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Ock J, Gwon E, Kim T, On S, Moon S, Kyung YS, Kim N. Patient-specific, deliverable, and self-expandable surgical guide development and evaluation using 4D printing for laparoscopic partial nephrectomy. Sci Rep 2024; 14:5722. [PMID: 38459159 PMCID: PMC10924080 DOI: 10.1038/s41598-024-56075-5] [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: 11/07/2023] [Accepted: 03/01/2024] [Indexed: 03/10/2024] Open
Abstract
Accurate lesion diagnosis through computed tomography (CT) and advances in laparoscopic or robotic surgeries have increased partial nephrectomy survival rates. However, accurately marking the kidney resection area through the laparoscope is a prevalent challenge. Therefore, we fabricated and evaluated a 4D-printed kidney surgical guide (4DP-KSG) for laparoscopic partial nephrectomies based on CT images. The kidney phantom and 4DP-KSG were designed based on CT images from a renal cell carcinoma patient. 4DP-KSG were fabricated using shape-memory polymers. 4DP-KSG was compressed to a 10 mm thickness and restored to simulate laparoscopic port passage. The Bland-Altman evaluation assessed 4DP-KSG shape and marking accuracies before compression and after restoration with three operators. The kidney phantom's shape accuracy was 0.436 ± 0.333 mm, and the 4DP-KSG's shape accuracy was 0.818 ± 0.564 mm before compression and 0.389 ± 0.243 mm after restoration, with no significant differences. The 4DP-KSG marking accuracy was 0.952 ± 0.682 mm before compression and 0.793 ± 0.677 mm after restoration, with no statistical differences between operators (p = 0.899 and 0.992). In conclusion, our 4DP-KSG can be used for laparoscopic partial nephrectomies, providing precise and quantitative kidney tumor marking between operators before compression and after restoration.
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Affiliation(s)
- Junhyeok Ock
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eunseo Gwon
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Taehun Kim
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sungchul On
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sojin Moon
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoon Soo Kyung
- Department of Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Korea
| | - Namkug Kim
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, Korea.
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Ock J, Kim T, On S, Lee S, Kyung YS, Kim N. Utilizing patient-specific 3D printed kidney surgical guide with realistic phantom for partial nephrectomy. Sci Rep 2023; 13:15531. [PMID: 37726415 PMCID: PMC10509158 DOI: 10.1038/s41598-023-42866-9] [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: 04/04/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023] Open
Abstract
Partial nephrectomy has been demonstrated to preserve renal function compared with radical nephrectomy. Computed tomography (CT) is used to reveal localized renal cell carcinoma (RCC). However, marking RCC directly and quantitatively on a patient's kidney during an operation is difficult. We fabricated and evaluated a 3D-printed kidney surgical guide (3DP-KSG) with a realistic kidney phantom. The kidney phantoms including parenchyma and three different RCC locations and 3DP-KSG were designed and fabricated based on a patient's CT image. 3DP-KSG was used to insert 16-gauge intravenous catheters into the kidney phantoms, which was scanned by CT. The catheter insertion points and angle were evaluated. The measurement errors of insertion points were 1.597 ± 0.741 mm, and cosine similarity of trajectories was 0.990 ± 0.010. The measurement errors for X-axis, Y-axis, and Z-axis in the insertion point were 0.611 ± 0.855 mm, 0.028 ± 1.001 mm, and - 0.510 ± 0.923 mm. The 3DP-KSG targeted the RCC accurately, quantitatively, and immediately on the surface of the kidney, and no significant difference was shown between the operators. Partial nephrectomy will accurately remove the RCC using 3DP-KSG in the operating room.
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Affiliation(s)
- Junhyeok Ock
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Taehun Kim
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Artificial Intelligence and Robotics Institute, Korea Institute of Science and Technology, Seoul, South Korea
| | - Sungchul On
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sangwook Lee
- ANYMEDI Inc., 388-1 Pungnap2-dong, Songpa-gu, Seoul, South Korea
| | - Yoon Soo Kyung
- Department of Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Namkug Kim
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Beksac AT, Corrigan D, Abou Zeinab M, Ferguson E, Kaviani A, Schwen ZR, Kaouk JH. Long-term comparative outcomes of partial nephrectomy and cryoablation in patients with solitary kidneys: a single-center analysis. Minerva Urol Nephrol 2022; 74:722-729. [PMID: 35622349 DOI: 10.23736/s2724-6051.22.04840-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients with solitary kidneys are amenable to postoperative acute kidney injury (AKI) after PN. We compared the functional and oncological outcomes of cryoablation (CA) and PN in patients with a solitary kidney and a cT1a renal mass. METHODS From a single-institution series, we analyzed 74 patients (31 PN, 43 CA) with a solitary kidney who underwent treatment for a cT1a renal mass. The functional outcomes were AKI and estimated glomerular filtration rate (eGFR) preservation. Oncological outcomes were recurrence and death. Linear mixed-effects and logistic regression models were used for functional outcomes analysis, whereas oncological outcomes were analyzed using the Kaplan-Meier method. RESULTS Median follow-up was 63.9 months. PN group had lower median age (59 years vs. 68, P<0.001) and larger median tumor size (2.80 cm vs. 2.0, p =0.003). AKI was more common in the PN group on postoperative day 1 (58% vs. 2.8%, P<0.001). However, only one patient in the PN group required temporary dialysis in the perioperative period. eGFR preservation was similar at postoperative 3 months (89% vs. 90%, P=0.083), or 12 months (85% vs. 94%, P=0.2) follow-up. CA group had higher recurrence rate (29% vs. 3.2%, P=0.005), and worse recurrence-free survival (P=0.027). Overall survival (OS) was comparable (P=0.31). CONCLUSIONS In a solitary kidney setting, CA is associated with a lower risk of AKI at postoperative day 1 compared to PN. Functional outcome is comparable upon longer follow-up. The local recurrence rates are significantly higher in the CA group with no significant difference in OS.
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Affiliation(s)
- Alp T Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Dillon Corrigan
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mahmoud Abou Zeinab
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ethan Ferguson
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Aaron Kaviani
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Zeyad R Schwen
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA -
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Flippo B, Stone B, Stahr S, Khalil M, Davis R, Kamel M, Singh M. Short-Term and Long-Term Renal Outcomes in Patients With Obesity After Minimally Invasive Versus Open Partial Nephrectomy for the Treatment of Renal Cancer: Retrospective Study. JMIR Form Res 2022; 6:e19750. [PMID: 35006078 PMCID: PMC8787657 DOI: 10.2196/19750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 03/01/2021] [Accepted: 08/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background Obesity is significantly associated with renal cell carcinoma. Surgery is the preferred treatment for demarcated lesions of renal cell carcinoma; however, obesity increases the complexity of surgical outcomes. Minimally invasive surgical techniques are preferred over open partial nephrectomy (OPN), but controversy remains regarding the most efficacious technique in patients with obesity. Objective This study aims to determine whether minimally invasive partial nephrectomy (MIPN) or OPN better preserves renal function and investigate short- and long-term renal outcomes in patients with obesity undergoing a partial nephrectomy. Methods We conducted a retrospective chart review of 242 adult patients aged ≥18 years who underwent MIPN or OPN between January 1, 2005, and December 31, 2016, at the University of Arkansas for Medical Sciences. Using creatinine as a measure of kidney function, patients’ preoperative levels were compared with their postoperative levels in 2-time frames: short (3-6 months postsurgery) or long (>6 months). The primary outcome was the change in creatinine values from preoperative to >6 months postoperatively in patients with obesity. Secondary outcomes included the change in creatinine values from preoperative to 3 to 6 months postoperatively in patients with obesity who underwent MIPN versus OPN. We also analyzed the creatinine values of nonobese patients (BMI <30) who underwent partial nephrectomy using the same time frames. Unconditional logistic regression was used to estimate crude and multivariable-adjusted odds ratios (ORs) and 95% CI to observe associations between surgery type and changes in creatinine values from while stratifying for obesity. Results A total of 140 patients were included in the study, of whom 75 were obese and 65 were nonobese. At >6 months after MIPN (n=20), the odds of patients with obesity having a decrease or no change in creatinine values was 1.24 times higher than those who had OPN (n=13; OR 1.24, 95% CI 0.299-6.729; P=.80). At 3 to 6 months after MIPN (n=27), the odds were 0.62 times lower than those after OPN (n=17; OR 0.62, 95% CI 0.140-2.753; P=.56). In the nonobese group, at 3 to 6 months after undergoing minimally invasive surgery (n=18), the odds of having a decrease or no change in creatinine values was 4.86 times higher than those who had open surgery (n=21; OR 4.86, 95% CI 1.085-21.809; P=.04). At more than 6 months after MIPN (n=14), the odds were 4.13 times higher than those after OPN (n=11; OR 4.13, 95% CI 0.579-29.485; P=.16). Conclusions We observed a nonstatistically significant preservation of renal function in patients with obesity who underwent OPN at 3 to 6 months postoperatively. Conversely, after 6 months, the same was true for MIPN, indicating the long-term benefit of MIPN. In the nonobese group, MIPN was favored over OPN.
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Affiliation(s)
- Brittany Flippo
- University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Bradley Stone
- University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Shelbie Stahr
- University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mahmoud Khalil
- University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Rodney Davis
- University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mohamed Kamel
- University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Manisha Singh
- University of Arkansas for Medical Sciences, Little Rock, AR, United States
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Akarken İ, Bilen CY, Özden E, Gülşen M, Üçer O, Şahin H. Can Aortic and Renal Arteries Calcium Scores Be New Factors to Predict Post-Operative Renal Function After Nephron Sparing Surgery? Clin Genitourin Cancer 2021; 20:e45-e52. [PMID: 34690082 DOI: 10.1016/j.clgc.2021.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION This study aims to investigate whether the calcification of renal arteries and aorta may be risk factors for developing chronic kidney disease (CKD) after Nephron sparing surgery (NSS). MATERIALS AND METHODS The patients that underwent either open or laparoscopic NSS from 2000 to 2019 in 4 different centers were retrospectively assessed. Of these patients, 328 had a non-contrast-enhanced computer tomography. Calcium scores of the renal arteries and abdominal aorta were measured in the non-contrast-enhanced images with the calcium score plugin (version 2.0) of Horos™. Univariate and multivariate logistic regression analysis was performed to determine significant risk factors for developing CKD at the last check-up. Roc curve analysis was performed to determine the optimal cut-off values of age and abdominal aorta calcium scores. RESULTS A total of 302 patients, of which 52 (16,6%) with CKD and 252 (83,4%) without CKD at the last check-up, were included in the analysis. The mean warm ischemia duration was significantly higher in patients with CKD (18,79±6,72 vs 16,38±5,57 minutes, p=0,016). The mean size of the tumor diameter and the number of the patients with ≥stage T1b were higher in the group with CKD (p=0,024 and 0,005, respectively). The median calcium scores of the aorta and renal arteries were higher in the group with CKD (p<0,001 and p<0,001, respectively). In multivariate analysis, age >60 years (OR:3,65, p=0,022), calcium score of the aorta (OR:4,07, p=0,029), tumor diameter (OR:1,03, p=0,026) and pre-operative CKD stage (OR:10,13, p<0,001) found the be significant factors for predicting last check-up CKD. CONCLUSION The calcium score of the aorta may be used as an additional risk factor to predict post-operative CKD risk after NSS with sensitivity over 80%.
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Affiliation(s)
- İlker Akarken
- Department of Urology, Faculty of Medicine, Sitki Kocman University, Muğla, Turkey.
| | - Cenk Yücel Bilen
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ender Özden
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Murat Gülşen
- Department of Urology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Oktay Üçer
- Department of Urology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Hayrettin Şahin
- Department of Urology, Faculty of Medicine, Sitki Kocman University, Muğla, Turkey
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Luzzago S, Palumbo C, Rosiello G, Pecoraro A, Deuker M, Stolzenbach F, Mistretta FA, Tian Z, Musi G, Montanari E, Shariat SF, Saad F, Briganti A, de Cobelli O, Karakiewicz PI. Metabolic Syndrome Predicts Worse Perioperative Outcomes in Patients Treated With Partial Nephrectomy for Renal Cell Carcinoma. Urology 2020; 140:91-97. [PMID: 32151650 DOI: 10.1016/j.urology.2020.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/25/2020] [Accepted: 02/22/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To test the association between metabolic syndrome (MetS) and its components (high blood pressure, body mass index [BMI] ≥ 30, altered fasting glucose, low high-density lipoprotein cholesterol and high triglycerides) on perioperative outcomes after partial nephrectomy (PN). METHODS Within the National Inpatient Sample database (2000-2015) we identified all PN patients. First, temporal trends of MetS were reported. Second, the effect of MetS components was tested in multivariable logistic regression models predicting overall and specific perioperative complications. Third, we tested for dose-response from the concomitant effect of multiple MetS components. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics. RESULTS Of 25,875 patients: (1) 59.3% had high blood pressure, (2) 14.7% had BMI ≥ 30, (3) 21.7% had altered fasting glucose, (4) 20.2% had high triglycerides, and (5) <0.01% had low high-density lipoprotein cholesterol. One vs 2 vs 3 vs 4 MetS components were recorded in 34.9% vs 22.9% vs 8.9% vs 2.2% patients. Of all, 11.1% exhibited ≥ 3 components and qualified for MetS. The rates of MetS increased over time (estimated annual percentage changes: +12.0%;P <.001). The 4 tested MetS components (high blood pressure, BMI ≥ 30, altered fasting glucose, and high triglycerides) achieved independent predictor status in multivariable models predicting overall, cardiac, miscellaneous medical, vascular, and respiratory complications, as well as transfusions. Moreover, a statistically significant dose-response was confirmed for the same endpoints. CONCLUSION MetS and its components consistently and strongly predict perioperative complications after PN. Moreover, the strength of the effect was directly proportional to the number of MetS components exhibited by each individual patient, even if formal MetS diagnosis of ≥ 3 components has not been met.
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Affiliation(s)
- Stefano Luzzago
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy.
| | - Carlotta Palumbo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Urology Unit, ASST Spedali Civili of Brescia. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Italy
| | - Giuseppe Rosiello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Angela Pecoraro
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Marina Deuker
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Franziska Stolzenbach
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Alessandro Mistretta
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, IRCCS Fondazione Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Departments of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern, Dallas, TX; Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
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Jimenez-Romero ME, Moreno-Cortes JC, Canelon-Castillo EY, Diez-Farto S, Santotoribio JD. Predictive Factors of Renal Function in Partial Laparoscopic Nephrectomy in Patients with a Kidney Tumor. Curr Urol 2019; 13:150-156. [PMID: 31933594 DOI: 10.1159/000499277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/10/2019] [Indexed: 01/08/2023] Open
Abstract
Background Laparoscopic partial nephrectomy has proven to be an ideal option for tumors in initial stages, preserving part of the renal parenchyma and reducing the possible risk of glomerular filtration decrease. Objectives The main objective of this study is to determine the factors that can influence, to a greater extent, renal function deterioration after surgery. Methods This is an observational, descriptive and longitudinal study. The renal funct ion was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula, and patients were divided into 2 groups depending on whether or not their renal function had been affected after surgery. We studied the correlation between the decrease of renal function and other variables. Results The sample comprised 48 patients. In 30 of these cases, renal function had deteriorated after surgery. We observed a statistically significant relationship between the weight of the patient (p = 0.0230), size of the tumor (p = 0.0035), ischemic time (p = 0.0287), duration of the surgery (p = 0.0297), the RENAL score (p = 0.0230) and renal function deterioration. Conclusions Partial laparoscopic nephrectomy is associated with a deterioration in renal function, where there is a decrease in glomerular filtration after surgery. The deterioration will depend on the weight of the patient, size of the tumour, ischemic time and duration of the surgery. The RENAL score can be used to predict said deterioration.
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Affiliation(s)
- Miguel E Jimenez-Romero
- Department of Urology, Puerto Real University Hospital.,Department of Surgery, Cadiz University School of Medicine
| | | | | | | | - Jose D Santotoribio
- Department of Laboratory Medicine, Puerto Real University Hospital.,Department of Biomedicine, Biotechnology and Public Health, Cadiz University School of Medicine, Cadiz, Spain
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Yoon HK, Lee HJ, Yoo S, Park SK, Kwon Y, Jun K, Jeong CW, Kim WH. Acute Kidney Injury Adjusted for Parenchymal Mass Reduction and Long-Term Renal Function after Partial Nephrectomy. J Clin Med 2019; 8:jcm8091482. [PMID: 31540394 PMCID: PMC6780324 DOI: 10.3390/jcm8091482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 01/20/2023] Open
Abstract
We sought to evaluate the association of postoperative acute kidney injury (AKI) adjusted for parenchymal mass reduction with long-term renal function in patients undergoing partial nephrectomy. A total of 629 patients undergoing partial nephrectomy were reviewed. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria, by using either the unadjusted or adjusted baseline serum creatinine level, accounting for renal parenchymal mass reduction. Estimated glomerular filtration rates (eGFRs) were followed up to 61 months (median 28 months) after surgery. The primary outcome was the functional change ratio (FCR) of eGFR calculated by the ratio of the most recent follow-up value, at least 24 months after surgery, to eGFR at 3-12 months after surgery. Multivariable linear regression analysis was performed to evaluate whether unadjusted or adjusted AKI was an independent predictor of FCR. As a sensitivity analysis, functional recovery at 3-12 months after surgery compared to the preoperative baseline was analyzed. Median parenchymal mass reduction was 11%. Unadjusted AKI occurred in 16.5% (104/625) and adjusted AKI occurred in 8.6% (54/629). AKI using adjusted baseline creatinine was significantly associated with a long-term FCR (β = -0.129 ± 0.026, p < 0.001), while unadjusted AKI was not. Adjusted AKI was also a significant predictor of functional recovery (β = -0.243 ± 0.106, p = 0.023), while unadjusted AKI was not. AKI adjusted for the parenchymal mass reduction was significantly associated with a long-term functional decline after partial nephrectomy. A creatinine increase due to remaining parenchymal ischemic injury may be important in order to predict long-term renal functional outcomes after partial nephrectomy.
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Affiliation(s)
- Hyun-Kyu Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Seokha Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Sun-Kyung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Yongsuk Kwon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Kwanghoon Jun
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.
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9
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de Cássio Zequi S, da Costa WH, Korkes F, dos Reis RB, Busato WFS, Matheus WE, da Silva Neto DCV, de Almeida e Paula F, Carvalhal GF, Nogueira L, de Carvalho Fernandes R, Silva AGE, Sasse AD, Fay AP, Jardim DL, Bastos DA, da Rosa DAR, Wierman E, Kater F, Schutz FA, Maluf FC, de Oliveira FNG, Morbeck IAP, Rinck JA, da Trindade KM, Maia MC, Souza VC, Monteiro FSM, Soares A. Renal cell cancer treatment: an expert panel recommendation from the Latin American cooperative group-genitourinary and the Latin American renal cancer group: focus on surgery. Ther Adv Urol 2019; 11:1756287219872324. [PMID: 31523281 PMCID: PMC6734614 DOI: 10.1177/1756287219872324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/28/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Renal cell cancer (RCC) is one of the 10 most common cancers in the world,
and its incidence is increasing, whereas mortality is declining only in
developed countries. Therefore, two collaborative groups, The Latin American
Oncology Cooperative Group-Genitourinary Section (LACOG-GU) and the Latin
American Renal Cancer Group (LARCG), held a consensus meeting to develop
this guideline. Methods: Issues (134) related to the treatment of RCC were previously formulated by a
panel of experts. The voting panel comprised 26 specialists (urologists and
medical oncologists) from the LACOG-GU/LARCG. A consensus was reached if 75%
agreement was achieved. If there was less concordance, a new discussion was
undertaken, and a consensus was determined by the most votes after a second
voting session. Results: The expert meeting provided recommendations that were in line with the global
literature; 75.0% of the recommendations made by the panel of experts were
evidence-based level A, 22.5% of the recommendations were level B, and 2.5%
of the recommendations were level D. Conclusions: This review suggests recommendations for the surgical treatment of RCC
according to the LACOG-GU/LARCG experts.
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Affiliation(s)
| | | | - Fernando Korkes
- Hospital Israelita Albert Einstein, São Paulo,
Brazil
- ABC Medical School, Santo André, Brazil
| | | | | | | | | | | | - Gustavo Franco Carvalhal
- Escola de Medicina e Hospital São Lucas da
Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre,
Brazil
| | - Lucas Nogueira
- Hospital das Clínicas da Universidade Federal
de Minas Gerais, Belo Horizonte, Brazil
| | - Roni de Carvalho Fernandes
- Faculdade de Ciências Médicas da Santa Casa de
São Paulo, Brazil
- Hospital Central da Santa Casa de Misericórdia
de São Paulo, Brazil
| | | | | | - André P. Fay
- Escola de Medicina e Hospital São Lucas da
Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre,
Brazil
- Grupo Oncoclínicas, Porto Alegre, Brazil
| | | | | | | | | | - Fabio Kater
- Beneficência Portuguesa de São Paulo,
Brazil
| | | | - Fernando Cotait Maluf
- Hospital Israelita Albert Einstein, São Paulo,
Brazil
- Beneficência Portuguesa de São Paulo,
Brazil
- Hospital Santa Lúcia, Brasilia, Brazil
| | | | | | | | - Karine Martins da Trindade
- Hospital São Carlos/Oncocentro, Fortaleza,
Brazil
- Santa Casa de Misericórdia de Fortaleza,
Fortaleza, Brazil
| | | | | | | | - Andrey Soares
- Hospital Israelita Albert Einstein, São Paulo,
Brazil
- Centro Paulista de Oncologia, São Paulo,
Brazil
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10
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The association between intraoperative urine output and postoperative acute kidney injury differs between partial and radical nephrectomy. Sci Rep 2019; 9:760. [PMID: 30679704 PMCID: PMC6345871 DOI: 10.1038/s41598-018-37432-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/04/2018] [Indexed: 01/27/2023] Open
Abstract
We sought to investigate the association between intraoperative urine output and postoperative acute kidney injury (AKI) in patients undergoing radical and partial nephrectomy. We retrospectively reviewed data of 742 patients. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes criteria. The relationship between intraoperative urine output and the risk of AKI was evaluated by multivariable logistic regression analysis in radical and partial nephrectomy, separately. Minimum P-value approach was used to find the optimal threshold of intraoperative oliguria associated with the risk of AKI. The incidence of AKI was 14.4% (67/466) after partial nephrectomy and 57.6% (159/276) after radical nephrectomy. For partial nephrectomy, multivariable analysis showed that renal ischemic time, operation time, open surgery and intraoperative transfusion were significantly associated with AKI. For radical nephrectomy, history of hypertension, baseline glomerular filtration rate and intraoperative mean urine output were significantly associated with AKI. Intraoperative mean urine output during radical nephrectomy was associated with AKI after radical nephrectomy, while not after partial nephrectomy. Mean urine output <1.0 mL/kg/h was determined to be an optimal cutoff of AKI after radical nephrectomy. Intraoperative oliguria may have different clinical implication for AKI between partial and radical nephrectomy.
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11
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Johnson BA, Crivelli J, Sorokin I, Gahan J, Cadeddu JA. Surgical Outcomes of Three vs Four Arm Robotic Partial Nephrectomy: Is the Fourth Arm Necessary? Urology 2019; 123:140-145. [DOI: 10.1016/j.urology.2018.06.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/05/2018] [Accepted: 06/14/2018] [Indexed: 01/06/2023]
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