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Naughton A, Ryan ÉJ, Keenan R, Thomas AZ, Smyth LG, Manecksha RP, Flynn RJ, Casey RG. Surgical Approach for Partial Nephrectomy in the Management of Small Renal Masses: A Systematic Review and Network Meta-Analysis. J Endourol 2024; 38:358-370. [PMID: 38149582 DOI: 10.1089/end.2023.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Background: A variety of surgical and nonsurgical management options for small renal masses (SRMs) now exist. Surgery in the form of partial nephrectomy (PN) has three different approaches. It is unclear which PN approach, if any, offers superior clinical outcomes. Aim: The aim of this study is to compare outcomes in patients with SRMs <4 cm undergoing PN through the open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), or robotic partial nephrectomy (RPN) approach and to establish the advantages and disadvantages of the various approaches. Methods: A systematic literature search was conducted for studies comparing at least two of the above techniques. Eighteen studies and 17,013 patients were included in our study. A network meta-analysis with a frequentist framework was performed. OPN was used as the baseline comparator. The prespecified primary outcome was R0 resection rates. Secondary outcomes included operating time, ischemia time, blood loss, transfusion rates, urine leak rates, significant morbidity, length of stay, and recurrence. Results: There was no significant difference between the techniques in terms of R0 rates, tumor recurrence, urine leak rates, renal function, and >3a Clavien-Dindo complications. LPN had a longer ischemic time and operating time. OPN had a longer length of stay and higher average intraoperative blood loss. RPN had lower blood transfusion rates. Discussion: All approaches are acceptable from an oncological perspective. The minimally invasive approaches (i.e., RPN and LPN) offer advantages in terms of morbidity; however, LPN may increase ischemic time and operative duration. Variations between perioperative outcomes may influence the choice of approach on a case-by-case and institutional basis.
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Affiliation(s)
- Ailish Naughton
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - Éanna J Ryan
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Robert Keenan
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - Arun Z Thomas
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Lisa G Smyth
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rustom P Manecksha
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Robert J Flynn
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rowan G Casey
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
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Martínez Rodríguez C, Tardáguila de la Fuente G, Villanueva Campos A. Current management of small renal masses. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Martínez Rodríguez C, Tardáguila de la Fuente G, Villanueva Campos AM. Current management of small renal masses. RADIOLOGIA 2019; 62:167-179. [PMID: 31882171 DOI: 10.1016/j.rx.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 12/12/2022]
Abstract
One of the consequences of the growing use of diagnostic imaging techniques is the notable growth in the detection of small renal masses presumably corresponding to localized tumors that are potentially curable with surgical treatment. When faced with the finding of a small renal mass, radiologists must determine whether it is benign or malignant, and if it is malignant, what subtype it belong to, and whether it should be managed with surgical treatment, with ablative techniques, or with watchful waiting with active surveillance. Small renal masses are now a clinical entity that require management different from the approaches used for classical renal cell carcinomas. In this scenario, radiologists are key because they are involved in all aspects of the management of these tumors, including in their diagnosis, treatment, and follow-up.
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Shen L, Li Y, Li N, Zhao Y, Zhou Q, Li Z. Clinical utility of contrast-enhanced ultrasonography in the diagnosis of benign and malignant small renal masses among Asian population. Cancer Med 2019; 8:7532-7541. [PMID: 31642189 PMCID: PMC6912038 DOI: 10.1002/cam4.2635] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/29/2022] Open
Abstract
We assessed the clinical utility of contrast-enhanced ultrasonography (CEUS) in the diagnosis of benign and malignant small renal masses using a meta-analysis of diagnostic test. We performed a comprehensive online search in the following database including PubMed, Embase, Web of Science, Wanfang, and Chinese National Knowledge Infrastructure from the inception to August 25, 2019. the following index were calculated for assessing the diagnostic ability, including sensitivity, specificity, diagnostic odds ratio (DOR), negative likelihood ratio (NLR), positive likelihood ratio (PLR), area under the curve (AUC) with 95% confidence intervals (CIs). Seventeen studies were included in the qualitative and quantitative analyses. The overall sensitivity was 0.93 with 95% CI of 0.88-0.95. The specificity was 0.71 and the 95% CI was 0.60-0.80. The pooled AUC was 0.91 (95% CI: 0.88-0.93). The diagnostic odds ratio was 31 (95% CI: 21-45). The NLR and PLR were 0.10 (95% CI: 0.07-0.15) and 3.2(95% CI: 2.3-4.4), respectively. There is a slight heterogeneity within studies. The subgroup analysis was also performed. For retrospective and perspective, the sensitivity and specificity were 0.93, 0.92 and 0.71, 0.73; For different diameter lesions, the sensitivity and specificity were 0.93, 0.94 and 0.64, 0.74; For sample size (≤median vs. >median), the sensitivity and specificity were 0.94, 0.93 and 0.67, 0.77. The Deek's funnel plot asymmetry test in indicated no publication bias. The CEUS have a high diagnostic ability in differentiating benign and malignant small renal masses among Asian population.
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Affiliation(s)
- Lin Shen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanyan Li
- Department of Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Na Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yajie Zhao
- Department of Nuclear Medicine, Central South University, Changsha, Hunan, China
| | - Qin Zhou
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhanzhan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Leão LRDS, Mussi TC, Yamauchi FI, Baroni RH. Common pitfalls in renal mass evaluation: a practical guide. Radiol Bras 2019; 52:254-261. [PMID: 31435088 PMCID: PMC6696749 DOI: 10.1590/0100-3984.2018.0007] [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] [Indexed: 01/16/2023] Open
Abstract
More than half of patients over 50 years of age have had at least one focal renal lesion detected as an incidental finding during an ultrasound, computed tomography, or magnetic resonance imaging examination. Although the majority of such lesions can be easily detected and correctly characterized, misdiagnoses may occur and are often related to methodological limitations, inappropriate imaging protocols, or misinterpretation. This pictorial essay provides recommendations on how to recognize benign and malignant renal processes that can be potentially missed or mischaracterized in imaging studies.
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Affiliation(s)
| | - Thais Caldara Mussi
- Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Fernando Ide Yamauchi
- Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Ronaldo Hueb Baroni
- Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Salagierski M, Wojciechowska A, Zając K, Klatte T, Thompson RH, Cadeddu JA, Kaouk J, Autorino R, Ahrar K, Capitanio U. The Role of Ablation and Minimally Invasive Techniques in the Management of Small Renal Masses. Eur Urol Oncol 2018; 1:395-402. [PMID: 31158078 DOI: 10.1016/j.euo.2018.08.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/14/2018] [Accepted: 08/31/2018] [Indexed: 12/25/2022]
Abstract
CONTEXT Nephron-sparing approaches are increasingly recommended for incidental small renal masses. Herein, we review the current literature regarding the safety and efficacy of focal therapy, including percutaneous ablation, for small renal masses. OBJECTIVE To summarize the application of ablative therapy in the management of small renal masses. EVIDENCE ACQUISITION PubMed and Medline database search was performed to look for findings published since 2000 on focal therapy for small renal masses. After literature review, 64 articles were selected and discussed. EVIDENCE SYNTHESIS Radiofrequency ablation and cryotherapy are the most widely used procedures with intermediate-term oncological outcome comparable with surgical series. Cost effectiveness seems excellent and side effects appear acceptable. To date, no randomized trial comparing percutaneous focal therapy with standard surgical approach or active surveillance has been performed. CONCLUSIONS Focal ablative therapies are now accepted as effective treatment for small renal tumors. For tumors <3cm, oncological effectiveness of ablative therapies is comparable with that of partial nephrectomy. Percutaneous ablation has fewer complications and a better postoperative profile when compared with minimally invasive partial nephrectomy. PATIENT SUMMARY Focal ablative therapies are now accepted as effective treatment for small renal tumors. For tumors <3cm, oncological effectiveness of ablative therapies is comparable with that of partial nephrectomy.
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Affiliation(s)
- Maciej Salagierski
- Urology Department, The Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland.
| | - Adrianna Wojciechowska
- Urology Department, The Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland
| | - Kinga Zając
- Urology Department, The Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth and Christchurch Hospitals, Bournemouth, UK
| | | | | | - Jihad Kaouk
- Department of Urology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Kamran Ahrar
- Interventional Radiology, The University of Texas MD Anderson Cancer Center, TX, USA
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
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Raman JD, Jafri SM, Qi D. Kidney function outcomes following thermal ablation of small renal masses. World J Nephrol 2016; 5:283-287. [PMID: 27152264 PMCID: PMC4848151 DOI: 10.5527/wjn.v5.i3.283] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/13/2016] [Accepted: 03/23/2016] [Indexed: 02/06/2023] Open
Abstract
The diagnosis of small renal masses (SRMs) continues to increase likely attributable to widespread use of axial cross-sectional imaging. Many of these SRMs present in elderly patients with abnormal baseline renal function. Such patients are at risk for further decline following therapeutic intervention. Renal thermal ablation presents one approach for management of SRMs whereby tumors are treated in situ without need for global renal ischemia. These treatment characteristics contribute to favorable renal function outcomes following kidney tumor ablation particularly in patients with an anatomic or functional solitary renal unit.
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Atri M, Tabatabaeifar L, Jang HJ, Finelli A, Moshonov H, Jewett M. Accuracy of Contrast-enhanced US for Differentiating Benign from Malignant Solid Small Renal Masses. Radiology 2015; 276:900-8. [PMID: 25919803 DOI: 10.1148/radiol.2015140907] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To test the hypothesis that qualitative and quantitative features of contrast material-enhanced ultrasonography (US) can be used to differentiate benign from malignant small renal masses. MATERIALS AND METHODS This is an institutional review board approved, HIPAA-compliant prospective study with written informed consent. Patients with histologically characterized solid small renal masses, excluding lipid-rich angiomyolipomas, underwent qualitative contrast-enhanced US with a combination of three different US machines. A subgroup of patients underwent quantitative contrast-enhanced US. Patients received a bolus injection of 0.2 mL of contrast material for qualitative and quantitative evaluations and were followed for 3 minutes. Two radiologists independently reviewed videotaped qualitative contrast-enhanced US examinations and were blinded to the final diagnoses. Features that were evaluated included lesion vascularity relative to the adjacent cortex in the arterial phase, the presence of a capsule, homogeneity, the pattern of vascularity, and washout. One radiologist separately reviewed a subset of contrast-enhanced US examinations that were performed with all three machines. Parameters of a first-pass time intensity curve were calculated for quantitative analysis. The Mann-Whitney test was used for quantitative parameters, the χ(2) or Fisher exact test was used for qualitative parameters, and κ statistics and Fleiss methodology were used to determine interobserver and intermachine agreement. RESULTS The study population consisted of 91 patients (35 women and 56 men) with 94 lesions. The mean age was 62 years ± 14 (range, 21-91). Three patients had two lesions each, which were evaluated at two different sessions. There were 26 benign small renal masses (including 18 oncocytomas, seven lipid-poor angiomyolipomas, and one hemangioblastoma) and 68 malignant masses (including 41 clear cell, 20 papillary, and seven chromophobe renal cell carcinomas [RCCs[) that were 1.1-4.0 cm in diameter (mean, 2.7 cm ± 0.9). All patients underwent contrast-enhanced US on the same one machine, and 68 patients were imaged on all three machines. Vascularity was present in all lesions (n = 94) at contrast-enhanced US. Lesion hypovascularity relative to the adjacent cortex in the arterial phase was seen in only malignant lesions by both reviewers; reviewer 1 saw hypovascularity in 24 of 94 lesions (P = .0001), and reviewer 2 saw hypovascularity in 21 of 94 lesions (P = .0006), for a specificity of 100% (95% confidence interval [CI]: 84, 100). This feature had κ values of 0.91 (95%CI: 0.82, 1.00) between the two reviewers and 0.85 (95% CI: 0.72, 0.99) between the three machines. Eighteen of 20 papillary RCCs were hypovascular. Quantitative parameters of area under the receiver operating characteristics curve, peak intensity, wash-in slope of 10%-90% and 5%-45%, and washout slope of 100%-10% and 50%-10% were significantly higher in malignant renal masses (P = .018, P = .002, P = .036, P = .016, P = .001, and P = .005, respectively) than in benign lesions. CONCLUSION Excluding lipid-rich angiomyolipoma, hypovascularity-which has high interobserver and intermachine agreement-of solid small renal masses relative to the cortex in the arterial phase has 100% specificity (95% CI: 84, 100) for detecting malignancy, most often papillary RCC.
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Affiliation(s)
- Mostafa Atri
- From the Departments of Medical Imaging (M.A., L.T., H.J.J.), Urology (A.F., M.J.), and Statistics (H.M.), University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Leila Tabatabaeifar
- From the Departments of Medical Imaging (M.A., L.T., H.J.J.), Urology (A.F., M.J.), and Statistics (H.M.), University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Hyun-Jung Jang
- From the Departments of Medical Imaging (M.A., L.T., H.J.J.), Urology (A.F., M.J.), and Statistics (H.M.), University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Anthony Finelli
- From the Departments of Medical Imaging (M.A., L.T., H.J.J.), Urology (A.F., M.J.), and Statistics (H.M.), University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Hadas Moshonov
- From the Departments of Medical Imaging (M.A., L.T., H.J.J.), Urology (A.F., M.J.), and Statistics (H.M.), University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Michael Jewett
- From the Departments of Medical Imaging (M.A., L.T., H.J.J.), Urology (A.F., M.J.), and Statistics (H.M.), University Health Network, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
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Evans AJ, Delahunt B, Srigley JR. Issues and challenges associated with classifying neoplasms in percutaneous needle biopsies of incidentally found small renal masses. Semin Diagn Pathol 2015; 32:184-95. [DOI: 10.1053/j.semdp.2015.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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10
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Abstract
The treatment of renal cell carcinoma (RCC) has changed greatly over the past 15 years. Progress in the surgical management of the primary tumor and increased understanding of the molecular biology and genomics of the disease have led to the development of new therapeutic agents. The management of the primary tumor has changed owing to the realization that clean margins around the primary lesion are sufficient to prevent local recurrence, as well as the development of more sophisticated tools and techniques that increase the safety of partial nephrectomy. The management of advanced disease has altered even more dramatically as a result of new agents that target the tumor vasculature or that attenuate the activation of intracellular oncogenic pathways. This review summarizes data from prospective randomized phase III studies on the surgical management and systemic treatment of RCC, and provides an up to date summary of the histology, genomics, staging, and prognosis of RCC. It describes the management of the primary tumor and offers an overview of systemic agents that form the mainstay of treatment for advanced disease. The review concludes with an introduction to the exciting new class of immunomodulatory agents that are currently in clinical trials and may form the basis of a new therapeutic approach for patients with advanced RCC.
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Affiliation(s)
- Eric Jonasch
- Department of GU Medical Oncology, MD Anderson Cancer Center, Houston, TX 77230-1439, USA
| | - Jianjun Gao
- Department of GU Medical Oncology, MD Anderson Cancer Center, Houston, TX 77230-1439, USA
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Rendon RA, Kapoor A, Breau R, Leveridge M, Feifer A, Black PC, So A. Surgical management of renal cell carcinoma: Canadian Kidney Cancer Forum Consensus. Can Urol Assoc J 2014; 8:E398-412. [PMID: 25024794 DOI: 10.5489/cuaj.1894] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Anil Kapoor
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON
| | - Rodney Breau
- Division of Urology, University of Ottawa, Ottawa, ON
| | - Michael Leveridge
- Departments of Urology and Oncology, Queen's University, Kingston, ON
| | | | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
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Efficacy of Antegrade Pyeloperfusion to Protect the Renal Pelvis in Kidney Microwave Ablation Using an In Vivo Swine Model. Invest Radiol 2013; 48:863-8. [DOI: 10.1097/rli.0b013e3182a2af82] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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13
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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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