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In Vivo (Athens, Greece) 2022Trifecta represents a composite outcome reflecting the quality level of treatment in nephron sparing surgery. However, there is substantial heterogeneity concerning the... (Review)
Review
BACKGROUND/AIM
Trifecta represents a composite outcome reflecting the quality level of treatment in nephron sparing surgery. However, there is substantial heterogeneity concerning the criteria required for its fulfilment. The present study aimed to highlight the potential of a unified view for the different definitions of trifecta when comparing robotic and open approaches in partial nephrectomy.
MATERIALS AND METHODS
A systematic literature search was carried out for all relevant comparative studies published until April 2022. Trifecta definitions were clustered according to two criteria for postoperative renal function reduction. The first set as an upper limit the 10% decrease in the estimated glomerular filtration rate, while the second set as an upper limit 25 min of ischemia. To mathematically investigate the point of intersection between the above two groups, a suitable model of volume conservation equations was formulated.
RESULTS
A total of 11 studies were investigated for their methodological features and grouped accordingly. The ischemic zone volume surrounding the tumor resection site emerged as the central parameter connecting the two main definitions. Specifically, for patients with solitary renal masses, a given change in the value of one parameter resulted in a fixed change in the value of the other.
CONCLUSION
The two main definitions of the "trifecta outcome" extracted from the international literature represent the two sides of the same coin. Thus, trifecta achievement rates could be utilized by future studies as aggregate data to yield a quantitative estimate of the comparative effect between robotic and open approaches in partial nephrectomy procedures.
Topics: Humans; Models, Theoretical; Nephrectomy; Robotic Surgical Procedures; Treatment Outcome
PubMed: 36309375
DOI: 10.21873/invivo.12992 -
Frontiers in Surgery 2022Partial nephrectomy (PN) is one of the most preferred nephron-sparing treatments for clinical T1 (cT1) renal cancer, while radiofrequency ablation (RFA) is usually used...
BACKGROUND
Partial nephrectomy (PN) is one of the most preferred nephron-sparing treatments for clinical T1 (cT1) renal cancer, while radiofrequency ablation (RFA) is usually used for patients who are poor surgical candidates. The long-term oncologic outcome of RFA vs. PN for cT1 renal cancer remains undetermined. This meta-analysis aims to compare the treatment efficacy and safety of RFA and PN for patients with cT1 renal cancer with long-term follow-up of at least 5 years.
METHOD
This meta-analysis was performed following the PRISMA reporting guidelines. Literature studies that had data on the comparison of the efficacy or safety of RFA vs. PN in treating cT1 renal cancer were searched in databases including PubMed, Embase, Web of Science, and the Cochrane Library from 1 January2000 to 1 May 2022. Only long-term studies with a median or mean follow-up of at least 5 years were included. The following measures of effect were pooled: odds ratio (OR) for recurrence and major complications; hazard ratio (HR) for progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS). Additional analyses, including sensitivity analysis, subgroup analysis, and publication bias analysis, were also performed.
RESULTS
A total of seven studies with 1,635 patients were finally included. The treatment efficacy of RFA was not different with PN in terms of cancer recurrence (OR = 1.22, 95% CI, 0.45-3.28), PFS (HR = 1.26, 95% CI, 0.75-2.11), and CSS (HR = 1.27, 95% CI, 0.41-3.95) as well as major complications (OR = 1.31, 95% CI, 0.55-3.14) ( > 0.05 for all). RFA was a potential significant risk factor for OS (HR = 1.76, 95% CI, 1.32-2.34, < 0.001). No significant heterogeneity and publication bias were observed.
CONCLUSION
This is the first meta-analysis that focuses on the long-term oncological outcomes of cT1 renal cancer, and the results suggest that RFA has comparable therapeutic efficacy with PN. RFA is a nephron-sparing technique with favorable oncologic efficacy and safety and a good treatment alternative for cT1 renal cancer.
PubMed: 36684152
DOI: 10.3389/fsurg.2022.1012897 -
Diagnostics (Basel, Switzerland) Sep 2023The prevalence of renal cell carcinoma (RCC) is increasing due to advanced imaging techniques. Surgical resection is the standard treatment, involving complex radical... (Review)
Review
The prevalence of renal cell carcinoma (RCC) is increasing due to advanced imaging techniques. Surgical resection is the standard treatment, involving complex radical and partial nephrectomy procedures that demand extensive training and planning. Furthermore, artificial intelligence (AI) can potentially aid the training process in the field of kidney cancer. This review explores how artificial intelligence (AI) can create a framework for kidney cancer surgery to address training difficulties. Following PRISMA 2020 criteria, an exhaustive search of PubMed and SCOPUS databases was conducted without any filters or restrictions. Inclusion criteria encompassed original English articles focusing on AI's role in kidney cancer surgical training. On the other hand, all non-original articles and articles published in any language other than English were excluded. Two independent reviewers assessed the articles, with a third party settling any disagreement. Study specifics, AI tools, methodologies, endpoints, and outcomes were extracted by the same authors. The Oxford Center for Evidence-Based Medicine's evidence levels were employed to assess the studies. Out of 468 identified records, 14 eligible studies were selected. Potential AI applications in kidney cancer surgical training include analyzing surgical workflow, annotating instruments, identifying tissues, and 3D reconstruction. AI is capable of appraising surgical skills, including the identification of procedural steps and instrument tracking. While AI and augmented reality (AR) enhance training, challenges persist in real-time tracking and registration. The utilization of AI-driven 3D reconstruction proves beneficial for intraoperative guidance and preoperative preparation. Artificial intelligence (AI) shows potential for advancing surgical training by providing unbiased evaluations, personalized feedback, and enhanced learning processes. Yet challenges such as consistent metric measurement, ethical concerns, and data privacy must be addressed. The integration of AI into kidney cancer surgical training offers solutions to training difficulties and a boost to surgical education. However, to fully harness its potential, additional studies are imperative.
PubMed: 37835812
DOI: 10.3390/diagnostics13193070 -
Turkish Journal of Urology May 2022Clamping of renal vessels during partial nephrectomy is usually performed to improve the visualization of tumor margins. However, clamping of renal vessels has been...
Clamping of renal vessels during partial nephrectomy is usually performed to improve the visualization of tumor margins. However, clamping of renal vessels has been associated with detrimental effects on renal function after surgery. This study aimed to compare artery only versus artery and vein clamping as regards the surgical and functional outcomes in patients undergoing partial nephrectomy. The literature was searched for English published studies from January 1, 2000 to August 7, 2021. The search included MEDLINE/ PubMed, Cochrane Library, Scopus, Web of Science, Google Scholar, and ProQuest, using the terms {"par- tial nephrectomy"} OR {"nephron-sparing surgery"} AND {"renal artery and vein clamping} AND {"renal artery only clamping}. Nine studies were included. Meta-analysis showed the artery only clamping grouphad a significantly less percentage of change in glomerular filtration rate at last follow-up (standardizedmean difference: -0.42 [95% CI: -0.70, -0.13], P = .004) as well as a rate of postoperative complications(odds ratio: 0.64 [95% CI: 0.41, 0.98], P = .04). However, no significant difference was observed regarding the development of chronic kidney disease. There was no significant difference regarding the warm ischemiatime, blood loss, or positive surgical margin. Artery only clamping has a comparable safety to artery and vein clamping and may produce a renoprotective effect. Due to limitations of the included studies, the conduction of large-size randomized clinical trials with a long duration of follow-up is required before recommending the replacement of artery and vein clamping with artery only clamping during partial nephrectomy.
PubMed: 35634936
DOI: 10.5152/tud.2022.22009 -
Clinical Genitourinary Cancer Oct 2022To determine the effect of positive surgical margins in patients who undergo a partial nephrectomy regarding recurrence, overall survival, disease-free survival,... (Meta-Analysis)
Meta-Analysis
Effect of Positive Surgical Margins in Patients Who Undergo a Partial Nephrectomy Regarding Recurrence, Overall Survival, Recurrence/Progression-Free Survival, and Metastasis-Free Survival. A Systematic Review and Meta-Analysis.
BACKGROUND
To determine the effect of positive surgical margins in patients who undergo a partial nephrectomy regarding recurrence, overall survival, disease-free survival, recurrence and progression-free survival, and metastasis-free survival.
METHODS
We performed a systematic review accomplishing with Cochrane recommendations. We searched in Medline, Embase, and central. We also looked for unpublished literature. There was no language or setting restrictions. We performed a random-effects meta-analysis for all outcomes.
RESULTS
We included 44 studies for qualitative and quantitative analysis. We found that positive margins increase the risk of local recurrence (RR 4.14 95%CI 2.75-6.24), recurrence (RR 4.8 95%CI 3.38-6.62), mortality (RR 1.83 95%CI 1.08-3.1), metastasis (RR 8.1 95%CI 3.88-16.92), and improved the recurrence/progression-free survival (HR 2.9 95%CI 1.88-4.49) and metastasis-free survival (HR 2.91 95%CI 1.25-6.79) with moderate, moderate, very low, very low, and high certainty of the evidence, respectively. We found no change in overall survival (HR 1.48 95%CI 0.98-2.22) with very low certainty of evidence.
CONCLUSIONS
A positive margin is an independent predictor of local recurrence, recurrence, mortality, metastasis, with no effect on overall survival. Therefore, a tailored intense and prolonged follow-up is mandatory.
Topics: Disease-Free Survival; Humans; Margins of Excision; Neoplasm Recurrence, Local; Nephrectomy; Progression-Free Survival
PubMed: 35840533
DOI: 10.1016/j.clgc.2022.05.011 -
Journal of Endourology May 2021To systematically explore the superiority of the transperitoneal approach in robot-assisted partial nephrectomy (TP-RAPN) and retroperitoneal approach in robot-assisted... (Meta-Analysis)
Meta-Analysis
To systematically explore the superiority of the transperitoneal approach in robot-assisted partial nephrectomy (TP-RAPN) and retroperitoneal approach in robot-assisted partial nephrectomy (RP-RAPN). Several databases were searched including PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, CBM, Wan Fang, and VIP to identify relevant studies that reported the comparison of the TP-RAPN and RP-RAPN. Outcomes of data were pooled and analyzed with Review Manager 5.3 to compare the intraoperative and postoperative variables and postoperative complications. Based on the heterogeneity of the studies, odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using a random-effect model or fixed-effect model. The sensitivity analysis and the subgroup analysis were used to minimize the effects of heterogeneity. And, publication bias was assessed by funnel plots. In all, 16 studies met the inclusion criteria, including 2336 TP-RAPN patients and 1705 RP-RAPN patients. This meta-analysis reviewed 16 studies on RAPN, and the RP-RAPN showed shorter operative time (OT) (WMD 13.18 minutes; 95% CI 5.04-21.31; = 0.001), shorter postoperative bowel function recovery (WMD 1.97 days; 95% CI 0.43-3.52; = 0.01), shorter length of stay (LOS) (WMD 0.51 days; 95% CI 0.25-0.77; = 0.0001), and lower estimated blood loss (EBL) (WMD 7.08 mL; 95% CI 1.41-12.74; = 0.01) than the TP-RAPN. Additionally, no significant differences were found in other outcomes. In comparison, the RP-RAPN had significantly shorter OT, postoperative bowel function recovery time, LOS, and lower EBL. The RP-RAPN is associated with better value for posterior and laterally located tumors and is faster and equally safe and low costs for the patient.
Topics: Humans; Kidney Neoplasms; Nephrectomy; Operative Time; Postoperative Complications; Retrospective Studies; Robotic Surgical Procedures; Robotics; Treatment Outcome
PubMed: 33076702
DOI: 10.1089/end.2020.0432 -
Annals of Surgical Oncology Jul 2024Which is superior, partial nephrectomy (PN) or radical nephrectomy (RN), for the treatment of complex renal tumours (RENAL or score ≥ 7)? (Meta-Analysis)
Meta-Analysis Comparative Study Review
OBJECTIVE
Which is superior, partial nephrectomy (PN) or radical nephrectomy (RN), for the treatment of complex renal tumours (RENAL or score ≥ 7)?
METHODS
This systematic review and meta-analysis was conducted in accordance with the PRISMA statement. A systematic search of the literature published before November 2023 was conducted using Pubmed, Embase, Cochran, and Web of Science libraries. We included studies comparing perioperative and oncologic outcomes of partial nephrectomy and radical nephrectomy for complex renal tumors.
RESULTS
A total of 2602 patients from six studies meeting the criteria were included. The PN group had a longer operative time, increased estimated blood loss, and major complications but a smaller reduction in renal function. There were no significant differences in complications, length of hospital stay, and blood transfusion. In terms of oncological outcomes, the PN group had longer OS, CSS, and no significant difference in RFS.
CONCLUSIONS
For complex renal tumours, PN requires more operative time and has a higher chance of complications in the short term. However, in long-term follow-up, PN has a small decrease in renal function with longer OS and CSS.
Topics: Humans; Kidney Neoplasms; Nephrectomy; Survival Rate; Postoperative Complications; Operative Time; Prognosis; Length of Stay
PubMed: 38630418
DOI: 10.1245/s10434-024-15223-x -
Minimally Invasive Therapy & Allied... Oct 2022In this study, we aimed to examine the effectiveness of augmented reality (AR)-assisted technology in laparoscopic partial nephrectomy (LPN) compared to conventional... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
In this study, we aimed to examine the effectiveness of augmented reality (AR)-assisted technology in laparoscopic partial nephrectomy (LPN) compared to conventional technique.
MATERIAL AND METHODS
We performed a systematic search through the Cochrane Library, PubMed, Embase, Web of Science, ScienceDirect, and Wanfang for eligible studies published up to 30 September 2021. The literature quality was independently evaluated by two investigators, and all statistical analysis was performed using STATA version 12.0 (STATA Corporation, Houston, TX, USA). According to the different surgical techniques and surgical risks, the included articles were divided into two subgroups.
RESULTS
The reviewed studies included five retrospective comparative studies (RCS), two prospective controlled studies (PCS), one randomized controlled trial (RCT) including 548 patients. The AR-assisted LPN had following distinctive advantages compared to conventional nephrectomy: shorter procedure times and lower intraoperative blood loss. Additionally, there was no statistically significant difference in margin-positive resection rate, warm ischemia time, complications, eGFR decline and length of stay between these two technologies.
CONCLUSION
Compared to the conventional technique, AR-assisted LPN appears to be a preferable treatment. However, a high degree of statistical heterogeneity was observed in the meta-analysis. Well-designed prospective trials and large-scale RCTs are needed to draw definitive findings from this analysis.
Topics: Augmented Reality; Humans; Kidney Neoplasms; Laparoscopy; Nephrectomy; Technology; Treatment Outcome; Warm Ischemia
PubMed: 35337249
DOI: 10.1080/13645706.2022.2051190 -
Frontiers in Surgery 2023To evaluate the impact of augmented reality surgical navigation (ARSN) technology on short-term outcomes of partial nephrectomy (PN). (Review)
Review
AIM
To evaluate the impact of augmented reality surgical navigation (ARSN) technology on short-term outcomes of partial nephrectomy (PN).
METHODS
A systematic literature search was conducted in PubMed, Embase, Cochrane, and Web of Science for eligible studies published through March 28, 2022. Two researchers independently performed the article screening, data extraction and quality review. Data analysis was performed using Cochrane Review Manager software.
RESULTS
A total of 583 patients from eight studies were included in the analysis, with 313 in the ARSN-assisted PN group (AR group) and 270 in the conventional PN group (NAR group). ARSN-assisted PN showed better outcomes than conventional surgery in terms of operative time, estimated blood loss, global ischemia rate, warm ischemia time, and enucleation rate. However, there were no significant differences in the rate of Conversion to radical nephrectomy (RN), postoperative estimated glomerular filtration rate (eGFR), positive margin rate, and postoperative complication rate.
CONCLUSION
The utilization of ARSN can improve the perioperative safety of PN. Compared with conventional PN, ARSN-assisted PN can reduce intraoperative blood loss, shorten operative time, and improve renal ischemia. Although direct evidence is lacking, our results still suggest a potential advantage of ARSN in improving renal recovery after PN. However, as the ARSN system is still in an exploratory stage, its relevance in PN have been poorly reported. Additional high-quality randomized controlled trial (RCT) studies will be required to confirm the effect of ARSN on PN.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=301798, identifier PROSPERO ID: CRD42022301798.
PubMed: 37123539
DOI: 10.3389/fsurg.2023.1067275 -
Cancer Medicine Aug 2021To parallelly compare the applicability of the radius, exophytic/endophytic, nearness, anterior/posterior, location nephrometry score (R.E.N.A.L.), the Preoperative... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
To parallelly compare the applicability of the radius, exophytic/endophytic, nearness, anterior/posterior, location nephrometry score (R.E.N.A.L.), the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA), and the centrality index (C-index) scoring systems in predicting clinical outcomes after partial nephrectomy (PN).
METHODS
We searched EMBASE, PubMed, Ovid, and Web of Science to perform a meta-analysis examining the correlation coefficients between three nephrometry scores (NSs) and warm ischemia time (WIT), estimated blood loss (EBL), operation time (OT), length of stay (LOS), and absolute change in eGFR (ACE) up to 25 January 2021.
RESULTS
In total, 13 studies including 1496 patients met the criteria for further analysis. Overall, all scoring systems had statistically significant correlations with the WIT, EBL, OT, ACE and LOS and ACE, except for the correlation between PADUA and LOS (r = 0.16 [-0.00, 0.31], p > 0.05). The C-index had the strongest correlation with WIT (r = -0.35 [-0.43, -0.26], p < 0.05) and ACE (r = -0.29 [-0.48, -0.10], p < 0.05). Weak correlations were observed between OT as well as EBL and each scoring system. Publication bias was observed in PADUA score predicting ACE (p = 0.04) and high heterogeneity was found in some of our results.
CONCLUSION
Until now, this is the first meta-analysis that parallelly compares these three scoring systems in predicting outcomes after PN. We found that all NSs showed a statistically significant correlation with WIT, EBL, OT, and ACE. Moreover, the C-index scoring system is the best predictor of WIT and ACE. Due to the existence of publication bias and high heterogeneity, more well-designed and large-scale studies are warranted for validation.
Topics: Blood Loss, Surgical; Carcinoma, Renal Cell; Glomerular Filtration Rate; Humans; Kidney; Kidney Neoplasms; Length of Stay; Nephrectomy; Operative Time; Publication Bias; Research Design; Retrospective Studies; Treatment Outcome; Warm Ischemia
PubMed: 34258874
DOI: 10.1002/cam4.4047