2-S51. [DOI: 10.1016/s1166-7087(20)30749-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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15
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Yin X, Jiang S, Shao Z, Lu Y, Guo J, Xiao Y, Zhu X, Yu H, Ma H, Yang Y, Gao J. Kidney ventrally rotation technique in retroperitoneal robot-assisted partial nephrectomy for posterior hilar tumor: technical feasibility and preliminary results. World J Surg Oncol 2020; 18:148. [PMID: 32605570 PMCID: PMC7325664 DOI: 10.1186/s12957-020-01928-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/21/2020] [Indexed: 04/15/2023] Open
Abstract
PURPOSE The retroperitoneal robotic assisted partial nephrectomy (RAPN) is suitable for tumors locating on the posterior side of the kidney. However, the posterior hilar tumor poses an additional surgical challenge due to the special location and poor tumor exposure. We developed a novel kidney ventrally rotation technique to overcome this difficulty during retroperitoneal RAPN and evaluated its efficacy in a retrospective case-control comparative study. METHODS From March 2016 to April 2019, a total of 39 patients with posterior renal hilar tumor underwent retroperitoneal RAPN. The kidney ventrally rotation technique, which improved the tumor exposure by opening the peritoneum and rotating the kidney ventrally, was applied in 24 cases, and the conventional RAPN was performed in the other 15 cases (control group). Perioperative data was analyzed to evaluate the efficacy of the kidney ventrally rotation technique. RESULTS In kidney rotation group, the 24 patients underwent RAPN successfully without converting to open surgery or radical nephrectomy. The warm ischemia time was 17.4 ± 6.6 min, which was significantly shorter than 24.5 ± 8.3 min in control group. The mean operation time (80 ± 24 min) and estimated blood loss (104 ± 65 ml) were not different from the control group. No sever complications occurred, and no positive surgical margin was found in all the malignant cases. After 14 months follow-up, no recurrence or metastasis occurred in all cases. CONCLUSION Kidney ventrally rotation technique is safe and feasible for improving the exposure of posterior renal hilar tumor during retroperitoneal RAPN. It could be regarded as an efficient option for the management of posterior hilar tumor.
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Affiliation(s)
- Xiaotao Yin
- Department of Urology, The Forth Medical Center of the PLA General Hospital, No. 51 Fucheng Rd, Haidian District, Beijing, 100048, China
| | - Sinan Jiang
- Department of Urology, The Forth Medical Center of the PLA General Hospital, No. 51 Fucheng Rd, Haidian District, Beijing, 100048, China
| | - Zhiqiang Shao
- Department of Urology, Linyi People's Hospital, Linyi, China
| | - Yongliang Lu
- Department of Urology, The Forth Medical Center of the PLA General Hospital, No. 51 Fucheng Rd, Haidian District, Beijing, 100048, China
| | - Jiaxiang Guo
- Department of Urology, The Forth Medical Center of the PLA General Hospital, No. 51 Fucheng Rd, Haidian District, Beijing, 100048, China
| | - Yi Xiao
- Department of Urology, The Forth Medical Center of the PLA General Hospital, No. 51 Fucheng Rd, Haidian District, Beijing, 100048, China
| | - Xiaoying Zhu
- Department of Urology, The Forth Medical Center of the PLA General Hospital, No. 51 Fucheng Rd, Haidian District, Beijing, 100048, China
| | - Hualiang Yu
- Department of Urology, The Forth Medical Center of the PLA General Hospital, No. 51 Fucheng Rd, Haidian District, Beijing, 100048, China
| | - Han Ma
- Department of Urology, The Forth Medical Center of the PLA General Hospital, No. 51 Fucheng Rd, Haidian District, Beijing, 100048, China
| | - Yu Yang
- Department of Urology, The Forth Medical Center of the PLA General Hospital, No. 51 Fucheng Rd, Haidian District, Beijing, 100048, China
| | - Jiangping Gao
- Department of Urology, The Forth Medical Center of the PLA General Hospital, No. 51 Fucheng Rd, Haidian District, Beijing, 100048, China. .,Department of Urology, First Medical Center of the Chinese PLA General Hospital, Beijing, China.
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16
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Althaus AB, Chang P, Mao J, Olugbade K, Taylor K, Dewey L, Percy A, Crociani C, McNally K, Wagner AA. Patient-Reported Quality of Life and Convalescence After Minimally Invasive Kidney Cancer Surgery. Urology 2020; 144:123-129. [PMID: 32603743 DOI: 10.1016/j.urology.2020.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/25/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To better characterize recovery after minimally invasive kidney surgery, we present a study describing patient-reported health-related quality of life (HRQOL) following minimally invasive radical nephrectomy (RN) and partial nephrectomy (PN). METHODS Patients who underwent minimally invasive PN or RN for renal cancer were invited to enroll in a prospective, patient-reported HRQOL study using the Convalescence and Recovery Evaluation (CARE) instrument and Short Form-12. Patients completed questionnaires at baseline, 2, 4, 8, and 12 weeks after surgery. Mixed repeated measures model were used to assess time effect on HRQOL scores and predictors of scores within each surgery groups. RESULTS One hundred seventy-seven patients were included in the study: 50 had RN and 127 had PN. At 2 weeks, both groups had significant decreases in Overall CARE, as well as the Pain, Gastrointestinal, and Activity domain scores which remained slightly below baseline at 4 weeks. At 4 weeks only 50% of patients in both the RN and PN cohorts returned to baseline overall CARE score. By 12 weeks 82% returned to baseline overall CARE score in the RN group while 76% of patients did so in the PN group. CONCLUSION Convalescence after minimally invasive renal surgery can often extend beyond 4 weeks post-treatment in PN and RN subjects. This information may be used to provide more accurate preoperative counseling in an attempt to improve overall patient satisfaction.
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Affiliation(s)
- Adam B Althaus
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA
| | - Peter Chang
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA
| | - Jialin Mao
- Weill Cornell Medical College; New York, NY
| | - Kola Olugbade
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA
| | - Kimberly Taylor
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA
| | - Lauren Dewey
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA
| | - Andrew Percy
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA
| | - Catrina Crociani
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA
| | - Kyle McNally
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA
| | - Andrew A Wagner
- Beth Israel Deaconess Medical Center, Division of Urology, Boston, MA.
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17
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Beisland E, Hauge EM, Aarstad AKH, Hjermstad MJ, Aarstad HJ, Beisland C. Personality and educational level determine self-reported health-related quality-of-life and distress in patients with renal tumors awaiting radical surgery. Scand J Urol 2020; 54:304-312. [PMID: 32500779 DOI: 10.1080/21681805.2020.1773528] [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] [Indexed: 10/24/2022]
Abstract
Objective: Data on preoperative distress and health-related quality-of-life (HRQoL) is lacking for patients with newly diagnosed renal tumors. This study aims to compare HRQoL within this group with the general population and to study the relationship between distress, HRQoL, personality, coping, and patient/tumor-related factors.Materials and methods: Between January 2011 and June 2014, 153 patients (100 males/53 females), scheduled for surgery were prospectively included. Distress was determined by the General Health Questionnaire (GHQ), HRQoL by EORTC-QLQ-C30 questionnaire, personality by Eysenck Personality Inventory and coping by COPE questionnaire. HRQoL-data from an age and gender matched Norwegian reference population was used for comparison.Results: The study patients had significantly poorer HRQoL than the reference population. GHQ and HRQoL sum scores had a common variance (CV = r2) of 29-35%. In regression models, the measured variables accounted for 33% of the variance for the GHQ score. Significant predictors of the measured variance were neuroticism (18%), education level (3%) and avoidant coping (2%). Similarly, the measured variables accounted for 33-44% of the variance for the HRQoL sum scores. For all HRQoL sum scores, neuroticism predicted 17-28%, while education predicted 4-11% of the measured variance. Large tumor size, comorbidity, performance status and CRP predicted 2-7% of individual sum scores.Conclusions: For both preoperative distress and HRQoL, personality traits such as neuroticism and education level were the most important predictors. Tumor-related factors and other preexisting conditions seemed to be of lesser importance. Thus, preoperatively screening of psychological factors could be helpful to identify those at risk of poor outcomes.
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Affiliation(s)
- Elisabeth Beisland
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Elen M Hauge
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | | | - Marianne J Hjermstad
- Regional Advisory Unit in Palliative Care, Dept. of Oncology, Oslo University Hospital, Oslo, Norway.,European Palliative Care Research Centre (PRC), Dept. of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hans J Aarstad
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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18
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Alrishan Alzouebi I, Williams A, Thiagarjan NR, Kumar M. Omitting Cortical Renorrhaphy in Robot-Assisted Partial Nephrectomy: Is it Safe? A Single Center Large Case Series. J Endourol 2020; 34:840-846. [PMID: 32316759 DOI: 10.1089/end.2020.0121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Introduction: Preserving renal function after robot-assisted partial nephrectomy (RAPN) is important and influenced by the technique of renal reconstruction among other parameters, including ischemia time and amount of healthy renal tissue resected. It is believed that reconstruction with a second layer of cortical renorrhaphy is necessary to prevent urinary leaks and postoperative bleeding, but this is associated with the potential loss of healthy renal parenchyma and may result in worse outcomes postoperatively. Purpose: To assess the safety of omitting cortical renorrhaphy during RAPN. Patients and Methods: A retrospective analysis of 146 consecutive patients undergoing a RAPN with single or double layer renorrhaphy at the Wirral University Teaching Hospital from 2014 to 2019. Data obtained included: Patient demographics, tumor RENAL nephrometry, Perioperative parameters; blood loss, duration, and warm ischemia time (WIT), Postop complications, change in estimated glomerular filtration rate (eGFR) (pre and 3 months postop), length of stay, and oncologic outcomes. Results: In total 146 patients were identified. One hundred-six had double renorrhaphy and 40 inner layer only renorrhaphy. No significant differences were seen between these two cohorts in terms of patient demographics, RENAL nephrometry score, tumor size, or location. Perioperative parameters showed a reduced duration of surgery in the single renorrhaphy group with a mean of 125 minutes compared to143 minutes in the double renorrhaphy (p = 0.006) and a tendency toward a shorter WIT of 12.9 minutes vs 14.0 minutes reaching borderline statistical significance (p = 0.05) but no difference in blood loss volume (p = 0.25). Postoperatively there was no statistical difference in the length of hospital stay (p = 0.85), loss in eGFR at 3 months (0.06), or complication (p = 0.56). After a median follow-up of 35 months no recurrences or deaths were observed in either group. Conclusions: Omission of cortical renorrhaphy appears feasible and safe with no urine leaks or excess complications observed.
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Affiliation(s)
| | - Aled Williams
- Urology Department, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, United Kingdom
| | - Nambi Rajan Thiagarjan
- Urology Department, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, United Kingdom
| | - Manal Kumar
- Urology Department, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, United Kingdom
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19
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Wei X, Ren X, Ding Y, Wang H, Li Y, Li X, Gao Y. Comparative outcomes of radio frequency ablation versus partial nephrectomy for T1 renal tumors: a systematic review. Transl Androl Urol 2020; 8:601-608. [PMID: 32038956 DOI: 10.21037/tau.2019.10.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background The role of radio frequency ablation (RFA) in small renal tumors remains controversial. This systematic review was performed to compare clinical outcomes of RFA versus partial nephrectomy (PN) for the treatment of T1 renal tumors. Methods A total of 11 studies including 2,397 patients were analyzed in this systematic review after searching the databases of PubMed, EMBASE and Web of Science. P value and odds ratio (OR)/hazard ratio (HR) with 95% confidence interval (CI) were used to evaluate the strength of the association. Results A total of six studies (2,056 patients) provided either survival curves or HR and its 95% CI, demonstrating that the majority of the patients with RFA treatment tended to exhibit a similar long-term survival rate to those with PN treatment. In addition, according to four studies, no differences were found in the overall rate of complications between the two groups. Furthermore, there were significant differences in glomerular filtration rate (GFR) change between the two methods in four studies but no differences were observed in other two. Conclusions Our systematic review indicated that RFA is an effective treatment option which could provide comparable oncologic outcomes to PN. Moreover, it may present obvious advantages in renal function preservation.
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Affiliation(s)
- Xiyi Wei
- Department of Urology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China.,First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China
| | - Xiaohan Ren
- First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China
| | - Yichao Ding
- School of Nursing of Nanjing Medical University, Nanjing 210029, China
| | - Hongye Wang
- First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China
| | - Yunxin Li
- First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China
| | - Xiao Li
- Department of Urology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| | - Yang Gao
- Department of Radiology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
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20
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Sandbergen L, Spriensma AS, de la Rosette JJ, Laguna MP. Health-related quality of life in localized renal masses: A matter of sparing nephrons or minimizing the incision? Urol Oncol 2019; 38:43.e1-43.e11. [PMID: 31711835 DOI: 10.1016/j.urolonc.2019.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/10/2019] [Accepted: 09/22/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE Longitudinal assessment of health-related quality of life (HRQoL) differences in patients with localized renal masses according to treatment strategy. METHODS Consecutive patients ≥ 18 years with localized renal masses treated with different approaches (open [O], laparoscopic [L], and percutaneous [P]) and modalities (radical nephrectomy [RN], nephron sparing surgery [NSS] and cryoablation [CA]). The SF-36, Functional Assessment of Cancer Therapy-Kidney Symptom Index-15 questionnaires and pain visual analog scale were completed pretreatment and at 1, 3, and 12 months posttreatment. Questionnaire results were stratified according to approach and treatment modality using a longitudinal multilevel linear regression model. Clinical patient and tumor characteristics, complications, and histopathology results were tested as confounders. RESULTS Ninety eight patients completed baseline and at least one follow-up questionnaires; 27.5%, 16.3%, 22.5%, 9.2%, 13.3%, and 11.2% patients received LNSS, ONSS, LRN, ORN, LCA, and PCA, respectively. Higher baseline SF-36 (3 domains) and Functional Assessment of Cancer Therapy-Kidney Symptom Index-15 scores were reported in L group compared with the O approach. Overall, HRQoL decreased at 1 month and gradually normalized to baseline level or higher at 1 year. For treatment modality at baseline, higher mean visual analog scale was observed in CA than RN group. A trend to decreased HRQoL was observed at 1 month for RN and NSS; thereafter, scores normalized to baseline levels or higher. Approach or treatment modality HRQoL did not change substantially when corrected for confounders. CONCLUSION At short-term, HRQoL outcome favored minimally invasive treatment of RCC; at mid-term, these advantages were no longer apparent. This suggest that in selecting the best surgical treatment for the patient, oncological outcome should be the primary consideration as both approach and treatment modality result in similar HRQoL outcomes.
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Affiliation(s)
- Laura Sandbergen
- Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Amsterdam, the Netherlands
| | - Alette S Spriensma
- Amsterdam UMC, VU University Medical Center, Department of Epidemiology & Biostatistics, Amsterdam, the Netherlands
| | | | - M Pilar Laguna
- Istanbul Medipol University, Department of Urology, Istanbul, Turkey.
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21
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Frees SK, Mager R, Borgmann H, Jäger W, Thomas C, Haferkamp A. [Standard surgery for small renal masses (<4 cm)]. Urologe A 2019; 57:280-284. [PMID: 29468282 DOI: 10.1007/s00120-018-0583-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Several new treatment strategies have emerged in the treatment of small renal masses (<4 cm in diameter). Active surveillance and ablative techniques have been introduced but it remains unclear which patients will benefit the most from these new treatment options. A surgical approach remains standard of care. In recent decades, radical nephrectomy has been replaced by nephron-sparing surgery for the management of small renal masses. RESULTS In addition to the open partial nephrectomy, which is considered the standard approach, the number of surgeries performed using minimally invasive techniques is increasing. Recent data show that there might be some benefits such as less blood loss. The disadvantages shown by laparoscopic partial nephrectomy such as prolonged warm ischemia, longer operation times, and postoperative renal impairment might be negligible for the robotic approach. Therefore, current guidelines allow these approaches in addition to open partial nephrectomy if sufficient surgical expertise is given.
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Affiliation(s)
- S K Frees
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - R Mager
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - H Borgmann
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - W Jäger
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - C Thomas
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - A Haferkamp
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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22
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Renal volume matters: Assessing the association between excisional volume loss and renal function after partial nephrectomy. Asian J Surg 2019; 43:257-264. [PMID: 31324510 DOI: 10.1016/j.asjsur.2019.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/23/2019] [Accepted: 05/31/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND/OBJECTIVES To investigate the oncological and functional outcomes after partial nephrectomy for clinical stage T1 (cT1) renal cell carcinoma (RCC), and assess the association between excisional volume loss (EVL) and postoperative renal function. METHODS We retrospectively reviewed 150 patients with cT1 RCC undergoing partial nephrectomy from 2002 to 2016. End-point evaluation was assessed by recurrence free survival (RFS), overall survival (OS), stage III and stage IV chronic kidney disease (CKD). Regression models were used to determine the risk factors of CKD after surgery. The relationship between EVL and renal function decline was evaluated using Spearman correlation method. RESULTS Ninety patients with clinical stage T1a (cT1a) tumors and 60 patients with clinical stage T1b (cT1b) tumors were included. There were no differences in RFS, OS, and risk of stage III and stage IV CKD between the two groups. In Cox regression models, multivariate analysis showed that preoperative estimated glomerular filtration rate (eGFR) was an independent risk factor for developing stage III (hazard ratio 0.937, P < 0.001) and stage IV CKD (hazard ratio 0.929, P = 0.027). EVL was significantly associated with postoperative eGFR decrease. (Correlation Coefficient = 0.325, P = 0.003). CONCLUSIONS Patients with cT1a and cT1b RCC have comparable oncological and functional outcome after partial nephrectomy, and preoperative eGFR is an independent factor to predict developing CKD. EVL has influence on the postoperative renal function decline.
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Giuseppa Vitale M, Bracarda S, Cosmai L, Crocetti E, Di Lorenzo G, Lapini A, Mandressi A, Martorana G, Masini C, Montironi R, Ortega C, Passalacqua R, Porta C, Procopio G, Sepe P, Romano L, Luigi Pappagallo G, Conti G, Guida M, Martignoni G, Nolè F, Pignata S, Gori S, Cartenì G. Management of kidney cancer patients: 2018 guidelines of the Italian Medical Oncology Association (AIOM). TUMORI JOURNAL 2019; 105:3-12. [DOI: 10.1177/0300891619853392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In the past two decades, the treatment landscape for patients with metastatic renal cell carcinoma has significantly changed thanks to the approval of several targeted molecular therapies (VEGF and mTOR inhibitors) and recently immune-checkpoint inhibitors. The Italian Association of Medical Oncology (AIOM) Renal Cell Cancer (RCC) Guidelines Panel has developed clinical guidelines to provide evidence-based information and recommendations to oncologists, urologists and all professionals involved in the management of patients with renal cell cancer.
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Affiliation(s)
| | - Sergio Bracarda
- Medical Oncology Unit, Azienda Ospedaliera S.Maria, Terni, Italy
| | - Laura Cosmai
- Onco-Nephrology Outpatient Clinic, Division of Nephrology & Dialysis, San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Emanuele Crocetti
- Romagna Cancer Registry, IRCCS, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Giuseppe Di Lorenzo
- Medical Oncology Division, Department of Clinical Medicine and Surgery, University Federico II of Naples, Napoli, Italy
| | - Alberto Lapini
- Department of Urology, University of Florence, Careggi Hospital, Firenze, Italy
| | - Alberto Mandressi
- Ospedale Humanitas Mater Domini, Via Gerenzano 2, Castellanza, Varese, Italy
| | - Giuseppe Martorana
- Department of Urology, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cristina Masini
- Medical Oncology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, United Hospital, School of Medicine, Polytechnic University of the Marche Region, Ancona, Italy
| | | | | | - Camillo Porta
- Department of Internal Medicine, University of Pavia and Division of Translational Oncology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Giuseppe Procopio
- Medical Oncology-Genitourinary Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Pierangela Sepe
- Medical Oncology-Genitourinary Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Luigia Romano
- Department of Radiology, A. Cardarelli Hospital, Napoli, Italy
| | | | - Giario Conti
- Urology Unit, Azienda Socio-Sanitaria Territoriale Lariana, Sant’Anna Hospital, Como, Italy
| | - Michele Guida
- Division of Medical Oncology; National Cancer Institute “Giovanni Paolo II”, Bari, Italy
| | - Guido Martignoni
- Department of Diagnostic and Public Health, University of Verona, Italy
- Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Franco Nolè
- Medical Oncology Division of Urogenital and Head & Neck Tumours, European Institute of Oncology, Milano, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori “Fondazione G. Pascale”, Napoli, Italy
| | - Stefania Gori
- Medical Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Giacomo Cartenì
- Department of Medical Oncology, Azienda Ospedaliero di Rilievo Nazionale “A. Cardarelli”, Napoli, Italy
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24
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Liao X, Qiu S, Wang W, Zheng X, Jin K, Zhang S, Bao Y, Yang L, Wei Q. Partial nephrectomy vs cryoablation for T1a renal cell carcinoma: A comparison of survival benefit stratified by tumour size. Cancer Epidemiol 2019; 59:221-226. [PMID: 30836219 DOI: 10.1016/j.canep.2019.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We compared the impact on survival outcomes of partial nephrectomy (PN) and cryoablation (CA) for patients diagnosed with T1a renal cell carcinoma (RCC). PATIENTS AND METHODS Among patients diagnosed between 2004 and 2014 in the Surveillance, Epidemiology and End Results program, we identified histologically confirmed T1aN0M0 RCC treated with PN (n = 17644) or CA (n = 868). Propensity score matching (PSM) was performed. Kaplan-Meier method, Cox proportional hazards model were used to calculate cancer specific mortality (CSM) and overall mortality (OM) in the unmatched and matched cohort, and in subgroups based on tumour size (< 2 cm, 2-3 cm, 3-4 cm). Sensitivity analyses were performed. RESULTS A total of 18512 patients were identified: PN (93.88%) and CA (6.12%). In the propensity-score matched cohort, for tumours ≤ 2 cm, the CA and PN groups had similar CSM (HR: 1.41, 95% CI: 0.32-6.31, p = 0.65) and OM (HR 0.97, 95%CI: 0.47-2.01, p = 0.93). For tumours 2-3 cm, CA was associated with similar CSM (HR 1.64, 95%CI: 0.67-4.03, p = 0.28) but higher OM (HR 2.05, 95%CI: 1.35-3.11, p < 0.001), compared with PN. For tumours 3-4 cm, CA was associated with increased CSM (HR: 3.76, 95% CI: 1.62-8.69, p = 0.002) and OM (HR 2.17, 95%CI: 1.48-3.18, p < 0.001). CONCLUSION For RCC ≤ 2 cm, PN and CA are equal in survival outcomes. For RCC 2-4 cm, PN may have a possible advantage over CA.
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Affiliation(s)
- Xinyang Liao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Shi Qiu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China; Center of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Wanyu Wang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Xiaonan Zheng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Kun Jin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Shiyu Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Yige Bao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
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Chen K, Lee A, Huang HH, Tay KJ, Sim A, Lee LS, Cheng CWS, Ng LG, Ho HSS, Yuen JSP. Evolving trends in the surgical management of renal masses over the past two decades: A contemporary picture from a large prospectively‐maintained database. Int J Urol 2019; 26:465-474. [DOI: 10.1111/iju.13909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/16/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Kenneth Chen
- Department of Urology Singapore General Hospital Singapore
| | - Alvin Lee
- Department of Urology Singapore General Hospital Singapore
| | | | - Kae Jack Tay
- Department of Urology Singapore General Hospital Singapore
| | - Allen Sim
- Department of Urology Singapore General Hospital Singapore
| | - Lui Shiong Lee
- Department of Urology Singapore General Hospital Singapore
| | | | - Lay Guat Ng
- Department of Urology Singapore General Hospital Singapore
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Surgical Methods in Treatment of Kidney Tumors: Open Surgery Versus Laparoscopy Versus Robotic Surgery. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Influence of symptomatic pseudoaneurysms on postoperative renal function after partial nephrectomy: results of a matched pair analysis. Int Urol Nephrol 2018; 51:33-40. [PMID: 30421098 DOI: 10.1007/s11255-018-2024-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/03/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE A symptomatic pseudoaneurysm (SPA) is a rare but severe complication after partial nephrectomy (PN). Selective trans-arterial embolization (TAE) is the treatment of choice with high success rates. However, the influence of this intervention on postsurgical renal function has not been studied. METHODS Between 2005 and 2016 we performed 1047 PNs at our institution. Postsurgical SPA occurred in 40 patients (3.8%). Patients with and without SPA were matched in a 1:2 ratio concerning tumor complexity (RENAL) and pre-operative renal function (CKD stage). Any CKD upstage and a relevant CKD progression (CKD ≥ III) were defined as endpoints. Furthermore, the influence of the amount of contrast agent applied during TAE was assessed. RESULTS All patients with SPA were treated successfully with TAE. No significant difference could be detected concerning clinical, functional and surgical aspects. Median follow-up time accounted for 12.5 (6.75-27.5) months. Kaplan-Meier analyses detected an increased rate of any CKD upstage (p = 0.066) and relevant CKD progression (p = 0.01) in patients with SPA. Multivariate analysis identified post-operative SPA to be an independent predictor for a relevant CKD progression (HR 4.15, p = 0.01). The amount of contrast agents used did not have an impact on the development of a relevant CKD progression (p = 0.72). CONCLUSION Patients treated with TAE after PN show an additional risk for an impairment of renal function over time. Hence, those patients should explicitly be informed about possible consequences and closely monitored by nephrologists.
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Drerup M, Magdy A, Hager M, Colleselli D, Kunit T, Lusuardi L, Janetschek G, Mitterberger M. Non-ischemic laparoscopic partial nephrectomy using 1318-nm diode laser for small exophytic renal tumors. BMC Urol 2018; 18:99. [PMID: 30413201 PMCID: PMC6230292 DOI: 10.1186/s12894-018-0405-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 10/16/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose Warm ischemia (WI) and bleeding constitute the main challenges for surgeons during laparoscopic partial nephrectomy (LPN). Current literature on the use of lasers for cutting and coagulation remains scarce and with small cohorts. We present the largest case series to date of non-ischemic LPN using a diode laser for small exophytic renal tumors. Methods We retrospectively evaluated 29 patients with clinically localized exophytic renal tumors who underwent non-ischemic laser–assisted LPN with a 1318-nm wavelength diode laser. We started applying the laser 5 mm beyond the visible tumor margin, 5 mm away from the tissue in a non-contact fashion for coagulation and in direct contact with the parenchymal tissue for cutting. Results The renal vessels were not clamped, resulting in a WIT (warm ischaemic time) of 0 min, except for one case that required warm ischemia for 12 min and parenchymal sutures. No transfusion was needed, with a mean Hemoglobin drop of 1,4 mg/dl and no postoperative complications. The eGFR did not significantly change by 6 months. Histologically, the majority of lesions (n = 22/29) were renal-cell carcinoma stage pT1a. The majority of malignant lesions (n = 13/22) had a negative margin. However, margin interpretation was difficult in 9 cases due to charring of the tumor base. A mean follow-up of 1.8 years revealed no tumor recurrence. The mean tumor diameter was 19.4 mm. Conclusion The 1318-nm diode laser has the advantages of excellent cutting and sealing properties when applied to small vessels in the renal parenchyma, reducing the need for parenchymal sutures. However, excessive smoke, charring of the surgical margin, and inability to seal large blood vessels are encountered with this technique.
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Affiliation(s)
- Martin Drerup
- Department of Urology, Paracelsus Medical University Salzburg, Muellner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Ahmed Magdy
- Department of Urology, Paracelsus Medical University Salzburg, Muellner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Martina Hager
- Department of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria.
| | - Daniela Colleselli
- Department of Urology, Paracelsus Medical University Salzburg, Muellner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Thomas Kunit
- Department of Urology, Paracelsus Medical University Salzburg, Muellner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Lukas Lusuardi
- Department of Urology, Paracelsus Medical University Salzburg, Muellner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Günter Janetschek
- Department of Urology, Paracelsus Medical University Salzburg, Muellner-Hauptstrasse 48, 5020, Salzburg, Austria
| | - Michael Mitterberger
- Department of Urology, Paracelsus Medical University Salzburg, Muellner-Hauptstrasse 48, 5020, Salzburg, Austria
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Bensalah K, Albiges L, Bernhard JC, Bigot P, Bodin T, Boissier R, Correas JM, Gimel P, Hetet JF, Long JA, Nouhaud FX, Ouzaïd I, Rioux-Leclercq N, Méjean A. Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : prise en charge du cancer du rein. Prog Urol 2018; 28 Suppl 1:R5-R33. [DOI: 10.1016/j.purol.2019.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/15/2018] [Indexed: 12/15/2022]
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30
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Bensalah K, Albiges L, Bernhard JC, Bigot P, Bodin T, Boissier R, Correas JM, Gimel P, Hetet JF, Long JA, Nouhaud FX, Ouzaïd I, Rioux-Leclercq N, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : prise en charge du cancer du reinFrench ccAFU guidelines – Update 2018–2020: Management of kidney cancer. Prog Urol 2018; 28:S3-S31. [PMID: 30473002 DOI: 10.1016/j.purol.2018.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/15/2018] [Indexed: 12/15/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: DOI:10.1016/j.purol.2019.01.004.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the DOI:10.1016/j.purol.2019.01.004.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- K Bensalah
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033, Rennes cedex, France.
| | - L Albiges
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Département d'oncologie génito-urinaire, Gustave-Roussy, 94805, Villejuif cedex, France
| | - J-C Bernhard
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie et transplantation rénale, CHU de Bordeaux, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - P Bigot
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, CHU d'Angers, 4, rue Larrey, 49000, Angers, France
| | - T Bodin
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Centre d'urologie Prado-Louvain, 188, rue du Rouet, 13008, Marseille, France
| | - R Boissier
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie et transplantation rénale, CHU Conception, 147, boulevard Baille, 13005, Marseille, France
| | - J-M Correas
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'imagerie médicale (radiologie), hôpital universitaire Necker-Enfants-malades, 149, rue de Sèvres, 75015, Paris, France
| | - P Gimel
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Centre d'urologie, site Médipôle, 5, avenue Ambroise-Croizat, 66330, Cabestany, France
| | - J-F Hetet
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service de chirurgie urologique, clinique Jules-Verne, 2-4, route de Paris, 44314, Nantes, France
| | - J-A Long
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service de chirurgie urologique et de la transplantation rénale, hôpital Michallon, CHU Grenoble, boulevard de la Chantourne, 38700, La Tronche, France
| | - F-X Nouhaud
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, CHU de Rouen, 1, rue de Germont, 76000, Rouen, France
| | - I Ouzaïd
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Clinique urologique, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018, Paris, France
| | - N Rioux-Leclercq
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'anatomie et cytologie pathologiques, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033, Rennes cedex 9, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe rein, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015, Paris, France
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Lourenco P, Bilbey N, Gong B, Bahrabadi A, Halkier B. Percutaneous Ablation Versus Nephrectomy for Small Renal Masses: Clinical Outcomes in a Single-Center Cohort. Cardiovasc Intervent Radiol 2018; 41:1892-1900. [DOI: 10.1007/s00270-018-2050-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/31/2018] [Indexed: 01/20/2023]
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Herlemann A, Odisho AY, Porten SP. Partial Nephrectomy is the Surgical Treatment of Choice for (Most) Complex Localized Renal Tumors. KIDNEY CANCER 2018. [DOI: 10.3233/kca-180039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Annika Herlemann
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Anobel Y. Odisho
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Sima P. Porten
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
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Quality of life outcomes in patients with localised renal cancer: a literature review. World J Urol 2018; 36:1961-1972. [PMID: 30051264 PMCID: PMC6280814 DOI: 10.1007/s00345-018-2415-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/18/2018] [Indexed: 12/26/2022] Open
Abstract
Purpose Patients with localised renal cell carcinoma (RCC) can expect excellent oncologic outcomes. As such, there has been a shift towards maximising health-related quality of life (HRQoL). A greater understanding of HRQoL outcomes associated with different treatment options for RCC can facilitate patient-centred care, shared decision-making and enable cost utility analyses to guide health policies. The aim of this literature review was to evaluate the evidence regarding HRQoL following different management strategies for localised RCC. Methods Three databases were searched to identify studies reporting HRQoL in patients with localised renal cancer, including Medline, the Tuft’s Medical Centre Cost Effectiveness Analysis registry and the EuroQol website. Results Considerable methodological heterogeneity was noted. Laparoscopic nephrectomy was associated with significantly better short-term physical function compared to open surgery, although the effect on mental function was inconclusive. Nephron-sparing surgery was associated with better physical function compared to radical surgery. Patients’ perception of remaining renal function was a significant independent predictor of HRQoL, rather than surgery type. Tumour size, stage, post-operative complications, age, body mass index, occupational status, educational level and comorbidities were significant predictors of HRQoL. Only three studies were available regarding non-surgical management options and very little data were available regarding the impact of follow-up protocols and long-term effects of “cancer survivorship.” Conclusion There is a need for validated and reproducible RCC-specific HRQoL instruments and standardisation amongst studies to enable comparisons. Increased awareness regarding determinants of poor HRQoL may enable high-risk patients to receive tailored support. Electronic supplementary material The online version of this article (10.1007/s00345-018-2415-3) contains supplementary material, which is available to authorized users.
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Luk ACO, Pandian RMK, Heer R. Laparoscopic renal surgery is here to stay. Arab J Urol 2018; 16:314-320. [PMID: 30140467 PMCID: PMC6104665 DOI: 10.1016/j.aju.2018.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/23/2018] [Indexed: 01/20/2023] Open
Abstract
Objectives To review the current literature comparing the outcomes of renal surgery via open, laparoscopic and robotic approaches. Materials and methods A comprehensive literature search was performed on PubMed, MEDLINE and Ovid, to look for studies comparing outcomes of renal surgery via open, laparoscopic, and robotic approaches. Results Limited good-quality evidence suggests that all three approaches result in largely comparable functional and oncological outcomes. Both laparoscopic and robotic approaches result in less blood loss, analgesia requirement, with a shorter hospital stay and recovery time, with similar complication rates when compared with the open approach. Robotic renal surgeries have not shown any significant clinical benefit over a laparoscopic approach, whilst the associated cost is significantly higher. Conclusion With the high cost and lack of overt clinical benefit of the robotic approach, laparoscopic renal surgery will likely continue to remain relevant in treating various urological pathologies.
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Key Words
- (L)(LESS-)DN, (laparoscopic) (laparoendoscopic single-site-) donor nephrectomy
- (L)(O)(RA)PN, (laparoscopic) (open) (robot-assisted) partial nephrectomy
- (L)(O)(RA)PY, (laparoscopic) (open) (robot-assisted) pyeloplasty
- (L)(O)(RA)RN, (laparoscopic) (open) (robot-assisted) radical nephrectomy
- BMI, body mass index
- Donor nephrectomy
- LOS, length of hospital stay
- Laparoscopic/open/robotic renal surgery
- NOTES, natural orifice transluminal endoscopic surgery
- PUJO, PUJ obstruction
- Partial nephrectomy
- Pyeloplasty
- RCT, randomised controlled trial
- Radical nephrectomy
- WIT, warm ischaemia time
- eGFR, estimated GFR
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Affiliation(s)
- Angus Chin On Luk
- Department of Urology, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
| | | | - Rakesh Heer
- Department of Urology, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
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Wang Y, Mossanen M, Chang SL. Cost and cost-effectiveness studies in urologic oncology using large administrative databases. Urol Oncol 2018; 36:213-219. [PMID: 29500134 DOI: 10.1016/j.urolonc.2018.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 01/23/2018] [Accepted: 01/28/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Urologic cancers are not only among the most common types of cancers, but also among the most expensive cancers to treat in the United States. This study aimed to review the use of CEAs and other cost analyses in urologic oncology using large databases to better understand the value of management strategies of these cancers. METHODS A literature review on CEAs and other cost analyses in urologic oncology using large databases. RESULTS The options for and costs of diagnosing, treating, and following patients with urologic cancers can be expected to rise in the coming years. There are numerous opportunities in each urologic cancer to use CEAs to both lower costs and provide high-quality services. Improved cancer care must balance the integration of novelty with ensuring reasonable costs to patients and the health care system. CONCLUSION With the increasing focus cost containment, appreciating the value of competing strategies in caring for our patients is pivotal. Leveraging methods such as CEAs and harnessing large databases may help evaluate the merit of established or emerging strategies.
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Affiliation(s)
- Ye Wang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Matthew Mossanen
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Steven L Chang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Karalli A, Ghaffarpour R, Axelsson R, Lundell L, Bozoki B, Brismar T, Gustafsson O. Transarterial Chemoembolization of Renal Cell Carcinoma: A Prospective Controlled Trial. J Vasc Interv Radiol 2017; 28:1664-1672. [DOI: 10.1016/j.jvir.2017.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 01/20/2023] Open
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Patel HD, Pierorazio PM, Johnson MH, Sharma R, Iyoha E, Allaf ME, Bass EB, Sozio SM. Renal Functional Outcomes after Surgery, Ablation, and Active Surveillance of Localized Renal Tumors: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol 2017; 12:1057-1069. [PMID: 28483780 PMCID: PMC5498358 DOI: 10.2215/cjn.11941116] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/06/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Management strategies for localized renal masses suspicious for renal cell carcinoma include radical nephrectomy, partial nephrectomy, thermal ablation, and active surveillance. Given favorable survival outcomes across strategies, renal preservation is often of paramount concern. To inform clinical decision making, we performed a systematic review and meta-analysis of studies comparing renal functional outcomes for radical nephrectomy, partial nephrectomy, thermal ablation, and active surveillance. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from January 1, 1997 to May 1, 2015 to identify comparative studies reporting renal functional outcomes. Meta-analyses were performed for change in eGFR, incidence of CKD, and AKI. RESULTS We found 58 articles reporting on relevant renal functional outcomes. Meta-analyses showed that final eGFR fell 10.5 ml/min per 1.73 m2 lower for radical nephrectomy compared with partial nephrectomy and indicated higher risk of CKD stage 3 or worse (relative risk, 2.56; 95% confidence interval, 1.97 to 3.32) and ESRD for radical nephrectomy compared with partial nephrectomy. Overall risk of AKI was similar for radical nephrectomy and partial nephrectomy, but studies suggested higher risk for radical nephrectomy among T1a tumors (relative risk, 1.37; 95% confidence interval, 1.13 to 1.66). In general, similar findings of worse renal function for radical nephrectomy compared with thermal ablation and active surveillance were observed. No differences in renal functional outcomes were observed for partial nephrectomy versus thermal ablation. The overall rate of ESRD was low among all management strategies (0.4%-2.8%). CONCLUSIONS Renal functional implications varied across management strategies for localized renal masses, with worse postoperative renal function for patients undergoing radical nephrectomy compared with other strategies and similar outcomes for partial nephrectomy and thermal ablation. Further attention is needed to quantify the changes in renal function associated with active surveillance and nephron-sparing approaches for patients with preexisting CKD.
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Affiliation(s)
- Hiten D. Patel
- James Buchanan Brady Urological Institute, Department of Urology, and
| | | | | | | | | | - Mohamad E. Allaf
- James Buchanan Brady Urological Institute, Department of Urology, and
| | - Eric B. Bass
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Departments of
- Health Policy and Management and
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; and
| | - Stephen M. Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Departments of
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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Jelley CR, Kurukulaarachchi KASH, Forster L, Bardgett H, Singh R, Addla SK. Comparison of open and robotic nephron sparing surgery: a single centre experience. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415816668942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To compare robotic partial nephrectomy (RAPN) with open partial nephrectomy (OPN) to assess efficacy and impact of learning curve. Methods: From 2010 to 2015 159 patients had a partial nephrectomy (82 OPN and 77 RAPN). All data were collected prospectively. We compared the demographics, peri and postoperative outcomes. Results: Mean age was 60 years in both groups; 59% of patients were men. Tumour size was larger in the open group (34 mm vs 30 mm; P<0.08), but RENAL nephrometry scores greater than 6 were comparable (over 60%). Mean ischaemic time was longer in the RAPN group (18 vs 13 minutes; P<0.04) but complication rates were similar. The RAPN cohort had a reduced estimated blood loss (100 ml vs 300 ml; P<0.01) and shorter median hospital stay (2 vs 5 days; P<0.01). Only two patients in each group were margin positive. The RAPN cohort demonstrated reduced estimated blood loss and a trend towards more complex tumours with increasing learning curve. Conclusion: RAPN is superior to OPN in terms of reduced hospital stay and estimated blood loss without compromising oncological outcomes. This service can be delivered safely and effectively in a low to medium volume cancer centre; these results are similar to published figures from high volume international centres.
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Affiliation(s)
| | | | - Luke Forster
- Department of Urology, Bradford Royal Infirmary, UK
| | | | | | - Sanjai K Addla
- Department of Urology, Bradford Royal Infirmary, UK
- Apollo Cancer Institutes, Apollo Health City, Jubilee Hills, Hyderabad, India
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Kramer MW, Merseburger AS, Hoda R. Surgical Methods in Treatment of Kidney Tumors: Open Surgery Versus Laparoscopy Versus Robotic Surgery. Urol Oncol 2017. [DOI: 10.1007/978-3-319-42603-7_63-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pierorazio PM, Johnson MH, Patel HD, Sozio SM, Sharma R, Iyoha E, Bass EB, Allaf ME. Management of Renal Masses and Localized Renal Cancer: Systematic Review and Meta-Analysis. J Urol 2016; 196:989-99. [PMID: 27157369 PMCID: PMC5593254 DOI: 10.1016/j.juro.2016.04.081] [Citation(s) in RCA: 235] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE Several options exist for management of clinically localized renal masses suspicious for cancer, including active surveillance, thermal ablation and radical or partial nephrectomy. We summarize evidence on effectiveness and comparative effectiveness of these treatment approaches for patients with a renal mass suspicious for localized renal cell carcinoma. MATERIALS AND METHODS We searched MEDLINE®, Embase® and the Cochrane Central Register of Controlled Trials from January 1, 1997 through May 1, 2015. Paired investigators independently screened articles to identify controlled studies of management options or cohort studies of active surveillance, abstracted data sequentially and assessed risk of bias independently. Strength of evidence was graded by comparisons. RESULTS The search identified 107 studies (majority T1, no active surveillance or thermal ablation stratified outcomes of T2 tumors). Cancer specific survival was excellent among all management strategies (median 5-year survival 95%). Local recurrence-free survival was inferior for thermal ablation with 1 treatment but reached equivalence to other modalities after multiple treatments. Overall survival rates were similar among management strategies and varied with age and comorbidity. End-stage renal disease rates were low for all strategies (0.4% to 2.8%). Radical nephrectomy was associated with the largest decrease in estimated glomerular filtration rate and highest incidence of chronic kidney disease. Thermal ablation offered the most favorable perioperative outcomes. Partial nephrectomy showed the highest rates of urological complications but overall rates of minor/major complications were similar among interventions. Strength of evidence was moderate, low and insufficient for 11, 22 and 30 domains, respectively. CONCLUSIONS Comparative studies demonstrated similar cancer specific survival across management strategies, with some differences in renal functional outcomes, perioperative outcomes and postoperative harms that should be considered when choosing a management strategy.
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Affiliation(s)
- Phillip M Pierorazio
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Michael H Johnson
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Hiten D Patel
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Stephen M Sozio
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Ritu Sharma
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Emmanuel Iyoha
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Eric B Bass
- Johns Hopkins Evidence-Based Practice Center, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Mohamad E Allaf
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Rassweiler JJ, Klein J, Tschada A, Gözen AS. Laparoscopic retroperitoneal partial nephrectomy using an ergonomic chair: demonstration of technique and matched-pair analysis. BJU Int 2016; 119:349-357. [DOI: 10.1111/bju.13627] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Jens J. Rassweiler
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Jan Klein
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Alexandra Tschada
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Ali Serdar Gözen
- Department of Urology; SLK Kliniken Heilbronn; University of Heidelberg; Heilbronn Germany
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Vahlensieck W, Hoffmann W, Zermann DH. [Social medicine assessment after surgical and targeted treatment of renal cell cancer]. Urologe A 2016; 55:1601-1604. [PMID: 27306354 DOI: 10.1007/s00120-016-0159-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In Germany, renal cell cancer counts for 2.5 % of all carcinomas in women and 3.5 % in men. Curative therapy ensures good chances of recovery. But there might be permanent complications like renal insufficiency, pain, incisional hernia, flank muscle relaxation, and paresis. In addition, targeted therapy is associated with several potential side effects. In both therapy groups, severe psychological problems may occur. Still employed patients with these problems must be examined by an expert to estimate the possibilities of returning to working (positive scope of work) and occupations which can not be performed anymore (negative scope of work).
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Affiliation(s)
- W Vahlensieck
- Fachklinik Urologie, Kurpark-Klinik, Kurstr. 41-45, 61231, Bad Nauheim, Deutschland.
| | - W Hoffmann
- Fachklinik für onkologische Rehabilitation und Anschlussrehabilitation (AHB), Klinik Park-Therme, Badenweiler, Deutschland
| | - D-H Zermann
- Fachklinik für Urologie, Uroonkologie und Nephrologie, Rehabilitationszentrum Vogtland-Klinik, Bad Elster, Deutschland
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Quiroga Matamoros W, Fernandez F, Citarella Otero D, Rangel J, Estrada Guerrero A, Patiño ID. Guía de manejo del carcinoma de células renales. Rev Urol 2016. [DOI: 10.1016/j.uroco.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Patel HD, Riffon MF, Joice GA, Johnson MH, Chang P, Wagner AA, McKiernan JM, Trock BJ, Allaf ME, Pierorazio PM. A Prospective, Comparative Study of Quality of Life among Patients with Small Renal Masses Choosing Active Surveillance and Primary Intervention. J Urol 2016; 196:1356-1362. [PMID: 27140071 DOI: 10.1016/j.juro.2016.04.073] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE To our knowledge quality of life has not been evaluated in rigorous fashion in patients undergoing active surveillance for small renal masses. The prospective, multi-institutional DISSRM (Delayed Intervention and Surveillance for Small Renal Masses) Registry was opened on January 1, 2009, enrolling patients with cT1a (4.0 cm or less) small renal masses who elected primary intervention or active surveillance. MATERIALS AND METHODS Patients were enrolled following a choice of active surveillance or primary intervention. The active surveillance protocol includes imaging every 4 to 6 months for 2 years and every 6 to 12 months thereafter. The SF12® quality of life questionnaire was completed at study enrollment, at 6 and 12 months, and annually thereafter. MCS (Mental Component Summary), PCS (Physical Component Summary) and overall score were evaluated among the groups and with time using ANOVA and linear regression mixed modeling. RESULTS At 82 months among 3 institutions 539 patients were enrolled with a mean ± SD followup of 1.8 ± 1.7 years. Of the patients 254 were on active surveillance, 285 were on primary intervention and 21 were on active surveillance but crossed over to delayed intervention. A total of 1,497 questionnaires were completed. Total and PCS quality of life scores were better for primary intervention at enrollment through 5 years. There were generally no differences in MCS scores among the groups and there was a trend of improving scores with time. CONCLUSIONS In a prospective registry of patients undergoing active surveillance or primary intervention for small renal masses those undergoing primary intervention had higher quality of life scores at baseline. This was due to a perceived benefit in the physical health domain, which persisted throughout followup. Mental health, which includes the domains of depression and anxiety, was not adversely affected while on active surveillance, and it improved with time after selecting a management strategy.
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Affiliation(s)
- Hiten D Patel
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Mark F Riffon
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gregory A Joice
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael H Johnson
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter Chang
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Andrew A Wagner
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - James M McKiernan
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Bruce J Trock
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
The diagnosis and management of renal cell carcinoma have changed remarkably rapidly. Although the incidence of renal cell carcinoma has been increasing, survival has improved substantially. As incidental diagnosis of small indolent cancers has become more frequent, active surveillance, robot-assisted nephron-sparing surgical techniques, and minimally invasive procedures, such as thermal ablation, have gained popularity. Despite progression in cancer control and survival, locally advanced disease and distant metastases are still diagnosed in a notable proportion of patients. An integrated management strategy that includes surgical debulking and systemic treatment with well established targeted biological drugs has improved the care of patients. Nevertheless, uncertainties, controversies, and research questions remain. Further advances are expected from translational and clinical studies.
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Affiliation(s)
- Umberto Capitanio
- Department of Urology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Francesco Montorsi
- Division of Experimental Oncology, URI, Urological Research Institute, Renal Cancer Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Kamel AI, Badawy MH, Elganzoury H, Elkhouly A, Elesaily K, Eldahshan S, Ismail MAA, Elshafie MF, Abdel Aziz EM, El Baz AG, Roshdy MA, El Leithy TR, Ghobashy S, Kamal AM. Clinical versus Pathologic staging of Renal Tumors: Role of Multi-Detector CT Urography. Electron Physician 2016; 8:1791-5. [PMID: 26955451 PMCID: PMC4768930 DOI: 10.19082/1791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 11/20/2015] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Our ability to diagnose renal cell carcinoma (RCC) has increased in the past 30 years as a result of the extensive application of imaging techniques, such as ultrasonography, computed tomography, and magnetic resonance imaging. Multi-detector computed tomography (MDCT) remains the most appropriate imaging modality for the diagnosis and staging of RCC. The aim of this work was to compare the findings of MDCT with surgical pathology to determine the accuracy of delineating tumor size, localization, organ confinement, lymph node metastases, and the extent of tumor thrombus in the renal vein and inferior vena cava. METHODS The clinical, surgical, and anatomo-pathologic records of 99 patients treated by nephrectomy (radical or partial) for solid renal tumors at Theodor Bilharz Research Institute and Nasser Institute from 2005 to 2011 were reviewed retrospectively. All cases were staged pre-operatively with abdominal MDCT (pre- and post-contrast enhancement) in addition to the routine biochemical, hematological, and radiological work-up. The tumors' histologic types were determined according to the WHO classification of renal tumors in adults in 2004, and staging was updated to the TNM 2010 system. Data were analyzed using the t-test. RESULTS The mean age was 52 (range 21-73). Seventy-eight patients were males, and 21 patients were females (Male/Female ratio: 3.7:1). There were no significant differences in the mean tumor size between radiographic and pathologic assessments in different tumor stages. The overall incidence of lymph node invasion in surgical specimens was 76%, whereas MDCT showed a positive incidence in 68.4% of cases (false negative result in 7 cases, 7.6%). CONCLUSION Our findings indicated that MDCT urography is an accurate method to estimate renal tumor size, lymph node, vascular and visceral metastases preoperatively. Also, preoperative staging of renal tumors with MDCT represents a valuable and accurate tool.
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Affiliation(s)
- Ahmed I Kamel
- Urology department, Theodor Bilharz Research Institute, Giza, Egypt
| | | | | | - Amr Elkhouly
- Urology department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Khalid Elesaily
- Urology department, Theodor Bilharz Research Institute, Giza, Egypt
| | - S Eldahshan
- Urology department, Theodor Bilharz Research Institute, Giza, Egypt
| | | | | | | | - Ahmed G El Baz
- Urology department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Mamdouh A Roshdy
- Urology department, Theodor Bilharz Research Institute, Giza, Egypt
| | | | - Samir Ghobashy
- Urology department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Ahmed M Kamal
- Urology department, Theodor Bilharz Research Institute, Giza, Egypt
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Yin X, Cui L, Li F, Qi S, Yin Z, Gao J. Radiofrequency Ablation Versus Partial Nephrectomy in Treating Small Renal Tumors: A Systematic Review and Meta-Analysis. Medicine (Baltimore) 2015; 94:e2255. [PMID: 26683944 PMCID: PMC5058916 DOI: 10.1097/md.0000000000002255] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Radiofrequency ablation (RFA) has emerged as an alternative treatment to surgical partial nephrectomy (PN) in the treatment of small renal tumors (SRTs). But its safety and oncological efficacy are still controversial. We conducted this systematic review and meta-analysis to compare the peritoperative and oncological outcomes of RFA and PN in the treatment of SRTs. Pubmed, EMBASE, Cochrane CENTRAL, and Web of Science were searched to identify eligible studies that compared the RFA and PN in the treatment of SRTs. Twelve retrospective studies that compared RFA with PN in the treatment of SRTs met our selection criterion and were included in this meta-analysis. The pooled results indicated that the local recurrence rate (4.14% vs 4.10%, RR: 1.18, 95% CI: 0.68, 2.07, P = 0.550) and distant metastases rate (2.76% vs 1.89%, RR: 1.31, 95% CI: 0.70, 2.46, P = 0.686) were not significantly different between the RFA group and the PN group. In terms of perioperative outcomes, RFA was associated with shorter length of stay (LOS) (WMD: -2.02 days, 95% CI: -2.77, -1.27, P < 0.001), lower eGFR decline after treatment (WMD: -3.90, 95% CI: -6.660, -1.140, P = 0.006). However, the overall perioperative complication rate (7.5% vs 6.2%, RR:1.10, 95% CI: 0.64, 1.87, P = 0.740) and the major complication rate (3.7% vs 4.4%, RR: 0.83, 95% CI: 0.43, 1.60, P = 0.579) were both similar between RFA and PN groups. Compared with PN, RFA achieves an equal oncological outcome for SRTs with similar local recurrence rate and distant metastases rate. Additionally, RFA is associated with a similar perioperative complication rate, lower decline of eGFR, and shorter LOS. Therefore, RFA is an effective option in the treatment of SRTs for selected patients.
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Affiliation(s)
- Xiaotao Yin
- From the Department of Urology, Chinese PLA General Hospital (XY, FL, SQ, ZY); Department of Urology, General Hospital of Civil Aviation of China (LC); and Department of Urology, The First Affiliated Hospital of PLA General Hospital, Beijing, China (JG)
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Hamza A, Günther M, Behrendt W, Tietze S, Beige J. Reconstructive kidney surgery for organ-preserving therapy of renal tumors. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2015; 4:Doc10. [PMID: 26605133 PMCID: PMC4647129 DOI: 10.3205/iprs000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The objective of this study was to evaluate differences in various clinical endpoints in patients with reconstructive surgery by renal partial nephrectomy for tumors up to 4 cm compared to tumors larger than 4 cm. Material and methods: A total of 170 partial renal resection patients that presented malignant tumors were included in the retrospective study. Data was analyzed retrospectively based on internal clinic files, as well as a questionnaire to enhance the follow-up clinical outcomes data obtained. The most important outcomes determined included post-operative renal function, intra- and post-operative complications, local recurrence rate and total survival time. Results: The local recurrence rate was 6.1% for tumors up to 4 cm in size, compared to 14.9% for tumors that were larger than 4 cm. Compared to results for partial resection of T1a tumors, results for partial resection of tumors larger than 4 cm are worse in terms of post-operative renal function (p=0.007), as well as in terms of a total complications rate (p=0.048). It is important to note that there was not only a higher risk of post-operative bleeding that required transfusions (p=0.012), but also a higher risk of a hypertensive episode during the post-operative period reviewed (p=0.022). In addition, the total survival time for patients presenting tumors of up to 4 cm in size was significantly better (p=0.003). Conclusion: The results of our retrospective study of 170 patients that underwent partial renal resection after the diagnosis of malignant tumors, is that partial renal resection presents an oncologicaly safe surgical solution with low local recurrence rates. Additionally, partial resection in case of tumors that are larger than 4 cm showed worse post-operative renal function, a higher complications rate and a worse survival rate.
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Affiliation(s)
- Amir Hamza
- Department of Urology, Hospital St. Georg, Leipzig, Germany
| | - Manuel Günther
- Department of Urology, Hospital St. Georg, Leipzig, Germany
| | - Wolf Behrendt
- Department of Urology, Hospital St. Georg, Leipzig, Germany
| | - Stefan Tietze
- Department of Urology, Hospital St. Georg, Leipzig, Germany
| | - Joachim Beige
- Department of Nephrology and KfH Renal Unit, Hospital St. Georg, Leipzig, Germany
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Open Partial Nephrectomy for High-Risk Renal Masses Is Associated with Renal Pseudoaneurysms: Assessment of a Severe Procedure-Related Complication. BIOMED RESEARCH INTERNATIONAL 2015; 2015:981251. [PMID: 26539549 PMCID: PMC4619914 DOI: 10.1155/2015/981251] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/15/2015] [Accepted: 08/27/2015] [Indexed: 11/21/2022]
Abstract
Objectives. A symptomatic renal pseudoaneurysm (RPA) is a severe complication after open partial nephrectomy (OPN). The aim of our study was to assess incidence and risk factors for RPA formation. Furthermore, we present our management strategy. Patients and Methods. Clinical records of consecutive patients undergoing OPN were assessed for surgical outcome and postoperative complications. Renal masses were risk stratified for tumor complexity according to the PADUA score. Uni- and multivariate analysis for symptomatic RPAs were performed using the t-tests and logistic regression. Results. We identified 233 patients treated with OPN. Symptomatic RPAs were observed in 13 (5.6%) patients, on average 14 (4–42) days after surgery. Uni- and multivariate analysis identified tumor complexity to be an independent predictor for symptomatic RPAs (p = 0.004). There was a significant correlation between RPAs and transfusion and the duration of stay (p < 0.001 and p = 0.021). Symptomatic RPAs were diagnosed with CT scans and successfully treated with arterial embolization. Discussion. Symptomatic RPAs are not uncommon after OPN for high-risk renal masses. A high nephrometry score is a predictor for this severe complication and may enable a risk-stratified followup. RPAs can successfully be located by CT angiography, which enables targeted angiographic treatment.
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