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Agnesi S, Mauro Di Lucca G, Benedetti F, Fattori L, Degrate L, Roccamatisi L, Braga M, Ceresoli M. Effect of in-hospital delay on acute appendicitis severity: does time really matter? Updates Surg 2024:10.1007/s13304-024-01823-5. [PMID: 38565830 DOI: 10.1007/s13304-024-01823-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
Appendicitis is one of the most common abdominal emergencies. Evidence is controversial in determining if the in-hospital time delay to surgery can worsen the clinical presentation of appendicitis. This study aimed to clarify if in-hospital surgical delay significantly affected the proportion of complicated appendicitis in a large prospective cohort of patients treated with appendectomy for acute appendicitis. Patients were grouped into low, medium, and high preoperative risk for acute appendicitis based on the Alvarado scoring system. Appendicitis was defined as complicated in cases of perforation, abscess, or diffuse peritonitis. The primary outcome was correlation of in-hospital delay with the proportion of complicated appendicitis. The study includes 804 patients: 278 (30.4%) had complicated appendicitis and median time delay to surgery in low-, medium-, and high-risk group was 23.15 h (13.51-31.48), 18.47 h (10.44-29.42), and 13.04 (8.13-24.10) h, respectively. In-hospital delay was not associated with the severity of appendicitis or with the presence of postoperative complications. It appears reasonably safe to delay appendicectomy for acute appendicitis up to 24 h from hospital admission. Duration of symptoms was a predictor of complicated appendicitis and morbidity. Timing for appendicectomy in acute appendicitis should be calculated from symptoms onset rather than hospital presentation.
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Affiliation(s)
- Stefano Agnesi
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Gabriele Mauro Di Lucca
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Fabio Benedetti
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Luca Fattori
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Luca Degrate
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Linda Roccamatisi
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Marco Braga
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy
| | - Marco Ceresoli
- Department of General and Emergency Surgery, School of Medicine and Surgery, University of Milano-Bicocca, 20900, Monza, Italy.
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Pinelli D, Micalef A, Merelli B, Trezzi R, Amaduzzi A, Agnesi S, Guizzetti M, Camagni S, Fedele V, Colledan M. Pancreatic ductal adenocarcinoma complete regression after preoperative chemotherapy: Surgical results in a small series. Cancer Treat Res Commun 2023; 37:100770. [PMID: 37837717 DOI: 10.1016/j.ctarc.2023.100770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/30/2023] [Accepted: 10/07/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) becomes a systemic disease from an early stage. Complete surgical resection remains the only validated and potentially curative treatment; disappointingly only 20% of patients present with a resectable tumour. Although a complete pathological regression (pCR) after the preoperative chemotherapy could intuitively lead to better outcomes and prolonged survival some reports highlighted significant rates of recurrence. CASES PRESENTATION We describe three cases of pCR following preoperative chemotherapy for PDAC. The first two cases received neoadjuvant mFOLFIRINOX and PAX-G scheme for borderline resectable PDAC. Recurrence appeared 9 and 12 months after surgery. Although both patients started adjuvant therapy straight after the diagnosis of recurrence, the disease rapidly progressed and led them to death 12 and 15 months after surgery. The third case was characterized by germline BRCA2 mutation. The patient presented with PDAC of the body, intrapancreatic biliary stenosis and suspected peritoneal metastasis. One year later, after first and second-line chemotherapy, she underwent explorative laparoscopy and total spleno-pancreatectomy without evidence of viable tumour cells in the surgical specimen. At six months she is recurrence-free. CONCLUSIONS Very few reports describe a complete pathological response following preoperative chemotherapy in pancreatic cancer. We observed three cases in the last three years with disappointing oncological results. Further investigations are needed to predict PDAC prognosis in pCR after chemotherapy.
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Affiliation(s)
- Domenico Pinelli
- Department of Organ Failure and Transplantation, ASST-Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Andrea Micalef
- Department of Organ Failure and Transplantation, ASST-Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy; Università degli Studi di Milano, Milano, Italy.
| | - Barbara Merelli
- Unit of Medical Oncology, ASST-Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Rosangela Trezzi
- Unit of Pathology, ASST-Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Annalisa Amaduzzi
- Department of Organ Failure and Transplantation, ASST-Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Stefano Agnesi
- Department of Organ Failure and Transplantation, ASST-Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Michela Guizzetti
- Department of Organ Failure and Transplantation, ASST-Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Stefania Camagni
- Department of Organ Failure and Transplantation, ASST-Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy
| | - Veronica Fedele
- Department of Organ Failure and Transplantation, ASST-Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy; Università degli Studi di Milano, Milano, Italy
| | - Michele Colledan
- Department of Organ Failure and Transplantation, ASST-Papa Giovanni XXIII, Piazza OMS, 1, 24127, Bergamo, Italy; University of Bicocca, Milano, Italy
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3
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Cozzani F, Agnesi S, Dell'abate P, Rossini M, Viani L, Pedrazzi G, Del Rio P. The prognostic role of metastatic lymph node ratio in colon cancer: a retrospective cohort study on 241 patients in a single center. Minerva Surg 2023; 78:155-160. [PMID: 36193952 DOI: 10.23736/s2724-5691.22.09619-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND The detection of nodal status is based on examination of lymph nodes (LN) after the tumor surgical resection and the current guidelines recommend examining at least 12 regional LN. An inadequate number of examined LN may lead to a lower N stage or to a false-negative nodal disease. To overcome these issues, many authors proposed to consider the metastatic lymph node ratio (mLNR). MLNR is the ratio of the number of metastatic LN to the number of examined LN. METHODS Two hundred forty-one colon cancer (CC) specimens from patients who had undergone surgical resection between January 2010 and December 2015 at the General Surgery Unit of Parma University Hospital were analyzed. mLNR, which is defined as the ratio of the number of positive LN to the number of examined LN, was calculated in CCs with LN metastasis. In this study we focused on the following mLRN cutoffs: <0.15, 0.15-0.3 and >3 and we evaluated the prognostic implication of mLNRs. RESULTS Regarding the impact of examined LN on involved LN in CC, our results showed that the number of involved LN increased with the increasing number of examined LN (P=0.03). We found a significant correlation between OS and RFS rate of patients with CCs and mLNR. Patients with mLNR<0.15 were associated with better OS and RFS rate whereas patients with mLNR>0.3 were associated with worse OS and RFS rate. OS rate for patients with a mLNR<0.15 was 95.24% (89-100%) at 1 year, 83.27% (72.7-95.4%) at 3 years and 68.07% (55.1-84.1%) at 5 years whereas patients with a mLNR>0.3 had an OS rate of 51.7% (34.6-77.3%) at 1 year, 36.55% (20.08-64.3%) at 3 years and 31.33% (16.5-59.4%) at 5 years. RFS rate for patients with a mLNR<0.15 was 100% (100-100%) at 1 year, 92.2% (84-100%) at 3 years and 85.2% (73.8-98.31%) at 5 years whereas patients with a mLNR>0.3 had a RFS of 63.2% (42.8-93.58%) at 1 year and 54.2% (33.1-88.93%) at 3 and 5 years. CONCLUSIONS The prognostic value of pN stage could be more accurate if we consider both the number of LN metastasis and harvested LN. This can be achieved by using the mLNR that can be a useful tool in daily practice to predict the prognosis of patients who undergone surgery for CC.
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Affiliation(s)
- Federico Cozzani
- Unit of General Surgery, University Hospital of Parma, Parma, Italy -
| | - Stefano Agnesi
- Unit of General Surgery, University Hospital of Parma, Parma, Italy
| | - Paolo Dell'abate
- Unit of General Surgery, University Hospital of Parma, Parma, Italy
| | - Matteo Rossini
- Unit of General Surgery, University Hospital of Parma, Parma, Italy
| | - Lorenzo Viani
- Unit of General Surgery, University Hospital of Parma, Parma, Italy
| | - Giuseppe Pedrazzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Del Rio
- Unit of General Surgery, University Hospital of Parma, Parma, Italy
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4
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Conti CB, Agnesi S, Scaravaglio M, Masseria P, Dinelli ME, Oldani M, Uggeri F. Early Gastric Cancer: Update on Prevention, Diagnosis and Treatment. Int J Environ Res Public Health 2023; 20:2149. [PMID: 36767516 PMCID: PMC9916026 DOI: 10.3390/ijerph20032149] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 06/17/2023]
Abstract
Gastric cancer (GC) is a relevant public health issue as its incidence and mortality rates are growing worldwide. There are recognized carcinogen agents, such as obesity, tobacco, meat, alcohol consumption and some dietary protective factors. Strategies of early diagnosis through population-based surveillance programs have been demonstrated to be effective in lowering the morbidity and mortality related to GC in some countries. Indeed, the detection of early lesions is very important in order to offer minimally invasive treatments. Endoscopic resection is the gold standard for lesions with a low risk of lymph node metastasis, whereas surgical mini-invasive approaches can be considered in early lesions when endoscopy is not curative. This review outlines the role of lifestyle and prevention strategies for GC, in order to reduce the patients' risk factors, implement the surveillance of precancerous conditions and, therefore, improve the diagnosis of early lesions. Furthermore, we summarize the available treatments for early gastric cancer.
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Affiliation(s)
- Clara Benedetta Conti
- Interventional Endoscopy, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Stefano Agnesi
- Department of Surgery and Translational Medicine, Foundation IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Miki Scaravaglio
- Interventional Endoscopy, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Pietro Masseria
- Department of Surgery and Translational Medicine, Foundation IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Marco Emilio Dinelli
- Interventional Endoscopy, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Massimo Oldani
- General Surgery Unit, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Fabio Uggeri
- Department of Surgery and Translational Medicine, Foundation IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
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5
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Neves JB, Varley R, Agnesi S, Withington J, Rodrigues FB, Warren H, Yuminaga Y, Capitanio U, Rode N, Grant L, Tran-Dang MA, El-Sheikh S, Walkden M, Cullen D, Aitchison M, Patki P, Mumtaz F, Barod R, Bex A, Tran MGB. Growth and renal function dynamics of renal oncocytomas in patients on active surveillance. BJU Int 2021; 128:722-727. [PMID: 34046981 DOI: 10.1111/bju.15499] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To study the natural history of renal oncocytomas and address indications for intervention by determining how growth is associated with renal function over time, the reasons for surgery and ablation, and disease-specific survival. PATIENTS AND METHODS The study was conducted in a retrospective cohort of consecutive patients with renal oncocytoma on active surveillance reviewed at the Specialist Centre for Kidney Cancer at the Royal Free London NHS Foundation Trust (2012 to 2019). Comparison between groups was performed using Mann-Whitney U-tests and chi-squared tests. A mixed-effects model with a random intercept for patient was used to study the longitudinal association between tumour size and estimated glomerular filtration rate (eGFR). RESULTS Longitudinal data from 98 patients with 101 lesions were analysed. Most patients were men (68.3%) and the median (interquartile range [IQR]) age was 69 (13) years. The median (IQR) follow-up was 29 (26) months. Most lesions were small renal masses, and 24% measured over 4 cm. Over half (64.4%) grew at a median (IQR) rate of 2 (4) mm per year. No association was observed between tumour size and eGFR over time (P = 0.871). Nine lesions (8.9%) were subsequently treated. Two deaths were reported, neither were related to the diagnosis of renal oncocytoma. CONCLUSION Natural history data from the largest active surveillance cohort of renal oncocytomas to date show that renal function does not seem to be negatively impacted by growing oncocytomas, and confirms clinical outcomes are excellent after a median follow-up of over 2 years. Active surveillance should be considered the 'gold standard' management of renal oncocytomas up to 7cm.
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Affiliation(s)
- Joana B Neves
- Division of Surgery and Interventional Science, University College London, London, UK.,Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Rebecca Varley
- Department of General Surgery, Manchester University NHS Foundation Trust, London, UK
| | - Stefano Agnesi
- Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - John Withington
- Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Filipe B Rodrigues
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Hannah Warren
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | - Yuigi Yuminaga
- Department of Urology, Royal Perth Hospital, Perth, WA, Australia
| | - Umberto Capitanio
- Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Rode
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Lee Grant
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - My-Anh Tran-Dang
- Department of Histopathology, Royal Free London NHS Foundation Trust, London, UK
| | - Soha El-Sheikh
- Department of Histopathology, Royal Free London NHS Foundation Trust, London, UK
| | - Miles Walkden
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.,Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - David Cullen
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Michael Aitchison
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Prasad Patki
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Faiz Mumtaz
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Ravi Barod
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Axel Bex
- Division of Surgery and Interventional Science, University College London, London, UK.,Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Maxine G B Tran
- Division of Surgery and Interventional Science, University College London, London, UK.,Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
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6
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Larcher A, Fallara G, Rosiello G, Basile G, Re C, Baiamonte G, Agnesi S, Cignoli D, Colandrea G, Briganti A, Bertini R, Salonia A, Montorsi F, Capitanio U. The importance of sign and symptoms assessment in patients with metastatic renal cell carcinoma: implications for cytoreductive nephrectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35525-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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7
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Larcher A, Fallara G, Rosiello G, Re C, Baiamonte G, Agnesi S, Cignoli D, Colandrea G, Basile G, Briganti A, Salonia A, Bertini R, Montorsi F, Capitanio U. Cytoreductive Nephrectomy in Metastatic Patients with Signs or Symptoms: Implications for Renal Cell Carcinoma Guidelines. Eur Urol 2020; 78:321-326. [PMID: 32507335 DOI: 10.1016/j.eururo.2020.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/12/2020] [Indexed: 11/18/2022]
Abstract
The role of cytoreductive nephrectomy (CN) patients with metastatic renal cell carcinoma (mRCC) is unclear. To define the proportion of symptomatic mRCC, to investigate the impact of CN on symptomatic improvement and perioperative morbidity, and to elucidate the trade-off between such benefit and harm, an observational study of 317 mRCC patients treated with CN was performed. Symptomatic mRCC was defined as the presence of any sign or symptom causally related to the disease. Sign or symptom resolution and improvement were defined as the absence of all the signs and symptoms recorded at baseline, and the absence of at least one sign or symptom recorded at baseline, respectively. Perioperative morbidity was assessed using the Clavien-Dindo classification. Response to CN was classified as beneficial, mixed, or harmful according to the trade-off between symptomatic improvement and perioperative morbidity. The proportions of local, metastasis-specific, and general signs or symptoms were 37%, 23%, and 27%, respectively. The proportions of any sign or symptom resolution and improvement after CN were 43% and 71%, respectively. The proportions of local sign or symptom resolution and improvement after CN were 91% and 95%, respectively. The risks of any complication and major complication were 37% and 10%, respectively. At regression analysis, symptomatic status was not associated with perioperative morbidity. The proportion of beneficial response was invariably higher than the proportion of harmful response. At mRCC diagnosis, two out of three patients suffer from any sign or symptom, and one out of three suffers from local signs or symptoms. CN has a positive impact on symptomatic status. PATIENT SUMMARY: Most metastatic renal cell carcinoma patients are symptomatic, and they should be aware that cytoreductive nephrectomy has a positive impact on symptomatic status.
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Affiliation(s)
- Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, URI - Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Giuseppe Fallara
- Unit of Urology, Division of Experimental Oncology, URI - Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Rosiello
- Unit of Urology, Division of Experimental Oncology, URI - Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Re
- Unit of Urology, Division of Experimental Oncology, URI - Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Gianfranco Baiamonte
- Unit of Urology, Division of Experimental Oncology, URI - Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Agnesi
- Unit of Urology, Division of Experimental Oncology, URI - Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Cignoli
- Unit of Urology, Division of Experimental Oncology, URI - Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Gianmarco Colandrea
- Unit of Urology, Division of Experimental Oncology, URI - Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Basile
- Unit of Urology, Division of Experimental Oncology, URI - Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology, Division of Experimental Oncology, URI - Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Unit of Urology, Division of Experimental Oncology, URI - Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Bertini
- Unit of Urology, Division of Experimental Oncology, URI - Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, URI - Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, URI - Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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8
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Neves JB, Withington J, Varley R, Agnesi S, Capitanio U, Grant L, Tran-Dang MA, El-Sheikh S, Walkden M, Yuminaga Y, Patki P, Barod R, Mumtaz F, Bex A, Tran MGB. Renal tumor biopsy to reduce overtreatment of renal oncocytomas. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
623 Background: Up to 30% of renal masses are benign tumours, the most common of which is renal oncocytomas (RO). Our practice is to offer renal tumour biopsy (RTB) for small renal masses (SRM; ≤4cm) as part of a multi-disciplinary pathway. Our objective was to determine whether RTB influenced the management of RO. Methods: Retrospective descriptive analysis of the management of all sporadic cases with a histological diagnosis of RO (biopsy or surgical) at a high-volume tertiary centre from January/2012 to June/2019. Results: 170 patients (66% male; median age 67 years; median age-related Charlson comorbidity index 3) were diagnosed with 177 RO (median size 36mm). 70% (124) of RO were diagnosed using tumour biopsy (median size 33mm), of which 116 (93.4%) embarked on active surveillance (AS; 101) or watchful waiting (15). 53 (30%) RO were diagnosed after surgical excision (median size 50mm; 15 partial and 38 radical nephrectomies), of which 4 lesions were initially managed with AS. Median follow-up on AS was 20 months (2 to 84 months), with a median decrease in estimated glomerular filtration rate of 3 ml/min/1.73m2 over this period. 79% of RO on AS were SRMs. Median overall lesion size change was 1.1mm/year during follow up. Overall 62.6% of lesions grew, a quarter of which at a rate >5mm/year. Nine cases of RO on AS changed to intervention due to lesion growth or patient choice. No metastases were reported in the whole cohort. Three patients on AS died (stroke, respiratory arrest secondary to food inhalation, and unknown cause). One patient who had had surgical excision of RO died of unknown cause. Conclusions: Surgical risks for benign renal lesions are not different to those taken for renal cell carcinoma. RTB reduces the use of unnecessary surgery and its incumbent morbidity for benign renal lesions, such as RO. AS is a safe management option for patients with RO and can be used to reduce overtreatment-associated harm.
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Affiliation(s)
| | - John Withington
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | - Stefano Agnesi
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | - Lee Grant
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | - Soha El-Sheikh
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Miles Walkden
- University College London NHS Foundation Hospitals, London, United Kingdom
| | - Yuigi Yuminaga
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Prasad Patki
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Ravi Barod
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Faiz Mumtaz
- Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Axel Bex
- Royal Free London NHS Foundation Trust, London, United Kingdom
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