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Song Z, Xing J, Sun Z, Kang X, Li H, Ren G, Wang Y. Time trends in surgical provision and cancer-specific outcomes in patients with stage T2-3 kidney cancer: a SEER-based study. Front Surg 2024; 11:1370702. [PMID: 38742149 PMCID: PMC11089187 DOI: 10.3389/fsurg.2024.1370702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
Background and objective Surgery is the primary therapy that crucially affects the survival of patients with kidney cancer (KC). However, pertinent surgical decision criteria for individuals with stage T2-3 KC are lacking. This study aimed to display the practical choices and evolving trends of surgical procedures and elucidate their implied value. Methods Through the Surveillance, Epidemiology, and End Results (SEER) dataset, the levels and evolving trends of different surgical methods were examined to determine cancer-specific risk of death (CSRD). Additionally, stratification analysis and survival rate analysis were performed to explore the effectiveness of partial nephrectomy (PN). Results In this study, 9.27% of patients opted for PN. Interestingly, an upward trend was observed in its decision, with an average annual percentage change (AAPC) of 7.0 (95% CI: 4.8-9.3, P < 0.05). Patients who underwent PN and were in a relatively less severe condition exhibited more favorable CSRD levels (0.17-0.36 vs. 0.50-0.67) and an improvement trend compared with those who underwent radical nephrectomy (RN) (AAPC: -1.9 vs. -0.8). Further analysis showed that the levels of CSRD and survival rates for patients opting for different surgical methods followed a similar pattern. Conclusions This study showed that RN was still the most common surgical method. Patients with stage T2-3 KC had an increasing preference for PN and exhibited more favorable cancer-related survival outcomes, which underscores the need for further investigation and validation.
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Affiliation(s)
- Zhuo Song
- Department of Radiotherapy, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Jizhang Xing
- Department of Urology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Zhijia Sun
- Department of Radiotherapy, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Xiaoli Kang
- Department of Radiotherapy, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Hongzhao Li
- Department of Urology, The General Hospital of the People’s Liberation Army, Beijing, China
| | - Gang Ren
- Department of Radiotherapy, Peking University Shougang Hospital, Beijing, China
| | - Yingjie Wang
- Department of Radiotherapy, Air Force Medical Center, Air Force Medical University, Beijing, China
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Rawal S, Ganpule A, Singh G, Shrivastava N, Kishore TA, Dubey D, Mavuduru RS, Kumar A, Gautam G, Pooleri GK, Keshavamurthy M, Ragavan N, Baxi H, Addla SK, Raghunath SK, Dahiya A, Gupta D, Sharma G. Perioperative and functional outcomes following robot-assisted partial nephrectomy: Descriptive analysis of Indian study group on partial nephrectomy database. Indian J Urol 2024; 40:121-126. [PMID: 38725898 PMCID: PMC11078450 DOI: 10.4103/iju.iju_443_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/16/2024] [Accepted: 03/03/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction There is an unmet need for high-quality data for Robot-assisted partial nephrectomy (RAPN) in the Indian population. Indian study group on partial nephrectomy (ISGPN) is a consortium of Indian centers contributing to the partial nephrectomy (PN) database. The current study is a descriptive analysis of perioperative and functional outcomes following RAPN. Methods For this study, the retrospective ISGPN database was reviewed, which included patients who underwent RAPN for renal masses at 14 centers across India from September 2010 to September 2022. Demographic, clinical, radiological, perioperative, and functional data were collected and analyzed. Ethics approval was obtained from each of the participating centers. Results In this study, 782 patients were included, and 69.7% were male. The median age was 53 years (interquartile range [IQR 44-62]), median operative time was 180 min (IQR 133-240), median estimated blood loss was 100 mL (IQR 50-200), mean warm ischemia time was 22.7 min and positive surgical margin rates were 2.5%. The complication rate was 16.2%, and most of them were of minor grade. Trifecta and pentafecta outcomes were attained in 61.4% and 60% of patients, respectively. Conclusions This is the largest Indian multi-centric study using the Indian Robotic PN Collaborative database to evaluate the outcomes of robot-assisted PN, and has proven its safety and efficacy in the management of renal masses.
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Affiliation(s)
- Sudhir Rawal
- Department of Genito Uro-Oncology Services, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Arvind Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Gurpremjit Singh
- Department of Uro-Oncology and Robotic Surgery, Medanta, Gurugram, Haryana, India
| | - Nikita Shrivastava
- Department of Urology, DKS Super Speciality Hospital and Postgraduate Institute, Raipur, Chhattisgarh, India
| | - T. A. Kishore
- Department of Urology, Aster Medicity, Kochi, Kerala, India
| | - Deepak Dubey
- Department of Urology, Manipal Hospital, Bengaluru, India
| | - Ravimohan S. Mavuduru
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anant Kumar
- Department of Urology and Renal Transplantation, Max Hospitals, Delhi, India
| | - Gagan Gautam
- Department of Uro-Oncology and Robotic Surgery, Max Institute of Cancer Care, New Delhi, India
| | - Ginil Kumar Pooleri
- Department of Urology and Renal Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | | | - Hemang Baxi
- Department of Urology, HCG Cancer Center, Ahmedabad, Gujarat, India
| | - Sanjai Kumar Addla
- Department of Uro Oncology, Apollo Hospital, Hyderabad, Telangana, India
| | | | - Akhil Dahiya
- Department of Clinical and Medical Affairs, Intuitive Surgical, California, USA
| | | | - Gopal Sharma
- Department of Urology, Medanta, Gurugram, Haryana, India
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Xu H, Xing Z, Ai K, Wang J, Lv Z, Deng H, Li K, Wang Y, Li Y. Patients with high nuclear grade pT1-ccRCC are more suitable for radical nephrectomy than partial nephrectomy: a multicenter retrospective study using propensity score. World J Surg Oncol 2024; 22:24. [PMID: 38254091 PMCID: PMC10804783 DOI: 10.1186/s12957-024-03302-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/13/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Partial nephrectomy (PN) is usually recommended for T1 stage clear cell renal cell carcinoma (ccRCC) regardless of the nuclear grades. However, the question remains unresolved as to whether PN is non-inferior to RN in patients with T1-ccRCC at higher risk of recurrence. In fact, we found that patients with high nuclear grades treated with PN had poorer prognosis compared with those treated with radical nephrectomy (RN). Therefore, this study was designed to evaluate the associations of PN and RN in the four nuclear grade subsets with oncologic outcomes. METHODS A retrospective study was conducted in three Chinese urological centers that included 1,714 patients who underwent PN or RN for sporadic, unilateral, pT1, N0, and M0 ccRCC without positive surgical margins and neoadjuvant therapy between 2010 and 2019. Associations of nephrectomy type with local ipsilateral recurrence, distant metastases, and all-cause mortality (ACM) were evaluated using the Kaplan-Meier method and multivariable Cox proportional hazards regression models after overlap weighting (OW). RESULTS A total of 1675 patients entered the OW cohort. After OW, in comparison to PN, RN associated with a reduced risk of local ipsilateral recurrence in the G2 subset (HR = 0.148, 95% CI 0.046-0.474; p < 0.05), G3 subset (HR = 0.097, 95% CI 0.021-0.455; p < 0.05), and G4 subset (HR = 0.091, 95% CI 0.011-0.736; p < 0.05), and resulting in increased five-year local recurrence-free survival rates of 7.0%, 17.9%, and 36.2%, respectively. An association between RN and a reduced risk of distant metastases in the G4 subset (HR = 0.071, 95% CI 0.016-0.325; p < 0.05), with the five-year distant metastases-free survival rate increasing by 33.1% was also observed. No significant difference in ACM between PN and RN was identified. CONCLUSIONS Our findings substantiate that opting for RN, as opposed to PN, is more advantageous for local recurrence-free survival and distant metastases-free survival in patients with high nuclear grade (especially G4) pT1-ccRCC. We recommend placing a heightened emphasis on enhancing preoperative nuclear grade assessment, as it can significantly influence the choice of surgical plan. TRIAL REGISTRATION This study was registered at Chinese Clinical Trial Registry (ID: ChiCTR2200063333).
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Affiliation(s)
- Haozhe Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Zhuo Xing
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Kai Ai
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Jie Wang
- Department of Oncology, Hunan Cancer Hospital, Changsha, Hunan, China
| | - Zhengtong Lv
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Haitao Deng
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Ke Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yang Wang
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Yuan Li
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
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Lorette M, Bernhard JC, Bensalah CK, Bigot P, Villers A, Letouche ML, Doumerc N, Paparel P, Audenet F, Nouhaud FX, Parier B, Tricard T, Champy C, Brenier M, Pignot G, Long JA, Durand M, Vallee M, Waeckel T, Boissier R, Tambwe R, Ouzaid I, Olivier J, Khene ZE. Nephrometry scores to predict oncological outcomes following partial nephrectomy (UroCCR Study 70). World J Urol 2023; 41:3559-3566. [PMID: 37792008 DOI: 10.1007/s00345-023-04633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/11/2023] [Indexed: 10/05/2023] Open
Abstract
PURPOSE Partial nephrectomy (PN) for large or complex renal tumors can be difficult and associated with a higher risk of recurrence than radical nephrectomy. We aim to evaluate the clinical useful of nephrometry scores for predicting oncological outcomes in a large cohort of patients who underwent PN for renal cell carcinomas. METHODS Our analysis included patients who underwent PN for renal cell carcinoma in 21 French academic centers (2010-2020). RENAL, PADUA, and SPARE scores were calculated based on preoperative imaging. Uni- and multivariate cox models were performed to identify predictors of recurrence-free survival and overall survival. The area under the curve (AUC) was used to identify models with the highest discrimination. Decision curve analyses (DCAs) determined the net benefit associated with their use. RESULTS A total of 1927 patients were analyzed with a median follow-up of 32 months (14-45). RENAL score (p = 0.01), age (p = 0.002), histological type (p = 0.001), high nuclear grade (p = 0.001), necrotic component (p < 0.001), and positive margins (p = 0.005) were significantly related to recurrence in multivariate analyses. The discriminative performance of the 3 radiological scores was modest (65, 63, and 63%, respectively). All 3 scores showed good calibration, which, however, deteriorated with time. Decision curve analysis of the three models for the prediction of overall and recurrence-free survival was similar for all three scores and of limited clinical relevance. CONCLUSION The association between nephrometry scores and oncological outcomes after NP is very weak. The use of these scores for predicting oncological outcomes in routine practice is therefore of limited clinical value.
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Affiliation(s)
- Martin Lorette
- Department of Urology, Lille University Hospital, Lille, France.
- Service d'Urologie, Hôpital Claude Huriez, Rue Michel Polonowski, 59037, Lille, France.
| | | | | | - Pierre Bigot
- Department of Urology, University Hospital, Angers, France
| | - Arnauld Villers
- Department of Urology, Lille University Hospital, Lille, France
- Department of Urology, University Hospital, Lille, France
| | | | - Nicolas Doumerc
- Department of Urology, University Hospital of Rangueil, Toulouse, France
| | | | - François Audenet
- Department of Urology, Georges Pompidou European University Hospital, Paris, France
| | | | - Bastien Parier
- Department of Urology, Kremlin Bicetre University Hospital, Paris, France
| | | | - Cécile Champy
- Department of Urology, Mondor University Hospital, Créteil, France
| | - Martin Brenier
- Department of Urology, St Joseph Hospital, Paris, France
| | - Géraldine Pignot
- Department of Urology, Paoli-Calmettes Institute, Marseille, France
| | | | | | - Maxime Vallee
- Department of Urology, University Hospital, Poitiers, France
| | | | - Romain Boissier
- Department of Urology, University Hospital, Marseille, France
| | - Ricky Tambwe
- Department of Urology, University Hospital, Reims, France
| | - Idir Ouzaid
- Department of Urology, Bichat University Hospital, Paris, France
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Li KP, Wan S, Wang CY, Chen SY, Yang L. Perioperative, functional, and oncologic outcomes of robot-assisted versus open partial nephrectomy for complex renal tumors (RENAL score ≥ 7): an evidence-based analysis. J Robot Surg 2023:10.1007/s11701-023-01565-3. [PMID: 36913056 DOI: 10.1007/s11701-023-01565-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023]
Abstract
This study aims to assess the efficacy and safety of robot-assisted partial nephrectomy (RAPN) compared with open partial nephrectomy (OPN) in the management of complex renal tumors (defined as RENAL score ≥ 7). We conducted a comprehensive literature search in PubMed, Embase, Web of Science, and Cochrane Library to identify relevant comparative studies up to January 2023. This study was conducted with the Review Manager 5.4 software, and included RAPN and OPN-controlled trials for complex renal tumors. The prime outcomes were to assess the perioperative results, complications, renal function, and oncologic outcomes. A total of 1493 patients were included in seven studies. Compared to OPN, RAPN was associated with a significantly shorter hospital stay (weighted mean difference [WMD] - 1.53 days, 95% confidence interval [CI] - 2.44, - 0.62; p = 0.001), less blood loss (WMD - 95.88 mL, 95% CI - 144.19, - 47.56; p = 0.0001), lower transfusion rates (OR 0.33, 95% CI 0.15, 0.71; p = 0.005), fewer major complications (OR 0.63, 95% CI 0.39, 1.01; p = 0.05), and fewer overall complications (OR 0.49, 95% CI 0.36, 0.65; p < 0.00001). Nevertheless, no statistically significant differences were found between the two groups in operative time, warm ischemia time, estimated glomerular decline, intraoperative complications, positive surgical margins, local recurrence, overall survival, and recurrence-free survival. The study demonstrated that RAPN had superior perioperative parameters and fewer complications when compared to OPN for complex renal tumors. However, no significant differences were found in terms of renal function and oncologic outcomes.
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Affiliation(s)
- Kun-Peng Li
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Shun Wan
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Chen-Yang Wang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Si-Yu Chen
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Li Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, China.
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Radiofrequency Ablation, Cryoablation, and Microwave Ablation for the Treatment of Small Renal Masses: Efficacy and Complications. Diagnostics (Basel) 2023; 13:diagnostics13030388. [PMID: 36766493 PMCID: PMC9914157 DOI: 10.3390/diagnostics13030388] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/22/2023] Open
Abstract
Over the last two decades the detection rate of small renal masses has increased, due to improving diagnostic accuracy, and nephron-sparing treatments have become the first-choice curative option for small renal masses. As a minimally invasive alternative, thermal ablation has increased in popularity, offering a good clinical outcome and low recurrence rate. Radiofrequency ablation, Cryoablation, and Microwave ablation are the main ablative techniques. All of them are mostly overlapping in term of cancer specific free survival and outcomes. These techniques require imaging study to assess lesions features and to plan the procedure: US, CT, and both of them together are the leading guidance alternatives. Imaging findings guide the interventional radiologist in assessing the risk of complication and possible residual disease after procedure. The purpose of this review is to compare different ablative modalities and different imaging guides, underlining the effectiveness, outcomes, and complications related to each of them, in order to assist the interventional radiologist in choosing the best option for the patient.
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European Association of Urology Guidelines on Renal Cell Carcinoma: The 2022 Update. Eur Urol 2022; 82:399-410. [DOI: 10.1016/j.eururo.2022.03.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 03/10/2022] [Indexed: 12/22/2022]
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The Benign Renal Masses that Were Exposed after Nephron-Sparing Surgery: "Postsurgical Fatty Tumor." Is It Related to the Surgical Technique? J Kidney Cancer VHL 2021; 9:1-8. [PMID: 34888127 PMCID: PMC8571989 DOI: 10.15586/jkcvhl.v9i1.195] [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] [Received: 06/17/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
After nephron-sparing surgery (NSS), postsurgical fatty tumor could be mistakenly reported as angiomyolipoma during radiologic imaging of some patients. In the present paper, we studied the postsurgical fatty tumor detected after NSS but not covered before in the literature. In addition, we also evaluated whether the postsurgical fatty tumor was related to the surgical technique employed. Patients admitted to the urology department of our university hospital from 2014 to 2019 and operated with open NSS were evaluated retrospectively. We detected those 156 patients were operated with NSS. Nine patients with angiomyolipoma as primary pathology and four patients with surgical border positivity were excluded from the study. The patients were divided into two groups based on the repair of tumor extraction region. In Group 1, fatty tissue was used for repair, and Group 2 is the primary repair group. In all, 143 patients (Group 1 = 79, and Group 2 = 64) were included in the study. No demographic and radiologic differences, such as number of patients, age, gender, positioning of tumor, mass localization, tumor diameter, and RENAL nephrometry scoring system, were detected between the two groups. Postsurgical fatty tumors were detected in 28 patients in Group 1 and in two patients in Group 2 (P < 0.001). In patients with negative surgical margins after partial nephrectomy, lesions that were radiologically detected mimicking as angiomyolipoma were defined as “postsurgical fatty tumor.” This mass containing adipose tissue only neither depicted vascularization and enhancement nor increase in size for at least 1 year. We assumed that these lesions must be followed as benign lesions not requiring additional treatment.
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Paludo ADO, Knijnik P, Brum P, Cachoeira E, Gorgen A, Burttet L, Cabral R, Puliatti S, Rosito T, Berger M, Neto BS. Urology Residents Simulation Training Improves Clinical Outcomes in Laparoscopic Partial Nephrectomy. JOURNAL OF SURGICAL EDUCATION 2021; 78:1725-1734. [PMID: 33849788 DOI: 10.1016/j.jsurg.2021.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/08/2021] [Accepted: 03/21/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Partial nephrectomy (PN) is the preferred modality of treatment for small renal masses. Laparoscopic partial nephrectomy (LPN) has been adopted worldwide and a fundamental role is played by surgical skills. The need for skill instruction outside the operating room is well recognized in the modern models of surgery residency training. We aim to investigate the impact of residents' laparoscopic surgical skills training on the successful implementation of LPN in a reference public teaching hospital in southern Brazil. METHODS We accessed all patients undergoing LPN by senior's urology residents at Hospital de Clínicas de Porto Alegre. Patients were stratified in 2 periods of time named 'LPN eras' 1 and 2, to report the training impact on the outcome. LPN era 1 was from October 2012 to February 2017 and LPN era 2 from March 2017 to June 2019. All the senior residents of LPN era 2 followed a simulation training divided into 4 years with a total training time of 244 hours before performing the LPN. Residents from LPN era 1 did not have simulation training. RESULTS 124 patients underwent LPN during the study period, 53 (42.7%) of those were performed in LPN era 1 and 71 (57.3%) in LPN era 2. Baseline characteristics of the patients in the two groups were similar. The training performed by LPN era 2 residents was able to significantly reduce estimated blood loss, ischemia time and LOS with p value respectively 0.007, 0.001 and 0.001. LPN era 2 group also reached Trifecta in 77.5% of patients, being significantly more than in the LPN era 1 (p = 0.007). CONCLUSIONS Simulation in residents surgical training was able to improve clinical outcomes in LPN. These data reinforce the fundamental importance of adequate residents training before performing surgery on a patient.
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Affiliation(s)
- Artur de Oliveira Paludo
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil.
| | - Pedro Knijnik
- Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Pietro Brum
- Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduardo Cachoeira
- Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Antonio Gorgen
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Lucas Burttet
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil
| | - Renan Cabral
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil
| | - Stefano Puliatti
- ORSI Academy - Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia - Modena, Italy
| | - Tiago Rosito
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Milton Berger
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Brasil Silva Neto
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
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Alvim R, Tin A, Nogueira L, Lebdai S, Wong N, Takeda T, Assel M, Hakimi AA, Touijer K, Russo P, Coleman J. A comparison of oncologic and functional outcomes in patients with pt3a renal cell carcinoma treated with partial and radical nephrectomy. Int Braz J Urol 2021; 47:777-783. [PMID: 33848068 PMCID: PMC8321499 DOI: 10.1590/s1677-5538.ibju.2020.0149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/24/2020] [Indexed: 01/20/2023] Open
Abstract
HYPOTHESIS Partial Nephrectomy is oncological safe in patients with pT3a RCC. PURPOSE To compare the oncological and functional outcomes of patients with pT3a RCC scheduled for PN and RN. MATERIALS AND METHODS We retrospectively reviewed patients with pT3a N0 M0 RCC who underwent partial or radical nephrectomy from 2005 to 2016. Perioperative characteristics, including estimated glomerular filtration rate, tumor size, pathological histology, and RENAL nephrometry score, were compared between patients scheduled for partial or radical nephrectomy. We used multivariable Cox proportional hazards regression models to compare overall survival, cancer-specific survival, and recurrence-free survival between planned procedure type. RESULTS Of the 589 patients, 369 (63%) and 220 (37%) were scheduled for radical and partial nephrectomy, respectively; 26 (12%) of the scheduled partial nephrectomy cases were intraoperatively converted to radical nephrectomy. After adjusting for tumor size and histology, there were no statistically significant differences in overall survival (hazard ratio 0.66; 95% CI, 0.38-1.13), cancer-specific survival (hazard ratio 0.53; 95% CI, 0.16-1.75), or recurrence-free survival (hazard ratio 0.66; 95% CI, 0.34-1.28) between patients scheduled for partial or radical nephrectomy. Fewer patients scheduled for partial nephrectomy had estimated glomerular filtration rate reductions 3 to 9 months after surgery than patients scheduled for radical nephrectomy. CONCLUSION We found no evidence that patients scheduled to undergo partial nephrectomy had poorer oncologic outcomes than patients scheduled to undergo radical nephrectomy. In select patients with pT3a renal cell carcinoma in whom partial nephrectomy is deemed feasible by the surgeon, partial nephrectomy should not be discouraged.
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Affiliation(s)
- Ricardo Alvim
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Amy Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Lucas Nogueira
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Souhil Lebdai
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Nathan Wong
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Toshikazu Takeda
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, NY, USA
| | - A Ari Hakimi
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Karim Touijer
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Paul Russo
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Jonathan Coleman
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, NY, USA
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11
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Elective partial and radical nephrectomy in patients with renal cell carcinoma in CT1B stadium. VOJNOSANIT PREGL 2021. [DOI: 10.2298/vsp200520008m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. In renal cell carcinoma (RCC) the choice of surgical
technique, radical (RN) or partial nephrectomy (PN) is still centre
dependant because there still are no absolute recommendations for this
approach. This study aims to analyze the oncological aspects, time until
recurrent disease appears and cancer-specific survival in patients with RCC
in T1bN0?0 depending on the type of surgical procedure partial or radical
nephrectomy. Methods. A clinical observational study of a series of cases
was conducted that analyzed data of 154 patients operated in our institution
with a mean follow up a period not less than five years. The inclusion
criteria included: renal tumours 4-7 cm, histopathological confirmation of
RCC, absence of metastasis and normal serum creatinine. Exclusion criteria
included: the presence of other malignancies, solitary functional kidney or
comorbidities that can compromise renal function, bilateral tumours or
unilateral multiple tumours. Results. The study analyzed data of 154
patients, 97 radical nephrectomies and 57 patients that underwent partial
nephrectomy. Analyzing cancer-specific survival in four patients with RN
there was a disease advancement that led to a lethal outcome, one PN patient
died as a result of local relapse and distant metastasis. Conclusion. Based
on our results PN is a good and safe treatment option for patients with RCC
in T1b stadium. Partial nephrectomy offers a similar tumour control and
better cancer-specific survival.
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12
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Guo J, Arellano RS. Percutaneous Microwave Ablation of Stage T1b Renal Cell Carcinoma: Short-Term Assessment of Technical Feasibility, Short-Term Oncologic Outcomes, and Safety. J Endourol 2020; 34:1021-1027. [PMID: 32498630 DOI: 10.1089/end.2020.0382] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose: To report on the safety, technical results, and oncologic outcomes of computed tomography guided percutaneous microwave ablation of stage cT1b renal cell carcinoma. Materials and Methods: This single-center retrospective study investigated consecutive patients with T1b renal cell carcinoma who were treated with CT guided percutaneous microwave ablation between December 2015 and May 2019. Patient baseline characteristics, tumor biologic features, technical parameters, clinical outcomes, and complications were recorded and evaluated. Local tumor progression-free survival and overall survival rates were estimated using the Kaplan-Meier methods. Results: This study included 23 patients (18 men [mean age ± standard deviation, 74.6 years ±10.2; range 58-89 years] and 5 women [mean age, 71.6 years ±10.1; range 62-86 years]; overall mean age, 74.0 years ±10.0; range 58-89 years) with 23 T1b renal cell carcinomas. Primary technical success was achieved in 20/23 (87%) patients. Secondary technical success was achieved in 3/3 (100%) patients. Local tumor progression-free survival was 100.0%, 90.9%, and 90.9% at 1, 2, and 3 years, respectively. Overall survival was 95.2%, 85.7%, and 71.4% at 1, 2, and 3 years, respectively. There were 2 (8.7%) complications; both were classified as minor complications according to the Society of Interventional Radiology grading system. Conclusions: Computed tomography guided percutaneous microwave ablation for T1b renal cell carcinoma is associated with high rates of technical success, excellent local tumor progression-free survival, short-term survival and overall survival, and low complication rates.
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Affiliation(s)
- Jianhai Guo
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Interventional Therapy, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Ronald S Arellano
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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13
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Abedali ZA, Monn MF, Huddleston P, Cleveland BE, Sulek J, Bahler CD, Foster RS, Koch MO, Mellon MJ, Kaimakliotis HZ, Cary C, Bihrle R, Gardner TA, Masterson TA, Boris RS, Sundaram CP. Robotic and open partial nephrectomy for intermediate and high complexity tumors: a matched-pairs comparison of surgical outcomes at a single institution. Scand J Urol 2020; 54:313-317. [PMID: 32401119 DOI: 10.1080/21681805.2020.1765017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To compare peri-operative factors and renal function following open partial nephrectomy (OPN) and robotic partial nephrectomy (RPN) for intermediate and high complexity tumors when controlling for tumor and patient complexity.Methods: A retrospective review of 222 patients undergoing partial nephrectomy was performed. Patients with intermediate (nephrometry score NS 7-9) or high (NS 10-12) complexity tumors were matched 2:1 for RPN:OPN using NS, Charlson Comorbidity Index (CCI), and BMI. Patient demographics, peri-operative values, renal function, and complication rates were analyzed and compared.Results: Seventy-four OPN patients were matched to 148 RPN patients with no difference in patient demographics. Estimated blood loss in OPN patients was significantly higher (368.5 vs 210.5 mL, p < 0.001) as was transfusion rate (17% vs 1.6%, p < 0.001). Warm ischemia time was longer in OPN (25.5 vs 19.7 min, p = 0.001) while operative time was reduced (200.5 vs 226.5 min, p = 0.010). RPN patients had significantly shorter hospitalizations (5.3 vs 3.0 days, p < 0.001). GFR decrease after one month was not statistically significant (12.9 vs 6.6 ml/min, p = 0.130). Clavien III-V complications incidence was higher for OPN compared to RPN although not significantly (20.3% vs 10.8%, p = 0.055).Conclusion: When matching for tumor and patient complexity, RPN patients had fewer high grade post-operative complications, decreased blood loss, and shorter hospitalizations. RPN is a safe option for patients with intermediate and high complexity tumors.
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Affiliation(s)
- Zain A Abedali
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M Francesca Monn
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Patrick Huddleston
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brent E Cleveland
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jay Sulek
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Clinton D Bahler
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard S Foster
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael O Koch
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew J Mellon
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard Bihrle
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Thomas A Gardner
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ronald S Boris
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chandru P Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
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14
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Liu X, Huang X, Zhao P, Zhang P. Survival benefit of nephron-sparing surgery for patients with pT1b renal cell carcinoma: A population-based study. Oncol Lett 2020; 19:498-504. [PMID: 31897163 DOI: 10.3892/ol.2019.11065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 04/15/2019] [Indexed: 02/05/2023] Open
Abstract
The use of partial nephrectomy (PN) to treat patients with large renal cell carcinoma (RCC) remains controversial, particularly among elderly patients. The present study compared the improvement in cancer-specific survival (CSS) in patients with pT1b RCC who underwent either PN or radical nephrectomy (RN) and investigated the effects of age and sex on CSS. A total of 20,343 patients were identified in the Surveillance, Epidemiology and End Results database. Kaplan-Meier curves and Cox regression analysis were used to compare the CSS of patients who received PN vs. those who received RN. In total, 5,375 (26.42%) and 14,968 (73.58%) patients with pT1b RCC received PN and RN, respectively. Kaplan-Meier and Cox regression analysis indicated that PN resulted in an improved CSS compared with RN (P<0.001). In addition, PN was observed to be beneficial in male (P<0.001) and female patients <75 years of age. However, it was not beneficial for female patients of ≥75 years of age (P=0.197). These preliminary results warrant further investigation in clinical trials.
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Affiliation(s)
- Xiaode Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.,Department of Radiation Oncology, Sichuan Cancer Center, Sichuan Cancer Hospital and Institute, School of Medicine University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Xuemei Huang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.,Department of Radiation Oncology, Sichuan Cancer Center, Sichuan Cancer Hospital and Institute, School of Medicine University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Pan Zhao
- Department of Radiation Oncology, Sichuan Cancer Center, Sichuan Cancer Hospital and Institute, School of Medicine University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, P.R. China
| | - Peng Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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15
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Zhang Y, Long G, Shang H, Ding B, Sun G, Ouyang W, Liu M, Chen Y, Li H, Xu H, Ye Z. Comparison of the oncological, perioperative and functional outcomes of partial nephrectomy versus radical nephrectomy for clinical T1b renal cell carcinoma: A systematic review and meta-analysis of retrospective studies. Asian J Urol 2019; 8:117-125. [PMID: 33569278 PMCID: PMC7859367 DOI: 10.1016/j.ajur.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/22/2019] [Accepted: 10/24/2019] [Indexed: 12/29/2022] Open
Abstract
Objective To conduct a meta-analysis assessing the perioperative, functional and oncological outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for T1b tumours. The primary endpoints were the oncological outcomes. The secondary endpoints were the perioperative and functional outcomes. Methods A systematic literature review was performed by searching multiple databases through February 2019 to identify eligible comparative studies according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Identified reports were assessed according to the Newcastle-Ottawa Scale for nonrandomized controlled trials. Results Overall, 13 retrospective cohort studies were included in the analysis. Patients undergoing PN were younger (weighted mean difference [WMD] -3.49 years, 95% confidence interval [CI] -5.16 to -1.82; p<0.0001) and had smaller masses (WMD -0.45 cm, 95% CI -0.59 to -0.31; p<0.0001). There were no differences in the oncological outcome, which was demonstrated by progression-free survival (hazard ratio [HR] 0.70; p=0.22), cancer-specific mortality (HR 0.91; p=0.57) and all-cause mortality (HR 1.01; p=0.96). The two procedures were similar in estimated blood loss (WMD -16.47 mL; p=0.53) and postoperative complications (risk ratio [RR] 1.32; p=0.10), and PN provided better renal function preservation and was related to a lower likelihood of chronic kidney disease onset (RR 0.38; p=0.006). Conclusion PN is an effective treatment for T1b tumours because it offers similar surgical morbidity, equivalent cancer control, and better renal preservation compared to RN.
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Affiliation(s)
- Yucong Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gongwei Long
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haojie Shang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Beichen Ding
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoliang Sun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Ouyang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Man Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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16
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Yang F, Zhou Q, Xing N. Comparison of survival and renal function between partial and radical laparoscopic nephrectomy for T1b renal cell carcinoma. J Cancer Res Clin Oncol 2019; 146:261-272. [DOI: 10.1007/s00432-019-03058-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 10/15/2019] [Indexed: 01/28/2023]
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17
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Bertolo R, Garisto J, Dagenais J, Agudelo J, Armanyous S, Lioudis M, Kaouk J. Cold Versus Warm Ischemia Robot-Assisted Partial Nephrectomy: Comparison of Functional Outcomes in Propensity-Score Matched "At Risk" Patients. J Endourol 2019; 32:717-723. [PMID: 29926742 DOI: 10.1089/end.2018.0383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To compare functional outcomes of warm ischemia RPN (wRPN) to cold ischemia RPN (cRPN) in "at risk" patients. MATERIALS AND METHODS Retrospective review of institutional database queried for all patients who underwent cRPN/wRPN (January 2007-December 2016). For the study purpose, patients with solitary kidney and/or history of partial nephrectomy and/or multiple tumors and/or preoperative estimated Glomerular Filtration Rate (eGFR) <60 mL/minute were extracted. To reduce inherent biases, groups were matched on key variables related to renal function through a greedy matching algorithm with no replacement. Renal functional outcomes were evaluated by eGFR drops at 1-3 days and at 1, 3, 6, and 12 months postoperatively. A linear mixed effects model was used to assess eGFR at each follow-up who received either cRPN or wRPN. Follow-up was treated as a factor variable to account for nonlinear time trends. Contrast analysis was used to compare cRPN vs wRPN groups at each follow-up, using Sidak-Holm p-value adjustments for multiple comparisons. RESULTS Out of 19 cRPN patients and 279 wRPN patients, 14 cRPN patients were finally matched 1:1 with no replacement to 14 wRPN. There was no significant difference in preoperative eGFR for matched patients undergoing cRPN vs wRPN. Since the first postoperative day, cRPN patients had higher eGFR. The difference was statistically significant since the third month postoperatively (mean difference = 18.201, 95% confidence interval [CI]: 1.930-34.472) and remained at both the sixth month (mean difference = 18.839, 95% CI: 2.568-35.109) and the 12th month (mean difference = 21.277, 95% CI: 5.006-37.547) follow-up. CONCLUSIONS Accounting for unmodifiable and modifiable factors, in a cohort of highly selected patients "at risk" for postoperative significant decline in renal function after RPN, renal functional outcomes appear to be superior with cold ischemia technique.
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Affiliation(s)
- Riccardo Bertolo
- 1 Department of Urology, Cleveland Clinic, Glickman Urological and Kidney Institute , Cleveland, Ohio
| | - Juan Garisto
- 1 Department of Urology, Cleveland Clinic, Glickman Urological and Kidney Institute , Cleveland, Ohio
| | - Julien Dagenais
- 1 Department of Urology, Cleveland Clinic, Glickman Urological and Kidney Institute , Cleveland, Ohio
| | - Jose Agudelo
- 1 Department of Urology, Cleveland Clinic, Glickman Urological and Kidney Institute , Cleveland, Ohio
| | - Sherif Armanyous
- 2 Department of Nephrology, Cleveland Clinic, Glickman Urological and Kidney Institute , Cleveland, Ohio
| | - Michael Lioudis
- 2 Department of Nephrology, Cleveland Clinic, Glickman Urological and Kidney Institute , Cleveland, Ohio
| | - Jihad Kaouk
- 1 Department of Urology, Cleveland Clinic, Glickman Urological and Kidney Institute , Cleveland, Ohio
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18
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Sagalovich D, Dagenais J, Bertolo R, Garisto JD, Kaouk JH. Trifecta Outcomes in Renal Hilar Tumors: A Comparison Between Robotic and Open Partial Nephrectomy. J Endourol 2019; 32:831-836. [PMID: 29984597 DOI: 10.1089/end.2018.0445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To report a comparative analysis of outcomes in patients who underwent excisions of renal hilar tumors using both open and robotic approaches. MATERIALS AND METHODS We retrospectively reviewed robotic and open patients who underwent partial nephrectomy of renal hilar tumors between 2011 and 2016. "Trifecta" was defined as negative surgical margins, no complications, and a glomerular filtration rate (GFR) preservation of ≥90% at last follow-up. Inverse probability of treatment weighting (IPTW) was applied to equilibrate treatment groups, minimize selection bias, and optimize inference on the basis of each patient's clinicodemographic characteristics. RESULTS One hundred robotic and 64 open patients had sufficient data for IPTW. After weighting, there were no statistical differences in baseline characteristics between the two groups (p < 0.05). On adjusted analyses, robotic partial nephrectomy (RPN) achieved equivalent rates of trifecta to open surgery (21.1% vs 13.9%, respectively, p = 0.387). There were no differences between robotic and open cohorts for negative margin rates (72.8% vs 90.4%, p = 0.124), absence of complications (68.6% vs 75.2%, p = 0.587), or GFR ≥90% (39.4% vs 21.6%, p = 0.111). The robotic cohort had a shorter mean length of stay (3.8 vs 5.0 days, p = 0.012), and no difference in estimated blood loss (253.3 vs 357.1, p = 0.091) or operating time (199.8 vs 200.4, p = 0.961). CONCLUSIONS In our analysis both open and RPN for hilar tumors were equally likely to achieve a low "trifecta" outcome with a shorter mean length of stay in the robotic cohort.
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Affiliation(s)
- Daniel Sagalovich
- Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Julien Dagenais
- Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Riccardo Bertolo
- Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Juan D Garisto
- Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
| | - Jihad H Kaouk
- Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio
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Li G, Dong J, Huang W, Zhang Z, Wang D, Zou M, Xu Q, Lu G, Cao Z. Establishment of a novel system for the preoperative prediction of adherent perinephric fat (APF) occurrence based on a multi-mode and multi-parameter analysis of dual-energy CT. Transl Androl Urol 2019; 8:421-431. [PMID: 31807419 DOI: 10.21037/tau.2019.09.23] [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] [Indexed: 01/06/2023] Open
Abstract
Background Adherent perinephric fat (APF) is evaluated preoperatively with the Mayo adhesive probability (MAP) scoring system using conventional single-form computed tomography (CT) images. An objective or quantitative indicator for predicting APF is urgently needed for clinical application. Methods A total of 150 patients with renal tumours who underwent laparoscopic partial nephrectomy (LPN) were retrospectively enrolled and divided into the APF group (n=100) and the non-APF group (n=50) according to surgical results. All patients underwent a renal contrast-enhanced dual-energy CT (DECT) scan. The obtained CT DICOM data were transmitted to the DECT post-processing workstation and adopted virtual non-contrast (VNC), Rho/Z Maps, and Monoenergetic Plus (mono+) modes separately to undergo a multi-parameter analysis. A logistic stepwise investigation was utilized to analyse the related risk factors. The cutoff value was determined by the Youden index. Fifty patients were prospectively enrolled to validate the constructed model. The area under the curve (AUC), sensitivity, specificity and accuracy of the model were calculated. Results The study demonstrated that age, sex, body mass index (BMI), smoking status, tumour diameter, exophytic status, degree of malignancy and posterior perinephric fat thickness were related to the occurrence of APF (P<0.05). Model 1 was selected with the contrast material (CM) parameter (cutoff point 0.5), model 2 was selected with the effective atomic number (Zeff) parameter (cutoff point 6.5), and model 3 was selected with the slope K (K) parameter (cutoff point -0.95). The AUC, sensitivity, specificity and accuracy of model 1 were 0.94, 0.94, 0.93 and 0.94, respectively; for model 2, they were 0.94, 0.93, 0.93 and 0.96, respectively; and for model 3, they were 0.92, 0.92, 0.93 and 0.92, respectively. Conclusions Multi-mode and multi-parameter models of DECT can effectively be used to predict the occurrence of APF.
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Affiliation(s)
- Guan Li
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Jie Dong
- Department of Urology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Wei Huang
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Zhengyu Zhang
- Department of Urology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Di Wang
- Department of Pathology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Mingyu Zou
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Qinmei Xu
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Guangming Lu
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, China
| | - Zhiqiang Cao
- Department of Urology, General Hospital of Northern Theater Command, Shenyang 110016, China
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20
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Jiang YL, Peng CX, Wang HZ, Qian LJ. Comparison of the long-term follow-up and perioperative outcomes of partial nephrectomy and radical nephrectomy for 4 cm to 7 cm renal cell carcinoma: a systematic review and meta-analysis. BMC Urol 2019; 19:48. [PMID: 31174522 PMCID: PMC6554915 DOI: 10.1186/s12894-019-0480-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/27/2019] [Indexed: 01/25/2023] Open
Abstract
Background The efficacy of partial nephrectomy (PN) for T1b renal cell carcinoma (RCC) is controversial. The oncological outcomes, the change in postoperative renal function and the perioperative complications are unclear. Methods We searched PUBMED, EMBASE and the Cochrane Central Register for studies from March 1998 to March 2018 for studies comparing PN to radical nephrectomy (RN) for the treatment of T1b RCC. After data extraction and quality assessment, we used RevMan 5.2 to pool the data. Then, we used Stata 12.0 to perform sensitivity analyses and meta-regression. We used the GRADE profiler to evaluate the evidence according to the GRADE approach. Results A total of 16 studies involving 33,117 patients were included in our meta-analysis. No significant difference was found in the 5-year overall survival (OS), 10-year OS, 5-year recurrence-free survival (RFS) and 10-year RFS. The 5-year cancer-special survival (CSS) and 10-year CSS were better in RN compared to PN, respectively, at RR = 1.02, P < 0.05 and RR = 1.04, P < 0.05. PN was better than RN in the preservation of renal function (WMD = -9.15, 95% CI: − 10.30 to − 7.99, P < 0.05). The confidence level grading of the evidence was moderate for 5-year OS, 10-year OS, 5-year CSS, 10-year CSS, 5-year RFS, 10-year RFS, tumor recurrence, decline in eGFR, and postoperative complications. Conclusions PN may provide comparable outcomes in terms of RFS & OS, and better renal function preservation although CSS was worse. Electronic supplementary material The online version of this article (10.1186/s12894-019-0480-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yu-Li Jiang
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China. .,School of Medicine, Hang Zhou Normal University, Hangzhou, 310016, China.
| | - Cheng-Xia Peng
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.,School of Medicine, Hang Zhou Normal University, Hangzhou, 310016, China
| | - Heng-Zi Wang
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.,School of Medicine, Hang Zhou Normal University, Hangzhou, 310016, China
| | - Lu-Jie Qian
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.,School of Medicine, Hang Zhou Normal University, Hangzhou, 310016, China
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Trifecta Outcomes in Open, Laparoscopy or Robotic Partial Nephrectomy: Does the Surgical Approach Matter? J Kidney Cancer VHL 2019; 6:8-12. [PMID: 31149561 PMCID: PMC6532825 DOI: 10.15586/jkcvhl.2019.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/04/2019] [Indexed: 01/20/2023] Open
Abstract
This retrospective study evaluated perioperative outcomes of open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robot-assisted partial nephrectomy (RAPN) and identified predictive factors of Trifecta achievement for renal tumors that underwent partial nephrectomy (PN) in a single institutional cohort. The study involved patients who underwent PN from January 2011 to July 2018. Trifecta was defined as absence of perioperative complications, no positive surgical margins, and ischemia time <30 min. Fifty-five PN procedures were reviewed: 28 OPN, 14 LPN, and 13 RAPN. OPN, LPN and RAPN had similar median tumor size (5.75, 5.25, and 5 cm), nephrometry score (7, 6, and 6), and preoperative creatinine (1.09, 1.1, and 1.1 mg/dl, respectively). Blood loss was higher for OPN (550 ml) than for LPN (400 ml) and RAPN (300 ml), P = 0.042. Drain was removed after 6 days in OPN which was higher than LPN and RAPN (4.5 and 4 days, respectively), P = 0.008. OPN, LPN, and RAPN had similar median operative time (190, 180, and 180 min, respectively), P = 0.438. Median postoperative stay for OPN, LPN, and RAPN was 5, 6.5, and 10 days, respectively. Trifecta outcomes of 73.1%, 64.3%, and 61.53% were achieved in OPN, LPN, and RAPN, respectively, P = 0.730. It was concluded that Trifecta outcomes had no significant difference among OPN, LPN, and RAPN. LPN can produce as good results as RAPN. Keeping in mind the cost-effectiveness, LPN holds an important position in developing countries where expenditure by patient is a major factor.
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Khalil MAI, Khan N, Ali A, Abu Bakar M, Adnan S, Fiaz S, Akbar Khan A, Mir K. Outcomes of Nephron Sparing in a Specialist Cancer Hospital of a Developing Country. Cureus 2019; 11:e4150. [PMID: 31058033 PMCID: PMC6488336 DOI: 10.7759/cureus.4150] [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: 11/17/2022] Open
Abstract
Introduction Nephron-sparing surgery in the form of partial nephrectomy (PN) is currently considered the standard treatment for relatively small localized renal cell tumors. Objectives This study aimed to determine outcomes of PN regarding complications, recurrence, and survival rates at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Methods We assessed the data of patients older than 18 years undergoing PN from January 2010 to June 2017 who met our inclusion criteria. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY). Results A total of 35 patients were studied, with a male to female ratio of 2.5:1 with median age of 50 years. The median hospital stay was four days (range: 3-7), and the median RENAL (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior/posterior location relative to polar lines) Score was five (range: 4-10). The most common pathological tumor stage was T1 (94%), and the median size was 3.5 cm. On histopathology, clear-cell carcinoma was the most common tumor (incidence, 71%). The median Fuhrman’s grade was two. On final histopathology, four patients had positive margins. Among them, two patients showed a progressive deterioration in renal functions and were found to have residual disease six months later. Only one patient developed metastasis in the lung. Wound infection was observed in one patient while another had wound dehiscence. Urine leakage was noted in two patients. The median follow-up duration was 18 months (range: 3-84). Mean cancer-free survival was 78.6 months, and overall survival was 79.2 months. The projected three-year and five-year disease-free and overall survival was 96% and 94%, respectively. Conclusion PN is a viable option with excellent outcomes regarding the complication profile, recurrence-free, and overall survival in patients with relatively small localized renal tumors.
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Affiliation(s)
| | - Nouman Khan
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Azfar Ali
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Muhammad Abu Bakar
- Biostatistics and Epidemiology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Siddique Adnan
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Shaukat Fiaz
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Aleena Akbar Khan
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Khurram Mir
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
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23
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Ljungberg B, Albiges L, Abu-Ghanem Y, Bensalah K, Dabestani S, Fernández-Pello S, Giles RH, Hofmann F, Hora M, Kuczyk MA, Kuusk T, Lam TB, Marconi L, Merseburger AS, Powles T, Staehler M, Tahbaz R, Volpe A, Bex A. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update. Eur Urol 2019; 75:799-810. [PMID: 30803729 DOI: 10.1016/j.eururo.2019.02.011] [Citation(s) in RCA: 869] [Impact Index Per Article: 173.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/07/2019] [Indexed: 12/12/2022]
Abstract
CONTEXT The European Association of Urology Renal Cell Carcinoma (RCC) Guideline Panel has prepared evidence-based guidelines and recommendations for the management of RCC. OBJECTIVE To provide an updated RCC guideline based on standardised methodology including systematic reviews, which is robust, transparent, reproducible, and reliable. EVIDENCE ACQUISITION For the 2019 update, evidence synthesis was undertaken based on a comprehensive and structured literature assessment for new and relevant data. Where necessary, formal systematic reviews adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were undertaken. Relevant databases (Medline, Cochrane Libraries, trial registries, conference proceedings) were searched until June 2018, including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm, systematic reviews, and meta-analyses. Where relevant, risk of bias (RoB) assessment, and qualitative and quantitative syntheses of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment. Clinical practice recommendations were developed and issued based on the modified GRADE framework. EVIDENCE SYNTHESIS All chapters of the RCC guidelines were updated based on a structured literature assessment, for prioritised topics based on the availability of robust data. For RCTs, RoB was low across studies. For most non-RCTs, clinical and methodological heterogeneity prevented pooling of data. The majority of included studies were retrospective with matched or unmatched cohorts, based on single- or multi-institutional data or national registries. The exception was for the treatment of metastatic RCC, for which there were several large RCTs, resulting in recommendations based on higher levels of evidence. CONCLUSIONS The 2019 RCC guidelines have been updated by the multidisciplinary panel using the highest methodological standards. These guidelines provide the most reliable contemporary evidence base for the management of RCC in 2019. PATIENT SUMMARY The European Association of Urology Renal Cell Carcinoma Guideline Panel has thoroughly evaluated the available research data on kidney cancer to establish international standards for the care of kidney cancer patients.
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Affiliation(s)
- Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
| | - Laurance Albiges
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | - Saeed Dabestani
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund, Sweden
| | | | - Rachel H Giles
- Department of Nephrology and Hypertension, Patient Advocate International Kidney Cancer Coalition (IKCC), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Fabian Hofmann
- Department of Urology, Sunderby Hospital, Sunderby, Sweden
| | - Milan Hora
- Department of Urology, Faculty Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - Markus A Kuczyk
- Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany
| | - Teele Kuusk
- Department of Urology, Royal Free Hospital, Pond Street, London, UK
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Thomas Powles
- The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Michael Staehler
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Rana Tahbaz
- Department of Urology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Alessandro Volpe
- Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Axel Bex
- The Royal Free London NHS Foundation Trust, London, UK; UCL Division of Surgery and Interventional Science, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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24
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Autorino R, Mayer Grob B, Guruli G, Hampton LJ. Partial Versus Total Nephrectomy: Indications, Limitations, and Advantages. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Chong JT, Paulucci D, Lubin M, Beksac AT, Gin G, Sfakianos JP, Badani KK. Comparison of overall survival and unplanned hospital readmissions between partial and radical nephrectomy for cT1a and cT1b renal masses. Ther Adv Urol 2018; 10:383-391. [PMID: 30574198 PMCID: PMC6295788 DOI: 10.1177/1756287218810313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/11/2018] [Indexed: 11/17/2022] Open
Abstract
Background: The aim of the study was to compare overall survival (OS) and unplanned hospital readmissions (UHRs) within 30 days between partial nephrectomy (PN) and radical nephrectomy (RN) for clinically localized T1 renal tumors. Methods: The National Cancer Database was queried to identify 51,018 patients who had undergone RN (n = 23,904; 46.9%) or PN (n = 27,114; 53.1%) for a cT1N0M0 renal mass from 2004 to 2013. OS and UHRs were compared using inverse probability of treatment weighted (IPTW)-adjusted Cox proportional hazards regression models. Results: For patients with a cT1a tumor, IPTW-adjusted analysis showed PN compared with RN was associated with improved OS (hazard ratio [HR] = 0.62; 95% confidence interval [CI] = 0.56, 0.67; p < 0.001) with a 5-year and 10-year IPTW-adjusted OS of 93.0% versus 88.2% and 78.1% versus 71.7%, respectively with no difference in UHR (odds ratio [OR] = 1.02; 95% CI = 0.90, 1.16; p = 0.727). For patients with a cT1b tumor, IPTW-adjusted analysis showed PN compared with RN to be associated with marginally improved OS (HR = 0.89; 95% CI = 0.82, 0.99; p = 0.025) with a 5-year and 10-year IPTW-adjusted OS of 85.3% versus 84.3% and 70.8% versus 63.6%, respectively, with more UHRs for PN (OR = 1.43; 95% CI = 1.19, 1.72; p < 0.001). Conclusions: PN compared with RN was associated with a significant survival benefit for patients with a cT1a renal mass and a modest survival benefit for patients with a cT1b renal mass. PN should be offered over RN when feasible despite a marginal increase in UHRs for PN of cT1b tumors. Randomized controlled trials are necessary to confirm these findings.
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Affiliation(s)
- Julio T Chong
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - David Paulucci
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Marc Lubin
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Greg Gin
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA, and Department of Urology, Veterans Affairs Long Beach Health System, Long Beach, CA, USA
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 5 E 98th Street, New York, NY 10029, USA
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26
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Chung JS, Son NH, Lee SE, Hong SK, Jeong CW, Kwak C, Kim HH, Hong SH, Kim YJ, Kang SH, Chung J, Kwon TG, Hwang EC, Byun SS. Partial versus Radical Nephrectomy for T1-T2 Renal Cell Carcinoma in Patients with Chronic Kidney Disease Stage III: a Multiinstitutional Analysis of Kidney Function and Survival Rate. J Korean Med Sci 2018; 33:e277. [PMID: 30344463 PMCID: PMC6193884 DOI: 10.3346/jkms.2018.33.e277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 06/29/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND To examine survival rates and renal function after partial nephrectomy (PN) and radical nephrectomy (RN) in patients with chronic kidney disease (CKD). METHODS We studied 4,332 patients who underwent PN or RN for pathological T1a-T2N0M0 renal cell carcinoma from 1988 to 2014. Patients were divided into two subgroups of CKD stage I-II and stage III. Kidney function, and survival outcomes were compared between groups. RESULTS We included 1,756 patients with CKD I-II and 276 patients with CKD III in the final pair-matched analysis. Kidney function was significantly better preserved in the PN than in the RN group among all patients. However, the beneficial effect of PN on kidney function gradually disappeared over time in CKD III patients. The 5-year overall survival (OS) rates after PN and RN differed in patients with CKD I-II disease (99.4% vs. 96.5%, respectively, P = 0.015). The 5-year OS rates after surgery were not affected by mode of nephrectomy in CKD III patients (97.8% vs. 93.5%, P = 0.103). The 5-year cancer-specific survival rates did not differ between treatment groups in all CKD stage. Cox hazard analysis showed that the operative method was a significant factor for OS in CKD I-II patients (hazard ratio [HR], 0.320; confidence interval [CI], 0.122-0.840; P = 0.021). However, PN was not beneficial in terms of OS in CKD III patients (HR, 0.395; CI, 0.086-1.172; P = 0.117). CONCLUSION PN is associated with a higher OS rate and better kidney function in patients with preoperative CKD stage I and II, but not in those with CKD stage III.
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Affiliation(s)
- Jae-Seung Chung
- Department of Urology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Nak Hoon Son
- Department of Biostatistics, Yonsei University, Seoul, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Sung Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong June Kim
- Department of Urology, Chungbuk National University Hospital, Cheongju, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Anam Hospital, Seoul, Korea
| | - Jinsoo Chung
- Department of Urology, National Cancer Center, Goyang, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University Medical Center, Daegu, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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27
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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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28
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Bertolo R, Autorino R, Simone G, Derweesh I, Garisto JD, Minervini A, Eun D, Perdona S, Porter J, Rha KH, Mottrie A, White WM, Schips L, Yang B, Jacobsohn K, Uzzo RG, Challacombe B, Ferro M, Sulek J, Capitanio U, Anele UA, Tuderti G, Costantini M, Ryan S, Bindayi A, Mari A, Carini M, Keehn A, Quarto G, Liao M, Chang K, Larcher A, De Naeyer G, De Cobelli O, Berardinelli F, Zhang C, Langenstroer P, Kutikov A, Chen D, De Luyk N, Sundaram CP, Montorsi F, Stein RJ, Haber GP, Hampton LJ, Dasgupta P, Gallucci M, Kaouk J, Porpiglia F. Outcomes of Robot-assisted Partial Nephrectomy for Clinical T2 Renal Tumors: A Multicenter Analysis (ROSULA Collaborative Group). Eur Urol 2018; 74:226-232. [DOI: 10.1016/j.eururo.2018.05.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 05/03/2018] [Indexed: 12/11/2022]
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29
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Venkatramani V, Koru-Sengul T, Miao F, Nahar B, Prakash NS, Swain S, Punnen S, Ritch C, Gonzalgo M, Parekh D. A comparison of overall survival and perioperative outcomes between partial and radical nephrectomy for cT1b and cT2 renal cell carcinoma—Analysis of a national cancer registry. Urol Oncol 2018; 36:90.e9-90.e14. [DOI: 10.1016/j.urolonc.2017.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/01/2017] [Accepted: 11/12/2017] [Indexed: 11/26/2022]
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30
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Haifler M, Ristau BT, Higgins AM, Smaldone MC, Kutikov A, Zisman A, Uzzo RG. External Validation of Contact Surface Area as a Predictor of Postoperative Renal Function in Patients Undergoing Partial Nephrectomy. J Urol 2018; 199:649-654. [DOI: 10.1016/j.juro.2017.09.070] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Miki Haifler
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
- Department of Urology, Itzhak Shamir Medical Center, Tzrifin, Be’er Ya’akov, Israel
| | - Benjamin T. Ristau
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
| | - Andrew M. Higgins
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
| | - Marc C. Smaldone
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
| | - Alexander Kutikov
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
| | - Amnon Zisman
- Department of Urology, Itzhak Shamir Medical Center, Tzrifin, Be’er Ya’akov, Israel
| | - Robert G. Uzzo
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
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31
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Ameri C, Lopez F, Vitagliano G, Rios Pita H, Guglielmi J, Blas L. New technique for nephron-sparing surgery in polar tumours. A modification of the Kim technique. Actas Urol Esp 2017; 41:535-539. [PMID: 28363423 DOI: 10.1016/j.acuro.2017.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 12/26/2016] [Accepted: 01/02/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Nephron-sparing surgery (NSS) is the indication, provided it is feasible and meets the international treatment guidelines. One of the objectives of performing NSS is to reduce the ischemia time as much as possible. We propose a surgical technique for treating polar renal tumours and those larger than 4cm based on the principle of the technique described by Kim in 1964. METHOD The technique performs a continuous circular suture on the base of the tumour, achieving compression of the renal pole without vascular clamping, facilitating haemostasis and avoiding the blind transfixion performed in Kim's original technique. We selected 28 patients for the implementation of the technique. RESULTS The patients' mean age was 56 years (30-69). The R.E.N.A.L. scores were as follows: 12 of low complexity, 12 of moderate complexity and 4 of high complexity. The mean surgical time was 109minutes (75-140), and the mean estimated blood loss was 120mL (50-300mL). No positive margins were identified, and no patients required blood transfusions. The mean stay was 3.7 days (2-6). There were no Clavien grade 2 or higher complications. There were 3 Clavien 1 complications (fever). The difference in glomerular filtration rate was -0.71mL/min/m2. The pathology was malignant in 26 cases, 19 of them clear-cell carcinomas. Two cases were reported as oncocytomas. CONCLUSION The proposed technique showed acceptable results, with a low rate of complications in the patient group.
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Focal ablation therapy for renal cancer in the era of active surveillance and minimally invasive partial nephrectomy. Nat Rev Urol 2017; 14:669-682. [PMID: 28895562 DOI: 10.1038/nrurol.2017.143] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Partial nephrectomy is the optimal surgical approach in the management of small renal masses (SRMs). Focal ablation therapy has an established role in the modern management of SRMs, especially in elderly patients and those with comorbidities. Percutaneous ablation avoids general anaesthesia and laparoscopic ablation can avoid excessive dissection; hence, these techniques can be suitable for patients who are not ideal surgical candidates. Several ablation modalities exist, of which radiofrequency ablation and cryoablation are most widely applied and for which safety and oncological efficacy approach equivalency to partial nephrectomy. Data supporting efficacy and safety of ablation techniques continue to mature, but they originate in institutional case series that are confounded by cohort heterogeneity, selection bias, and lack of long-term follow-up periods. Image guidance and surveillance protocols after ablation vary and no consensus has been established. The importance of SRM biopsy, its optimal timing, the type of biopsy used, and its role in treatment selection continue to be debated. As safety data for active surveillance and experience with minimally invasive partial nephrectomy are expanding, the role of focal ablation therapy in the treatment of patients with SRMs requires continued evaluation.
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Lee H, Oh JJ, Byun SS, Jeong CW, Kwak C, Jeong BC, Jeon SS, Lee HM, Choi HY, Seo SI. Can partial nephrectomy provide equal oncological efficiency and safety compared with radical nephrectomy in patients with renal cell carcinoma (≥4 cm)? A propensity score–matched study. Urol Oncol 2017; 35:379-385. [DOI: 10.1016/j.urolonc.2017.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/02/2017] [Accepted: 02/08/2017] [Indexed: 11/26/2022]
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34
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Bamias A, Escudier B, Sternberg CN, Zagouri F, Dellis A, Djavan B, Tzannis K, Kontovinis L, Stravodimos K, Papatsoris A, Mitropoulos D, Deliveliotis C, Dimopoulos MA, Constantinides CA. Current Clinical Practice Guidelines for the Treatment of Renal Cell Carcinoma: A Systematic Review and Critical Evaluation. Oncologist 2017; 22:667-679. [PMID: 28592625 PMCID: PMC5469586 DOI: 10.1634/theoncologist.2016-0435] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/05/2017] [Indexed: 02/07/2023] Open
Abstract
The landscape of local and systemic therapy of renal cell carcinoma (RCC) is rapidly changing. The increase in the incidental finding of small renal tumors has increased the application of nephron-sparing procedures, while ten novel agents targeting the vascular endothelial growth factor (VEGF) or the mammalian target of rapamycin pathways, or inhibiting the interaction of the programmed death 1 receptor with its ligand, have been approved since 2006 and have dramatically improved the prognosis of metastatic RCC (mRCC). These rapid developments have resulted in continuous changes in the respective Clinical Practice Guidelines/Expert Recommendations. We conducted a systematic review of the existing guidelines in MEDLINE according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement, aiming to identify areas of agreement and discrepancy among them and to evaluate the underlying reasons for such discrepancies. Data synthesis identified selection criteria for nonsurgical approaches in renal masses; the role of modern laparoscopic techniques in the context of partial nephrectomy; selection criteria for cytoreductive nephrectomy and metastasectomy in mRCC; systemic therapy of metastatic non-clear-cell renal cancers; and optimal sequence of available agents in mRCC relapsed after anti-VEGF therapy as the major areas of uncertainty. Agreement or uncertainty was not always correlated with the availability of data from phase III randomized controlled trials. Our review suggests that the combination of systematic review and critical evaluation can define practices of wide applicability and areas for future research by identifying areas of agreement and uncertainty among existing guidelines. IMPLICATIONS FOR PRACTICE Currently, there is uncertainity on the role of surgery in MRCC and on the choice of available guidelines in relapsed RCC. The best practice is individualization of targeted therapies. Systematic review of guidelines can help to identify unmet medical needs and areas of future research.
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Affiliation(s)
- Aristotle Bamias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece
- Hellenic GU Cancer Group, Athens, Greece
| | | | - Cora N Sternberg
- Department of Medical Oncology San Camillo and Forlanini Hospitals, Rome, Italy
| | - Flora Zagouri
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece
| | - Athanasios Dellis
- Hellenic GU Cancer Group, Athens, Greece
- 2nd Department of Surgery, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Bob Djavan
- Department of Onology, Medical School, New York University, New York, New York, USA
- Department of Onology, Medical School, University of Vienna, Vienna, Austria
| | | | | | - Konstantinos Stravodimos
- Hellenic GU Cancer Group, Athens, Greece
- 1st Department of Urology National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
| | - Athanasios Papatsoris
- Hellenic GU Cancer Group, Athens, Greece
- 2nd Department of Urology, National and Kapodistrian University of Athens Medical School, Sismanoglion Hospital, Athens, Greece
| | - Dionysios Mitropoulos
- Hellenic GU Cancer Group, Athens, Greece
- 1st Department of Urology National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
| | - Charalampos Deliveliotis
- Hellenic GU Cancer Group, Athens, Greece
- 2nd Department of Urology, National and Kapodistrian University of Athens Medical School, Sismanoglion Hospital, Athens, Greece
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece
- Hellenic GU Cancer Group, Athens, Greece
| | - Constantine A Constantinides
- Hellenic GU Cancer Group, Athens, Greece
- 1st Department of Urology National and Kapodistrian University of Athens Medical School, Laiko Hospital, Athens, Greece
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Kunath F, Schmidt S, Krabbe L, Miernik A, Dahm P, Cleves A, Walther M, Kroeger N. Partial nephrectomy versus radical nephrectomy for clinical localised renal masses. Cochrane Database Syst Rev 2017; 5:CD012045. [PMID: 28485814 PMCID: PMC6481491 DOI: 10.1002/14651858.cd012045.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Partial nephrectomy and radical nephrectomy are the relevant surgical therapy options for localised renal cell carcinoma. However, debate regarding the effects of these surgical approaches continues and it is important to identify and summarise high-quality studies to make surgical treatment recommendations. OBJECTIVES To assess the effects of partial nephrectomy compared with radical nephrectomy for clinically localised renal cell carcinoma. SEARCH METHODS We searched CENTRAL, MEDLINE, PubMed, Embase, Web of Science, BIOSIS, LILACS, Scopus, two trial registries and abstracts from three major conferences to 24 February 2017, together with reference lists; and contacted selected experts in the field. SELECTION CRITERIA We included a randomised controlled trial comparing partial and radical nephrectomy for participants with small renal masses. DATA COLLECTION AND ANALYSIS One review author screened all of the titles and abstracts; only citations that were clearly irrelevant were excluded at this stage. Next, two review authors independently assessed full-text reports, identified relevant studies, evaluated the eligibility of the studies for inclusion, assessed trial quality and extracted data. The update of the literature search was performed by two independent review authors. We used Review Manager 5 for data synthesis and data analyses. MAIN RESULTS We identified one randomised controlled trial including 541 participants that compared partial nephrectomy to radical nephrectomy. The median follow-up was 9.3 years.Based on low quality evidence, we found that time-to-death of any cause was decreased using partial nephrectomy (HR 1.50, 95% CI 1.03 to 2.18). This corresponds to 79 more deaths (5 more to 173 more) per 1000. Also based on low quality evidence, we found no difference in serious adverse events (RR 2.04, 95% CI 0.19 to 22.34). Findings are consistent with 4 more surgery-related deaths (3 fewer to 78 more) per 1000.Based on low quality evidence, we found no difference in time-to-recurrence (HR 1.37, 95% CI 0.58 to 3.24). This corresponds to 12 more recurrences (14 fewer to 70 more) per 1000. Due to the nature of reporting, we were unable to analyse overall rates for immediate and long-term adverse events. We found no evidence on haemodialysis or quality of life.Reasons for downgrading related to study limitations (lack of blinding, cross-over), imprecision and indirectness (a substantial proportion of patients were ultimately found not to have a malignant tumour). Based on the finding of a single trial, we were unable to conduct any subgroup or sensitivity analyses. AUTHORS' CONCLUSIONS Partial nephrectomy may be associated with a decreased time-to-death of any cause. With regards to surgery-related mortality, cancer-specific survival and time-to-recurrence, partial nephrectomy appears to result in little to no difference.
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Affiliation(s)
- Frank Kunath
- University Hospital ErlangenDepartment of UrologyKrankenhausstrasse 12ErlangenGermany91054
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
| | | | - Laura‐Maria Krabbe
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
- University of Muenster Medical CenterDepartment of UrologyAlbert‐Schweitzer Campus 1, GB A1MuensterNRWGermany48149
| | - Arkadiusz Miernik
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
- Medical University Centre FreiburgDepartment of UrologyHugstetterstrasse 55FreiburgBaden‐WürttembergGermany79106
| | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55417
| | - Anne Cleves
- Cardiff University Library ServicesVelindre NHS TrustVelindre Cancer CentreCardiffWalesUKCF14 2TL
| | | | - Nils Kroeger
- UroEvidence@Deutsche Gesellschaft für UrologieBerlinGermany
- University Hospital GreifswaldDepartment of Urology17489 GreifswaldGreifswaldGermany
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Daugherty M, Bratslavsky G. Surgical Techniques in the Management of Small Renal Masses. Urol Clin North Am 2017; 44:233-242. [DOI: 10.1016/j.ucl.2016.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Yong TY, Khow KSF. Chronic kidney disease after radical nephrectomy for suspected renal cancers. World J Clin Urol 2017; 6:10-17. [DOI: 10.5410/wjcu.v6.i1.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/13/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
Nephrectomy is the treatment of choice for early stage renal cell carcinoma. However, radical nephrectomy is consistently associated with higher rates of new-onset chronic kidney disease (CKD) than the general population, regardless of the method used in measuring renal function. The higher rates of CKD are associated with worsened survival because of increased risk of cardiovascular diseases and mortality. Comorbidities and adjacent non-neoplastic kidney diseases are important risk factors for the development of CKD after nephrectomy. Partial nephrectomy has become the standard of care for patients with stage 1a tumours (diameter < 4 cm) and an attractive option for those with stage 1b (diameter 4-7 cm). Therefore stratifying the risk of postoperative CKD before surgery is important and ongoing monitoring of kidney function after radical nephrectomy is needed in addition to oncological surveillance. More research is needed to better understand the risk of CKD after radical nephrectomy and develop effective strategies to optimize kidney function after such surgery.
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Yoo S, You D, Jeong IG, Hong B, Hong JH, Kim CS, Ahn H, Song C. Preserving Renal Function through Partial Nephrectomy Depends on Tumor Complexity in T1b Renal Tumors. J Korean Med Sci 2017; 32:495-501. [PMID: 28145654 PMCID: PMC5290110 DOI: 10.3346/jkms.2017.32.3.495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/09/2016] [Indexed: 01/30/2023] Open
Abstract
This study aimed to determine patients with T1b renal cell carcinoma (RCC) who could benefit from partial nephrectomy (PN) and method to identify them preoperatively using nephrometry score (NS). From a total of 483 radical nephrectomy (RN)-treated patients and 40 PN-treated patients who received treatment for T1b RCC between 1995 and 2010, 120 patients identified through 1:2 propensity-score matching were included for analysis. Probability of chronic kidney disease (CKD) until postoperative 5-years was calculated and regressed with respect to the surgical method and NS. Median follow-up was 106 months. CKD-probability at 5-years was 40.7% and 13.5% after radical and PN, respectively (P = 0.005). While PN was associated with lower risk of CKD regardless of age, comorbidity, preoperative estimated renal function, the effect was observed only among patients with NS ≤ 8 (P < 0.001) but not in patients with NS ≥ 9 (P = 0.746). Percent operated-kidney volume reduction and ischemia time were similar between the patients with NS ≥ 9 and ≤ 8. In the stratified Cox regression accounting for the interaction observed between the surgical method and the NS, PN reduced CKD-risk only in patients with NS ≤ 8 (hazard ratio [HR], 0.054; P = 0.005) but not in ≥ 9 (HR, 0.996; P = 0.994). In T1b RCC with NS ≥ 9, the risk of postoperative CKD was not reduced following PN compared to RN. Considering the potential complications of PN, minimally invasive RN could be considered with priority in this subgroup of patients.
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Affiliation(s)
- Sangjun Yoo
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dalsan You
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Choung Soo Kim
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheryn Song
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Mouracade P, Kara O, Dagenais J, Maurice MJ, Nelson RJ, Malkoc E, Kaouk JH. Perioperative morbidity, oncological outcomes and predictors of pT3a upstaging for patients undergoing partial nephrectomy for cT1 tumors. World J Urol 2017; 35:1425-1433. [DOI: 10.1007/s00345-017-2004-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/06/2017] [Indexed: 01/20/2023] Open
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40
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Partial Versus Total Nephrectomy: Indications, Limitations, and Advantages. Urol Oncol 2017. [DOI: 10.1007/978-3-319-42603-7_62-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Mouracade P, Kara O, Maurice MJ, Dagenais J, Malkoc E, Nelson RJ, Kaouk JH. Patterns and Predictors of Recurrence after Partial Nephrectomy for Kidney Tumors. J Urol 2016; 197:1403-1409. [PMID: 27993666 DOI: 10.1016/j.juro.2016.12.046] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE We sought to identify patterns and predictors of recurrence in patients with clinically localized renal cell carcinoma managed by partial nephrectomy. MATERIALS AND METHODS We performed a retrospective study of 830 consecutive cases of partial nephrectomy done between 2007 and 2015 for clinically localized renal cell carcinoma at a single institution. Patient demographics and pathological characteristics were correlated with recurrence patterns (overall, local and distant) and overall survival using Kaplan-Meier and Cox regression analyses. Differences in the recurrence patterns were evaluated. RESULTS Median patient age was 61 years and median tumor size was 3.1 cm. Overall, 11.6% of tumors were stage pT3, 39.3% were high grade, 2.9% had lymphovascular invasion and 7.1% had positive margins. Higher grade, higher stage, positive surgical margins and increased R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of deepest tumor portion to collecting system or sinus, anterior/posterior and location relative to polar line) score were associated with shorter disease-free survival on Kaplan-Meier analysis. On multivariable regression pT (p <0.01), grade (p <0.01) and R.E.N.A.L. score (p = 0.03) remained independent predictors of disease-free survival. Predictors of metastasis were pT stage (HR 4.5) and grade (HR 3.9, both p <0.01), while R.E.N.A.L. score (HR 3.2, p = 0.03) was the single predictor of local recurrence. Five-year disease-free and overall survival probabilities were 91% and 94%, respectively. Local recurrence manifested and developed earlier than metastasis (median 13 vs 22 months, p <0.01). CONCLUSIONS High pT stage, high grade and high R.E.N.A.L. score increase the risk of disease recurrence after partial nephrectomy. The pT stage and grade are predictors of metastasis, while R.E.N.A.L. score predicts local recurrence. Because relapse features and risk factors differ between the 2 recurrence patterns, they should be studied separately in the future.
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Affiliation(s)
- Pascal Mouracade
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Onder Kara
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Matthew J Maurice
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Julien Dagenais
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ercan Malkoc
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ryan J Nelson
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
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Li X, Yu J, Liang P, Yu X, Cheng Z, Han Z, Huang H, Duan S, Zheng J. Combination therapy of three-dimensional (3D) visualisation operative treatment planning system and US-guided percutaneous microwave ablation in larger renal cell carcinomas (D ≥ 4 cm): preliminary results. Int J Hyperthermia 2016; 33:271-277. [PMID: 27724046 DOI: 10.1080/02656736.2016.1247299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To analyse the clinical outcomes of combination therapy of three-dimensional (3D) visualisation operative treatment planning system and US-guided percutaneous microwave ablation (PMWA) in larger renal cell carcinomas (RCCs) (D ≥ 4 cm). MATERIALS AND METHODS The results from 20 patients with 20 larger RCCs treated with a 3D visualisation operative treatment planning system and US-guided PMWA were reviewed retrospectively. The patients were followed up by contrast-enhanced images at 1, 3, and 6 months and every 6 months thereafter. The outcomes of overall survival and local tumour progression rate were statistically analysed. RESULTS The median follow-up period was 26 months. The mean time of ablation for one tumour was 1.1 ± 0.3 sessions. The average number of ablation points of one tumour was 4.5 ± 0.9. The mean output power of ablation was 50.50 ± 2.2 W. The mean time of ablation for one tumour was 1374.4 ± 391.1 s. Artificial ascites was used in 12 (60%) tumours adjacent to the intestinal tract, and thermal monitoring system was used in all tumours (100%). Technical effectiveness and metastasis-free status were achieved in all tumours. The 1- and 2-year local tumour progression rates were both 5%. The cancer-specific survival rate and 2-year overall survival rates were both 100%. No severe major complications occurred. There was no significant difference in creatinine or urea nitrogen before or 3 days after ablation. CONCLUSIONS Combination therapy of 3D visualisation operative treatment planning system and US-guided PMWA appeared to be a safe and effective technique for the management of larger RCCs, which could improve clinical efficacy.
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Affiliation(s)
- Xin Li
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China.,b Minimally Intervention Therapy Center of Liver Diseases and Oncology , Beijing You An Hospital, Capital Medical University , Beijing , China
| | - Jie Yu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Ping Liang
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Xiaoling Yu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Zhigang Cheng
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Zhiyu Han
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Hui Huang
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Shaobo Duan
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Jiasheng Zheng
- b Minimally Intervention Therapy Center of Liver Diseases and Oncology , Beijing You An Hospital, Capital Medical University , Beijing , China
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Mir MC, Derweesh I, Porpiglia F, Zargar H, Mottrie A, Autorino R. Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1b and T2 Renal Tumors: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol 2016; 71:606-617. [PMID: 27614693 DOI: 10.1016/j.eururo.2016.08.060] [Citation(s) in RCA: 289] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/25/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Partial nephrectomy (PN) is the reference standard of management for a cT1a renal mass. However, its role in the management of larger tumors (cT1b and cT2) is still under scrutiny. OBJECTIVE To conduct a meta-analysis assessing functional, oncologic, and perioperative outcomes of PN and radical nephrectomy (RN) in the specific case of larger renal tumors (≥cT1b). The primary endpoint was an overall analysis of cT1b and cT2 masses. The secondary endpoint was a sensitivity analysis for cT2 only. EVIDENCE ACQUISITION A systematic literature review was performed up to December 2015 using multiple search engines to identify eligible comparative studies. A formal meta-analysis was performed for studies comparing PN to RN for both cT1b and cT2 tumors. In addition, a sensitivity analysis including the subgroup of studies comparing PN to RN for cT2 only was conducted. Pooled estimates were calculated using a fixed-effects model if no significant heterogeneity was identified; alternatively, a random-effects model was used when significant heterogeneity was detected. For continuous outcomes, the weighted mean difference (WMD) was used as summary measure. For binary variables, the odds ratio (OR) or risk ratio (RR) was calculated with 95% confidence interval (CI). Statistical analyses were performed using Review Manager 5 (Cochrane Collaboration, Oxford, UK). EVIDENCE SYNTHESIS Overall, 21 case-control studies including 11204 patients (RN 8620; PN 2584) were deemed eligible and included in the analysis. Patients undergoing PN were younger (WMD -2.3 yr; p<0.001) and had smaller masses (WMD -0.65cm; p<0.001). Lower estimated blood loss was found for RN (WMD 102.6ml; p<0.001). There was a higher likelihood of postoperative complications for PN (RR 1.74, 95% CI 1.34-2.2; p<0.001). Pathology revealed a higher rate of malignant histology for the RN group (RR 0.97; p=0.02). PN was associated with better postoperative renal function, as shown by higher postoperative estimated glomerular filtration rate (eGFR; WMD 12.4ml/min; p<0.001), lower likelihood of postoperative onset of chronic kidney disease (RR 0.36; p<0.001), and lower decline in eGFR (WMD -8.6ml/min; p<0.001). The PN group had a lower likelihood of tumor recurrence (OR 0.6; p<0.001), cancer-specific mortality (OR 0.58; p=0.001), and all-cause mortality (OR 0.67; p=0.005). Four studies compared PN (n=212) to RN (n=1792) in the specific case of T2 tumors (>7cm). In this subset of patients, the estimated blood loss was higher for PN (WMD 107.6ml; p<0.001), as was the likelihood of complications (RR 2.0; p<0.001). Both the recurrence rate (RR 0.61; p=0.004) and cancer-specific mortality (RR 0.65; p=0.03) were lower for PN. CONCLUSIONS PN is a viable treatment option for larger renal tumors, as it offers acceptable surgical morbidity, equivalent cancer control, and better preservation of renal function, with potential for better long-term survival. For T2 tumors, PN use should be more selective, and specific patient and tumor factors should be considered. Further investigation, ideally in a prospective randomized fashion, is warranted to better define the role of PN in this challenging clinical scenario. PATIENT SUMMARY We performed a cumulative analysis of the literature to determine the best treatment option in cases of localized kidney tumor of higher clinical stage (T1b and T2, as based on preoperative imaging). Our findings suggest that removing only the tumor and saving the kidney might be an effective treatment modality in terms of cancer control, with the advantage of preserving the kidney function. However, a higher risk of perioperative complications should be taken into account when facing larger tumors (clinical stage T2) with kidney-sparing surgery.
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Affiliation(s)
- Maria Carmen Mir
- Department of Urology, Hospital del Mar-Parc de Salut Mar-IMIM, Barcelona, Spain
| | - Ithaar Derweesh
- Department of Urology, UC San Diego Health System, La Jolla, CA, USA
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, University of Turin San Luigi Hospital, Orbassano, Italy
| | - Homayoun Zargar
- Urology Department, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | | | - Riccardo Autorino
- Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
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Forbes CM, Rendon RA, Finelli A, Kapoor A, Moore RB, Breau RH, Lacombe L, Kawakami J, Drachenberg DE, Pautler SE, Jewett MMA, Saarela O, Liu Z, Tanguay S, Black PC. Disease progression and kidney function after partial vs. radical nephrectomy for T1 renal cancer. Urol Oncol 2016; 34:486.e17-486.e23. [PMID: 27423824 DOI: 10.1016/j.urolonc.2016.05.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 04/26/2016] [Accepted: 05/30/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE Partial nephrectomy (PN) for early stage renal cancer preserves renal function better than radical nephrectomy (RN) and is generally considered oncologically similar. The Intergroup European Organisation for Research and Treatment of Cancer trial comparing outcomes after PN vs. RN, however, showed reduced overall survival in the PN group. Our aim was to evaluate recurrence, death, and renal function after PN vs. RN for T1 tumors in a Canadian population. MATERIALS AND METHODS From 2000 to 2015, 2,358 patients with a first occurrence of a clinical T1 renal cancer who underwent PN or RN were identified from the Canadian Kidney Cancer Information System. Clinical, surgical, and pathologic parameters were analyzed. Time to progression was compared after PN vs. RN using a Cox proportional hazards model, adjusted for pertinent variables. RESULTS Inclusion criteria were met in 1,615 PN and 743 RN. Preoperative characteristics appeared similar in both groups. Time to progression was not different after PN vs. RN, adjusted for potential confounders (hazard ratio = 1.17 [95% CI: 0.8-1.72, P = 0.42]). Postoperative estimated glomerular filtration rate at 1 and 3 years was significantly greater for PN vs. RN in a linear regression model, accounting for preoperative estimated glomerular filtration rate. CONCLUSIONS These results suggest that progression-free survival after PN and RN in patients with T1 renal cancer was similar, but that there was better preservation of renal function after PN. This suggests that both PN and RN have similar oncological efficiency, and that selection of surgical approach should be based on other factors such as technical feasibility, potential complications, and preservation of renal function.
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Affiliation(s)
- Connor M Forbes
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Antonio Finelli
- Department of Surgery (Urology), Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Ronald B Moore
- Department of Urology, University of Alberta, Edmonton, Alberta, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, Ontario, Canada
| | - Louis Lacombe
- Department of Surgery (Urology), Laval University, Quebec City, Quebec, Canada
| | - Jun Kawakami
- Division of Urology, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Michael M A Jewett
- Department of Surgery (Urology), Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Zhihui Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, Québec, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
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Kim HY, Choe HS, Lee DS, Yoo JM, Lee SJ. Extending the indication for robot-assisted retroperitoneal partial nephrectomy to antero-lateral renal tumors. Int J Med Robot 2016; 13. [DOI: 10.1002/rcs.1755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Hee Youn Kim
- Department of Urology, St. Vincent's Hospital, College of Medicine; The Catholic University of Korea; Suwon Republic of Korea
| | - Hyun-Sop Choe
- Department of Urology, St. Vincent's Hospital, College of Medicine; The Catholic University of Korea; Suwon Republic of Korea
| | - Dong Sup Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine; The Catholic University of Korea; Suwon Republic of Korea
| | - Jae Mo Yoo
- Department of Urology, St. Vincent's Hospital, College of Medicine; The Catholic University of Korea; Suwon Republic of Korea
| | - Seung-Ju Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine; The Catholic University of Korea; Suwon Republic of Korea
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46
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Anastasiadis E, O'Brien T, Fernando A. Open partial nephrectomy in renal cell cancer - Essential or obsolete? Int J Surg 2016; 36:541-547. [PMID: 27174506 DOI: 10.1016/j.ijsu.2016.05.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 04/27/2016] [Accepted: 05/02/2016] [Indexed: 12/22/2022]
Abstract
Since the first partial nephrectomy was first conducted 131 years ago, the procedure has evolved into the gold standard treatment for small renal masses. Over the past decade, with the introduction of minimally invasive surgery, open partial nephrectomy still retains a valuable role in the treatment of complex tumours in challenging clinical situations (e.g. hereditary renal cancer or single kidneys), and enables surgeons to push the boundaries of nephron-sparing surgery. In this article, we consider the origin of the procedure and how it has evolved over the past century, the surgical techniques involved, and the oncological and functional outcomes.
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Affiliation(s)
- Eleni Anastasiadis
- Department of Urology, Guy's and St Thomas NHS Foundation Trust, London, UK.
| | - Timothy O'Brien
- Department of Urology, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Archana Fernando
- Department of Urology, Guy's and St Thomas NHS Foundation Trust, London, UK
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47
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Raman JD, Jafri SM, Qi D. Kidney function outcomes following thermal ablation of small renal masses. World J Nephrol 2016; 5:283-287. [PMID: 27152264 PMCID: PMC4848151 DOI: 10.5527/wjn.v5.i3.283] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/13/2016] [Accepted: 03/23/2016] [Indexed: 02/06/2023] Open
Abstract
The diagnosis of small renal masses (SRMs) continues to increase likely attributable to widespread use of axial cross-sectional imaging. Many of these SRMs present in elderly patients with abnormal baseline renal function. Such patients are at risk for further decline following therapeutic intervention. Renal thermal ablation presents one approach for management of SRMs whereby tumors are treated in situ without need for global renal ischemia. These treatment characteristics contribute to favorable renal function outcomes following kidney tumor ablation particularly in patients with an anatomic or functional solitary renal unit.
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48
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Affiliation(s)
- Zhamshid Okhunov
- Department of Urology, University of California, Irvine, Orange, CA
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49
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Zhang F, Chang X, Liu T, Wang W, Zhao X, Ji C, Yang R, Guo H. Prognostic Factors for Long-Term Survival in Patients with Renal-Cell Carcinoma After Radiofrequency Ablation. J Endourol 2016. [PMID: 26222920 DOI: 10.1089/end.2015.0454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Fan Zhang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaofeng Chang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Tieshi Liu
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wei Wang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaozhi Zhao
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Changwei Ji
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Rong Yang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongqian Guo
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Porpiglia F, Mari A, Bertolo R, Antonelli A, Bianchi G, Fidanza F, Fiori C, Furlan M, Morgia G, Novara G, Rocco B, Rovereto B, Serni S, Simeone C, Carini M, Minervini A. Partial Nephrectomy in Clinical T1b Renal Tumors: Multicenter Comparative Study of Open, Laparoscopic and Robot-assisted Approach (the RECORd Project). Urology 2015; 89:45-51. [PMID: 26743388 DOI: 10.1016/j.urology.2015.08.049] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/17/2015] [Accepted: 08/28/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate perioperative results of open (OPN), laparoscopic (LPN), and robot-assisted partial nephrectomies (RAPN) and to identify predictive factors of Trifecta achievement for clinical T1b renal tumors in a multicenter prospective dataset. METHODS Data of 285 patients who had OPN (133), LPN (57), or RAPN (95) for cT1b renal tumors were extracted from the RECORd Project. High-volume centers were defined as ≥50 overall cases of partial nephrectomy per year. Trifecta was defined as simultaneous absence of perioperative complications, negative surgical margins, and ischemia time <25 minutes. RESULTS The 3 groups had comparable body mass index, preoperative hemoglobin, creatinine and estimated glomerular filtration rate, tumor clinical diameter, and growth pattern. LPN and RAPN were more frequently exclusive of high-volume centers. RAPN showed significantly lower median estimated blood loss compared with OPN and LPN. Trifecta was achieved in 62.4%, 63.2%, and 69.5% of OPN, LPN, and RAPN (P = NS) cases. Median warm ischemia time (WIT) was significantly shorter during OPN than during LPN and RAPN. RAPN had significantly shorter WIT compared with LPN. RAPN was significantly less morbid than OPN regarding intraoperative and postoperative complications. LPN (1.9%) and RAPN (2.5%) showed a lower rate of positive margins compared with OPN (6.8%) (P = NS). At multivariable analysis, exophytic tumor growth pattern, estimated blood loss, and high-volume centers were significant predictive factors for Trifecta achievement. CONCLUSION Clinically, T1b renal tumors suitable for NSS can be safely treated by LPN or RAPN in high-volume centers. RAPN allows for significantly lower WIT and estimated blood loss with higher rate of Trifecta achievement compared with LPN.
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Affiliation(s)
- Francesco Porpiglia
- Department of Urology, University of Turin, Ospedale San Luigi Gonzaga, Orbassano, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Bertolo
- Department of Urology, University of Turin, Ospedale San Luigi Gonzaga, Orbassano, Italy
| | | | - Giampaolo Bianchi
- Policlinico di Modena, Department of Urology, University of Modena, Italy
| | - Francesco Fidanza
- Policlinico di Modena, Department of Urology, University of Modena, Italy
| | - Cristian Fiori
- Department of Urology, University of Turin, Ospedale San Luigi Gonzaga, Orbassano, Italy
| | - Maria Furlan
- Department of Urology, Azienda AO Spedali Civili di Brescia, Italy
| | | | | | - Bernardo Rocco
- Department of Urology, University of Padua, I.R.C.C.S. Foundation Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Bruno Rovereto
- I.R.C.C.S. Policlinico San Matteo-Department of Urology, Pavia, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Claudio Simeone
- Department of Urology, Azienda AO Spedali Civili di Brescia, Italy
| | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
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