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Actas Urologicas Espanolas Sep 2022Urinary fistula is expected to become more frequent in urological practice as a result of expanding indication of partial nephrectomy given it's oncological results... (Review)
Review
INTRODUCTION
Urinary fistula is expected to become more frequent in urological practice as a result of expanding indication of partial nephrectomy given it's oncological results equivalent to those of radical nephrectomy but at a lower risk of progression to chronic kidney disease, lower cardiovascular morbidity, and overall mortality.
OBJECTIVES
Review and compare different techniques of contemporary active management for urinary fistula after partial nephrectomy.
METHODS
A systematic literature search on the MEDLINE database was conducted in March 2020, combining the terms: "urine leak", "urine leakage", "urinary leak" and "urinary fistula", with: "partial nephrectomy", "nephron sparing surgery" and "renal sparing surgery". This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Only articles related to active treatment were eligible. Abstracts in English and Spanish from the last two decades were screened. No restriction based on study design nor the length of follow-up.
PRIMARY OUTCOMES
1) Leak resolution rate 2) Time course of leak resolution and 3) Number of interventions needed for resolution.
RESULTS
Multiple studies were found. There were no randomized controlled trials. Urinary fistula can be solved in many ways with active treatment, with a high success rate (97.5%), an average of 1.4 intervention-per-patients and a mean time for leak resolution of 11 days (median of 3 days).
CONCLUSION
There is a high risk of bias due to the study's methodology. There is a broad range of effective alternatives and various approaches to solve urinary fistula in an appropriate timing.
Topics: Humans; Kidney; Kidney Neoplasms; Nephrectomy; Urinary Fistula
PubMed: 35780049
DOI: 10.1016/j.acuroe.2022.06.004 -
The Cochrane Database of Systematic... May 2017Partial nephrectomy and radical nephrectomy are the relevant surgical therapy options for localised renal cell carcinoma. However, debate regarding the effects of these... (Review)
Review
BACKGROUND
Partial nephrectomy and radical nephrectomy are the relevant surgical therapy options for localised renal cell carcinoma. However, debate regarding the effects of these surgical approaches continues and it is important to identify and summarise high-quality studies to make surgical treatment recommendations.
OBJECTIVES
To assess the effects of partial nephrectomy compared with radical nephrectomy for clinically localised renal cell carcinoma.
SEARCH METHODS
We searched CENTRAL, MEDLINE, PubMed, Embase, Web of Science, BIOSIS, LILACS, Scopus, two trial registries and abstracts from three major conferences to 24 February 2017, together with reference lists; and contacted selected experts in the field.
SELECTION CRITERIA
We included a randomised controlled trial comparing partial and radical nephrectomy for participants with small renal masses.
DATA COLLECTION AND ANALYSIS
One review author screened all of the titles and abstracts; only citations that were clearly irrelevant were excluded at this stage. Next, two review authors independently assessed full-text reports, identified relevant studies, evaluated the eligibility of the studies for inclusion, assessed trial quality and extracted data. The update of the literature search was performed by two independent review authors. We used Review Manager 5 for data synthesis and data analyses.
MAIN RESULTS
We identified one randomised controlled trial including 541 participants that compared partial nephrectomy to radical nephrectomy. The median follow-up was 9.3 years.Based on low quality evidence, we found that time-to-death of any cause was decreased using partial nephrectomy (HR 1.50, 95% CI 1.03 to 2.18). This corresponds to 79 more deaths (5 more to 173 more) per 1000. Also based on low quality evidence, we found no difference in serious adverse events (RR 2.04, 95% CI 0.19 to 22.34). Findings are consistent with 4 more surgery-related deaths (3 fewer to 78 more) per 1000.Based on low quality evidence, we found no difference in time-to-recurrence (HR 1.37, 95% CI 0.58 to 3.24). This corresponds to 12 more recurrences (14 fewer to 70 more) per 1000. Due to the nature of reporting, we were unable to analyse overall rates for immediate and long-term adverse events. We found no evidence on haemodialysis or quality of life.Reasons for downgrading related to study limitations (lack of blinding, cross-over), imprecision and indirectness (a substantial proportion of patients were ultimately found not to have a malignant tumour). Based on the finding of a single trial, we were unable to conduct any subgroup or sensitivity analyses.
AUTHORS' CONCLUSIONS
Partial nephrectomy may be associated with a decreased time-to-death of any cause. With regards to surgery-related mortality, cancer-specific survival and time-to-recurrence, partial nephrectomy appears to result in little to no difference.
Topics: Carcinoma, Renal Cell; Cause of Death; Humans; Kidney Neoplasms; Neoplasm Recurrence, Local; Nephrectomy; Randomized Controlled Trials as Topic; Time Factors
PubMed: 28485814
DOI: 10.1002/14651858.CD012045.pub2 -
Cancers Mar 2023(1) Background: In recent years there have been advances in imaging techniques, in addition to progress in the surgery of renal tumors directed towards minimally... (Review)
Review
(1) Background: In recent years there have been advances in imaging techniques, in addition to progress in the surgery of renal tumors directed towards minimally invasive techniques. Thus, nephron-sparing surgery has become the gold standard for the treatment of T1 renal masses. The aim of this study is to investigate the benefits of robotic partial nephrectomy in comparison with laparoscopic nephrectomy. (2) Methods: We performed a systematic review according to the PRISMA criteria during September 2022. We included clinical trials, and cohort and case-control studies published between 2000 and 2022. This comprised studies performed in adult patients with T1 renal cancer and studies comparing robotic with open and laparoscopic partial nephrectomy. A risk of bias assessment was performed according to the Newcastle-Ottawa scale. (3) Results: We observed lower hot ischemia times in the robotic surgery groups, although at the cost of an increase in total operative time, without appreciating the differences in terms of serious surgical complications (Clavien III-V). (4) Conclusions: Robotic partial nephrectomy is a safe procedure, with a shorter learning curve than laparoscopic surgery and with all the benefits of minimally invasive surgery.
PubMed: 36980679
DOI: 10.3390/cancers15061793 -
International Journal of Surgery... Jun 2016To compare the perioperative outcomes of the transperitoneal (TP) and retroperitoneal (RP) approaches in robot-assisted partial nephrectomy (RAPN). (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
To compare the perioperative outcomes of the transperitoneal (TP) and retroperitoneal (RP) approaches in robot-assisted partial nephrectomy (RAPN).
METHODS
A literature search of MEDLINE, EMBASE, SCOPUS and the Cochrane Library was performed to identify relevant studies up to March 2016. All studies with enough data comparing TP-RAPN with RP-RAPN were included. Outcomes of interest were complication, conversion, operative time (OT), warm ischemia time (WIT), estimated blood loss (EBL), and positive surgical margin (PSM). Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using fixed-effect or random-effect model. Publication bias was assessed by funnel plots.
RESULTS
Four studies with the total number of 449 patients assessing TP-RAPN (n = 229) versus RP-RAPN (n = 220) were included. There was no significant difference between the two groups in any of demographic variables. There were also no significant differences between TP-RAPN and RP-RAPN groups regarding tumor size, tumor laterality, R.E.N.A.L. nephrometry score, and tumor pathology. There was marginally significant difference between the two groups regarding OT (p = 0.05, WMD: 28.03; 95% CI, 0.41-55.65). No significant differences were found regarding complication, conversion, WIT, EBL, and PSM. No obvious publication bias was observed.
CONCLUSIONS
The present meta-analysis suggests that RP-RAPN appears to be equally safe and efficacious in terms of complication, conversion, WIT, EBL and PSM compared with TP-RAPN. In addition, RP-RAPN has marginally significant advantage of shorter OT. Randomized controlled trials and high-quality observational cohort studies with large sample size and long-term follow-up are needed to update our findings.
Topics: Humans; Kidney Neoplasms; Laparoscopy; Nephrectomy; Peritoneal Cavity; Retroperitoneal Space; Robotic Surgical Procedures; Treatment Outcome
PubMed: 27107660
DOI: 10.1016/j.ijsu.2016.04.023 -
BJU International Oct 2023To perform a systematic review and network meta-analysis (NMA) to determine the advantages and disadvantages of open (OPN), laparoscopic (LPN), and robot-assisted... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To perform a systematic review and network meta-analysis (NMA) to determine the advantages and disadvantages of open (OPN), laparoscopic (LPN), and robot-assisted partial nephrectomy (RAPN) with particular attention to intraoperative, immediate postoperative, as well as longer-term functional and oncological outcomes.
METHODS
A systematic review was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-NMA guidelines. Binary data were compared using odds ratios (ORs). Mean differences (MDs) were used for continuous variables. ORs and MDs were extracted from the articles to compare the efficacy of the various surgical approaches. Statistical validity is guaranteed when the 95% credible interval does not include 1.
RESULTS
In total, there were 31 studies included in the NMA with a combined 7869 patients. Of these, 33.7% (2651/7869) underwent OPN, 20.8% (1636/7869) LPN, and 45.5% (3582/7689) RAPN. There was no difference for either LPN or RAPN as compared to OPN in ischaemia time, intraoperative complications, positive surgical margins, operative time or trifecta rate. The estimated blood loss (EBL), postoperative complications and length of stay were all significantly reduced in RAPN when compared with OPN. The outcomes of RAPN and LPN were largely similar except the significantly reduced EBL in RAPN.
CONCLUSION
This systematic review and NMA suggests that RAPN is the preferable operative approach for patients undergoing surgery for lower-staged RCC.
Topics: Humans; Kidney Neoplasms; Robotics; Network Meta-Analysis; Treatment Outcome; Robotic Surgical Procedures; Nephrectomy; Postoperative Complications; Laparoscopy; Retrospective Studies
PubMed: 37259476
DOI: 10.1111/bju.16093 -
European Urology Focus Jan 2024Partial nephrectomy (PN) with intraoperative guidance by biophotonics has the potential to improve surgical outcomes due to higher precision. However, its value remains... (Review)
Review
CONTEXT
Partial nephrectomy (PN) with intraoperative guidance by biophotonics has the potential to improve surgical outcomes due to higher precision. However, its value remains unclear since high-level evidence is lacking.
OBJECTIVE
To provide a comprehensive analysis of biophotonic techniques used for intraoperative real-time assistance during PN.
EVIDENCE ACQUISITION
We performed a comprehensive database search based on the PICO criteria, including studies published before October 2022. Two independent reviewers screened the titles and abstracts followed by full-text screening of eligible studies. For a quantitative analysis, a meta-analysis was conducted.
EVIDENCE SYNTHESIS
In total, 35 studies were identified for the qualitative analysis, including 27 studies on near-infrared fluorescence (NIRF) imaging using indocyanine green, four studies on hyperspectral imaging, two studies on folate-targeted molecular imaging, and one study each on optical coherence tomography and 5-aminolevulinic acid. The meta-analysis investigated seven studies on selective arterial clamping using NIRF. There was a significantly shorter warm ischemia time in the NIRF-PN group (mean difference [MD]: -2.9; 95% confidence interval [CI]: -5.6, -0.1; p = 0.04). No differences were noted regarding transfusions (odds ratio [OR]: 0.5; 95% CI: 0.2, 1.7; p = 0.27), positive surgical margins (OR: 0.7; 95% CI: 0.2, 2.0; p = 0.46), or major complications (OR: 0.4; 95% CI: 0.1, 1.2; p = 0.08). In the NIRF-PN group, functional results were favorable at short-term follow-up (MD of glomerular filtration rate decline: 7.6; 95% CI: 4.6, 10.5; p < 0.01), but leveled off at long-term follow-up (MD: 7.0; 95% CI: -2.8, 16.9; p = 0.16). Remarkably, these findings were not confirmed by the included randomized controlled trial.
CONCLUSIONS
Biophotonics comprises a heterogeneous group of imaging modalities that serve intraoperative decision-making and guidance. Implementation into clinical practice and cost effectiveness are the limitations that should be addressed by future research.
PATIENT SUMMARY
We reviewed the application of biophotonics during partial removal of the kidney in patients with kidney cancer. Our results suggest that these techniques support the surgeon in successfully performing the challenging steps of the procedure.
PubMed: 38278713
DOI: 10.1016/j.euf.2024.01.005 -
Indian Journal of Urology : IJU :... 2022Multiple studies have been published recently assessing feasibility of robot-assisted partial nephrectomy (RAPN) for moderate to highly complex renal masses. Some... (Review)
Review
INTRODUCTION
Multiple studies have been published recently assessing feasibility of robot-assisted partial nephrectomy (RAPN) for moderate to highly complex renal masses. Some studies have even compared partial nephrectomy (PN) performed through various modalities such as open PN (OPN) versus RAPN and laparoscopic PN (LPN) versus OPN. The primary aim of this review was to analyze perioperative outcomes such as warm ischemia time (WIT), duration of surgery, estimated blood loss (EBL), complications, blood transfusion, length of stay, and margin status following RAPN for complex renal masses. Another objective was to compare perioperative outcomes following various surgical modalities, i.e., OPN, LPN, or RAPN.
METHODS
Literature search was conducted to identify studies reporting perioperative outcomes following RAPN for moderate (Radius, Endophytic/Exophytic, Nearness, Anterior/posterior location [RENAL] score 7-9 or Preoperative Aspects of Dimension used for anatomic classification [PADUA] score 8-9) to high complexity renal masses (RENAL or PADUA score ≥ 10). Meta-analysis of robotic versus OPN and robotic versus LPN was also performed. Study protocol was registered with PROPSERO (CRD42019121259).
RESULTS
In this review, 22 studies including 2,659 patients were included. Mean duration of surgery, WIT, and EBL was 132.5-250.8 min, 15.5-30 min, and 100-321 ml, respectively. From pooled analysis, positive surgical margin, need for blood transfusion, minor and major complications were seen in 3.9%, 5.2%, 19.3%, and 6.3% of the patients. No significant difference was noted between RAPN and LPN for any of the perioperative outcomes. Compared to OPN, RAPN had significantly lower EBL, complications rate, and need for transfusion.
CONCLUSIONS
RAPN for moderate to high complexity renal masses is associated with acceptable perioperative outcomes. LPN and RAPN were equal in terms of perioperative outcomes for complex masses whereas, OPN had significantly higher blood loss, complications rate, and need for transfusion as compared to RAPN.
PubMed: 35983124
DOI: 10.4103/iju.iju_393_21 -
Journal of Cancer 2019: Cryoablation has been considered as the most efficacious ablative alternative to partial nephrectomy (PN) for selected patients. Our objective is to assess the... (Review)
Review
: Cryoablation has been considered as the most efficacious ablative alternative to partial nephrectomy (PN) for selected patients. Our objective is to assess the existing evidence relating to the safety and efficacy of cryoablation compared with PN for clinical T1 renal masses. : A comprehensive search of PMC, EMBASE, and the Cochrane Library was conducted to identify studies containing comparison of cryoablation and PN. By utilizing those included studies, a systematic review and cumulative meta-analyses were performed to assess the safety and efficacy between cryoablation and PN for T1 renal masses. : 17 retrospective studies providing available data were included in our study. Significant differences were found about all oncological variables including all-cause death, cancer-specific death, metastasis and local-recurrence (p < 0.001, p = 0.03, p < 0.001, and p < 0.001, respectively) between the PN group and the cryoablation group. The mean difference between two groups for percent estimated glomerular filtration rate decrease and creatinine increase was -4.84 and 0.15 respectively (p < 0.001 and p = 0.006, respectively). The incidences of overall and postoperative complications in the PN group were significantly higher than that in the cryoablation group (p = 0.001 and p < 0.001, respectively), but the result about intraoperative complications didn't show a significant difference between the two groups (p = 0.53). : Comparing with PN, cryoablation for clinical T1 renal tumors is associated with poorer oncological outcomes, but the existing disadvantages are accompanied by lower rate of overall and postoperative complications and superior renal functional preservation. For patients with imperative indications for nephron-sparing surgery who can't risk more invasive PN, cryoablation could be an attractive option. Owing to the inherent limitations of eligible studies, conclusions drawn from our meta-analyses should be interpreted cautiously and be confirmed further with well-designed randomized controlled trials with extensive follow-up length.
PubMed: 30854132
DOI: 10.7150/jca.28881 -
International Journal of Clinical... Apr 2021To investigate the association of adherent perinephric fat (APF) with perioperative outcomes, we conducted a systematic review and meta-analysis of the literature to... (Meta-Analysis)
Meta-Analysis Review
To investigate the association of adherent perinephric fat (APF) with perioperative outcomes, we conducted a systematic review and meta-analysis of the literature to clarify the impact of APF in patients undergoing partial nephrectomy. A systematic literature search using the Medline, Scopus, and Cochrane databases was performed in April 2019 and updated in November 2019 to identify studies investigating the effect of APF on perioperative outcomes in patients treated with partial nephrectomy with the aim of evaluating its impact on intraoperative, postoperative and oncological outcomes. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. A total of 1534 patients in nine nonrandomized, observational studies met our inclusion criteria. Patients with APF were significantly older (p = 0.0001), had a higher BMI (p = 0.0001) and were predominately male (p = 0.003). APF was associated with a higher operative time (p = 0.001) and higher blood loss (p = 0.002). No significant impact of APF was found in terms of postoperative complications, positive margins or length of stay. APF was also found to be associated with malignant renal histology of RCC on final pathology (p = 0.005). APF was associated with some adverse perioperative outcomes, especially a prolonged operating time and higher blood loss. In addition, APF was also associated with underlying renal malignancy, but the precise causal mechanism requires further exploration.
Topics: Adipose Tissue; Body Mass Index; Humans; Kidney; Kidney Neoplasms; Male; Nephrectomy; Postoperative Complications; Robotic Surgical Procedures; Treatment Outcome
PubMed: 33502646
DOI: 10.1007/s10147-021-01871-6 -
Frontiers in Oncology 2023The perioperative, functional, and oncological outcomes of patients with solitary small renal tumors (SRMs) treated with ablation (AT) or partial nephrectomy (PN) remain... (Review)
Review
Perioperative, functional, and oncologic outcomes after ablation or partial nephrectomy for solitary renal tumors: a systematic review and meta-analysis of comparative trials.
OBJECTIVES
The perioperative, functional, and oncological outcomes of patients with solitary small renal tumors (SRMs) treated with ablation (AT) or partial nephrectomy (PN) remain controversial. The aim of this study was to compare the outcomes of these two surgical techniques.
METHODS
In April 2023, we conducted a literature search in several widely used databases worldwide, including PubMed, Embase, and Google Scholar. Review Manager was used to compare various parameters. The study was registered with PROSPERO (CRD42022377157).
RESULTS
Our final meta-analysis included 13 cohort studies with a total of 2,107 patients. Compared to partial nephrectomy (PN), ablation (AT) had shorter hospital stays (WMD -2.37 days, 95% CI -3.05 to -1.69; p < 0.00001), shorter operating times (WMD -57.06 min, 95% CI -88.92 to -25.19; p = 0.0004), less postoperative creatinine increases (WMD -0.17 mg/dL, 95% CI -0.29 to -0.05; p = 0.006), less postoperative glomerular filtration rate decreases (WMD -9.84 mL/min/1.73 m2, 95% CI -14.25 to -5.44; p < 0.0001), less postoperative new-onset chronic kidney disease (OR 0.33, 95% CI 0.16 to 0.71; p = 0.005), and less intraoperative blood loss (WMD -285.92 ml, 95% CI -428.44 to -143.40; p < 0.0001). The transfusion rate was lower in the ablation group (OR 0.17, 95% CI 0.06 to 0.51; p = 0.001). The risk of local recurrence was higher in the ablation group (OR 2.96, 95% CI 1.27 to 6.89; p = 0.01), while the risk of distant metastasis was higher in the partial nephrectomy group (OR 2.81, 95% CI 1.28 to 6.18; p = 0.01). The intraoperative and postoperative complication rates were lower in the ablation group (OR 0.23, 95% CI 0.08 to 0.62; p = 0.004 and OR 0.21, 95% CI 0.11 to 0.38; p < 0.00001, respectively). However, overall survival, postoperative dialysis rate, and tumor-specific survival were not different between the two groups.
CONCLUSIONS
Our data suggest that ablation and partial nephrectomy are equally safe and effective in the treatment of small solitary kidney tumors and are better options for patients with poor preoperative physical condition or poor renal function.
PubMed: 37434978
DOI: 10.3389/fonc.2023.1202587