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Lei K, Wang X, Yang Z, Zhong Y, Liu Y, Sun T. Robotic-assisted tumor enucleation versus robotic-assisted partial nephrectomy for intermediate and high complexity renal cell carcinoma: a single-institution experience. World J Surg Oncol 2023; 21:175. [PMID: 37287019 DOI: 10.1186/s12957-023-03060-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/03/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES To compare the perioperative and oncological outcomes of robotic-assisted tumor enucleation (RATE) and robotic-assisted partial nephrectomy (RAPN) in the treatment of intermediate and high complexity renal cell carcinoma (RCC). METHODS We retrospectively collected the data of 359 patients with intermediate and high complexity RCC who underwent RATE and RAPN. The perioperative, oncological, and pathological outcomes of the two groups were compared, and univariate and multivariate analyses were used to evaluate the risk factors for warm ischemia time (WIT) > 25 min. RESULTS Compared with RAPN group, patients in RATE group had shorter operative time (P < 0.001), shorter WIT (P < 0.001), and less estimated blood loss (EBL) (P < 0.001). The decrease rate of estimated glomerular filtration rate (eGFR) in RATE group was better than that in RAPN group (P < 0.001). Multivariable analysis showed that RAPN and higher PADUA score were independent risk factors for WIT > 25 min (both P < 0.001). The rate of positive surgical margin was similar between the two groups, but the local recurrence rate of the RATE group was higher than that of the RAPN group (P = 0.027). CONCLUSIONS RATE and RAPN have similar oncological outcomes for the treatment of intermediate and high complexity RCC. In addition, RATE was superior to RAPN in perioperative outcomes.
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Affiliation(s)
- Kunyang Lei
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xu Wang
- Department of Pathology, the First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Zhongsheng Yang
- Department of Urology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China
| | - Yuming Zhong
- Department of Urology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China.
| | - Yifu Liu
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Ting Sun
- Department of Urology, the First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
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Cho S, Lee JH, Jeon SH, Park J, Lee SH, Kim CH, Sung JY, Kim JH, Pyun JH, Lee JG, Kim JJ, Cheon J, Kang SG, Kang SH. A prospective, multicenter analysis of pseudocapsule characteristics: Do all stages of renal cell carcinoma have complete pseudocapsules? Urol Oncol 2017; 35:370-378. [PMID: 28188091 DOI: 10.1016/j.urolonc.2017.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 12/22/2016] [Accepted: 01/04/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the characteristics of pseudocapsule (PC) in localized renal cell carcinoma (RCC) by analyzing the rates of completeness of PC and pseudocapsular invasion and clinical and pathological risk factors of it. MATERIALS AND METHODS Between February 2013 and September 2015, data were gathered prospectively from 180 consecutive patients who underwent partial nephrectomy or radical nephrectomy at 3 institutions, and 161 were enrolled. Evaluated factors included age and sex; histologic factors such as tumor diameter, stage, tumor subtype, necrosis, and Fuhrman grade; and clinical factors such as RENAL score; and completeness of PC. RESULTS Only 94 tumors (58.4%) were surrounded by a continuous PC completely, 62 (38.5%) were partially surrounded, and 5 (3.1%) had no PC. Overall, 56 PCs (34.8%) were free from invasion, 58 PCs (36.0%) had partial invasion of PC without parenchymal invasion, and 47 PCs (29.2%) had parenchymal invasion. Defining parenchymal invasion as true pseudocapsular invasion, histologic diameter, RCC subtype, and completeness of PC were significant predictors for parenchymal invasion on multivariate analysis (P = 0.006, 0.046, and 0.002, respectively). CONCLUSIONS Rate of complete PC in RCC is relatively low in this study. The risk factors for pseudocapsular invasion were a histologic diameter greater than 4cm, non-clear cell histology, and an incomplete PC. Surgeons must prepare for the possibility of a positive surgical margin if a tumor has at least one of these risk factors.
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Affiliation(s)
- Seok Cho
- Department of Urology, Korea University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hyeon Lee
- Department of Pathology, Korea University School of Medicine, Seoul, Republic of Korea
| | - Seung Hyun Jeon
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Jinsung Park
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Sang Hyub Lee
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Chul Hwan Kim
- Department of Pathology, Korea University School of Medicine, Seoul, Republic of Korea
| | - Ji-Youn Sung
- Department of Pathology, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Joo Heon Kim
- Department of Pathology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Jong Hyun Pyun
- Department of Urology, Korea University School of Medicine, Seoul, Republic of Korea
| | - Jeong Gu Lee
- Department of Urology, Korea University School of Medicine, Seoul, Republic of Korea
| | - Je Jong Kim
- Department of Urology, Korea University School of Medicine, Seoul, Republic of Korea
| | - Jun Cheon
- Department of Urology, Korea University School of Medicine, Seoul, Republic of Korea
| | - Sung Gu Kang
- Department of Urology, Korea University School of Medicine, Seoul, Republic of Korea
| | - Seok Ho Kang
- Department of Urology, Korea University School of Medicine, Seoul, Republic of Korea.
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Rod X, Peyronnet B, Seisen T, Pradere B, Gomez FD, Verhoest G, Vaessen C, De La Taille A, Bensalah K, Roupret M. Impact of ischaemia time on renal function after partial nephrectomy: a systematic review. BJU Int 2016; 118:692-705. [PMID: 27409986 DOI: 10.1111/bju.13580] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the impact of ischaemia on renal function after partial nephrectomy (PN). MATERIALS AND METHODS A literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. In January 2015, the Medline and Embase databases were systematically searched using the protocol ('warm ischemia'[mesh] OR 'warm ischemia'[ti]) AND ('nephrectomy'[mesh] OR 'partial nephrectomy'[ti]). An updated search was performed in December 2015. Only studies based on a solitary kidney model or on a two-kidney model but with assessment of split renal function were included in this review. RESULTS Of the 1119 studies identified, 969 abstracts were screened after duplicates were removed: 29 articles were finally included in this review, including nine studies that focused on patients with a solitary kidney. None of the nine studies adjusting for the amount of preserved parenchyma found a negative impact of warm ischaemia time on postoperative renal function, unless this was extended beyond a 25-min threshold. The quality and the quantity of preserved parenchyma appeared to be the main contributors to postoperative renal function. CONCLUSION Currently, no evidence supports that limited ischaemia time (i.e. ≤25 min) has a higher risk of reducing renal function after PN compared to a 'zero ischaemia' technique. Several recent studies have suggested that prolonged warm ischaemia (>25-30 min) could cause an irreversible ischaemic insult to the surgically treated kidney.
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Affiliation(s)
- Xavier Rod
- AP-HP, Service d'Urologie, Hopital de la Pitié Salpétrière, Paris, France
| | | | - Thomas Seisen
- AP-HP, Service d'Urologie, Hopital de la Pitié Salpétrière, Paris, France
| | | | | | | | - Christophe Vaessen
- AP-HP, Service d'Urologie, Hopital de la Pitié Salpétrière, Paris, France
| | | | - Karim Bensalah
- Service d'Urologie, Hopital Pontchaillou, Rennes, France
| | - Morgan Roupret
- AP-HP, Service d'Urologie, Hopital de la Pitié Salpétrière, Paris, France. .,Université PARIS VI Pierre et Marie Curie, Paris, France.
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Biles MJ, DeCastro GJ, Woldu SL. Renal Function Following Nephron Sparing Procedures: Simply a Matter of Volume? Curr Urol Rep 2016; 17:8. [DOI: 10.1007/s11934-015-0561-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Simple enucleation for the treatment of highly complex renal tumors: Perioperative, functional and oncological results. Eur J Surg Oncol 2015; 41:934-40. [DOI: 10.1016/j.ejso.2015.02.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/25/2015] [Accepted: 02/05/2015] [Indexed: 01/12/2023] Open
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Mukkamala A, Allam CL, Ellison JS, Hafez KS, Miller DC, Montgomery JS, Weizer AZ, Wolf JS. Tumor enucleation vs sharp excision in minimally invasive partial nephrectomy: technical benefit without impact on functional or oncologic outcomes. Urology 2014; 83:1294-9. [PMID: 24713137 DOI: 10.1016/j.urology.2014.02.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/14/2014] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To present the benefits and utility of tumor enucleation as an alternative technique to sharp excision during minimally invasive partial nephrectomy (MIPN). METHODS We retrospectively compared enucleation and sharp excision during MIPN, with the aim of determining benefits and limitations of enucleation in this setting. RESULTS Among 602 patients undergoing MIPN at our institution, 86 and 516 underwent enucleation and sharp excision, respectively, as determined by the surgeon. The nephrometry score was greater in the enucleation vs sharp excision group (mean, 6.7 vs 6.3), but all other preoperative parameters were similar. The mean ischemia and operative times were 4 and 32 minutes shorter in the enucleation group, respectively, likely owing to less frequent entry into renal sinus (21% vs 41%) and need for tumor bed suturing (41% vs 62%), compared with those in the sharp excision group. There was no association with blood loss, positive margins, urine leak, blood transfusion, major complications, renal function, recurrence, or survival. CONCLUSION Enucleation appears to provide the benefits of reduced surgical entry into the renal sinus, less need for tumor bed suturing, and shorter operative time, without any impact on functional or oncologic outcomes. Given favorable preoperative radiography and intraoperative findings, enucleation is a useful technique for patients undergoing MIPN.
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Affiliation(s)
- Anudeep Mukkamala
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | | | - Jonathan S Ellison
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Khaled S Hafez
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - David C Miller
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | | | - Alon Z Weizer
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - J Stuart Wolf
- Department of Urology, University of Michigan Health System, Ann Arbor, MI.
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Robotic vs Open Simple Enucleation for the Treatment of T1a-T1b Renal Cell Carcinoma: A Single Center Matched-pair Comparison. Urology 2014; 83:331-7. [DOI: 10.1016/j.urology.2013.08.080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 07/26/2013] [Accepted: 08/06/2013] [Indexed: 01/31/2023]
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Minervini A, Siena G, Carini M. Robotic-assisted partial nephrectomy: the next gold standard for the treatment of intracapsular renal tumors. Expert Rev Anticancer Ther 2014; 11:1779-82. [DOI: 10.1586/era.11.182] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Minervini A, Vittori G, Salvi M, Sebastianelli A, Tuccio A, Siena G, Masieri L, Gacci M, Lapini A, Serni S, Carini M. Analysis of surgical complications of renal tumor enucleation with standardized instruments and external validation of PADUA classification. Ann Surg Oncol 2012; 20:1729-36. [PMID: 23263701 DOI: 10.1245/s10434-012-2801-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess surgical results and morbidity of tumor enucleation (TE), and to evaluate their correlation with PADUA nephrometric score. METHODS We prospectively gathered data, including accurate analysis of tumor nephrometry, from 244 consecutive patients treated with TE for clinically localized renal cell carcinoma. All surgical results were collected, and perioperative complications were stratified for severity according to Clavien system. Correlation between preoperative variables and surgical results/complications was assessed with uni- and multivariate analysis. RESULTS Mean (range) tumor size was 3.6 (0.8-10.0) cm, and mean (range) warm ischemia time was 16.8 (5-35) min. Overall, perioperative complications occurred in 45 patients (18.4 %), and of those 8 were medical and 37 were surgical (4 Clavien grade 1, 25 grade 2, and 8 grade 3) complications. Urine leakage rate was 2.0 %. No grade 4/5 complications occurred in this series. At univariate analysis PADUA score, endophytic tumor growth, tumor diameter, involvement of UCS and renal sinus resulted associated with warm ischemia time (p < 0.0001 each) and surgical complications (p = 0.0007, p = 0.049, p = 0.021, p = 0.036, and p = 0.029, respectively). At logistic regression, nephrometry score resulted independently associated with overall complications (related risk for each increased point 1.54; p = 0.017), surgical complications (related risk 1.58; p = 0.016), and Clavien grade 3 surgical complications (related risk 2.99; p = 0.008). CONCLUSIONS The TE technique was associated with a 15.2 % surgical complication rate with a 3.3 % reintervention rate (including ureteral stenting and superselective renal artery embolization). Tumor nephrometry and surgical indication resulted independent predictors of Clavien grade 3 complications. The PADUA score is a reliable tool to predict surgical results and morbidity of TE.
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Affiliation(s)
- Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
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Current world literature. Curr Opin Urol 2012; 22:432-43. [PMID: 22854603 DOI: 10.1097/mou.0b013e3283572fe1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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