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Liu H, Kong QF, Li J, Wu YQ, Pan KH, Xu B, Wang YL, Chen M. A meta-analysis for comparison of partial nephrectomy vs. radical nephrectomy in patients with pT3a renal cell carcinoma. Transl Androl Urol 2021; 10:1170-1178. [PMID: 33850752 PMCID: PMC8039616 DOI: 10.21037/tau-20-1262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Kidney cancer is the most common malignant tumor of the kidney in adults. However, in terms of the treatment for pT3a renal cell carcinoma (RCC), whether partial nephrectomy (PN) can be selected is still controversial. This study was conducted to compare the efficacy of PN and radical nephrectomy (RN) in treatment for patients with pT3a RCC. Methods The relative English databases including PubMed and EMBASE were searched for studies comparing PN and RN for pT3a RCC between 2010 and 2020. Stata 13.0 software was used to compare the cancer-specific survival (CSS), overall survival (OS), cancer-specific mortality (CSM), relapse-free survival (RFS), complications and positive surgical margin. Results Nine articles were included with a total of 3,391 patients, of whom 2,113 received RN and 1,278 received PN. The results showed that there is no statistical difference in CSS, OS, CSM, RFS, complications and positive surgical margin between RN and PN. No heterogeneity was shown in study. Conclusions There were no differences in the CSS, OS, CSM, RFS, complications and positive surgical margin of the patients in RN and PN group. For pT3a RCC, RN did not provide a better survival benefit compared to PN. Considering PN can suppress the progression of tumor and reduce the risk of postoperative chronic renal insufficiency, we found PN is a good choice for pT3a RCC. However, further large-sample, studies are still needed in future.
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Affiliation(s)
- Hui Liu
- Department of Urology, Binhai People's Hospital, Yancheng, China
| | - Qing-Fang Kong
- Department of Nosocomial Infection, Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Jian Li
- Department of Urology, Jinhu People's Hospital, Jinhu, China
| | - Yu-Qing Wu
- Zhongda Hospital of Southeast University, Southeast University, Lishui District People's Hospital, Nanjing, China
| | - Ke-Hao Pan
- Department of Urology, Binhai People's Hospital, Yancheng, China
| | - Bin Xu
- Department of Urology, Binhai People's Hospital, Yancheng, China
| | - Ya-Li Wang
- Department of Urology, Binhai People's Hospital, Yancheng, China
| | - Ming Chen
- Department of Urology, Binhai People's Hospital, Yancheng, China
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Becher E, Jericevic D, Huang WC. Minimally Invasive Surgery for Patients with Locally Advanced and/or Metastatic Renal Cell Carcinoma. Urol Clin North Am 2020; 47:389-397. [PMID: 32600540 DOI: 10.1016/j.ucl.2020.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite advances in systemic therapy and immunotherapy, surgery continues to have a role in management of advanced renal cell carcinoma (aRCC). Minimally invasive surgery (MIS) is considered standard of care for smaller, localized tumors due to faster recovery without compromising oncologic outcomes. There are concerns about MIS for aRCC due to a potential risk of inferior oncologic outcomes and unusual patterns of disease recurrence. Recent studies, however, suggest that in properly selected patients with aRCC, MIS can provide improved peri-operative outcomes without compromising oncologic control.
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Affiliation(s)
- Ezequiel Becher
- Department of Urology, NYU Langone Health, 222 East 41st, 12th Floor, New York, NY 10017, USA.
| | - Dora Jericevic
- Department of Urology, NYU Langone Health, 222 East 41st, 12th Floor, New York, NY 10017, USA
| | - William C Huang
- Department of Urology, NYU Langone Health, 222 East 41st, 12th Floor, New York, NY 10017, USA
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Kasuya G, Tsuji H, Nomiya T, Makishima H, Haruyama Y, Kobashi G, Ebner DK, Hayashi K, Omatsu T, Kishimoto R, Yasuda S, Igarashi T, Oya M, Akakura K, Suzuki H, Ichikawa T, Shimazaki J, Kamada T. Updated long-term outcomes after carbon-ion radiotherapy for primary renal cell carcinoma. Cancer Sci 2018; 109:2873-2880. [PMID: 29981249 PMCID: PMC6125442 DOI: 10.1111/cas.13727] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 07/03/2018] [Indexed: 12/31/2022] Open
Abstract
Long‐term oncological outcomes for primary renal cell carcinoma (RCC) treated with carbon‐ion radiotherapy (CIRT) are poorly understood. Patients with primary RCC were treated with 12 or 16‐fraction CIRT at The Hospital of the National Institute of Radiological Sciences outside of clinical trials. Outcome data were pooled and retrospectively analyzed for toxicity, local control, and disease‐free, cancer‐specific, and overall survival. From 1997 to 2014, 19 RCC patients (11 with T1aN0M0, 4 with T1bN0M0, and 4 with inoperable advanced stage [T4N0M0, T3aN1M0, and T1aN0M1]) were treated with CIRT and followed up for a median of 6.6 (range, 0.7‐16.5) years; 9 of these patients were inoperable because of comorbidities or advanced‐stage disease. Diagnoses were confirmed by imaging in 11 patients and by biopsy in the remaining 8. In 4 of 5 patients with definitive renal comorbidities, including diabetic nephropathy, sclerotic kidney or solitary kidney pre‐CIRT progressed to grade 4 chronic kidney disease (CKD). In contrast, the remaining 14 patients without definitive renal comorbidities did not progress to grade 3 or higher CKD. Furthermore, although 1 case of grade 4 dermatitis was observed, there were no other grade 3 or higher non‐renal adverse events. Local control rate, and disease‐free, cancer‐specific, and overall survival rates at 5 years of all 19 patients were 94.1%, 68.9%, 100%, and 89.2%, respectively. This updated retrospective analysis based on long‐term follow‐up data suggests that CIRT is a safe treatment for primary RCC patients without definitive renal comorbidities pre‐CIRT, and yield favorable treatment outcomes, even in inoperable cases.
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Affiliation(s)
- Goro Kasuya
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Hiroshi Tsuji
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Takuma Nomiya
- Department of Radiology, Joban Hospital, Iwaki, Japan
| | - Hirokazu Makishima
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Yasuo Haruyama
- Department of Public Health, Dokkyo Medical University, Tochigi, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University, Tochigi, Japan
| | - Daniel K Ebner
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Brown University Alpert Medical School, Providence, Rhode Island
| | - Kazuhiko Hayashi
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Tokuhiko Omatsu
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Riwa Kishimoto
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Shigeo Yasuda
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,Chiba Rosai Hospital, Chiba, Japan
| | - Tatsuo Igarashi
- Department of Urology, Seirei Sakura Citizen Hospital, Chiba, Japan.,Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Koichiro Akakura
- Department of Urology, Japan Community Health Care Organization Tokyo, Shinjuku Medical Center, Tokyo, Japan
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Chiba, Japan
| | | | - Jun Shimazaki
- Department of Urology, Seirei Sakura Citizen Hospital, Chiba, Japan
| | - Tadashi Kamada
- The Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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Kassouf W, Monteiro LL, Drachenberg DE, Fairey AS, Finelli A, Kapoor A, Lattouf JB, Leveridge MJ, Power NE, Pouliot F, Rendon RA, Sabbagh R, So AI, Tanguay S, Breau RH. Canadian Urological Association guideline for followup of patients after treatment of non-metastatic renal cell carcinoma. Can Urol Assoc J 2018; 12:231-238. [PMID: 30139427 DOI: 10.5489/cuaj.5462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Wassim Kassouf
- Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Adrian S Fairey
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Robert Sabbagh
- Division of Urology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Simon Tanguay
- Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
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5
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Patel P, Nayak JG, Liu Z, Saarela O, Jewett M, Rendon R, Kapoor A, Black P, Tanguay S, Kawakami J, Moore R, Breau RH, Morash C, Pouliot F, Drachenberg DE. A Multicentered, Propensity Matched Analysis Comparing Laparoscopic and Open Surgery for pT3a Renal Cell Carcinoma. J Endourol 2018; 31:645-650. [PMID: 28381117 DOI: 10.1089/end.2016.0787] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION To compare outcomes following laparoscopic renal surgery (LRS) and open renal surgery (ORS) in the treatment of pathologic T3a (pT3a) renal cell carcinoma (RCC) using a propensity matched analysis. MATERIALS AND METHODS The Canadian Kidney Cancer Information System is a prospectively maintained database for patients diagnosed with RCC from 15 Canadian institutions. Patients treated for nonmetastatic pT3a RCC between 2008 and 2015 were included. Propensity score matching for age, gender, tumor size, grade, histology, and surgical approach was performed to compare laparoscopic radical and partial nephrectomy (LRN or LPN) with open radical or partial nephrectomy (ORN or OPN). The primary endpoint was recurrence-free survival (RFS). RESULTS Two hundred twenty-six (45%) patients underwent LRS (88% LRN and 12% LPN), and 275 (55%) underwent ORS (75% ORN and 25% OPN). After a median follow-up of 21.1 months, 155 (72 LRS and 83 ORS) patients experienced recurrence. The 3-year RFS was 63% and 50% for the LRS and ORS groups, respectively, p = 0.36. On subgroup analysis, there was no significant difference in RFS among patients who underwent radical nephrectomy (3-year RFS 61% in LRN compared with 46% in ORN group, p = 0.32) or partial nephrectomy (77% in LPN compared with 79% in OPN group, p = 0.82). CONCLUSIONS This study is the largest matched analysis comparing LRS and ORS for pT3a RCC. In matched patients, LRS showed no difference in oncologic outcomes compared with ORS and should be considered when technically feasible.
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Affiliation(s)
- Premal Patel
- 1 Section of Urology, University of Manitoba , Winnipeg, Canada
| | - Jasmir G Nayak
- 1 Section of Urology, University of Manitoba , Winnipeg, Canada
| | | | - Olli Saarela
- 3 Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
| | - Michael Jewett
- 4 Division of Urology, University of Toronto , Toronto, Canada
| | - Ricardo Rendon
- 5 Department of Urology, Dalhousie University , Halifax, Canada
| | - Anil Kapoor
- 6 Division of Urology, McMaster University , Hamilton, Canada
| | - Peter Black
- 7 Department of Urologic Sciences, University of British Columbia , Vancouver, Canada
| | - Simon Tanguay
- 8 Division of Urology, McGill University , Montreal, Canada
| | - Jun Kawakami
- 9 Southern Alberta Institute of Urology, University of Calgary , Calgary, Canada
| | - Ronald Moore
- 10 Division of Urology, University of Alberta , Edmonton, Canada
| | - Rodney H Breau
- 11 Division of Urology, The Ottawa Hospital Research Institute, University of Ottawa , Ottawa, Canada
| | - Chris Morash
- 11 Division of Urology, The Ottawa Hospital Research Institute, University of Ottawa , Ottawa, Canada
| | - Frédéric Pouliot
- 12 Centre Hospitalier Universitaire de Québec , Quebec City, Canada
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7
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Bragayrac LAN, Abbotoy D, Attwood K, Darwiche F, Hoffmeyer J, Kauffman EC, Schwaab T. Outcomes of Minimal Invasive vs Open Radical Nephrectomy for the Treatment of Locally Advanced Renal-Cell Carcinoma. J Endourol 2016; 30:871-6. [DOI: 10.1089/end.2016.0082] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Daniel Abbotoy
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | - Kristopher Attwood
- Department of Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Buffalo, New York
| | - Fadi Darwiche
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | - Jan Hoffmeyer
- Otto von Guericke Universität Magdeburg, Magdeburg, Germany
| | - Eric C. Kauffman
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | - Thomas Schwaab
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
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8
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Nunez Bragayrac L, Hoffmeyer J, Abbotoy D, Attwood K, Kauffman E, Spiess P, Wagner A, Schwaab T. Minimally invasive cytoreductive nephrectomy: a multi-institutional experience. World J Urol 2016; 34:1651-1656. [DOI: 10.1007/s00345-016-1827-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/04/2016] [Indexed: 10/21/2022] Open
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9
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Borregales LD, Kim DY, Staller AL, Qiao W, Thomas AZ, Adibi M, Tamboli P, Sircar K, Jonasch E, Tannir NM, Matin SF, Wood CG, Karam JA. Prognosticators and outcomes of patients with renal cell carcinoma and adjacent organ invasion treated with radical nephrectomy. Urol Oncol 2015; 34:237.e19-26. [PMID: 26707613 DOI: 10.1016/j.urolonc.2015.11.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 10/30/2015] [Accepted: 11/17/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To study the natural history, prognosticators, and outcomes in patients with renal cell carcinoma (RCC) with extension of tumor beyond Gerota׳s fascia or invading contiguously into the adrenal gland (pT4) or both. PATIENTS AND METHODS From 1992 to 2012, we identified 61 patients who underwent radical nephrectomy and were found to have pT4 disease. Clinicopathologic variables were queried using univariate analysis to identify relevant prognostic variables. Cox proportional hazards model was used for multivariate analysis of predictors of cancer-specific survival. Survival plots were estimated using Kaplan-Meier method and survival analysis using log-rank test. RESULTS Median age was 56 years (interquartile range: 49-64) and 49 (81.7%) patients had Eastern Cooperative Oncology Group Performance Status 0 or 1. At diagnosis, 22 (36.1%) patients showed nonmetastatic and 39 (63.9%) patients showed metastatic RCC. Overall, 49 (80.3%) patients had clear cell RCC, 24 (39.3%) patients had sarcomatoid features, and 39 (69.6%) patients had Fuhrman grade 3 to 4. There were 26 (42.6%) patients with pN0, 16 (26.2%) patients with pN1, and 19 (31.1%) patients with pNx. Median cancer-specific survival was 37 months for patients with nonmetastatic and 8 months for patients with metastatic RCC. On multivariate analysis, preoperative lactate dehydrogenase and alkaline phosphatase, M stage, pN stage, and sarcomatoid dedifferentiation were significantly associated with survival. CONCLUSIONS Survival in patients with pT4 remains poor. The pT4 disease is associated with a locally and regionally invasive biology that requires specific attention and warrants careful study. Understanding the drivers of this unique phenotype would generate therapeutic interventions that can change the behavior of these uniquely aggressive tumors.
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Affiliation(s)
- Leonardo D Borregales
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dae Y Kim
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Angie L Staller
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wei Qiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Arun Z Thomas
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mehrad Adibi
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Pheroze Tamboli
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kanishka Sircar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eric Jonasch
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Surena F Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher G Wood
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jose A Karam
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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10
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Nayak JG, Patel P, Bjazevic J, Liu Z, Saarela O, Kapoor A, Rendon R, Kawakami J, Tanguay S, Breau RH, Black PC, Drachenberg DE. Clinical outcomes following laparoscopic management of pT3 renal masses: A large, multi-institutional cohort. Can Urol Assoc J 2015; 9:397-402. [PMID: 26788228 DOI: 10.5489/cuaj.2848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION We described the clinical and oncological outcomes of patients treated by laparoscopic surgery for non-metastatic pT3 renal cell carcinoma (RCC). METHODS We queried a multi-institutional database for patients diagnosed with non-metastatic pathological T3 RCC from 13 Canadian centres treated laparoscopically (radical or partial nephrectomy) between 2008 and 2014. Clinical and pathological outcomes were evaluated. Progression was defined as the development of recurrence or metastatic disease. Log-rank testing and Kaplan-Meier statistical methods assessed for differences and estimated progression-free survival (PFS). RESULTS In total, 176 patients were identified with a median age of 64 years. The median tumour size was 7.0 cm. Pre-clinical stage was cT1 to cT4 in 39%, 28%, 30% and 3%, respectively. The median blood loss was 150 mL (range: 0-6000) and the median operative time was 124 minutes (range: 60-360). Most lesions were clear cell RCC (80%). After a median follow-up of 17.6 months (range: 0.2-75.0), disease progression occurred in 26% (46/176) of patients, consisting of local recurrence in 7% (3/46), and metastatic disease in 93% (43/46). The 3-year PFS was 67%, with a median PFS of 49 months. Of those who progressed, the median time to progression was 10.3 months. CONCLUSIONS This study is the largest cohort of pT3 RCC patients treated laparoscopically in the literature and suggests that for properly selected patients, laparoscopic management of locally advanced renal masses yields acceptable short-term oncological outcomes.
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Affiliation(s)
- Jasmir G Nayak
- Section of Urology, University of Manitoba, Winnipeg, MB;; Department of Urology, University of Washington, Seattle, WA
| | - Premal Patel
- Department of Urology, University of Washington, Seattle, WA
| | | | | | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, NS
| | - Jun Kawakami
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, QC
| | - Rodney H Breau
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
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Survival analysis of surgically treated renal cell carcinoma: a single Chinese medical center experience from 2002 to 2012. Int Urol Nephrol 2015; 47:1327-33. [PMID: 26163269 DOI: 10.1007/s11255-015-1046-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/28/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To analyze the survival and the associated factors affecting the prognosis of renal cell carcinoma (RCC) in China with a sufficiently large sample size. METHODS Clinical data with complete follow-up of 1326 RCC patients were successfully obtained. Progression-free survival (PFS) and cancer-specific survival (CSS) were calculated, survival analysis was performed by Kaplan-Meier analysis, and Cox proportional hazards regression models were served to estimate the prognostic significance of each variables. RESULTS The median length of follow-up was 43.55 months (25-75 %, 25.47-68.75 months). During follow-up, 147 patients developed RCC-related progression, with a median PFS of 18.2 months (25-75 %, 7.50-47.27); 64 patients died from RCC-related progression, with a median CSS of 27.67 months (25-75 %, 14.10-58.53). For RCC patients in T1 stage, 3-, 5-, 8-, and 10-year CSS rates of patients receiving nephron-sparing nephrectomy were 99.33, 98.21, 97.40, and 97.40 %, respectively, which were significantly higher than radical nephrectomy patients (97.88, 96.28, 95.09, and 88.58 %, respectively). Cox proportional hazards regression model showed that tumor N stage, signs of lung metastasis (such as cough and hemoptysis), signs of bone metastasis (such as bone pain and fracture), pathological subtype of RCC, microscopic sarcomatoid change, and progression were prognosis factors for Chinese RCC patients. CONCLUSIONS Tumor stage, nephrectomy type, lung metastasis, bone metastasis, pathological subtype, sarcomatoid change, and type of progression were important risk factors for RCC. For T1 stage RCC patients, nephron-sparing nephrectomy showed better CSS than radical nephrectomy, which may guide the doctors and patients in their choices of surgical procedures.
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12
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Outcomes of Robotic Nephrectomy Including Highest-complexity Cases: Largest Series to Date and Literature Review. Urology 2015; 85:1352-8. [DOI: 10.1016/j.urology.2014.11.063] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/08/2014] [Accepted: 11/02/2014] [Indexed: 11/19/2022]
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13
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Laird A, Stewart GD, Zhong J, Ang WJJ, Cutress ML, Riddick ACP, McNeill SA, Tolley DA. A generation of laparoscopic nephrectomy: stage-specific surgical and oncologic outcomes for laparoscopic nephrectomy in a single center. J Endourol 2014; 27:1008-14. [PMID: 23634886 DOI: 10.1089/end.2012.0562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To determine the stage-specific operative, postoperative and oncologic outcomes, for patients undergoing a laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) in a single center and assess changes over a generation of practice. PATIENTS AND METHODS From December 1992 to July 2011, data were collected prospectively for 854 consecutive simple laparoscopic necphrectomies (LNs) and LRNs, 397 of which were LRNs for RCC. The first LRN was performed in December 1997. Stage-specific surgical and oncologic outcomes were assessed across the study period. Patients were then grouped into three equal consecutive cohorts. Case mix and surgical outcomes were compared to assess changes with departmental experience. RESULTS There were 206, 71, 118, and 2 patients across stages pT1, pT2, pT3, and pT4, respectively. Median operative time was significantly shorter for pT1 tumors (125, 150 and 150 min for pT1-3, P<0.021), while median estimated blood loss (EBL) was greater for pT3 tumors (50, 50, 100 mL, for pT1-3, P<0.001). Median follow-up time was 31, 30, and 18 months, respectively, across pT1-pT3. There was a significant difference in 5-year overall survival (82.4%, 68.4%, 58.9%), cancer-specific survival (99.5%, 83.6%, 66.5%) and progression free survival (86.5%, 66.3%, 47.5%) across these stage-specific subgroups. Over the three cohorts, there was an increase in LRN performed for locally advanced disease and cytoreduction. With greater surgical experience, there was improvement in median operative time and median EBL in localized disease over the three periods, but no significant changes for locally advanced disease. CONCLUSION This is the largest reported series of LRN in the United Kingdom. Departmental experience has resulted in improved surgical outcomes for localized RCC, with expansion of practice in more complex advanced disease. Laparoscopic nephrectomy is both operatively and oncologically safe in T1 and T2 disease, and although technically more demanding, it is also safe in selected T3 disease.
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Affiliation(s)
- Alexander Laird
- Edinburgh Urological Cancer Group, University of Edinburgh, Western General Hospital, EH4 2XU, Edinburgh, United Kingdom.
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14
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Tang Q, Wang T, Li X, Zhang Z, Song G, He Z, Zhou L. Renal cell carcinoma with infrahepatic vena caval tumor thrombus treated with a novel combined retroperitoneal and transperitoneal pure laparoscopic procedure. Urology 2014; 83:e9-10. [PMID: 24767537 DOI: 10.1016/j.urology.2014.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 12/30/2013] [Accepted: 01/24/2014] [Indexed: 11/30/2022]
Abstract
A 61-year-old male patient presented with intermittent gross hematuria. A right renal mass with infrahepatic vena caval tumor thrombus was found using magnetic resonance imaging. We undertook a novel combined retroperitoneal and transperitoneal pure laparoscopic nephrectomy with vena caval thrombectomy for this patient. The patient recovered well after surgery and discharged on day 6. A clear cell renal cell carcinoma with venous extension was confirmed by pathologic assay. To our knowledge, this is the first report of such a novel hybrid surgical strategy.
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Affiliation(s)
- Qi Tang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Tianyu Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zheng Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Gang Song
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Zhisong He
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
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15
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Al-Aown A, Kallidonis P, Kontogiannis S, Kyriayis I, Panagopoulos V, Stolzenburg JU, Liatsikos E. Laparoscopic radical and partial nephrectomy: The clinical efficacy and acceptance of the techniques. Urol Ann 2014; 6:101-6. [PMID: 24833817 PMCID: PMC4021645 DOI: 10.4103/0974-7796.130521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 02/10/2014] [Indexed: 01/20/2023] Open
Abstract
The laparoscopic approach has been established as the surgical procedure of choice for radical nephrectomy during the recent years. The advantages of the laparoscopic radical nephrectomy in comparison to the open approach are well-documented. The oncological results of the laparoscopic approach are similar to the open procedure while the post-operative morbidity is lower. Laparoscopic partial nephrectomy seems to gain ground to its open counterpart, as the accumulation of experience in the technique grows. In this review, a PubMed search in the latest literature on radical and partial laparoscopic nephrectomy took place and the outcome of the search is presented. Several issues about the surgical techniques and clinical efficacy are discussed. In addition, the preliminary experience in laparoscopic nephrectomy of one of the authoring institutions is also presented.
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Affiliation(s)
- Abdulrahman Al-Aown
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Kingdom of Saudi Arabia
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16
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Laird A, Choy KCC, Delaney H, Cutress ML, O'Connor KM, Tolley DA, McNeill SA, Stewart GD, Riddick ACP. Matched pair analysis of laparoscopic versus open radical nephrectomy for the treatment of T3 renal cell carcinoma. World J Urol 2014; 33:25-32. [PMID: 24647880 DOI: 10.1007/s00345-014-1280-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/10/2014] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The perioperative and oncological outcomes of laparoscopic radical nephrectomy (LRN) for T1-T2 renal cell carcinoma (RCC) are well established. We aim to determine whether LRN is a comparable alternative to open radical nephrectomy (ORN) in the treatment of T3 RCC using a matched pair analysis study design. METHODS A review of a prospectively collected database at the Western General Hospital, Edinburgh, between 2000 and 2011 was conducted. Patient pairs were matched based on age at operation, gender, histological subgroup, maximal tumour diameter, TNM stage and grade. Patient demographics, operative and post-operative outcomes were compared. Overall, cancer-specific and progression-free survival [overall survival, cancer-specific survival (CSS) and progression-free survival (PFS)] were estimated using the Kaplan-Meier method. RESULTS From 252 patients with T3 disease, 25 pairs were matched. Patients were of median age 66.2 years, 64 % male. Tumours were all clear cell RCC, were stage pT3a (32 %) or pT3b and had maximal tumour diameters of 8.7 cm for LRN and 10.0 cm for ORN. Estimated blood loss (100 ml LRN; 650 ml ORN, p < 0.001) and length of post-operative hospital stay (4 days LRN: 9 days ORN, p < 0.001) were lower in the LRN group. Operation time and post-operative complication rates were comparable. CSS and PFS were comparable with a mean CSS of 91.3 months for LRN and 88.7 months for ORN. CONCLUSION This study reports the longest median follow-up in a T3 LRN cohort. In matched patients, LRN has been shown to have a superior perioperative profile to ORN for the treatment of pT3a/b RCC, with no adverse effect on midterm oncological outcomes.
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Affiliation(s)
- A Laird
- Edinburgh Urological Cancer Group, The University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK,
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17
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Patard JJ, Baumert H, Bensalah K, Bernhard JC, Bigot P, Escudier B, Grenier N, Hétet JF, Long JA, Méjean A, Paparel P, Richard S, Rioux-Leclercq N, Coloby P, Soulié M. Recommandations en onco-urologie 2013 du CCAFU: Cancer du rein. Prog Urol 2013; 23 Suppl 2:S177-204. [DOI: 10.1016/s1166-7087(13)70055-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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18
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Luciani LG, Porpiglia F, Cai T, D'Elia C, Vattovani V, Giusti G, Tiscione D, Chiodini S, Peschechera R, Fiori C, Spina R, Parma P, Celia A, Malossini G. Operative safety and oncologic outcome of laparoscopic radical nephrectomy for renal cell carcinoma >7 cm: a multicenter study of 222 patients. Urology 2013; 81:1239-44. [PMID: 23608667 DOI: 10.1016/j.urology.2012.12.065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 12/04/2012] [Accepted: 12/09/2012] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate the safety of laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) >7 cm, addressing the issue of modality and risk factors for complications and open conversion, and to assess the oncologic outcome. METHODS The data of 222 patients undergoing LRN for RCC >7 cm prospectively enrolled from 2002 to 2010 at 5 urologic centers were reviewed. Transperitoneal LRN was performed by 5 experienced laparoscopic surgeons. The Clavien-Dindo classification was used to assess complications. Multivariable analysis of factors predictive of conversions was performed. Oncologic outcomes for survival were estimated using the Kaplan-Meier method. RESULTS Median tumor size was 8.5 cm, operative time was 180 minutes, and blood loss was 280 mL. Forty-two patients (19%) received a blood transfusion. Six (2.7%) patients had grade III-IV complications: 2 with postoperative bleeding requiring abdominal re-exploration and 1 each with adrenal injury, splenic injury, wound diastasis, and respiratory insufficiency. Twelve patients (5.4%) were converted to open surgery. The diameter was 11.9 in converted groups and 8.5 cm in nonconverted groups (P = .001). Multivariable analysis revealed that pathologic stage was the only independent predictor of conversion (P = .002). The 5-year overall (OS), cancer-specific (CSS), and progression-free (PFS) survival was 74%, 78%, and 66%, respectively. The 5-year stage-adjusted CSS was 89% in pT2 and 40% in pT3 patients (P <.0001). Limitations of this study were its retrospective nature and the relatively short follow-up period for oncologic outcome. CONCLUSION LRN for large RCC is a safe operation. Stage pT3 is a risk factor for open conversion and is associated to significantly lower cancer-specific survival compared with pT2 stage.
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19
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Stewart GD, Phipps S, Little B, Leveckis J, Stolzenburg JU, Tolley DA, McNeill SA, Riddick ACP. Description and validation of a modular training system for laparoscopic nephrectomy. J Endourol 2013; 26:1512-7. [PMID: 22642561 DOI: 10.1089/end.2012.0096] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Laparoscopic nephrectomy (LN) has largely replaced open nephrectomy. The aim of this study was to describe a validated modular system for training urologists in LN in the context of the shorter training times available in the current era. METHODS After attendance at dry and wet laboratory courses, three mentees (trainee, new consultant, and an experienced open surgeon) were mentored through a five-module LN training system in our center followed by the mentee's own hospital. A minimum of 25 independent procedures were then performed by mentees in their own hospital. RESULTS There were 17 to 32 mentored cases needed to become competent in LN, followed by up to 5 observed cases in the mentee's own center. Subsequently, data from the first 105 cases (80 LN and 25 laparoscopic nephroureterectomies [LNU]) performed by the three surgeons after the end of their training without observation by their mentor were retrospectively collected and analyzed. There were three conversions (2.9%). For LN and LNU, respectively: median operative time was 140 minutes (65-390 min) and 180 minutes (90-300 min); median estimated blood loss was 30 mL (0-2000 mL) and 50 mL (0-2000 mL); median postoperative stay was 4 days (2-45 days) and 6 days (3-27 days). Four (3.8%) patients needed a postoperative transfusion. There was no 30-day mortality. CONCLUSION Mentees matched the median British Association for Urological Surgeons (BAUS) registry operative time (LN, 120-180 min, LNU, 180-240 min) and had lower conversion rates (2.9% vs 6.4% for BAUS). Mentees matched median BAUS database reported blood loss (LN and LNU <500 mL) and length of stay (LN-4 days, LNU-5 days). This modular training program allows urologists to become independent in LN after a short period of focused training in the training center followed by a short period of mentoring in the mentee's own center.
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Affiliation(s)
- Grant D Stewart
- Department of Urology, Western General Hospital, Edinburgh, United Kingdom
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