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Musi G, Vaccaro C, Luzzago S, Mauri G, Piccinelli ML, Maiettini D, Tozzi M, Varano G, Di Trapani E, Della Vigna P, Cordima G, Ferro M, Bonomo G, de Cobelli O, Mistretta FA, Orsi F. Thermal Ablation for Small Renal Masses: Identifying Anthropometric Factors for Predicting Perioperative and Oncological Outcomes. Clin Genitourin Cancer 2024; 22:102109. [PMID: 38820997 DOI: 10.1016/j.clgc.2024.102109] [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] [Received: 03/12/2024] [Revised: 04/23/2024] [Accepted: 04/27/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVES To test for specific anthropometric parameters to predict perioperative outcomes after thermal ablation (TA) for renal cell carcinoma (RCC). MATERIALS AND METHODS Retrospective single center (2008-2022) analysis of 538 T1a-b RCC patients treated with TA. We tested for specific anthropometric parameters, namely skin to tumor distance (STTD), perirenal fat thickness (PFT), median psoas muscle axial area (PMAA) and median paravertebral muscle axial area (PVMAA), to predict TRIFECTA achievement: (1) absence of CLAVIEN-DINDO≥ 3 complications; (2) complete ablation; (3) absence of ≥ 30% decrease in eGFR. Univariable (ULRM) and multivariable logistic regression models (MLRM) were used for testing TRIFECTA achievement. RESULTS Overall, 103 patients (19%) did not achieve TRIFECTA. Of all anthropometric factors, only lower PMAA was associated with no TRIFECTA achievement (10 vs. 11 cm2, P = .02). However, ULRMs and MLRMs did not confirmed the aforementioned association. We than tested for the 3 specific TRIFECTA items. In separate ULRM and MLRM predicting incomplete ablation, both continuously coded STTD (Odds Ratio [OR]: 1.02; CI: 1.01-1.03; P = .02) and STTD strata (STTD > 10 cm; OR: 2.1; CI: 1.1-4.1; P = .03) achieved independent predictor status. Conversely, in separate ULRM and MLRM predicting CLAVIEN-DINDO ≥3 complications, both continuously coded PFT (OR: 1.04; CI: 1.01-1.07; P = .01) and PFT strata (PFT ≥ 14 mm; OR: 3.3; CI: 1.6-10.2; P = .003) achieved independent predictor status. Last, none of the anthropometric parameters were associated with eGFR decrease ≥ 30%. CONCLUSION None of the tested anthropometric parameters predicted TRIFECTA achievement. However, when the 3 specific TRIFECTA items were tested, STTD and PFT were associated with, respectively, incomplete ablation and CLAVIEN-DINDO ≥ 3 complications.
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Affiliation(s)
- Gennaro Musi
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Chiara Vaccaro
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Stefano Luzzago
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Mauri
- Department of Interventional Radiology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | | | - Daniele Maiettini
- Department of Interventional Radiology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Marco Tozzi
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Gianluca Varano
- Department of Interventional Radiology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Ettore Di Trapani
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Paolo Della Vigna
- Department of Interventional Radiology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Giovanni Cordima
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Guido Bonomo
- Department of Interventional Radiology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Francesco A Mistretta
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Franco Orsi
- Department of Interventional Radiology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
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Deniz R, Güzelbey T, Mutlu İN, Erdim Ç, Akkuzu G, Karaalioğlu B, Özgür DS, Yıldırım F, Kılıçkesmez Ö, Bes C. Successful treatment of a rheumatoid arthritis patient with severe synovial hypertrophy and impaired shoulder function with microwave ablation technique. Skeletal Radiol 2024; 53:1639-1643. [PMID: 38225401 DOI: 10.1007/s00256-024-04580-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/17/2024]
Abstract
Rheumatoid arthritis (RA) is a chronic, inflammatory systemic disorder of synovial joints and results in polyarthritis, chronical degeneration, and finally deformities and ankylosis in severe cases. Synovitis and pannus formation are results of inflammatory changes and lead into restriction in joint movement. Shoulders are among the later affected and larger joints and formation of synovitis in early active stages and pannus in later stages might be concluded with frozen shoulder and severe impairment in functionality. These late-term changes cannot be controlled with systemic or local anti-inflammatory agents and synovectomy is chosen in some cases. However, the results are not satisfactory and recurrence is common. In this case report, we presented a case of RA with severe shoulder pain, restricted movement due to synovial hypertrophy, and pannus formation which are resistant to local and systemic interventions and not suitable for surgical or chemical synovectomy. Microwave ablation (MWA) was performed successfully without any complication and she well responded in terms of DAS-28, functional, and pain scores. Range of motion and funcitonal restriction were recovered. This case report describes the use and promising results of MWA in RA with severe synovial hypertrophy and pannus formation even in the absence of active arthritis and effusion. MWA is a safe and minimally invasive technique that can be easily performed in coordinance of rheumatologists and interventional radiologists in proper cases.
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Affiliation(s)
- Rabia Deniz
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey.
- School of Medicine, Faculty of Health Science, Department of Medical Biology and Genetics, Marmara University, Istanbul, Turkey.
| | - Tevfik Güzelbey
- Department of Radiology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - İlhan Nahit Mutlu
- Department of Radiology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Çağrı Erdim
- Department of Radiology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Gamze Akkuzu
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Bilgin Karaalioğlu
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Duygu Sevinç Özgür
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Fatih Yıldırım
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Özgür Kılıçkesmez
- Department of Radiology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Cemal Bes
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
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Knight A, Gunn AJ. Percutaneous Ablation of T1b Renal Cell Carcinoma: An Overview. Curr Oncol Rep 2024; 26:754-761. [PMID: 38767829 DOI: 10.1007/s11912-024-01531-8] [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] [Accepted: 04/08/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE OF REVIEW There is increasing incidence of renal cell carcinoma (RCC) with multiple treatment options currently available. The purpose of this review is to outline patient selection and technical approaches and present the current literature for percutaneous ablation of T1b (4.1-7 cm) RCC. RECENT FINDINGS An increasing number of retrospective studies and meta-analyses have evaluated the use of percutaneous ablation for T1b RCC. Overall, these studies tend to show that percutaneous ablation in this patient population is feasible. However, rates of major adverse events and local recurrence after percutaneous ablation for T1b RCC are both higher than when ablation is used for smaller tumors. As such, a multi-disciplinary, patient-centered approach is required. Due to the increasing literature in this area, the most recent National Comprehensive Cancer Network (NCCN) guidelines include percutaneous ablation as an option for non-surgical patients with T1b RCC.
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Affiliation(s)
- Alyssa Knight
- Division of Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35249, USA
| | - Andrew J Gunn
- Division of Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, 35249, USA.
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Jasinski M, Wisniewski P, Bielinska M, Siekiera J, Kamecki K, Salagierski M. Perioperative and Oncological Outcomes of Percutaneous Radiofrequency Ablation versus Partial Nephrectomy for cT1a Renal Cancers: A Retrospective Study on Groups with Similar Clinical Characteristics. Cancers (Basel) 2024; 16:1528. [PMID: 38672611 PMCID: PMC11049424 DOI: 10.3390/cancers16081528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/08/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Over the recent years, progress in imaging techniques has led to an increased detection of kidney tumours, including small renal masses. While surgery is still the standard of care, there is a growing interest in minimally invasive methods. Ultrasound (US)-guided percutaneous ablation is particularly attractive because it is a safe and relatively simple procedure. In this study, we investigated the results of US-guided percutaneous radiofrequency ablation (RFA) and partial nephrectomy (PN) in the treatment of cT1a renal cancers. Between August 2016 and February 2022, 271 patients with renal tumours underwent percutaneous RFA as initial treatment in our institution. In the same period, 396 patients with renal tumours underwent surgical tumour excision. For the purpose of this study, only patients with confirmed renal cancer with matched age and tumour characteristics (size, location) were selected for both groups. Thus, a group of 44 PN patients and 41 RFA patients were formed with the same qualification criteria for both groups. Parameters such as procedure length, blood loss, hospital stay, analgesics used, and pre- and post-procedural serum creatinine were compared between these groups. Patients followed up with contrast-enhanced CT. There was no significant difference in age, tumour size, tumour location, and creatinine levels between these groups. All procedures were generally well tolerated. During a median follow-up of 28 months, two cases of recurrence/residual disease were found in each group. The overall survival was 100% in both groups, and all patients were disease-free at the end of observation. Percutaneous RFA was associated with a significantly shorter procedure length and hospital stay, lower blood loss, and lower analgesics used than PN. In the selected group of renal cancer patients, US-guided percutaneous RFA was associated with a shorter hospital stay, less analgesics used, and a shorter procedure length than PN, without differences in the oncological results or kidney function.
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Affiliation(s)
- Milosz Jasinski
- Urology Department, Collegium Medicum, University of Zielona Góra, Zyty 28, 65-046 Zielona Góra, Poland;
- Department of Urology, Institute of Oncology, Romanowskiej 2, 85-796 Bydgoszcz, Poland
| | - Przemyslaw Wisniewski
- Department of Urology, Institute of Oncology, Romanowskiej 2, 85-796 Bydgoszcz, Poland
| | - Marta Bielinska
- Department of Coordination of Oncological Patient Handling, The University Clinical Centre in Gdańsk, Dębinki 7, 80-952 Gdańsk, Poland
| | - Jerzy Siekiera
- Department of Urology, Institute of Oncology, Romanowskiej 2, 85-796 Bydgoszcz, Poland
| | - Krzysztof Kamecki
- Department of Urology, Institute of Oncology, Romanowskiej 2, 85-796 Bydgoszcz, Poland
| | - Maciej Salagierski
- Urology Department, Collegium Medicum, University of Zielona Góra, Zyty 28, 65-046 Zielona Góra, Poland;
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Lambertini L, Mari A, Sandulli A, Amparore D, Antonelli A, Barale M, Bove P, Brunocilla E, Capitanio U, DA Pozzo LF, DI Maida F, Grosso AA, Fiori C, Gontero P, Li Marzi V, Campi R, Longo N, Marchioni M, Montanari E, Montorsi F, Porpiglia F, Porreca A, Schiavina R, Simeone C, Siracusano S, Terrone C, Ficarra V, Minervini A. Minimally invasive transperitoneal partial versus radical nephrectomy in obese patients: perioperative and long-term functional outcomes from a large perspective contemporary series (RECORd2 project). Minerva Urol Nephrol 2024; 76:185-194. [PMID: 38742553 DOI: 10.23736/s2724-6051.24.05692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND The aim of this study is to evaluate the perioperative and long-term functional outcomes of laparoscopic (LPN) and robot-assisted partial nephrectomy (RAPN) in comparison to laparoscopic radical nephrectomy (LRN) in obese patients diagnosed with renal cell carcinoma. METHODS Clinical data of 4325 consecutive patients from The Italian REgistry of COnservative and Radical Surgery for cortical renal tumor Disease (RECORD 2 Project) were gathered. Only patients treated with transperitoneal LPN, RAPN, or LRN with Body Mass Index (BMI) ≥30 kg/m2, clinical T1 renal tumor and preoperative estimated glomerular filtration rate (eGFR) ≥60 mL/min, were included. Perioperative, and long-term functional outcomes were examined. RESULTS Overall, 388 patients were included, of these 123 (31.7%), 120 (30.9%) and 145 (37.4%) patients were treated with LRN, LPN, and RAPN, respectively. No significant difference was observed in preoperative characteristics. Overall, intra and postoperative complication rates were comparable among the groups. The LRN group had a significantly increased occurrence of acute kidney injury (AKI) compared to LPN and RAPN (40.6% vs. 15.3% vs. 7.6%, P=0.001). Laparoscopic RN showed a statistically significant higher renal function decline at 60-month follow-up assessment compared to LPN and RAPN. A significant renal function loss was recorded in 30.1% of patients treated with LRN compared to 16.7% and 10.3% of patients treated with LPN and RAPN (P=0.01). CONCLUSIONS In obese patients, both LPN and RAPN showcased comparable complication rates and higher renal function preservation than LRN. These findings highlighted the potential benefits of minimally invasive PN over radical surgery in the context of obese individuals.
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Affiliation(s)
- Luca Lambertini
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Alessandro Sandulli
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Maurizio Barale
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Pierluigi Bove
- Department of Urology, University Hospital of Tor Vergata, Rome, Italy
| | | | - Umberto Capitanio
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Luigi F DA Pozzo
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, University Vita-Salute San Raffaele, Milan, Italy
- Department of Urology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fabrizio DI Maida
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Antonio Andrea Grosso
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Vincenzo Li Marzi
- Medicine and Surgery Department, University of Milano-Bicocca, Monza, Italy
| | - Riccardo Campi
- Medicine and Surgery Department, University of Milano-Bicocca, Monza, Italy
| | - Nicola Longo
- Department of Urology, Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | | | | | - Francesco Montorsi
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Angelo Porreca
- Department of Urology, Fondazione IRCCS Ca' Granda, Maggiore Polyclinic Hospital, University of Milan, Milan, Italy
- Veneto Institute of Oncology (IOV) IRCCS, Castelfranco Veneto, Treviso, Italy
| | | | - Claudio Simeone
- Department of Urology, Abano Terme Polyclinic, Abano Terme, Padua, Italy
| | - Salvatore Siracusano
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Carlo Terrone
- Department of Urology, Ospedali Civili, University of Brescia, Brescia, Italy
| | | | - Andrea Minervini
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, University of Florence, Careggi Hospital, Florence, Italy -
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Lucignani G, De Lorenzis E, Ierardi AM, Silvani C, Marmiroli A, Nizzardo M, Albo G, Carrafiello G, Montanari E, Boeri L. Perioperative and Survival Outcomes of Patients Treated With Robot-Assisted Partial Nephrectomy and Percutaneous Microwave Ablation for Small Renal Masses: A Single Center Experience. Clin Genitourin Cancer 2024; 22:237-243. [PMID: 38065718 DOI: 10.1016/j.clgc.2023.11.004] [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] [Received: 04/22/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Robot assisted partial nephrectomy (RAPN) and microwave ablation (MWA) are 2 of the most advanced techniques for the management of localized small renal masses. PURPOSE To compare the perioperative, functional and oncological results of RAPN and MWA. MATERIALS AND METHODS Data from 171 consecutive patients undergoing either RAPN or MWA for a localized small renal mass at a single academic center was retrospectively collected. Baseline features included patients' demographics and masses' characteristics. Procedures were compared in terms of perioperative outcomes and renal function variation Progression of a persistent lesion or local recurrence after a complete treatment defined local tumor progression. Descriptive statistics and survival analysis tested the association between predictors and local tumor progression. RESULTS Of all, 109 and 62 patients underwent RAPN and MWA. Patients in the MWA group were older (P = .002) had higher Charlson Comorbidity Index (CCI) (P < .001) and higher frequency of preoperative chronic kidney disease (P < .001). MWA led to a shorter postoperative hospitalization time (P < .001) and lower incidence of medical complications (6.5% vs. 22.9%, P = .02) than RAPN. GFR decline was similar between groups both at discharge (P = .39) and at the time of last follow up (P = 1.00). A lower rate of secondary interventions (11.7% vs. 2.8%, P = .037) and a better disease-free survival (83.2% vs. 96.5%, P = .027) were reported after RAPN. Conversely, cancer specific and overall survival were comparable (P > .05). At univariate regression analysis, MWA was associated with local tumor progression (HR 3.46, P = .040). CONCLUSION MWA displayed a lower perioperative impact, while functional outcomes were similar after each intervention. RAPN resulted superior in terms of tumor eradication, but no difference was noted regarding cancer specific survival. Thus, MWA represents a valid alternative in frail patients, though less radical than RAPN.
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Affiliation(s)
- Gianpaolo Lucignani
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Maria Ierardi
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Silvani
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Marmiroli
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Nizzardo
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Radiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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7
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Aveta A, Iossa V, Spena G, Conforti P, Pagano G, Dinacci F, Verze P, Manfredi C, Ferro M, Lasorsa F, Spirito L, Napolitano L, Tufano A, Fiorenza A, Russo P, Crocerossa F, Lucarelli G, Perdonà S, Sanseverino R, Siracusano S, Cilio S, Pandolfo SD. Ablative Treatments for Small Renal Masses and Management of Recurrences: A Comprehensive Review. Life (Basel) 2024; 14:450. [PMID: 38672721 PMCID: PMC11050889 DOI: 10.3390/life14040450] [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: 03/04/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
This review focuses on ablative techniques for small renal masses (SRMs), including radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), and irreversible electroporation (IRE), and discusses recurrence management. Through an extensive literature review, we outline the procedures, outcomes, and follow-up strategies associated with each ablative method. The review provides a detailed examination of these techniques-RFA, CA, MWA, and IRE-elucidating their respective outcomes. Recurrence rates vary among them, with RFA and CA showing comparable rates, MWA demonstrating favorable short-term results, and IRE exhibiting promise in experimental stages. For managing recurrences, various strategies are considered, including active surveillance, re-ablation, or salvage surgery. Surveillance is preferred post-RFA and post-CA, due to slow SRM growth, while re-ablation, particularly with RFA and CA, is deemed feasible without additional complications. Salvage surgery emerges as a viable option for larger or resistant tumors. While ablative techniques offer short-term results comparable to surgery, further research is essential to understand their long-term effects fully. Decisions concerning recurrence management should consider individual and tumor-specific factors. Imaging, notably contrast-enhanced ultrasounds, plays a pivotal role in assessing treatment success, emphasizing the necessity of a multidisciplinary approach for optimal outcomes. The lack of randomized trials highlights the need for further research.
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Affiliation(s)
- Achille Aveta
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
- Department of Urology, Umberto I Hospital, ASL Salerno, 84014 Nocera Inferiore, Italy; (V.I.); (R.S.)
| | - Vincenzo Iossa
- Department of Urology, Umberto I Hospital, ASL Salerno, 84014 Nocera Inferiore, Italy; (V.I.); (R.S.)
- Department of Urology, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Gianluca Spena
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (A.T.); (S.P.)
| | - Paolo Conforti
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Giovanni Pagano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Fabrizio Dinacci
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy;
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.M.); (L.S.)
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, IRCCS, 71013 Milan, Italy;
| | - Francesco Lasorsa
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.L.); (G.L.)
| | - Lorenzo Spirito
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.M.); (L.S.)
| | - Luigi Napolitano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Antonio Tufano
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (A.T.); (S.P.)
| | - Alessandra Fiorenza
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Pierluigi Russo
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito 1, 00168 Rome, Italy;
| | - Fabio Crocerossa
- Division of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Giuseppe Lucarelli
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.L.); (G.L.)
| | - Sisto Perdonà
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (G.S.); (A.T.); (S.P.)
| | - Roberto Sanseverino
- Department of Urology, Umberto I Hospital, ASL Salerno, 84014 Nocera Inferiore, Italy; (V.I.); (R.S.)
| | | | - Simone Cilio
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
| | - Savio Domenico Pandolfo
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (A.A.); (P.C.); (G.P.); (F.D.); (L.N.); (A.F.); (S.C.)
- Department of Urology, University of L’Aquila, 67100 L’Aquila, Italy;
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy;
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8
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Serhal M, Rangwani S, Seedial SM, Thornburg B, Riaz A, Nemcek AA, Sato KT, Perry KT, Choy B, Lewandowski RJ, Gordon AC. Safety and Diagnostic Efficacy of Image-Guided Biopsy of Small Renal Masses. Cancers (Basel) 2024; 16:835. [PMID: 38398226 PMCID: PMC10887197 DOI: 10.3390/cancers16040835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Image-guided renal mass biopsy is gaining increased diagnostic acceptance, but there are limited data concerning the safety and diagnostic yield of biopsy for small renal masses (≤4 cm). This study evaluated the safety, diagnostic yield, and management after image-guided percutaneous biopsy for small renal masses. METHODS A retrospective IRB-approved study was conducted on patients who underwent renal mass biopsy for histopathologic diagnosis at a single center from 2015 to 2021. Patients with a prior history of malignancy or a renal mass >4 cm were excluded. Descriptive statistics were used to summarize patient demographics, tumor size, the imaging modality used for biopsy, procedure details, complications, pathological diagnosis, and post-biopsy management. A biopsy was considered successful when the specimen was sufficient for diagnosis without need for a repeat biopsy. Complications were graded according to the SIR classification of adverse events. A chi-squared test (significance level set at p ≤ 0.05) was used to compare the success rate of biopsies in different lesion size groups. RESULTS A total of 167 patients met the inclusion criteria. The median age was 65 years (range: 26-87) and 51% were male. The median renal mass size was 2.6 cm (range: one-four). Ultrasound was solely employed in 60% of procedures, CT in 33%, a combination of US/CT in 6%, and MRI in one case. With on-site cytopathology, the median number of specimens obtained per procedure was four (range: one-nine). The overall complication rate was 5%. Grade A complications were seen in 4% (n = 7), consisting of perinephric hematoma (n = 6) and retroperitoneal hematoma (n = 1). There was one grade B complication (0.5%; pain) and one grade D complication (0.5%; pyelonephritis). There was no patient mortality within 30 days post-biopsy. Biopsy was successful in 88% of cases. A sub-group analysis showed a success rate of 85% in tumors <3 cm and 93% in tumors ≥3 cm (p = 0.01). Pathological diagnoses included renal cell carcinoma (65%), oncocytoma (18%), clear cell papillary renal cell tumors (9%), angiomyolipoma (4%), xanthogranulomatous pyelonephritis (1%), lymphoma (1%), high-grade papillary urothelial carcinoma (1%), and metanephric adenoma (1%), revealing benign diagnosis in 30% of cases. The most common treatment was surgery (40%), followed by percutaneous cryoablation (22%). In total, 37% of patients were managed conservatively, and one patient received chemotherapy. CONCLUSION This study demonstrates the safety and diagnostic efficacy of image-guided biopsy of small renal masses. The diagnostic yield was significantly higher for masses 3-4 cm in size compared to those <3 cm. The biopsy results showed a high percentage of benign diagnoses and informed treatment decisions in most patients.
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Affiliation(s)
- Muhamad Serhal
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (M.S.); (S.M.S.); (B.T.); (A.R.); (A.A.N.J.); (K.T.S.); (R.J.L.)
| | - Sean Rangwani
- Northwestern University Feinberg School of Medicine, Chicago Campus, Chicago, IL 60611, USA;
| | - Stephen M. Seedial
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (M.S.); (S.M.S.); (B.T.); (A.R.); (A.A.N.J.); (K.T.S.); (R.J.L.)
| | - Bartley Thornburg
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (M.S.); (S.M.S.); (B.T.); (A.R.); (A.A.N.J.); (K.T.S.); (R.J.L.)
| | - Ahsun Riaz
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (M.S.); (S.M.S.); (B.T.); (A.R.); (A.A.N.J.); (K.T.S.); (R.J.L.)
| | - Albert A. Nemcek
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (M.S.); (S.M.S.); (B.T.); (A.R.); (A.A.N.J.); (K.T.S.); (R.J.L.)
| | - Kent T. Sato
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (M.S.); (S.M.S.); (B.T.); (A.R.); (A.A.N.J.); (K.T.S.); (R.J.L.)
| | - Kent T. Perry
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Bonnie Choy
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Robert J. Lewandowski
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (M.S.); (S.M.S.); (B.T.); (A.R.); (A.A.N.J.); (K.T.S.); (R.J.L.)
| | - Andrew C. Gordon
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (M.S.); (S.M.S.); (B.T.); (A.R.); (A.A.N.J.); (K.T.S.); (R.J.L.)
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9
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Zhang G, Wang B, Liu H, Jia G, Tao B, Zhang H, Wang C. How many cases are required to achieving early proficiency in purely off-clamp robot-assisted partial nephrectomy? Front Surg 2024; 10:1309522. [PMID: 38234451 PMCID: PMC10792019 DOI: 10.3389/fsurg.2023.1309522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/16/2023] [Indexed: 01/19/2024] Open
Abstract
Background and purpose Off-clamp robot-assisted partial nephrectomy (Offc-RAPN) is a technically challenging procedure that can effectively avoid renal ischemia owing to the absence of hilar vessel preparation and clamping. However, data on the learning curve (LC) for this technique are limited. The purpose of this study was to assess the LC of Offc-RAPN and compare the perioperative outcomes between different learning phases. Methods This retrospective study included 50 consecutive patients who underwent purely Offc-RAPN between January 2022 and April 2023. Multidimensional cumulative sum (CUSUM) analysis method was used to assess LC. Spearman's correlation and LOWESS analysis were performed to analyze the continuous variables of perioperative outcomes. Baseline characteristics and perioperative outcomes were compared using χ2-test, t-test and U-test. Results CUSUM analysis identified two LC phases: phase I (the first 24 cases) and phase II (the subsequent 26 cases). Phase II showed significant reductions in mean operative time (133.5 vs. 115.31 min; p = 0.04), mean console time (103.21 vs. 81.27 min; p = 0.01), and mean postoperative length of stay (5.33 vs. 4.30 days; p = 0.04) compared to phase I. However, no significant differences were observed in other perioperative outcomes or baseline characteristics between the two LC phases. Conclusions Offc-RAPN performed by a surgeon with experience in laparoscopic and robotic surgeries achieved early proficiency in 24 cases. Moreover, Offc-RAPN alone is safe and feasible even in the initial phase of the LC for an experienced surgeon.
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Affiliation(s)
| | | | | | | | | | | | - Chunyang Wang
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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10
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Muglia R, Marra P, Pinelli D, Dulcetta L, Carbone FS, Barbaro A, Celestino A, Colledan M, Sironi S. Technical and Clinical Outcomes of Laparoscopic-Laparotomic Hepatocellular Carcinoma Thermal Ablation with Microwave Technology: Case Series and Review of Literature. Cancers (Basel) 2023; 16:92. [PMID: 38201536 PMCID: PMC10778313 DOI: 10.3390/cancers16010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To evaluate technical and clinical outcomes of intraoperative (laparoscopic/laparotomic) microwave ablation on HCC. MATERIALS AND METHODS This is a retrospective single-center study evaluating consecutive patients treated for very early/early-stage HCC with intraoperative microwave ablation from 1 July 2017 to 30 June 2023. In these patients, a percutaneous US-guided approach was excluded due to the nodule's suboptimal visibility or harmful location and liver resection for a deep position or adherences. Data about the clinical stage, surgical approach, liver pathology and nodules characteristics, technical success, complications, and follow-up were collected. Technical success was intended as the absence of locoregional persistence at follow-up CT/MRI controls. RESULTS A total of 36 cirrhotic patients (M:F = 30:6, median age 67 years) were enrolled; 18/36 (50%) had a single nodule, 13/36 (36%) had two, 4/36 had three (11%), and 1/36 had four (3%). Among the patients, 24 (67%) were treated with laparoscopy, and 12/36 (33%) with a laparotomic approach. Sixty HCCs of 16.5 mm (6-50 mm) were treated for 7 min (2-30 min) with 100 W of power. A total of 55 nodules (92%) were treated successfully and showed no residual enhancement at the first postoperative follow-up; the other 5/60 (8%) underwent chemo/radioembolization. There was one complication (3%): a biliary fistula treated with percutaneous drainage and glue embolization. The average hospital stay was 3.5 days (1-51 days), and patients were followed up on average for 238 days (13-1792 days). During follow-up, 5/36 patients (14%) underwent liver transplantation, 1/36 (2%) died during hospitalization and 1 after discharge. CONCLUSIONS Laparoscopic/laparotomic intraoperative HCC MW ablation is feasible in patients unsuitable for percutaneous approach or hepatic resection, with rare complications and with good technical and clinical outcomes.
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Affiliation(s)
- Riccardo Muglia
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.M.); (L.D.); (F.S.C.)
- School of Medicine, University of Milano-Bicocca, 20126 Milano, Italy (A.C.)
| | - Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.M.); (L.D.); (F.S.C.)
- School of Medicine, University of Milano-Bicocca, 20126 Milano, Italy (A.C.)
| | - Domenico Pinelli
- Department of General Surgery, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (D.P.); (M.C.)
| | - Ludovico Dulcetta
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.M.); (L.D.); (F.S.C.)
| | - Francesco Saverio Carbone
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.M.); (L.D.); (F.S.C.)
| | - Alessandro Barbaro
- School of Medicine, University of Milano-Bicocca, 20126 Milano, Italy (A.C.)
| | - Antonio Celestino
- School of Medicine, University of Milano-Bicocca, 20126 Milano, Italy (A.C.)
| | - Michele Colledan
- Department of General Surgery, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (D.P.); (M.C.)
| | - Sandro Sironi
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.M.); (L.D.); (F.S.C.)
- School of Medicine, University of Milano-Bicocca, 20126 Milano, Italy (A.C.)
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11
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Isgrò G, Rogers A, Veeratterapillay R, Rix D, Page T, Maestroni U, Bertolotti L, Pagnini F, Martini C, De Filippo M, Ziglioli F. Role of Renal Biopsy in the Management of Renal Cancer: Concordance between Ultrasound/CT-Guided Biopsy Results and Definitive Pathology, Adverse Events, and Complication Rate. J Clin Med 2023; 13:31. [PMID: 38202038 PMCID: PMC10779766 DOI: 10.3390/jcm13010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: In the last decade, the number of detected renal cancer cases has increased, with the highest incidence in Western countries. Although renal biopsy is reported as a safe procedure, it is not adopted in all centres. As it is not possible to accurately distinguish benign tumours using imaging, this may lead to overtreatment. Most of the cancer detected on imaging is treated by surgery, radiofrequency ablation (RFA), or cryotherapy. (2) Methods: This was a single-centre retrospective study of 225 patients studied preoperatively with ultrasound (US)/CT-guided renal biopsy, with the aim of supporting clinical management. Decisions regarding the biopsy were based on either MDT indication or physician preference. US-guided renal biopsy was the first option for all patients; CT-guided biopsy was used when US-guided biopsy was not feasible. The efficacy of renal biopsy in terms of diagnostic performance and the concordance between biopsy results and definitive pathology were investigated. Additionally, adverse events related to the biopsy were recorded and analysed. Data collected throughout the study were analysed using binary logistic regression, Fisher's exact test, and Pearson's chi-square test to investigate possible correlations between post-procedural complications and the size of the lesion. (3) Results: Renal biopsy was not diagnostic in 23/225 (10.2%) patients. A CT-guided approach was necessary in 20/225 patients after failure of US-guided biopsy. The complication rate of renal biopsy was 4.8% overall-all Clavien grade I and without any serious sequelae. Interestingly, complications occurred in patients with very different sizes of renal cell carcinoma. No correlation between complications and anticoagulant/antiplatelet drugs was found. No seeding was reported among the patients who underwent partial/radical nephrectomy. (4) Conclusions: Renal biopsy was shown to be safe and effective, with a high concordance between biopsy results and definitive pathology and a low rate of complications. The use of a CT-guided approach whenever the US-guided approach failed improved the diagnostic performance of renal biopsy.
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Affiliation(s)
- Gianmarco Isgrò
- Department of Urology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Alistair Rogers
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK (R.V.)
| | - Rajan Veeratterapillay
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK (R.V.)
| | - David Rix
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK (R.V.)
| | - Toby Page
- Department of Urology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Umberto Maestroni
- Department of Urology, University Hospital of Parma, 43100 Parma, Italy (F.Z.)
| | - Lorenzo Bertolotti
- Department of Medicine and Surgery, Section of Radiology, University-Hospital of Parma, 43100 Parma, Italy (M.D.F.)
| | - Francesco Pagnini
- Department of Medicine and Surgery, Section of Radiology, University-Hospital of Parma, 43100 Parma, Italy (M.D.F.)
| | - Chiara Martini
- Department of Medicine and Surgery, University-Hospital of Parma, 43100 Parma, Italy
| | - Massimo De Filippo
- Department of Medicine and Surgery, Section of Radiology, University-Hospital of Parma, 43100 Parma, Italy (M.D.F.)
| | - Francesco Ziglioli
- Department of Urology, University Hospital of Parma, 43100 Parma, Italy (F.Z.)
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12
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Ardeshna DR, Leupold M, Cruz-Monserrate Z, Pawlik TM, Cloyd JM, Ejaz A, Shah H, Burlen J, Krishna SG. Advancements in Microwave Ablation Techniques for Managing Pancreatic Lesions. Life (Basel) 2023; 13:2162. [PMID: 38004302 PMCID: PMC10672411 DOI: 10.3390/life13112162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Thermal ablation, including microwave ablation, has become increasingly important in the management of many solid tumors, including primary and metastatic tumors of the liver, kidney, and lung. However, its adoption to treat pancreatic lesions has been slowed due to concerns about potential adverse events. The success of radiofrequency ablation (RFA) in inoperable pancreatic cancers paved the way for its use in pancreatic neuroendocrine tumors and pancreatic cystic neoplasms (PCLs). In the last decade, other thermal ablation techniques, like microwave ablation, have emerged as alternatives to RFA. Microwaves, with frequencies ranging from 900 to 2450 MHz, generate heat by rapidly oscillating water molecules. Microwave ablation's advantage lies in its ability to achieve higher intra-lesion temperatures and uniform heating compared with RFA. Microwave ablation's application in pancreatic cancer and pancreatic neuroendocrine tumors has demonstrated promise with similar technical success to RFA. Yet, concern for peri-procedure complications, as well as a dearth of studies comparing RFA and microwave ablation, emphasize the need for further research. No studies have evaluated microwave ablation in PCLs. We herein review thermal ablation's potential to treat pancreatic lesions.
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Affiliation(s)
- Devarshi R. Ardeshna
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Matthew Leupold
- Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Zobeida Cruz-Monserrate
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Timothy M. Pawlik
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jordan M. Cloyd
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Aslam Ejaz
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Hamza Shah
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jordan Burlen
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Somashekar G. Krishna
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- The James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Pandolfo SD, Cerrato C, Wu Z, Franco A, Del Giudice F, Sciarra A, Verze P, Lucarelli G, Imbimbo C, Perdonà S, Cherullo EE, Porpiglia F, Derweesh IH, Autorino R. A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications: Large tumors (cT2-T3), solitary kidney, completely endophytic, hilar, recurrent, and multiple renal tumors. Asian J Urol 2023; 10:390-406. [PMID: 38024426 PMCID: PMC10659988 DOI: 10.1016/j.ajur.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/18/2023] [Accepted: 06/19/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Robot-assisted partial nephrectomy (RAPN) has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses. The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses, large tumors (cT2-T3), renal cell carcinoma in solitary kidney, recurrent tumors, completely endophytic and hilar masses, and simultaneous and multiple tumors. Methods A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers. The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered. The secondary endpoint was to evaluate the surgical and functional outcomes. Results After screening 1250 records, 43 full-text manuscripts were selected, comprising over 8500 patients. Twelve and thirteen studies reported data for endophytic and hilar renal masses, respectively. Five and three studies reported outcomes for cT2-T3 and solitary kidney patients, respectively. Four studies focused on redo-RAPN for recurrent tumors. Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney. Conclusion Over the past decade, evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown. Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes, the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result. Certainly, a higher likelihood of complication might be expected when facing extremely challenging cases. However, none of these indications should be considered per se an exclusion criterion for performing RAPN. Ultimately, a risk-adapted approach should be employed.
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Affiliation(s)
- Savio Domenico Pandolfo
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, “Federico II” University, Naples, Italy
| | - Clara Cerrato
- Department of Urology, University of Verona, Verona, Italy
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Department of Urology, Sant’ Andrea Hospital, La Sapienza University, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urologic Sciences, La Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urologic Sciences, La Sapienza University, Policlinico Umberto I Hospital, Rome, Italy
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, “Federico II” University, Naples, Italy
| | - Sisto Perdonà
- Department Uro-Gynecology, IRCCS G. Pascale Foundation, Naples, Italy
| | | | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Ithaar H. Derweesh
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
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14
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Maddalo M, Bertolotti L, Mazzilli A, Flore AGM, Perotta R, Pagnini F, Ziglioli F, Maestroni U, Martini C, Caruso D, Ghetti C, De Filippo M. Small Renal Masses: Developing a Robust Radiomic Signature. Cancers (Basel) 2023; 15:4565. [PMID: 37760532 PMCID: PMC10527518 DOI: 10.3390/cancers15184565] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background and (2) Methods: In this retrospective, observational, monocentric study, we selected a cohort of eighty-five patients (age range 38-87 years old, 51 men), enrolled between January 2014 and December 2020, with a newly diagnosed renal mass smaller than 4 cm (SRM) that later underwent nephrectomy surgery (partial or total) or tumorectomy with an associated histopatological study of the lesion. The radiomic features (RFs) of eighty-five SRMs were extracted from abdominal CTs bought in the portal venous phase using three different CT scanners. Lesions were manually segmented by an abdominal radiologist. Image analysis was performed with the Pyradiomic library of 3D-Slicer. A total of 108 RFs were included for each volume. A machine learning model based on radiomic features was developed to distinguish between benign and malignant small renal masses. The pipeline included redundant RFs elimination, RFs standardization, dataset balancing, exclusion of non-reproducible RFs, feature selection (FS), model training, model tuning and validation of unseen data. (3) Results: The study population was composed of fifty-one RCCs and thirty-four benign lesions (twenty-five oncocytomas, seven lipid-poor angiomyolipomas and two renal leiomyomas). The final radiomic signature included 10 RFs. The average performance of the model on unseen data was 0.79 ± 0.12 for ROC-AUC, 0.73 ± 0.12 for accuracy, 0.78 ± 0.19 for sensitivity and 0.63 ± 0.15 for specificity. (4) Conclusions: Using a robust pipeline, we found that the developed RFs signature is capable of distinguishing RCCs from benign renal tumors.
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Affiliation(s)
- Michele Maddalo
- Medical Physics Unit, University Hospital of Parma, 43126 Parma, Italy; (M.M.); (A.M.); (C.G.)
| | - Lorenzo Bertolotti
- Department of Medicine and Surgery, Section of Radiology, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (L.B.); (R.P.); (C.M.)
| | - Aldo Mazzilli
- Medical Physics Unit, University Hospital of Parma, 43126 Parma, Italy; (M.M.); (A.M.); (C.G.)
| | | | - Rocco Perotta
- Department of Medicine and Surgery, Section of Radiology, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (L.B.); (R.P.); (C.M.)
| | - Francesco Pagnini
- Diagnostic Department, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy;
| | - Francesco Ziglioli
- Department of Urology, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy; (F.Z.); (U.M.)
| | - Umberto Maestroni
- Department of Urology, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy; (F.Z.); (U.M.)
| | - Chiara Martini
- Department of Medicine and Surgery, Section of Radiology, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (L.B.); (R.P.); (C.M.)
- Diagnostic Department, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy;
| | - Damiano Caruso
- Radiology Unit, Department of Medical Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, Sapienza-University of Rome, 00100 Rome, Italy
| | - Caterina Ghetti
- Medical Physics Unit, University Hospital of Parma, 43126 Parma, Italy; (M.M.); (A.M.); (C.G.)
| | - Massimo De Filippo
- Department of Medicine and Surgery, Section of Radiology, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (L.B.); (R.P.); (C.M.)
- Diagnostic Department, Parma University Hospital, Via Gramsci 14, 43126 Parma, Italy;
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15
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Aveta A, Cilio S, Contieri R, Spena G, Napolitano L, Manfredi C, Franco A, Crocerossa F, Cerrato C, Ferro M, Del Giudice F, Verze P, Lasorsa F, Salonia A, Nair R, Walz J, Lucarelli G, Pandolfo SD. Urinary MicroRNAs as Biomarkers of Urological Cancers: A Systematic Review. Int J Mol Sci 2023; 24:10846. [PMID: 37446024 DOI: 10.3390/ijms241310846] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
MicroRNAs (miRNAs) are emerging as biomarkers for the detection and prognosis of cancers due to their inherent stability and resilience. To summarize the evidence regarding the role of urinary miRNAs (umiRNAs) in the detection, prognosis, and therapy of genitourinary cancers, we performed a systematic review of the most important scientific databases using the following keywords: (urinary miRNA) AND (prostate cancer); (urinary miRNA) AND (bladder cancer); (urinary miRNA) AND (renal cancer); (urinary miRNA) AND (testicular cancer); (urinary miRNA) AND (urothelial cancer). Of all, 1364 articles were screened. Only original studies in the English language on human specimens were considered for inclusion in our systematic review. Thus, a convenient sample of 60 original articles was identified. UmiRNAs are up- or downregulated in prostate cancer and may serve as potential non-invasive molecular biomarkers. Several umiRNAs have been identified as diagnostic biomarkers of urothelial carcinoma and bladder cancer (BC), allowing us to discriminate malignant from nonmalignant forms of hematuria. UmiRNAs could serve as therapeutic targets or recurrence markers of non-muscle-invasive BC and could predict the aggressivity and prognosis of muscle-invasive BC. In renal cell carcinoma, miRNAs have been identified as predictors of tumor detection, aggressiveness, and progression to metastasis. UmiRNAs could play an important role in the diagnosis, prognosis, and therapy of urological cancers.
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Affiliation(s)
- Achille Aveta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", 80138 Naples, Italy
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, 13055 Marseille, France
| | - Simone Cilio
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", 80138 Naples, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Gianluca Spena
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", 80138 Naples, Italy
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", 80138 Naples, Italy
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Antonio Franco
- Department of Urology, Sant'Andrea Hospital, "La Sapienza" University, 00189 Rome, Italy
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Clara Cerrato
- Urology Unit, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, 20122 Milan, Italy
| | | | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy
| | - Francesco Lasorsa
- Urology, Andrology and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Rajesh Nair
- The Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, Guy's Hospital, London SE1 9RT, UK
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, 13055 Marseille, France
| | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Savio Domenico Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples "Federico II", 80138 Naples, Italy
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy
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16
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Vrabel MR, Schulman JA, Gillam FB, Mantooth SM, Nguyen KG, Zaharoff DA. Focal Cryo-Immunotherapy with Intratumoral IL-12 Prevents Recurrence of Large Murine Tumors. Cancers (Basel) 2023; 15:cancers15082210. [PMID: 37190138 DOI: 10.3390/cancers15082210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
Focal ablation technologies are routinely used in the clinical management of inoperable solid tumors but they often result in incomplete ablations leading to high recurrence rates. Adjuvant therapies, capable of safely eliminating residual tumor cells, are therefore of great clinical interest. Interleukin-12 (IL-12) is a potent antitumor cytokine that can be localized intratumorally through coformulation with viscous biopolymers, including chitosan (CS) solutions. The objective of this research was to determine if localized immunotherapy with a CS/IL-12 formulation could prevent tumor recurrence after cryoablation (CA). Tumor recurrence and overall survival rates were assessed. Systemic immunity was evaluated in spontaneously metastatic and bilateral tumor models. Temporal bulk RNA sequencing was performed on tumor and draining lymph node (dLN) samples. In multiple murine tumor models, the addition of CS/IL-12 to CA reduced recurrence rates by 30-55%. Altogether, this cryo-immunotherapy induced complete durable regression of large tumors in 80-100% of treated animals. Additionally, CS/IL-12 prevented lung metastases when delivered as a neoadjuvant to CA. However, CA plus CS/IL-12 had minimal antitumor activity against established, untreated abscopal tumors. Adjuvant anti-PD-1 therapy delayed the growth of abscopal tumors. Transcriptome analyses revealed early immunological changes in the dLN, followed by a significant increase in gene expression associated with immune suppression and regulation. Cryo-immunotherapy with localized CS/IL-12 reduces recurrences and enhances the elimination of large primary tumors. This focal combination therapy also induces significant but limited systemic antitumor immunity.
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Affiliation(s)
- Maura R Vrabel
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
- Comparative Medicine Institute, NC State University, Raleigh, NC 27695, USA
| | - Jacob A Schulman
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
| | - Francis B Gillam
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
| | - Siena M Mantooth
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
- Comparative Medicine Institute, NC State University, Raleigh, NC 27695, USA
| | - Khue G Nguyen
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
| | - David A Zaharoff
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
- Comparative Medicine Institute, NC State University, Raleigh, NC 27695, USA
- Lineberger Comprehensive Cancer Center, UNC-Chapel Hill, Chapel Hill, NC 27599, USA
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17
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Jasinski M, Bielinska M, Siekiera J, Kamecki K, Salagierski M. Ultrasound-Guided Percutaneous Thermal Ablation of Renal Cancers-In Search for the Ideal Tumour. Cancers (Basel) 2023; 15:cancers15020518. [PMID: 36672467 PMCID: PMC9856471 DOI: 10.3390/cancers15020518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Over the recent years, the progress in imaging techniques has led to an increased detection of kidney tumours, including small renal masses. While surgery is still the standard of care, there is a growing interest in minimally invasive methods. Ultrasound (US)-guided percutaneous ablation is particularly attractive because it is a safe and relatively simple procedure. In this study, we investigated the success of percutaneous radiofrequency ablation (RFA) in relation to kidney tumour diameter and location. Between August 2016 and September 2021, 253 patients with 259 renal tumours underwent US-guided RFA as a primary treatment in our institution. A total of 67 patients were excluded from this study. Abdominal computed tomography (CT) and tumour biopsy were performed before the procedure. Patients were followed with contrast-enhanced CT, the average follow-up time was 28 months. The studied group was composed of 186 patients with 191 renal tumours-only biopsy-confirmed renal cancers were included. During the follow-up, 46 cases of residual disease and 4 cases of local progression were found. There was a significant correlation between tumour size and the ablation success rate. The success rate was 73.5% and 87.6% for lesions ≤25 mm, 94.6% for lesions ≤25 mm and exophytic, 79.1% for lesions 26-30 mm and 84.4% for lesions 26-30 mm and exophytic, respectively. Four Clavien-Dindo grade ≥2 complications were observed. US-guided percutaneous RFA of T1a renal cancers is safe and well-tolerated. Its effectiveness depends on tumour size, with best results for exophytic lesions smaller than 3 cm. Most of the recurrent or residual tumours can be successfully re-treated with US-guided percutaneous RFA.
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Affiliation(s)
- Milosz Jasinski
- Department of Urology, Collegium Medicum, University of Zielona Góra, Zyty 28, 65-046 Zielona Góra, Poland
- Department of Urology, Institute of Oncology, Romanowskiej 2, 85-796 Bydgoszcz, Poland
- Correspondence:
| | - Marta Bielinska
- Department of Oncology, Institute of Oncology, Romanowskiej 2, 85-796 Bydgoszcz, Poland
| | - Jerzy Siekiera
- Department of Urology, Institute of Oncology, Romanowskiej 2, 85-796 Bydgoszcz, Poland
| | - Krzysztof Kamecki
- Department of Urology, Institute of Oncology, Romanowskiej 2, 85-796 Bydgoszcz, Poland
| | - Maciej Salagierski
- Department of Urology, Collegium Medicum, University of Zielona Góra, Zyty 28, 65-046 Zielona Góra, Poland
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18
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John A, Spain L, Hamid AA. Navigating the Current Landscape of Non-Clear Cell Renal Cell Carcinoma: A Review of the Literature. Curr Oncol 2023; 30:923-937. [PMID: 36661719 PMCID: PMC9858145 DOI: 10.3390/curroncol30010070] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/24/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Non-clear cell renal cell carcinoma (nccRCC) is an entity comprised of a heterogeneous constellation of RCC subtypes. Genomic profiling has broadened our understanding of molecular pathogenic mechanisms unique to individual nccRCC subtypes. To date, clinical trials evaluating the use of immunotherapies and targeted therapies have predominantly been conducted in patients with clear cell histology. A comprehensive review of the literature has been undertaken in order to describe molecular pathogenic mechanisms pertaining to each nccRCC subtype, and concisely summarise findings from therapeutic trials conducted in the nccRCC space.
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Affiliation(s)
- Alexius John
- Department of Medical Oncology, Eastern Health, Melbourne, VIC 3128, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Lavinia Spain
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Anis A. Hamid
- Department of Medical Oncology, Eastern Health, Melbourne, VIC 3128, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC 3128, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC 3010, Australia
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19
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di Meo NA, Lasorsa F, Rutigliano M, Loizzo D, Ferro M, Stella A, Bizzoca C, Vincenti L, Pandolfo SD, Autorino R, Crocetto F, Montanari E, Spilotros M, Battaglia M, Ditonno P, Lucarelli G. Renal Cell Carcinoma as a Metabolic Disease: An Update on Main Pathways, Potential Biomarkers, and Therapeutic Targets. Int J Mol Sci 2022; 23:ijms232214360. [PMID: 36430837 PMCID: PMC9698586 DOI: 10.3390/ijms232214360] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) is the most frequent histological kidney cancer subtype. Over the last decade, significant progress has been made in identifying the genetic and metabolic alterations driving ccRCC development. In particular, an integrated approach using transcriptomics, metabolomics, and lipidomics has led to a better understanding of ccRCC as a metabolic disease. The metabolic profiling of this cancer could help define and predict its behavior in terms of aggressiveness, prognosis, and therapeutic responsiveness, and would be an innovative strategy for choosing the optimal therapy for a specific patient. This review article describes the current state-of-the-art in research on ccRCC metabolic pathways and potential therapeutic applications. In addition, the clinical implication of pharmacometabolomic intervention is analyzed, which represents a new field for novel stage-related and patient-tailored strategies according to the specific susceptibility to new classes of drugs.
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Affiliation(s)
- Nicola Antonio di Meo
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Francesco Lasorsa
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Monica Rutigliano
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Davide Loizzo
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Alessandro Stella
- Laboratory of Human Genetics, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Cinzia Bizzoca
- Division of General Surgery, Polyclinic Hospital, 70124 Bari, Italy
| | | | | | | | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy
| | - Emanuele Montanari
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Marco Spilotros
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Michele Battaglia
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Pasquale Ditonno
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70124 Bari, Italy
- Correspondence: or
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