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Sarkar PK, Nissanka-Jayasuria E, Eraibey M, Kommu S. Internist's tumour into thyroid: A case report. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2024; 14:348-351. [PMID: 38988434 PMCID: PMC11232783 DOI: 10.4103/jwas.jwas_131_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/31/2023] [Indexed: 07/12/2024]
Abstract
Renal cell carcinoma (RCC) is well known for its unpredictable and diverse behaviour, with tendency to cause synchronous or metachronous metastasis to unusual site, which is why it is called the "internist's tumour."Although thyroid gland is an infrequent site for metastasis of different primary malignancies, metastatic RCC is one of the most common secondary thyroid malignancies. Diagnosis relies on a high index of suspicion in patients with prior RCC, combined with cross-sectional imaging and biopsy. A case of secondary thyroid neoplasm from RCC after 13 years of radical nephrectomy is described with clinicopathological features and literature review.
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Affiliation(s)
- Pallab Kumar Sarkar
- Department of Urology, East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom
| | - Eranga Nissanka-Jayasuria
- Department of Pathology, East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom
| | - Muhammad Eraibey
- Department of Radiology, East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom
| | - Sashi Kommu
- Department of Urology, East Kent Hospitals University NHS Foundation Trust, Canterbury, United Kingdom
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2
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Satwikananda H, Wiratama MA, Putri KTC, Soebadi DM. Renal cell carcinoma in a patient with staghorn stones: A case report. Int J Surg Case Rep 2023; 110:108678. [PMID: 37603918 PMCID: PMC10445450 DOI: 10.1016/j.ijscr.2023.108678] [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: 07/03/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Staghorn stone fills the renal pelvic and two or more branches of renal calyces. The incidence of staghorn stones is between 10 and 20 % of all urinary tract stones. We report the case of a man with right staghorn stones and renal mass who underwent right radical nephrectomy with pathology anatomy result of renal cell carcinoma (RCC). CASE PRESENTATION A 56-year-old man came with a complaint of right flank pain for two months. Physical examination is within normal limits, but an abdominal CT scan revealed a staghorn stone with enhancing mass in the upper pole of the right kidney. Patient subsequently underwent right radical nephrectomy. Pathology examination revealed RCC. CLINICAL DISCUSSION The presence of kidney stones in renal malignancy is rare. Kidney stones can be a risk factor for renal cell malignancy, and renal cell malignancies can cause urinary stasis, making it a risk factor for kidney stones. A study conducted by Nugroho and colleagues concluded that renal and caliceal biopsy should be considered in large and chronic renal stone due to potential experiencing kidney malignancy in patient with renal stone. Therefore, early diagnosis and definitive can be carried out. CONCLUSION Kidney stones and malignancy are rarely found. Renal pelvis, and caliceal wall biopsy should be considered in chronic and large renal stone, especially staghorn stone in patient that did not have any signs of malignancy on CT scan. Treatment in such case is focused on the oncological outcome. Therefore, radical nephrectomy is the treatment of choice.
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Affiliation(s)
- Handaru Satwikananda
- Department of Urology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Made Adi Wiratama
- Department of Urology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Karinda Triharyu Caesari Putri
- Department of Urology, Faculty of Medicine, Jenderal Soedirman University/Prof. Dr. Margono Soekarjo Hospital, Purwokerto, Central Java, Indonesia
| | - Doddy Moesbadianto Soebadi
- Department of Urology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia.
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3
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Kang DH, Lee JY, Lee Y, Ha US. Optimal sequencing of the first- and second-line target therapies in metastatic renal cell carcinoma: based on nationally representative data analysis from the Korean National Health Insurance System. BMC Cancer 2023; 23:483. [PMID: 37254112 DOI: 10.1186/s12885-023-10991-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/22/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The authors intend to compare the effects of each targeted therapy (TT) in the treatment of patients with metastatic renal cell carcinoma (mRCC) using big data based on the Korean National Health Insurance System (NHIS) and determine the optimal treatment sequence. METHODS Data on the medical use of patients with kidney cancer were obtained from the NHIS database from January 1, 2002, to December 31, 2020. Patient variables included age, sex, income level, place of residence, prescribing department, and duration from diagnosis to the prescription date. The primary outcome was overall survival (OS) for each drug and sequencing. We performed propensity score matching (PSM) according to age, sex, and Charlson Comorbidity Index based on the primary TTs. RESULTS After 1:1 PSM, the sunitinib (SUN) (n = 1,214) and pazopanib (PAZ) (n = 1,214) groups showed a well-matched distribution across the entire cohort. In the primary treatment group, PAZ had lower OS than SUN (HR, 1.167; p = 0.0015). In the secondary treatment group, axitinib (AXI) had more favorable OS than cabozantinib (CAB) (HR, 0.735; p = 0.0118), and everolimus had more adverse outcomes than CAB (HR, 1.544; p < 0.0001). In the first to second TT sequencing, SUN-AXI had the highest OS; however, there was no statistically significant difference when compared with PAZ-AXI, which was the second highest (HR, 0.876; p = 0.3312). The 5-year survival rate was calculated in the following order: SUN-AXI (51.44%), PAZ-AXI (47.12%), SUN-CAB (43.59%), and PAZ-CAB (34.28%). When the four sequencing methods were compared, only SUN-AXI versus PAZ-CAB (p = 0.003) and PAZ-AXI versus PAZ-CAB (p = 0.017) were statistically significant. CONCLUSIONS In a population-based RWD analysis of Korean patients with mRCC, SUN-AXI sequencing was shown to be the most effective among the first to second TT sequencing methods in treatment, with a relative survival advantage over other sequencing combinations. To further support the results of this study, risk-stratified analysis is needed.
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Affiliation(s)
- Dong Hyuk Kang
- Department of Urology, Inha University College of Medicine, Incheon, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, Korea
| | - Yunhee Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Korea
| | - U-Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Korea.
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4
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Li JY, Bodda S, Jay A, Kichenadasse G, Chong M, Gleadle JM, O'Callaghan M. Protocol for the Flinders Kidney Health Registry: patient outcomes of kidney cancers and nephrectomies. BMC Urol 2022; 22:112. [PMID: 35864540 PMCID: PMC9306188 DOI: 10.1186/s12894-022-01065-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kidney cancer accounts for 2% of new cancers diagnosed in Australia annually. Partial and radical nephrectomy are the treatment of choice for kidney cancer. Nephrectomy is also performed for living donor kidney transplantation. Nephrectomy is a risk factor for new-onset chronic kidney disease (CKD) or deterioration of pre-existing CKD. Understanding the risk factors for new-onset or deterioration of existing CKD after nephrectomy is important in developing preventive measures to provide better care for these patients. There is also a need to understand the incidence, natural history, management trends, and sequelae of radiofrequency ablation as well as surveillance of small renal cancers or small renal masses (SRMs). Clinical registries are critical in providing excellent patient-centre care and clinical research as well as basic science research. Registries evaluate current practice and guide future practice. The Flinders Kidney Health Registry will provide the key information needed to assess various treatment outcomes of patients with kidney cancer and patients who underwent nephrectomy for other reasons. The registry aims to provide clinical decision makers with longitudinal data on patient outcomes, health systems performance, and the effect of evolving clinical practice. The registry will also provide a platform for large-scale prospective clinical studies and research. METHODS Patients above the age of 18 undergoing nephrectomy or radiofrequency ablation for any indication and patients with SRMs will be included in the registry. Demographic, clinical and quality of life data will be collected from hospital information systems and directly from the patient and/or caregiver. DISCUSSION The Registry will report a summary of patient characteristics including indication for treatment, clinical risk profiles, surgical and oncological outcomes, the proportion of patients who progress to CKD and end stage kidney disease, quality of life post treatment as well as other relevant outcomes for all patients who have undergone nephrectomy for any indication, ablation or surveillance for SRMs. The registry will record the follow-up practice after nephrectomy and patient on active surveillance, which will help to develop and enhance a best practice protocol. The collected prospective data will provide a platform for ongoing patient-orientated research and improve patient-centred healthcare delivery.
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Affiliation(s)
- Jordan Y Li
- Department of Renal Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia. .,Flinders Health and Medical Research Institute (FHMRI), College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia.
| | - Sarah Bodda
- Department of Renal Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia
| | - Alex Jay
- Department of Urology, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.,Flinders Health and Medical Research Institute (FHMRI), College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - Ganessan Kichenadasse
- Department of Medical Oncology, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.,Flinders Health and Medical Research Institute (FHMRI), College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - Michael Chong
- Department of Urology, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia
| | - Jonathan M Gleadle
- Department of Renal Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.,Flinders Health and Medical Research Institute (FHMRI), College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - Michael O'Callaghan
- Department of Urology, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.,Flinders Health and Medical Research Institute (FHMRI), College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
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5
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Stühler V, Herrmann L, Maas M, Walz S, Rausch S, Stenzl A, Bedke J. Prognostic impact of complete metastasectomy in metastatic renal cell carcinoma in the era of immuno-oncology-based combination therapies. World J Urol 2022; 40:1175-1183. [PMID: 35217885 PMCID: PMC9085676 DOI: 10.1007/s00345-022-03960-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/03/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Complete metastasectomy of renal cell carcinoma (RCC) is receding into the past due to the progress of immuno-oncology-based combinations (IO) in systemic therapy. The prognostic impact of curative intended complete metastasectomy vs. immediate IO-based therapy or tyrosine kinase inhibition (TKI) on progression-free survival (PFS) and cancer-specific survival (CSS) was investigated in the first-line setting. METHODS 205 patients with synchronous or metachronous metastasis received complete metastasectomy (n = 80) or systemic therapy (n = 125, TKI: 87, TKI-IO: 13, IO-IO: 25) as first-line therapy. The prognostic impact of these therapies was assessed using Cox regression and Kaplan-Meier analyses. RESULTS First-line complete metastasectomy significantly improved CSS compared to both TKI monotherapy (6.1 vs. 2.6 years, HR 0.45, p < 0.001) and IO-based combination therapy (IO-IO/TKI-IO, 6.1 vs. 3.5 years, HR 0.28, p = 0.007). Repetitive complete metastasectomy without ever receiving systemic therapy vs. systemic therapy in first-line significantly prolonged CSS (11.3 vs. 3.1 years, HR 0.34, p = 0.002). First-line complete metastasectomy and subsequent systemic therapy at tumor progression was associated with a significant CSS benefit vs. systemic therapy (5.8 vs. 3.1 years, HR 0.53, p = 0.003), also compared to IO-based combinations (5.8 vs. 3.5 years, HR 0.30, p = 0.017). Median PFS was improved by IO-based therapy compared to TKI monotherapy in the first-line setting (HR 0.61, p = 0.05), with maximal benefit of the TKI-IO combination vs. TKI monotherapy (HR 0.27, p = 0.01), as well as compared to PFS of complete metastasectomy (HR 0.34, p = 0.035). CONCLUSION Despite the progress of IO-based combination therapies in first line, complete metastasectomy remains an integral part of the multimodality treatment of metastatic RCC.
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Affiliation(s)
- Viktoria Stühler
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Lisa Herrmann
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Moritz Maas
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Simon Walz
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Steffen Rausch
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Jens Bedke
- Department of Urology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Tübingen, Germany.
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Radfar MH, Ameri F, Dadpour M, Khabazian R, Borumandnia N, Kabir SA. Partial nephrectomy and positive surgical margin, oncologic outcomes and predictors: a 15-year single institution experience. Cent European J Urol 2022; 74:516-522. [PMID: 35083070 PMCID: PMC8771139 DOI: 10.5173/ceju.2021.0191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/25/2021] [Accepted: 10/23/2021] [Indexed: 01/19/2023] Open
Abstract
Introduction The aim of this article was to compare oncological outcomes after partial nephrectomy between patients with positive (PSM) and negative (NSM) surgical margins. Material and methods In this retrospective study, the data of 733 patients who underwent partial nephrectomy with diagnosis of renal cell carcinoma (RCC) were analyzed. A total of 80 patients from the NSM group were matched to 42 PSM patients. The Kaplan-Meier method was used to estimate freedom from local disease recurrence and metastatic progression and overall survival. Cox proportional hazards models were used to assess the predictors for recurrence/metastasis. Results The mean age was 58.4 ±11.4 years (range: 29 to 82). Median follow-up was 24 months (IQ25-75: 15–36.2). A total of 5 patients from the PSM group (6.2%) developed local recurrence and metastasis was detected in 2 (2.5%) of them while no metastasis or recurrence was observed in the NSM group. In the multivariate analysis, positive surgical margin was the only independent predictor for recurrence/metastasis (HR[CI] = 0.19[0.04–0.75], p = 0.019). Recurrence-free survival was higher in the NSM group (100% for the NSM group vs 88.1%, p = 0.002) and recurrence/metastasis-free survival was also higher in the NSM group (100% for the NSM group vs 85.7%, p = 0.001), but there were no differences in overall survival between the two groups (96.3% for the NSM group vs 97.6% for the PSM group, p = 0.68). Conclusions Although tumor recurrence was more prevalent in positive surgical margin patients who underwent partial nephrectomy, there were no differences in overall survival between the two groups. Therefore, active surveillance against further surgery would be a proper option after finding the tumor-involved margins.
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Affiliation(s)
- Mohammad Hadi Radfar
- Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ameri
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Dadpour
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Khabazian
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Borumandnia
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sajjad Askarpour Kabir
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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7
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Byrnes KG, Khan JSA, Haroon UM, McCawley N, Cheema IA. Management of colon-invading renal cell carcinoma: Operative technique and systematic review. Urol Ann 2021; 13:1-8. [PMID: 33897156 PMCID: PMC8052896 DOI: 10.4103/ua.ua_86_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/12/2020] [Indexed: 01/04/2023] Open
Abstract
Invasion into adjacent organs by non-metastatic renal cell carcinoma (RCC) occurs in 1% of patients suitable for resection. Colonic invasion is rare and presents technical challenges. No prospective data exists to guide management of these patients. We present the first reported case of a colon-invading RCC managed with simultaneous open right radical nephrectomy and extended right hemicolectomy. PubMed, Scopus and EMBASE databases were searched for relevant case reports reporting management of colon-invading renal cell carcinoma. Case reports, case series and cohort studies were eligible. A chart review was performed on a patient who presented with right-sided colon-invading RCC. Four previously reported cases were identified. The current case was managed with simultaneous open radical nephrectomy and extended right hemicolectomy. The patient remains well six months postoperatively with no evidence of disease recurrence. Histopathological evaluation of the resected specimen confirmed a T4 clear cell RCC with sarcomatoid differentiation. Colon-invading RCC is rare. This is the first reported case of right-sided, colon-invading RCC treated with radical resection. The current case confirms radical resection is a feasible management strategy for similar presentations. En bloc resection of involved organs remains the only potentially curative option for locally advanced disease.
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Affiliation(s)
| | | | | | - Niamh McCawley
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
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8
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Kinnear N, Hua L, Heijkoop B, Hennessey D, Spernat D. The impact of intra-operative cell salvage during open nephrectomy. Asian J Urol 2019; 6:346-352. [PMID: 31768320 PMCID: PMC6872782 DOI: 10.1016/j.ajur.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 02/23/2018] [Accepted: 04/13/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the impact of intra-operative cell salvage on outcomes in open nephrectomy. METHODS A retrospective cohort study was performed of all patients undergoing open nephrectomy for suspected malignancy from 1 October 2013 to 1 October 2017. Patients were grouped and compared based on whether they received intra-operative cell salvage (ICS). Primary outcomes were allogeneic transfusion rates (ATRs), and if histology confirmed cancer, disease recurrence. Secondary outcomes were complications and transfusion-related cost. RESULTS Forty patients underwent open nephrectomy for suspected malignancy during the enrolment period. Sixteen patients received ICS while 24 did not (standard group). Compared with the standard group, ICS patients had similar median age (63.5 vs. 61.0 years; p = 0.83) but fewer females (19% vs. 58%; p = 0.013). The groups were similar in pre-operative and discharge haemoglobin, Charlson Comorbidity Index, length of hospital stay and proportion with thoracoabdominal surgical approach. The ICS group had a smaller proportion undergoing partial nephrectomy (19% vs. 54%; p = 0.025) and shorter median follow-up (278 vs. 827 days; p = 0.0005). Histology was malignant for 14 ICS and 15 standard patients. The ICS group had more frequent ≥T2 disease (79% vs. 27%; p = 0.005). There were no positive margins. Both groups had similar ATRs (6% vs. 4%; p = 0.96), complication rates (19% vs. 29%; p = 0.46) and recurrence rates (18% vs. 7%; p = 0.40). Transfusion costs were higher amongst ICS patients (AUD $878.18 vs. $49.65 per patient). CONCLUSION ICS appears safe, with low rates of recurrence and complication. Both groups had low ATRs, and therefore cost benefit for ICS was not seen.
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Affiliation(s)
- Ned Kinnear
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Lina Hua
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Bridget Heijkoop
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Derek Hennessey
- Department of Urology, Craigavon Area Hospital, Portadown, UK
| | - Daniel Spernat
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
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9
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Frees SK, Kamal MM, Nestler S, Levien PM, Bidnur S, Brenner W, Thomas C, Jaeger W, Thüroff JW, Roos FC. Risk-adjusted proposal for >60 months follow up after surgical treatment of organ-confined renal cell carcinoma according to life expectancy. Int J Urol 2018; 26:385-390. [PMID: 30588677 DOI: 10.1111/iju.13882] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/14/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the long-term oncological outcome of organ-confined (<pT3) renal cell carcinoma. METHODS We identified 889 patients with complete long-term follow-up data, who had been surgically treated for renal cell carcinoma (<T3) at our institution between 1976 and 2009. Kaplan-Meier analysis was used to assess the incidence and time interval of recurrence defined as local recurrences or metastases. We further compared patients who had tumor progression before or after 60 months. RESULTS After a median follow-up period of 74.33 months (range 3-329 months), 44 patients (4.9%) had disease recurrence. A total of 38.6% of the recurrences occurred after 60 months; 76.2% of patients had distant metastases and 23.8% of patients had local recurrences. In patients with low-grade (G1) and low-stage (pT1a) tumors, there was a trend to develop recurrence or metastases after longer intervals. Patients with lung metastasis and patients with multiple metastatic locations developed these metastases earlier than patients with bone metastasis. The risk of dying of other causes correlated with age, but the time interval to metastases did not. CONCLUSIONS Current guidelines recommend a follow-up period of 60 months after surgical treatment of organ-confined renal cell carcinoma. Our data shows that one-third of recurrences of <pT3 renal cell carcinoma occur after 60 months. According to our oncological analysis, we suggest an age-adjusted strategy of follow-up balancing the risk of tumor recurrence and the life expectancy of the patient.
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Affiliation(s)
| | - Mohammed M Kamal
- Department of Urology, University Medical Center, Mainz, Germany.,Urology and Nephrology Center, Mansoura, Egypt
| | - Sebastian Nestler
- Department of Urology, University Medical Center, Mainz, Germany.,Department of Urology, Hochtaunus Hospital Bad Homburg, Bad Homburg, Germany
| | | | - Samir Bidnur
- Vancouver Prostate Centre, Urological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Christian Thomas
- Department of Urology, University Medical Center, Mainz, Germany
| | - Wolfgang Jaeger
- Department of Urology, University Medical Center, Mainz, Germany
| | | | - Frederik C Roos
- Department of Urology, University Medical Center, Mainz, Germany
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10
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Patel P, Nayak JG, Liu Z, Saarela O, Jewett M, Rendon R, Kapoor A, Black P, Tanguay S, Kawakami J, Moore R, Breau RH, Morash C, Pouliot F, Drachenberg DE. A Multicentered, Propensity Matched Analysis Comparing Laparoscopic and Open Surgery for pT3a Renal Cell Carcinoma. J Endourol 2018; 31:645-650. [PMID: 28381117 DOI: 10.1089/end.2016.0787] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION To compare outcomes following laparoscopic renal surgery (LRS) and open renal surgery (ORS) in the treatment of pathologic T3a (pT3a) renal cell carcinoma (RCC) using a propensity matched analysis. MATERIALS AND METHODS The Canadian Kidney Cancer Information System is a prospectively maintained database for patients diagnosed with RCC from 15 Canadian institutions. Patients treated for nonmetastatic pT3a RCC between 2008 and 2015 were included. Propensity score matching for age, gender, tumor size, grade, histology, and surgical approach was performed to compare laparoscopic radical and partial nephrectomy (LRN or LPN) with open radical or partial nephrectomy (ORN or OPN). The primary endpoint was recurrence-free survival (RFS). RESULTS Two hundred twenty-six (45%) patients underwent LRS (88% LRN and 12% LPN), and 275 (55%) underwent ORS (75% ORN and 25% OPN). After a median follow-up of 21.1 months, 155 (72 LRS and 83 ORS) patients experienced recurrence. The 3-year RFS was 63% and 50% for the LRS and ORS groups, respectively, p = 0.36. On subgroup analysis, there was no significant difference in RFS among patients who underwent radical nephrectomy (3-year RFS 61% in LRN compared with 46% in ORN group, p = 0.32) or partial nephrectomy (77% in LPN compared with 79% in OPN group, p = 0.82). CONCLUSIONS This study is the largest matched analysis comparing LRS and ORS for pT3a RCC. In matched patients, LRS showed no difference in oncologic outcomes compared with ORS and should be considered when technically feasible.
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Affiliation(s)
- Premal Patel
- 1 Section of Urology, University of Manitoba , Winnipeg, Canada
| | - Jasmir G Nayak
- 1 Section of Urology, University of Manitoba , Winnipeg, Canada
| | | | - Olli Saarela
- 3 Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
| | - Michael Jewett
- 4 Division of Urology, University of Toronto , Toronto, Canada
| | - Ricardo Rendon
- 5 Department of Urology, Dalhousie University , Halifax, Canada
| | - Anil Kapoor
- 6 Division of Urology, McMaster University , Hamilton, Canada
| | - Peter Black
- 7 Department of Urologic Sciences, University of British Columbia , Vancouver, Canada
| | - Simon Tanguay
- 8 Division of Urology, McGill University , Montreal, Canada
| | - Jun Kawakami
- 9 Southern Alberta Institute of Urology, University of Calgary , Calgary, Canada
| | - Ronald Moore
- 10 Division of Urology, University of Alberta , Edmonton, Canada
| | - Rodney H Breau
- 11 Division of Urology, The Ottawa Hospital Research Institute, University of Ottawa , Ottawa, Canada
| | - Chris Morash
- 11 Division of Urology, The Ottawa Hospital Research Institute, University of Ottawa , Ottawa, Canada
| | - Frédéric Pouliot
- 12 Centre Hospitalier Universitaire de Québec , Quebec City, Canada
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11
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Dragomir A, Aprikian A, Kapoor A, Finelli A, Pouliot F, Rendon R, Black PC, Moore R, Breau RH, Kawakami J, Drachenberg D, Lattouf JB, Tanguay S. Follow-up imaging after nephrectomy for cancer in Canada: urologists' compliance with guidelines. An observational study. CMAJ Open 2017; 5:E834-E841. [PMID: 29229610 PMCID: PMC5741415 DOI: 10.9778/cmajo.20170005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Surgical tumour removal remains the preferred treatment for most patients with renal cell carcinoma, and many medical associations have proposed guidelines for the optimal surveillance of patients following surgery. This study evaluated the adherence of Canadian urologists to the follow-up guidelines proposed by the Canadian Urological Association (CUA) in 2009. METHODS The study cohort was identified from the Canadian Kidney Cancer Information System, a prospectively populated database from 15 academic institutions in 6 Canadian provinces: British Colombia, Alberta, Manitoba, Ontario, Quebec and Nova Scotia. A total of 1982 patients who underwent radical or partial nephrectomy for stage pT1-3N0M0 renal cancer between January 2011 and June 2016 were included in the cohort. Numbers of abdominal and chest imaging tests performed during the follow-up period were captured and compared with the 2009 CUA guidelines. The level of compliance was measured by means of weighted κ and Pearson correlation statistics. Multivariate logistic regression was used to evaluate factors associated with noncompliance (under- or overtesting) in the postoperative surveillance period. RESULTS Of the 1982 patients, 1380 had stage pT1 disease, 164 had stage pT2 disease, and 438 had stage pT3 disease. There was incongruent adherence to the CUA surveillance guidelines, with a ratio of observed to recommended tests of 0.71 and 2.27 for chest and abdominal imaging, respectively. Overall, moderate correlation between observed and recommended tests was observed, with the highest value found for abdominal imaging in the pT3 group (κ = 0.59 [95% confidence interval 0.52-0.66]). Patients who underwent radical nephrectomy and those who presented with a higher stage of the disease were less likely to receive fewer chest imaging tests than recommended, and those with stage pT2 disease, those with stage pT3 disease, those with conventional clear cell renal cell carcinoma and those with a low-risk histologic type had an increased risk of undertesting. INTERPRETATION In the 6 Canadian provinces, there are large differences between guidelines and clinical practice in imaging surveillance after nephrectomy for renal cell carcinoma. Better adherence to clinical guidelines could improve optimization of health care services.
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Affiliation(s)
- Alice Dragomir
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Armen Aprikian
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Anil Kapoor
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Antonio Finelli
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Frédéric Pouliot
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Ricardo Rendon
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Peter C Black
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Ronald Moore
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Rodney H Breau
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Jun Kawakami
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Darrell Drachenberg
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Jean-Baptiste Lattouf
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
| | - Simon Tanguay
- Affiliations: McGill University and McGill University Health Centre (Dragomir, Aprikian, Tanguay), Montréal, Que; McMaster University (Kapoor), Hamilton, Ont.; Princess Margaret Cancer Centre and University of Toronto (Finelli), Toronto, Ont.; Université Laval (Pouliot), Québec, Que.; Dalhousie University and Queen Elizabeth II Health Sciences Centre (Rendon), Halifax, NS; University of British Columbia (Black), Vancouver, BC; University of Alberta (Moore), Edmonton, Alta.; University of Ottawa (Breau), Ottawa, Ont.; University of Alberta (Kawakami), Calgary, Alta.; University of Manitoba (Drachenberg), Winnipeg, Man.; University of Montréal (Lattouf), Montréal, Que
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Bansal RK, Tanguay S, Finelli A, Rendon R, Moore RB, Breau RH, Lacombe L, Black PC, Kawakami J, Drachenberg D, Pautler S, Saarela O, Liu Z, Jewett MAS, Kapoor A. Positive surgical margins during partial nephrectomy for renal cell carcinoma: Results from Canadian Kidney Cancer information system (CKCis) collaborative. Can Urol Assoc J 2017; 11:182-187. [PMID: 28652876 DOI: 10.5489/cuaj.4264] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to determine the incidence, risk factors, and prognosis for patients with positive surgical margin (PSM) during partial nephrectomy (PN) for renal cell carcinoma (RCC). METHODS From the Canadian Kidney Cancer information system (CKCis) database, a historical cohort of PN patients with PSM were identified and compared to negative surgical margin (NSM). Risk factors for PSM were examined through multivariable logistic regression. Kaplan-Meier curves were used to compare progression-free survival. RESULTS Of 1103 patients, 972 (88.1%), 71 (6.4%), and 60 (5.4%) had NSM, PSM, and unknown status, respectively. Median patient age and tumour size were 61 years and 3.0 cm for both groups. From multivariable analysis, pathological stage ≥T3 (odds ratio [OR] 2.51; 95% confidence interval [CI] 1.13-5.60) and Fuhrman grade 4 (OR 5.35; 95% CI 1.11-25.72) were associated with PSM, whereas age, operative technique, and tumour size were not. Forty-nine (5.0%) patients from the NSM cohort and seven (9.9%) from the PSM cohort had a local/systemic progression of disease (adjusted hazard ratio [HR] 1.4; 95% CI 0.6-3.6). There were three (0.3%) cancer-related deaths in the NSM group and none in the PSM group. After median followup of 19 (interquartile range [IQR] 5-42) and 15 (IQR 7-30) months, 855 (91.4%) and 61 (89.7%) patients were alive in the NSM and PSM groups, respectively. CONCLUSIONS PSM occurred in 6.4% of PNs performed for RCC in this pan-Canadian cohort. Higher stage and grade are associated with a higher risk of positive margin. The small association between a PSM and progression suggests that complete nephrectomy is not necessary in patients with a PSM. The main study limitations are lack of nephrometry score and possible reporting bias.
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Affiliation(s)
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, QC
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON
| | - Ricardo Rendon
- Department of Urology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS
| | - Ronald B Moore
- Division of Urology, University of Alberta, Edmonton, AB
| | | | | | - Peter C Black
- Department of Urology, University of British Columbia, Vancouver, BC
| | - Jun Kawakami
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB
| | - Darrel Drachenberg
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB
| | - Stephen Pautler
- Divisions of Urology and Surgical Oncology, Departments of Surgery and Oncology, Western University, London, ON
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | | | - Michael A S Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON; Canada
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13
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Sorokin I, Canvasser NE, Margulis V, Lotan Y, Raj G, Sagalowsky A, Gahan JC, Cadeddu JA. Axial Abdominal Imaging after Partial Nephrectomy for T1 Renal Cell Carcinoma Surveillance. J Urol 2017; 198:1021-1026. [PMID: 28442383 DOI: 10.1016/j.juro.2017.04.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE The overall recurrence rate of T1 renal cell carcinoma is low. We evaluated abdominal imaging after partial nephrectomy based on current guidelines for T1 renal cell carcinoma surveillance. MATERIALS AND METHODS We retrospectively reviewed the records of patients with T1 renal cell carcinoma who underwent partial nephrectomy between 2006 and 2012 followed by abdominal imaging at our institution. Primary and secondary outcomes were the incidence and timing, respectively, of imaging diagnosed abdominal recurrences. A literature review was performed to summarize prior reports of recurrence incidence and timing after partial nephrectomy for T1 disease. RESULTS A total of 160 patients with stage T1a and 37 with T1b underwent partial nephrectomy. Seven patients had an abdominal recurrence, including 3 with local and distant recurrences, and 4 with a metachronous contralateral kidney recurrence. The incidence of abdominal recurrence detected by imaging was higher in the T1b than in the T1a group (10.8% vs 1.9%, p = 0.024). Although it was not significant, median time to recurrence was earlier in T1b vs T1a cases (13 vs 37 months, p = 0.480). In each group recurrences developed after 3 years of suggested guideline surveillance. In the literature combined with the current study the time to median recurrence for T1b vs T1a was 24 vs 29 months (p = 0.226). CONCLUSIONS Recurrences detected by abdominal imaging developed earlier and more frequently in T1b than in T1a cases. Future recommendations for surveillance strategies after partial nephrectomy should distinguish T1a from T1b with less intense frequency of imaging for T1a. A longer period of surveillance should be considered since recurrences can develop beyond 3 years.
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Affiliation(s)
- Igor Sorokin
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Noah E Canvasser
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ganesh Raj
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Arthur Sagalowsky
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey C Gahan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey A Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas.
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14
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Tubre RW, Parker WP, Dum T, Walmann T, Hamilton Z, Mirza M, Duchene DA. Findings and Impact of Early Imaging After Partial Nephrectomy. J Endourol 2016; 31:320-325. [PMID: 28006956 DOI: 10.1089/end.2016.0568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION American Urological Association guidelines for surveillance of renal-cell carcinoma after partial nephrectomy recommend imaging within 3-12 months of surgery. Imaging following partial nephrectomy may be difficult to interpret due to the surgical defect, the use of surgical material, and normal postoperative fluid collections. Our primary objective was to evaluate the frequency of indeterminate postoperative imaging results and how those radiographic findings altered patient management. METHODS Retrospective chart review from 2006 to 2013 of patients who had undergone open, laparoscopic, and robotic partial nephrectomy at our institution was completed. There was a minimum of 2 years of follow-up imaging. Radiology reports were reviewed from follow-up imaging and were categorized as "normal" or "abnormal." RESULTS We identified 180 patients with 127 (70.5%) considered to have normal findings on initial follow-up imaging, and 53 (29.5%) with abnormal findings. Median time to initial postoperative imaging for normal findings was 6.8 months compared with 4.4 months for patients with abnormal postoperative scans (p = 0.02). On subsequent imaging, 60% of abnormal studies were downgraded to normal. The median time to receive a second postoperative image from surgery in the normal and abnormal groups was 13.2 and 10.2 months, respectively. The median time interval to the second imaging study was 6.3 months for normal initial scans compared with 5.2 months for initially abnormal scans (p ≤ 0.01). CONCLUSIONS Early postoperative imaging after partial nephrectomy frequently results in "abnormal" findings and more subsequent radiology exams even though the findings rarely represent cancer recurrences. Based on our results, and pending further validation from other centers, we believe postoperative CT or MRI surveillance after partial nephrectomy can be safely deferred until 1 year after surgery.
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Affiliation(s)
- Ryan W Tubre
- 1 Department of Urology, University of Kansas Medical Center , Kansas City, Kansas
| | - William P Parker
- 2 Department of Urology, Mayo Medical Center , Rochester, Minnesota
| | - Travis Dum
- 1 Department of Urology, University of Kansas Medical Center , Kansas City, Kansas
| | - Tim Walmann
- 1 Department of Urology, University of Kansas Medical Center , Kansas City, Kansas
| | - Zachary Hamilton
- 3 Department of Urology, University of San Diego Medical Center , San Diego, California
| | - Moben Mirza
- 1 Department of Urology, University of Kansas Medical Center , Kansas City, Kansas
| | - David A Duchene
- 1 Department of Urology, University of Kansas Medical Center , Kansas City, Kansas
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15
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Errami M, Margulis V, Huerta S. Renal Cell Carcinoma Metastatic to the Scalp. Rare Tumors 2016; 8:6400. [PMID: 28191289 PMCID: PMC5226047 DOI: 10.4081/rt.2016.6400] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 06/11/2016] [Accepted: 06/15/2016] [Indexed: 12/14/2022] Open
Abstract
Because of the asymptomatic natural history of renal cell carcinoma (RCC), by the time a diagnosis is made, metastatic disease is present in about one third of the cases. Thus, the overall survival of patients with RCC remains poor. Ultimately up to 50% of patients with RCC will develop metastases. Metastatic lesions from RCC are usually observed in the lungs, liver or bone. Metastases to the brain or the skin from RCC are rare. Here we present a patient diagnosed with RCC, found to have no evidence of metastases at the time of nephrectomy, who presented two years later with metastases to the scalp. We review the literature of patients with this rare site of metastasis and outline the overall prognosis of this lesion compared to other site of metastases from RCC.
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Affiliation(s)
- Mounir Errami
- The University of Texas Southwestern Medical School , Dallas
| | - Vitali Margulis
- The University of Texas Southwestern Medical School , Dallas
| | - Sergio Huerta
- The University of Texas Southwestern Medical School, Dallas; Veterans' Affairs Hospital, Dallas, TX, USA
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16
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Bellio G, Cipolat Mis T, Kaso G, Dattola R, Casagranda B, Bortul M. Small bowel intussusception from renal cell carcinoma metastasis: a case report and review of the literature. J Med Case Rep 2016; 10:222. [PMID: 27509833 PMCID: PMC4980778 DOI: 10.1186/s13256-016-0998-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 07/06/2016] [Indexed: 12/11/2022] Open
Abstract
Background Renal cell carcinoma is the most frequent malignant neoplasia of the kidney accounting for 90 % of all renal solid tumors. Metastases from renal cell carcinoma are rarely located in the small bowel and generally their clinical presentation includes bleeding and obstruction. Intussusception in adults is an extremely rare pathological condition and only 30 to 35 % of small bowel intussusceptions are derived from malignant lesions. Case presentation We report here a clinical case of a 75-year-old white man hospitalized for anemia and subocclusion. An abdominal ultrasound and computed tomography showed a small bowel intussusception. During a surgical exploration, a polypoid lesion was found to be the lead point of the intussusception. His small intestine was resected and a functional side-to-side anastomosis was performed. The histological features of the surgical specimen confirmed the diagnosis of metastatic renal cell carcinoma. Conclusions Small bowel intussusception from renal cell carcinoma metastasis should always be considered in the setting of unexplained intestinal subocclusion in patients with a history of renal cell carcinoma.
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Affiliation(s)
- Gabriele Bellio
- Department of General Surgery, Cattinara University Hospital, Trieste, Italy.
| | - Tommaso Cipolat Mis
- Department of General Surgery, Cattinara University Hospital, Trieste, Italy
| | - Gladiola Kaso
- Department of Radiology, Cattinara University Hospital, Trieste, Italy
| | - Roberto Dattola
- Department of Anesthesiology and Critical Care, Cattinara University Hospital, Trieste, Italy
| | - Biagio Casagranda
- Department of General Surgery, Cattinara University Hospital, Trieste, Italy
| | - Marina Bortul
- Department of General Surgery, Cattinara University Hospital, Trieste, Italy
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17
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Sun M, Choueiri TK. Kidney cancer: Recurrence in renal cell carcinoma: the work is not done. Nat Rev Urol 2016; 13:246-7. [PMID: 27030528 DOI: 10.1038/nrurol.2016.57] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Maxine Sun
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, ASB II-3, Boston, Massachusetts, 02115, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, Massachusetts, 02115, USA
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18
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Comparison of Renal Cell Carcinoma Surveillance Guidelines: Competing Trade-Offs. J Urol 2016; 195:1664-70. [PMID: 26778713 DOI: 10.1016/j.juro.2015.12.094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE We estimated the differences in intensity, cost, radiation exposure and cancer control of published surveillance guidelines screening for secondary renal cell carcinoma in patients treated with partial nephrectomy. MATERIALS AND METHODS We developed a Monte Carlo simulation model to contrast the existing guidelines in terms of cost, radiation exposure and cancer control. Model inputs were extrapolated from the existing literature. Surveillance guidelines were analyzed from the AUA, CUA, EAU and NCCN®. Risk stratification among patients treated with partial nephrectomy was based on tumor characteristics. RESULTS Expected costs during the 5 years after partial nephrectomy were $587 (CUA), $1,076 (AUA), $1,705 (EAU) and $1,768 (NCCN) for low risk patients, and $903 (CUA), $2,525 (EAU) and $3,904 (AUA and NCCN) for high risk patients. Radiation exposure ranged from 31.41 mSv (CUA) to 104.34 mSv (NCCN) for low risk patients and 46.88 mSv (CUA) to 231.61 mSv (AUA and NCCN) for high risk patients. The EAU and CUA guidelines led to the diagnosis of the highest percentage of low risk patients (more than 95%) while all guidelines diagnosed more than 92% of high risk patients with recurrence. CONCLUSIONS Renal cell carcinoma surveillance guidelines differ greatly in terms of intensity, cost and radiation exposure. It is important for clinicians to adopt standardized surveillance strategies that limit unnecessary cost and radiation exposure without compromising cancer control.
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Williamson TJ, Pearson JR, Ischia J, Bolton DM, Lawrentschuk N. Guideline of guidelines: follow-up after nephrectomy for renal cell carcinoma. BJU Int 2016; 117:555-62. [PMID: 26617405 DOI: 10.1111/bju.13384] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/20/2015] [Indexed: 12/22/2022]
Abstract
The purpose of this article was to review and compare the international guidelines and surveillance protocols for post-nephrectomy renal cell carcinoma (RCC). PubMed database searches were conducted, according to the PRISMA statement for reporting systematic reviews, to identify current international surveillance guidelines and surveillance protocols for surgically treated and clinically localized RCC. A total of 17 articles were reviewed. These included three articles on urological guidelines, three on oncological guidelines and 11 on proposed strategies. Guidelines and strategies varied significantly in relation to follow-up, specifically with regard to the frequency and timing of radiological imaging. Although there is currently no consensus within the literature regarding surveillance protocols, various guidelines and strategies have been developed using both patient and tumour characteristics.
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Affiliation(s)
- Timothy J Williamson
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Vic., Australia
| | - John R Pearson
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Vic., Australia
| | - Joseph Ischia
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Vic., Australia
| | - Damien M Bolton
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Vic., Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Vic., Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Olivia Newton-John Cancer Research Institute, Austin Hospital, Melbourne, Vic., Australia
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20
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Pearson J, Williamson T, Ischia J, Bolton DM, Frydenberg M, Lawrentschuk N. National nephrectomy registries: Reviewing the need for population-based data. Korean J Urol 2015; 56:607-13. [PMID: 26366272 PMCID: PMC4565894 DOI: 10.4111/kju.2015.56.9.607] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/05/2015] [Indexed: 12/16/2022] Open
Abstract
Nephrectomy is the cornerstone therapy for renal cell carcinoma (RCC) and continued refinement of the procedure through research may enhance patient outcomes. A national nephrectomy registry may provide the key information needed to assess the procedure at a national level. The aim of this study was to review nephrectomy data available at a population-based level in Australia and to benchmark these data against data from the rest of the world as an examination of the national nephrectomy registry model. A PubMed search identified records pertaining to RCC nephrectomy in Australia. A similar search identified records relating to established nephrectomy registries internationally and other surgical registries of clinical importance. These records were reviewed to address the stated aims of this article. Population-based data within Australia for nephrectomy were lacking. Key issues identified were the difficulty in benchmarking outcomes and no ongoing monitoring of trends. The care centralization debate, which questions whether small-volume centers provide comparable outcomes to high-volume centers, is ongoing. Patterns of adherence and the effectiveness of existing protocols are uncertain. A review of established international registries demonstrated that the registry model can effectively address issues comparable to those identified in the Australian literature. A national nephrectomy registry could address deficiencies identified in a given nation's nephrectomy field. The model is supported by evidence from international examples and will provide the population-based data needed for studies. Scope exists for possible integration with other registries to develop a more encompassing urological or surgical registry. Need remains for further exploration of the feasibility and practicalities of initiating such a registry including a minimum data set, outcome indicators, and auditing of data.
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Affiliation(s)
- John Pearson
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - Timothy Williamson
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - Joseph Ischia
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - Damien M Bolton
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
- Olivia Newton-John Cancer Research Institute, Melbourne, Australia
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Jewett MAS, Rendon R, Lacombe L, Karakiewicz PI, Tanguay S, Kassouf W, Leveridge M, Cagiannos I, Kapoor A, Pautler S, Drachtenberg D, Moore R, Gleave M, Evans A, Haider M, Finelli A. Canadian guidelines for the management of small renal masses (SRM). Can Urol Assoc J 2015. [PMID: 26225162 DOI: 10.5489/cuaj.2969] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - Ricardo Rendon
- Department of Urology, Dalhousie University, Halifax, NS
| | - Louis Lacombe
- Division of Urology, Université Laval, Quebec City, QC
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, QC; Division of Urology, University of Ottawa, Ottawa, ON
| | - Wassim Kassouf
- Division of Urology, McGill University, Montreal, QC; Division of Urology, University of Ottawa, Ottawa, ON
| | - Mike Leveridge
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, ON
| | | | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON
| | | | | | - Ronald Moore
- Division of Urology, University of Alberta, Edmonton, AB
| | - Martin Gleave
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Andrew Evans
- Department of Pathology and Laboratory, Faculty of Medicine, University of Toronto, Toronto, ON
| | - Massoom Haider
- Department of Medical Imaging, University of Toronto, Toronto, ON
| | - Antonio Finelli
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON
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22
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North SA, Basappa N, Basiuk J, Bjarnason G, Breau R, Canil C, Heng D, Jewett MAS, Kapoor A, Kollmannsberger C, Potvin K, Neil Reaume M, Dean Ruether J, Venner P, Wood L. Management of advanced kidney cancer: Canadian Kidney Cancer Forum consensus update. Can Urol Assoc J 2015. [PMID: 26225164 DOI: 10.5489/cuaj.2894] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Scott A North
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
| | | | - Naveen Basappa
- Department of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB
| | - Joan Basiuk
- Kidney Cancer Research Network of Canada, Toronto, ON
| | - Georg Bjarnason
- Division of Medical Oncology/Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON
| | - Rodney Breau
- Division of Urology, University of Ottawa, Ottawa, ON; and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
| | | | - Daniel Heng
- Department of Medical Oncology, Tom Baker Cancer Center, and the University of Calgary, Calgary, AB
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON
| | - Christian Kollmannsberger
- Division of Medical Oncology, British Columbia Cancer Agency-Vancouver Cancer Centre, and the University of British Columbia, Vancouver, BC
| | - Kylea Potvin
- London Regional Cancer Centre, Western University, London, ON
| | - M Neil Reaume
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre and the University of Ottawa, Ottawa, ON
| | - J Dean Ruether
- Department of Medical Oncology, Tom Baker Cancer Center, and the University of Calgary, Calgary, AB
| | - Peter Venner
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
| | - Lori Wood
- Department of Medicine and Urology, Dalhousie University, Halifax, NS
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23
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Avances en imágenes para la estadificación y seguimiento de pacientes con carcinoma de células renales. Rev Urol 2014. [DOI: 10.1016/s0120-789x(14)50057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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24
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Moretto P, Jewett MAS, Basiuk J, Maskens D, Canil CM. Kidney cancer survivorship survey of urologists and survivors: The gap in perceptions of care, but agreement on needs. Can Urol Assoc J 2014; 8:190-4. [PMID: 25024789 DOI: 10.5489/cuaj.1907] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is lack of evidence-based literature addressing comprehensive long-term care for kidney cancer (KC) survivors. Additionally, it is unclear if the concerns of KC patients/caregivers are being adequately addressed. Therefore, Kidney Cancer Canada, a patient-led support organization for Canadians with KC, commissioned this first recorded survivorship survey specific to KC patients/caregivers. METHODS We conducted a cross-sectional online survey of Canadian patients/caregivers diagnosed with localized KC, and a separate parallel survey of Canadian urologists. The primary objectives were to assess patient/caregivers' and urologists' perceptions of information provided, as well as the physical/psychological/emotional impact of KC treatment. RESULTS Urologists recalled providing information about surgical complications (90%) and their management (63%), while patients/caregiver recalled much less (33% and 35%). Of the urologists, 93% recalled providing information on cancer recurrence, but only 42% of patients/caregivers remembered receiving this information. Concerns identified by patients/caregivers and urologists were similar: fear of recurrence, concerns about cancer, fatigue, and anxiety. Importantly, all agreed that survivorship information was paramount. Education of both patients/caregivers and physicians and the development of guidelines were factors identified to ensure optimal KC survivorship. Study limitations include potential biases in recall and selection of participants. CONCLUSION There was some discordance between urologists' and patients/caregivers' rates of recall of information provided. Patients/caregivers would have desired more information about their cancer, long-term follow-up, and potential complications. A survivorship care plan (SCP) tailored to KC may be an effective measure to address these needs. The impact of this SCP on survivor outcomes should be rigorously assessed.
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Affiliation(s)
- Patricia Moretto
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, The Ottawa Research Institute and University of Ottawa, Ottawa ON
| | - Michael A S Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, University Health Network, Toronto ON
| | - Joan Basiuk
- Kidney Cancer Research Network of Canada, Princess Margaret Cancer Centre, Toronto ON
| | | | - Christina M Canil
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, The Ottawa Research Institute and University of Ottawa, Ottawa ON
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25
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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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26
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Affiliation(s)
- D Robert Siemens
- Editor-in-Chief, CUAJ and Division of Urology, Queen's University, Kingston, ON
| | - Anthony Finelli
- Chair, CUA Guidelines Committee and Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, ON
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27
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Leveridge MJ. Solidifying prognosis after surgery for renal cell carcinoma. Can Urol Assoc J 2014; 8:133-4. [PMID: 24839484 DOI: 10.5489/cuaj.2074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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28
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Kowalczyk KJ, Harbin AC, Choueiri TK, Hevelone ND, Lipsitz SR, Trinh QD, Tina Shih YC, Hu JC. Use of Surveillance Imaging Following Treatment of Small Renal Masses. J Urol 2013; 190:1680-5. [DOI: 10.1016/j.juro.2013.05.109] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - Andrew C. Harbin
- Department of Urology, Georgetown University Hospital, Washington, DC
| | - Toni K. Choueiri
- Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Nathanael D. Hevelone
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stuart R. Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Quoc-Dien Trinh
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - Ya-Chen Tina Shih
- Department of Medicine Program in the Economics of Cancer, Cancer Prognostics and Health Outcomes Unit, University of Chicago, Chicago, Illinois
| | - Jim C. Hu
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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29
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North S, Basappa N, Bjarnason G, Blais N, Canil C, Heng D, Knox J, Reaume N, Ruether D, Soulières D, Zalewski P, Black P, Breau RH, Jewett M, Kapoor A, Lattouf JB, Moore R, Rendon R, Todd G, Pituskin E, Gedye C, Wood L. Management of advanced kidney cancer: Canadian Kidney Cancer Forum 2013 Consensus Update: Canadian Kidney Cancer Forum 2013. Can Urol Assoc J 2013; 7:238-43. [PMID: 24032057 DOI: 10.5489/cuaj.536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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31
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Management of kidney cancer: Canadian Kidney Cancer Forum Consensus Update. Can Urol Assoc J 2013; 3:200-204. [PMID: 19543462 DOI: 10.5489/cuaj.1069] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Lipsky MJ, Shapiro EY, Hruby GW, McKiernan JM. Diagnostic radiation exposure during surveillance in patients with pT1a renal cell carcinoma. Urology 2013; 81:1190-5. [PMID: 23540857 DOI: 10.1016/j.urology.2012.08.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 08/02/2012] [Accepted: 08/03/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the pattern of postoperative radiographic surveillance in patients with pT1a renal cell carcinoma (RCC) at a tertiary care hospital. METHODS An institutionally approved urologic oncology database was used to retrospectively identify patients who underwent partial or radical nephrectomy for pT1a RCC from 1990 to 2010 at a tertiary care center. Baseline characteristics were reviewed, and postoperative imaging for the indication of RCC surveillance was recorded. Radiation exposure was calculated using the effective dose according to imaging modality. Relative risks of the development of solid malignancies and leukemia were calculated from the dose of radiation exposure. RCC recurrence, defined as radiologic evidence of local recurrence or distant metastases, was noted. RESULTS A total of 1708 patients had undergone partial or radical nephrectomy for a renal mass. Of these, 315 patients had pT1a RCC with postsurgical follow-up, and 252 (80%) of these patients were exposed to ionizing radiation during postoperative surveillance. Mean radiation doses in years 1, 2 to 5, and ≥6 after surgery were 11.4, 47.0, and 13.8 mSv, respectively. Relative risks of radiation-induced solid cancers and leukemia were 1.05 and 1.12, respectively. There were 8 (2.5%) total recurrences. CONCLUSION During the past 20 years, 80% of patients undergoing surgery for pT1a RCC were monitored with radiation-based imaging during postoperative surveillance. Given the low rate of cancer recurrence in this population, expanded efforts in counseling physicians regarding the risk of ionizing radiation in imaging should be encouraged.
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Affiliation(s)
- Michael J Lipsky
- Department of Urology, Columbia University Medical Center, New York, NY 10032, USA
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33
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Jewett M, Finelli A, Kollmannsberger C, Wood L, Legere L, Basiuk J, Canil C, Heng D, Reaume N, Tanguay S, Atkins M, Bjarnason G, Dancey J, Evans M, Fleshner N, Haider M, Kapoor A, Uzzo R, Maskens D, Soulieres D, Yousef G, Basappa N, Bendali N, Black P, Blais N, Cagiannos I, Care M, Chow R, Chung H, Czaykowski P, Derosa D, Durrant K, Ellard S, Farquharson G, Filion-Brulotte C, Gingerich J, Godbout L, Grant R, Hamilton W, Kassouf W, Kurban G, Lane K, Lattouf J, Lau D, Leveridge M, McCarthy J, Moore R, North S, O'brien P, Pituskin E, Racine P, Rendon R, So A, Sridhar S, Stubbs K, Su Z, Taylor L, Udall T, Venner P, Vogel W, Yap S, Yau P, Cooper M, Giroux N, Miron D, Mosher D, Ross K, Willacy J. Management of kidney cancer: canadian kidney cancer forum consensus update 2011. Can Urol Assoc J 2012; 6:16-22. [PMID: 22396361 DOI: 10.5489/cuaj.11273] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
Renal cell carcinoma (RCC) diagnosis and management have undergone significant shifts in the recent past. The increasing rate of diagnosis of small renal masses, often in patients at high risk of morbidity with operative treatment, has led to studies, trials and discoveries in renal mass biopsy, active surveillance and minimally invasive thermal ablation. At the other end of the disease spectrum, targeted systemic therapies for metastatic RCC have supplanted cytokine-based treatment, with significant benefits to progression and survival. Recent reviews and trials have also cemented the role of partial nephrectomy as standard surgical management for most low-stage masses, and the roles of regional lymphadenectomy and adrenalectomy concomitant with nephrectomy have been clarified. This review aims to highlight recent evidence that has emerged in the management of this complicated oncologic issue.
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Affiliation(s)
- Michael J Leveridge
- Assistant Professor, Department of Urology, Kingston General Hospital, Queen's University, Kingston, ON
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35
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Chin CJ, Franklin JH, Moussa M, Chin JL. Metastasis from renal cell carcinoma to the thyroid 12 years after nephrectomy. CMAJ 2011; 183:1398-9. [PMID: 21242273 DOI: 10.1503/cmaj.092152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Christopher J Chin
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.
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Dion M, Martínez CH, Williams AK, Chalasani V, Nott L, Pautler SE. Cost analysis of two follow-up strategies for localized kidney cancer: a Canadian cohort comparison. Can Urol Assoc J 2010; 4:322-6. [PMID: 20944802 DOI: 10.5489/cuaj.10017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The cost of surveillance strategies in patients after radical nephrectomy for localized primary renal cell carcinoma (RCC) has not been evaluated. We compared the costs of 2 different surveillance strategies, the new Canadian Urological Association (CUA) guidelines and the old strategy implemented in our institution. METHODS Seventy-five patients who underwent radical nephrectomy for primary non-metastatic renal cancer were retrospectively reviewed. The direct cost of surveillance was determined and compared with the theoretical cost which would have been accrued using the CUA guidelines. RESULTS Our mean follow-up was 31.1 (SD ± 20.4) months. The overall and disease-free survival endpoints were 87.7% and 85.2%, respectively. Total medical costs were higher for our old institutional surveillance strategy than the CUA guidelines ($181 861 vs. $135 054). For the complete follow-up of 75 patients, a cost-savings of $46 806 could have been achieved following the CUA guidelines (p = 0.002). Of recurrences, 7 of 8 were detected by routine screening, only 1 recurrence was identified by symptoms. The cost per recurrence detected in our old protocol was $9 812.92. The increased cost of our institution was due to more visits with basic testing, symptomatic investigation, and follow-up of imaging tests. The median percent cost attributable to these extra tests was 15% (range 0 to 59). CONCLUSION Based on our results, we endorse the new CUA surveillance strategy in RCC follow-up as appropriate and cost effective in comparison with previous follow-up strategies used at our institution.
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Affiliation(s)
- Marie Dion
- Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
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37
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Abstract
The increased use of abdominal imaging techniques for a variety of indications has contributed to more-frequent detection of renal cell carcinoma (RCC). Ultrasonography has been used to characterize the solid versus cystic nature of renal masses. This modality has limitations, however, in further characterization of solid tumors and in staging of malignancy, although contrast-enhanced ultrasonography has shown promise. Cross-sectional imaging with multiplanar reconstruction capability via CT or MRI has become the standard-bearer in the diagnosis, staging and surveillance of renal cancers. The use of specific protocols and the exploitation of different imaging characteristics of RCC subtypes, including variations in contrast agent timing, MRI weighting and digital subtraction, have contributed to this diagnostic capability. Cystic renal masses are a special case, evaluation of which can require multiple imaging modalities. Rigorous evaluation of these lesions can provide information that is crucial to prediction of the likelihood of malignancy. Such imaging is not without risk, however, as radiation from frequent CT imaging has been implicated in the development of secondary malignancies, and contrast agents for CT and MRI can pose risks, particularly in patients with compromised renal function.
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Leveridge MJ, Mattar K, Kachura J, Jewett MA. Assessing Outcomes in Probe Ablative Therapies for Small Renal Masses. J Endourol 2010; 24:759-64. [DOI: 10.1089/end.2009.0503] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
| | - Kamal Mattar
- Urooncology Fellowship Program, University of Toronto, Toronto, Ontario, Canada
| | - John Kachura
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - Michael A.S. Jewett
- Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital and University Health Network, University of Toronto, Ontario, Canada
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39
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Abara E, Chivulescu I, Clerk N, Cano P, Goth A. Recurrent renal cell cancer: 10 years or more after nephrectomy. Can Urol Assoc J 2010; 4:E45-9. [PMID: 20368882 PMCID: PMC2845671 DOI: 10.5489/cuaj.829] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Localized renal cell carcinoma (RCC) responds well to surgery. Patients often question how long they have to be on surveillance after their surgery. Several follow-up patterns have been described in the literature. Until 2009, no published established Canadian guidelines existed to assist Canadian health-care practitioners in the surveillance of these patients. We present 3 cases of RCC that recurred 10 years or longer after the initial nephrectomy. These cases emphasize the need for careful long-term follow-up, as recommended in the Canadian Urological Association guidelines. We also discuss the optimism of prolonged disease survival in the era of novel therapeutic agents that target angiogenesis.
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Affiliation(s)
- Emmanuel Abara
- Richmond Hill Urology Practice & Prostate Institute, Richmond Hill, ON
| | | | | | - Pablo Cano
- Northeastern Ontario Regional Cancer Centre, Sudbury, ON
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40
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Abstract
Renal-cell carcinoma is the most lethal of all urologic malignancies, with a high metastatic potential. Approximately 25% of patients present with stage IV disease, and up to 40% of patients have disease recurrence after nephrectomy. Computed tomography (CT) is an important imaging modality for initial diagnosis and restaging of this patient population. Although extremely rare, clear-cell renal carcinoma has been reported to metastasize to the gallbladder. We present the case of a 50-year-old man who developed clear-cell renal carcinoma metastases to the contralateral adrenal gland and the gallbladder that were detected at initial restaging with CT scan.
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41
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Management of kidney cancer: Canadian Kidney Cancer Forum Consensus Statement. Can Urol Assoc J 2008; 2:175-182. [PMID: 18682778 PMCID: PMC2494902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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