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Pandolfo SD, Wu Z, Campi R, Bertolo R, Amparore D, Mari A, Verze P, Manfredi C, Franco A, Ditonno F, Cerrato C, Ferro M, Lasorsa F, Contieri R, Napolitano L, Tufano A, Lucarelli G, Cilio S, Perdonà S, Siracusano S, Autorino R, Aveta A. Outcomes and Techniques of Robotic-Assisted Partial Nephrectomy (RAPN) for Renal Hilar Masses: A Comprehensive Systematic Review. Cancers (Basel) 2024; 16:693. [PMID: 38398084 PMCID: PMC10886610 DOI: 10.3390/cancers16040693] [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: 12/25/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Robot-assisted partial nephrectomy (RAPN) is increasingly being employed in the management of renal cell carcinoma (RCC) and it is expanding in the field of complex renal tumors. The aim of this systematic review was to consolidate and assess the results of RAPN when dealing with entirely central hilar masses and to examine the various methods used to address the surgical difficulties associated with them. Methods: A thorough literature search in September 2023 across various databases focused on RAPN for renal hilar masses, adhering to PRISMA guidelines. The primary goal was to evaluate RAPN's surgical and functional outcomes, with a secondary aim of examining different surgical techniques. Out of 1250 records, 13 full-text manuscripts were reviewed. Results: Evidence is growing in favor of RAPN for renal hilar masses. Despite a predominance of retrospective studies and a lack of long-term data, RAPN shows positive surgical outcomes and preserves renal function without compromising cancer treatment effectiveness. Innovative suturing and clamping methods are emerging in surgical management. Conclusions: RAPN is a promising technique for managing renal hilar masses in RCC, offering effective surgical outcomes and renal function preservation. The study highlights the need for more long-term data and prospective studies to further validate these findings.
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Affiliation(s)
- Savio Domenico Pandolfo
- Department of Urology, University of L’Aquila, 67010 L’Aquila, Italy;
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (L.N.); (S.C.); (A.A.)
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy;
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China;
| | - Riccardo Campi
- Urological Robotic Surgery and Renal Transplantation Unit, Careggi Hospital, University of Florence, 50121 Firenze, Italy; (R.C.); (A.M.)
| | - Riccardo Bertolo
- Department of Urology, University of Verona, 37100 Verona, Italy; (R.B.); (F.D.)
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, 10043 Turin, Italy;
| | - Andrea Mari
- Urological Robotic Surgery and Renal Transplantation Unit, Careggi Hospital, University of Florence, 50121 Firenze, Italy; (R.C.); (A.M.)
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy;
| | - Celeste Manfredi
- Department of Urology, Rush University Medical Center, Chicago, IL 60637, USA; (C.M.); (A.F.); (R.A.)
- 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, Rush University Medical Center, Chicago, IL 60637, USA; (C.M.); (A.F.); (R.A.)
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00189 Rome, Italy
| | - Francesco Ditonno
- Department of Urology, University of Verona, 37100 Verona, Italy; (R.B.); (F.D.)
- Department of Urology, Rush University Medical Center, Chicago, IL 60637, USA; (C.M.); (A.F.); (R.A.)
| | - Clara Cerrato
- Urology Unit, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK;
| | - Matteo Ferro
- Division of Urology, IRCCS—European Institute of Oncology, 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.)
| | - Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy;
| | - Luigi Napolitano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (L.N.); (S.C.); (A.A.)
| | - Antonio Tufano
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (A.T.); (S.P.)
| | - 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.)
| | - Simone Cilio
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (L.N.); (S.C.); (A.A.)
| | - Sisto Perdonà
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (A.T.); (S.P.)
| | | | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL 60637, USA; (C.M.); (A.F.); (R.A.)
| | - Achille Aveta
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (L.N.); (S.C.); (A.A.)
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Koukourikis P, Alqahtani AA, Almujalhem A, Lee J, Han WK, Rha KH. Robot-assisted partial nephrectomy for high-complexity tumors (PADUA score ≥10): Perioperative, long-term functional and oncologic outcomes. Int J Urol 2021; 28:554-559. [PMID: 33604916 DOI: 10.1111/iju.14507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/27/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To evaluate the safety and efficacy, and long-term functional and oncologic outcomes of robot-assisted partial nephrectomy in high-complexity tumors. METHODS Data of 155 patients with a high-complexity tumor (PADUA score ≥10) were reviewed. Trifecta achievement, intra-, perioperative, functional, and oncologic outcomes were analyzed and compared between patients with increasing complexity. RESULTS Of the 155 patients, 65 (41.9%) patients had a PADUA score of 10, 55 (35.5%) had a PADUA score of 11, and 35 (22.6%) had a PADUA score of 12-13, respectively. The median (interquartile range) operative time, warm ischemia time and estimated blood loss were 150 min (112-186 min), 26 min (23-32 min) and 250 mL (100-500 mL), respectively. Postoperatively, complications occurred in 25 (16.1%) patients, and positive surgical margins in 15 (10.5%) patients. Trifecta was achieved in 67 (43.2%) patients. At a median follow-up period of 58 months, the median estimated glomerular filtration rate preservation was 87% (78-110), and 12 (7.7%) patients developed new-onset chronic kidney disease. Recurrence-free survival and overall survival rates were 93.6% and 96.7%, respectively. Positive surgical margins were statistically different between the groups of PADUA score 10, 11 and 12-13 (P = 0.017), whereas functional and oncologic outcomes were similar. In multivariate logistic regression analysis, increasing tumor size (odds ratio 1.48, 95% confidence interval 1.21-1.87; P < 0.001) and the American Society of Anesthesiologists score 2/3 (odds ratio 0.48, 95% confidence interval 0.24-0.96; P = 0.041) were independent predictors of trifecta failure. CONCLUSIONS Robot-assisted partial nephrectomy is a safe and effective treatment for high-complexity tumors providing excellent long-term functional and oncologic outcomes.
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Affiliation(s)
- Periklis Koukourikis
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ali Abdullah Alqahtani
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ahmad Almujalhem
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jongsoo Lee
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Takahara K, Sumitomo M, Fukaya K, Jyoudai T, Nishino M, Hikichi M, Nukaya T, Zennami K, Ichino M, Fukami N, Sasaki H, Kusaka M, Shiroki R. Predictors for trifecta achievement of robot-assisted partial nephrectomy in high-complexity tumors (Preoperative Aspects and Dimensions Used for an Anatomical score ≥10). Asian J Endosc Surg 2020; 13:390-396. [PMID: 31823487 PMCID: PMC7384074 DOI: 10.1111/ases.12767] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Robot-assisted partial nephrectomy (RAPN) is emerging as an effective treatment oncologically and functionally for clinically localized renal tumors. However, RAPN in high-complexity tumors with a Preoperative Aspects and Dimensions Used for an Anatomical score ≥10 remains challenging. In this study, the feasibility of RAPN for high-complexity tumors was assessed. METHODS The study cohort consisted of 177 cases with clinically localized renal cell carcinoma who had undergone RAPN at our hospital from July 2010 to February 2018. They were assessed for perioperative parameters and trifecta achievement (ie, negative surgical margins, warm ischemia time <25 minutes, and no complications). RESULTS Among the 177 cases who had undergone RAPN, 60 had high-complexity tumors, and 117 had non-high-complexity (ie, intermediate- or low-complexity) tumors. There were no significant differences in the operative and console times between the cohorts, but estimated intraoperative blood loss was much lower in the non-high-complexity group. Although the average warm ischemia time was less than 25 minutes in both groups, it was significantly shorter in the non-high-complexity group. Trifecta achievement rates significantly differed between the high- and non-high-complexity groups (68.3% vs 86.3%). Comparisons of four operative parameters (ie, BMI, tumor size, endophytic properties, and hilar tumor) using univariate analysis in the 60 high-complexity tumor cases showed that BMI and tumor size were independent factors (P = 0.05 and 0.018, respectively). In multivariate analysis, tumor size was the only factor directly associated with trifecta achievement (P = 0.029). CONCLUSION The trifecta achievement rate was significantly lower in the high-complexity group. Only tumor size affected trifecta achievement during RAPN in cases with high-complexity tumors (Preoperative Aspects and Dimensions Used for an Anatomical score ≥10).
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Affiliation(s)
- Kiyoshi Takahara
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Makoto Sumitomo
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Kosuke Fukaya
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Takahito Jyoudai
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Masashi Nishino
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Masaru Hikichi
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Takuhisa Nukaya
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Kenji Zennami
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Manabu Ichino
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Naohiko Fukami
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Hitomi Sasaki
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Mamoru Kusaka
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Ryoichi Shiroki
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
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Santok GD, Abdel Raheem A, Chang KD, Kim L, Lum TG, Alenzi MJ, Han WK, Choi YD, Rha KH. Estimated glomerular filtration rate's time to nadir after robot-assisted partial nephrectomy: Predictors and clinical significance on renal functional recovery. Int J Urol 2018; 25:660-667. [PMID: 29732637 DOI: 10.1111/iju.13589] [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] [Received: 06/21/2017] [Accepted: 03/05/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the impact of postoperative time to nadir of estimated glomerular filtration rate on renal functional changes after robot-assisted partial nephrectomy. METHODS From 2006 to 2015, 287 patients with renal mass who underwent robot-assisted partial nephrectomy in a referral center were analyzed. The cohort was evaluated based on their time to develop nadir: group 1 (no nadir), group 2 (<48 h) and group 3 (≥48 h). The outcome measures were to evaluate the renal function recovery between groups, risk factors for development of nadir ≥48 h, as well as predictors of chronic kidney disease upstaging. RESULTS The mean estimated glomerular filtration rate percentage change was the worst in group 3 compared with groups 1 and 2, with 13.8%, -0.67% and 8%, respectively (P < 0.001). Chronic kidney disease upstaging was more common in group 3 compared with the other groups (P < 0.001). Age, tumor size, PADUA score and warm ischemia time were predictors of developing ≥48 h estimated glomerular filtration rate nadir (odds ratio 1.04, P = 0.002; odds ratio 1.43, P < 0.001; odds ratio 1.24, P = 0.018; odds ratio 1.05, P < 0.001), respectively. The 5-year probability of freedom from chronic kidney disease upstaging was lower in group 3 (75.6%) compared with the other groups - 88.1% and 100% (P = 0.003). Time to nadir ≥48 h was a predictor of chronic kidney disease upstaging (odds ratio 3.02, P = 0.022). CONCLUSIONS A continuous decline in estimated glomerular filtration rate (≥48 h) after partial nephrectomy is associated with increased risk of poor functional recovery overtime. Age, tumor size, PADUA score and warm ischemia time are independent predictors of developing ≥48 h time to nadir of estimated glomerular filtration rate. This higher risk subgroup should be targeted for stricter follow up to allow early detection of future risk of renal functional decline.
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Affiliation(s)
- Glen Denmer Santok
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ali Abdel Raheem
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Department of Urology, Tanta University Medical School, Tanta, Egypt
| | - Ki Don Chang
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Lawrence Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Trenton G Lum
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Mohamed Jayed Alenzi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Department of Urology, Aljouf University, Sakaka, Saudi Arabia
| | - Woong Kyu Han
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Identifying molecular genetic features and oncogenic pathways of clear cell renal cell carcinoma through the anatomical (PADUA) scoring system. Oncotarget 2017; 7:10006-14. [PMID: 26848523 PMCID: PMC4891099 DOI: 10.18632/oncotarget.7129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 01/19/2016] [Indexed: 01/10/2023] Open
Abstract
Although the preoperative aspects and dimensions used for the PADUA scoring system were successfully applied in macroscopic clinical practice for renal tumor, the relevant molecular genetic basis remained unclear. To uncover meaningful correlations between the genetic aberrations and radiological features, we enrolled 112 patients with clear cell renal cell carcinoma (ccRCC) whose clinicopathological data, genomics data and CT data were obtained from The Cancer Genome Atlas (TCGA) and The Cancer Imaging Archive (TCIA). Overall PADUA score and several radiological features included in the PADUA system were assigned for each ccRCC. Despite having observed no significant association between the gene mutation frequency and the overall PADUA score, correlations between gene mutations and a few radiological features (tumor rim location and tumor size) were identified. A significant association between rim location and miRNA molecular subtypes was also observed. Survival analysis revealed that tumor size > 7 cm was significantly associated with poor survival. In addition, Gene Set Enrichment Analysis (GSEA) on mRNA expression revealed that the high PADUA score was related to numerous cancer-related networks, especially epithelial to mesenchymal transition (EMT) related pathways. This preliminary analysis of ccRCC revealed meaningful correlations between PADUA anatomical features and molecular basis including genomic aberrations and molecular subtypes.
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Abdel Raheem A, Alatawi A, Kim DK, Sheikh A, Alabdulaali I, Han WK, Choi YD, Rha KH. Outcomes of high-complexity renal tumours with a Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score of ≥10 after robot-assisted partial nephrectomy with a median 46.5-month follow-up: a tertiary centre experience. BJU Int 2016; 118:770-778. [DOI: 10.1111/bju.13501] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ali Abdel Raheem
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul South Korea
- Department of Urology; Tanta University Medical School; Egypt
| | - Atalla Alatawi
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul South Korea
| | - Dae K. Kim
- Department of Urology; CHA Seoul Station Medical Center; CHA University Medical School; Seoul South Korea
| | - Abulhasan Sheikh
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul South Korea
| | - Ibrahim Alabdulaali
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul South Korea
| | - Woong K. Han
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul South Korea
| | - Young D. Choi
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul South Korea
| | - Koon H. Rha
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul South Korea
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