Renal preservation therapy for renal cell carcinoma

Initial experience of robotic nephron sparing surgery in cases of high renal nephrometry scores

Introduction:

The renal nephrometry scoring (RNS) system enables prediction the feasibility of nephron-sparing surgery (NSS) in renal masses. There is insufficient data regarding the outcome of robot-assisted NSS in tumors with RNS ≥10. We reviewed the trifecta outcomes of patients undergoing robotic NSS with high RNS and compare it with tumors of low and intermediate RNS.

Materials and Methods:

Our prospectively maintained data of all robot-assisted NSS were reviewed, and those with RNS of ≥10 were identified. Patient data, outcomes and postoperative estimated glomerular filtration rate were compared between high, intermediate and low RNS patients.

Results:

In high RNS group, the mean age of the patients was 53 years (male:female = 15:3). Mean diameter of tumors was 6.28 cm (3.0–10.5 cm). Mean operative time was 173.61 ± 52.66 min and mean warm ischemia time was 27.85 ± 5.27 min. Mean estimated blood loss (EBL) was 363.89 ± 296.45 ml. Mean hospital length of stay was 5.39 ± 1.91 days (3–9 days). When compared with low and intermediate RNS, only EBL and need for pelvicalyceal system repair was significantly higher in high RNS group. Postoperative complications, renal function preservation and oncological outcomes at 3 months were comparable in all the three groups.

Conclusion:

Robot-assisted NSS is feasible with comparable outcomes in tumors with high RNS.

The impact of non-hilar clamping open partial technique performed for the treatment of patients with small renal masses with lower R.E.N.A.L. nephrometry scores on renal functions during the early postoperative period

OBJECTIVE

Herein, the impact of off-clamp open partial nephrectomy on early postoperative period renal functions were evaluated in patients with low RENAL nephrometry scoring small renal masses.

MATERIAL AND METHODS

Twenty-three patients (12 women, and 11 men) who had undergone non-hilar clamping open partial nephrectomy in our clinic between the years 2010, and 2013 were retrospectively evaluated. Mean age, body mass index (BMI), operative time, blood loss, renal nephrometry score, mean hospital stay, pre-, and postoperative serum creatinine (Cr), and glomerular filtration rate (GFR) of the patients were assessed.

RESULTS

Mean age, BMI, tumor size, and preoperative renal nephrometry scores were 56.09±10.49 years (36-70 yrs), 24.81±2.44 kg/m(2), 3.68±1.125 cm, and 6.41±1.77 pts, respectively. Mean operative time, intraoperative blood loss, and hospital stay were detected as 139.14±33.60 min, 274.9±77.02 mL, and 4.27±1.12 days, respectively. Preoperative mean serum Cr, and GFR levels were 0.804±0.216 mg/dL, and 93.97±25.83 mL/min/1.73 m(2), respectively. Postoperative 1. day mean serum Cr, and GFR levels were 0.896±0.25 mg/dL, and 85.94±28.85 mL/min/1,73 m(2), while corresponding 3. month-values were 0.81±0.205 mg/dL, and 93.59±21.00 mL/dk/1.73 m(2), respectively. A statistically significant difference was not found between preoperative, and postoperative 3. month- serum Cr, and GFR levels. However, postoperative 3. month-serum Cr, and GFR levels were lower than corresponding values estimated on postoperative 1. day (p<0.016).

CONCLUSION

One of the important considerations in partial nephrectomy is to preserve renal functions. Therefore, non-hilar clamping open partial nephrectomy should be taken into consideration for surgeons unexperienced especially in laparoscopic surgery with its lower morbidity, and complication rates.

Detection of intratumoral susceptibility signals using T2*-weighted gradient echo MRI in patients with clear cell renal cell carcinoma

Objective

To retrospectively evaluate whether T2*-weighted imaging can be used to grade clear cell renal cell carcinomas (ccRCC) based on intratumoral susceptibility signals (ISSs).

Materials and Methods

MR imaging from 37 patients with pathologically-proven ccRCCs was evaluated. ISSs on T2*WI were classified as linear or conglomerated linear structures (type I) and dot-like or patchy foci (type II). Two radiologists assessed the likelihood of the presence of ISS, dominant structure of ISS and ratio of ISS area to tumor area. Results were analyzed by nonparametric Mann-Whitney test.

Results

ISSs were seen in all patients except for four patients with low-grade ccRCCs and two patients with high-grade ccRCCs. There was no significant difference of the likelihood of the presence of ISS between low- and high-grade ccRCCs. More type I ISSs and less type II ISSs were predictive of low-grade tumors, whereas more conspicuity type II ISSs correlated with higher occurrence of high-grade tumors (P<0.05). The ratio of ISS area to tumor area was also significantly higher for the high-grade group (1.27±0.79) than that for the low-grade group (0.81±0.40) (P<0.05).

Conclusion

ISSs on T2*-weighted gradient-echo MR images can help grade ccRCCs before operations.