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Scientific Reports May 2023Cystic renal cell carcinoma (cRCC) is uncommon and surgical indication remains controversial. We compared radical nephrectomy (RN) with partial nephrectomy (PN) in...
Cystic renal cell carcinoma (cRCC) is uncommon and surgical indication remains controversial. We compared radical nephrectomy (RN) with partial nephrectomy (PN) in patients with cRCC using data from the Surveillance, Epidemiology and End Results (SEER) database and a retrospective cohort including 106 cRCC patients hospitalized in Ruijin and Renji Hospitals from 2013 to 2022. The baseline characteristics between RN and PN groups in both cohorts were adjusted by propensity score-matching (PSM). A total of 640 patients were included in the SEER cohort. Before PSM, PN group in the SEER cohort had a lower level of T stage (p < 0.001) and comprised more Caucasians (p < 0.001). After PSM, RN was associated with worse overall survival (p < 0.001) and cancer-specific survival (p = 0.006) in contrast to PN. In the Chinese cohort, 86 patients who underwent PN and 20 patients who underwent RN were finally included. The mean proportions of estimated glomerular filtration rate preserved after RN were worse than PN. Therefore, PN should be preferred in cRCC patients.
Topics: Humans; Carcinoma, Renal Cell; Retrospective Studies; Kidney Neoplasms; Nephrectomy; Propensity Score; Treatment Outcome
PubMed: 37198295
DOI: 10.1038/s41598-023-34950-x -
Urologia Internationalis 2014To compare peri- and postoperative variables, surgical complications, oncological outcomes and renal outcomes of off-clamp partial nephrectomy (PN) and on-clamp PN. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare peri- and postoperative variables, surgical complications, oncological outcomes and renal outcomes of off-clamp partial nephrectomy (PN) and on-clamp PN.
METHODS
A systematic search of the electronic databases, including MEDLINE, Embase and Cochrane Library, was performed. The pooled estimates of tumour size, operative time, estimated blood loss, length of stay, overall complications, transfusion rates, urinary leaks, positive surgical margins and eGFR were calculated.
RESULTS
14 studies were included. There was no significant difference between off-clamp PN and on-clamp PN in terms of tumour size, operative time, estimated blood loss, length of stay, overall complications, transfusion rates, urinary leaks, and positive surgical margins. However, a non-statistically significant trend towards increased blood loss (p = 0.12) and transfusion rates (p = 0.07) in those undergoing off-clamp PN was noted. Off-clamp PN was associated with a significantly lower reduction in eGFR than on-clamp PN (standardised weighted mean difference 0.27, 95% CI 0.14, 0.40, p < 0.0001).
CONCLUSIONS
Off-clamp PN may be associated with improved long-term renal outcomes when compared to on-clamp PN with no difference in in peri- and postoperative variables, surgical complications and oncological outcomes. However, the meta-analysis was limited by the design of the underlying studies, and hence further work is necessary.
Topics: Chi-Square Distribution; Constriction; Glomerular Filtration Rate; Humans; Kidney Neoplasms; Length of Stay; Nephrectomy; Odds Ratio; Postoperative Complications; Risk Factors; Time Factors; Treatment Outcome
PubMed: 24992994
DOI: 10.1159/000362799 -
International Braz J Urol : Official... 2017To assess and report the outcomes of laparoscopic partial nephrectomy )LPN) for T2 renal masses.
PURPOSE
To assess and report the outcomes of laparoscopic partial nephrectomy )LPN) for T2 renal masses.
MATERIALS AND METHODS
Retrospective review of patients undergoing LPN for clinically localized renal masses ≥7cm between the years 2005-2016. Descriptive analyses were generated for demographics, lesion characteristics, perioperative variables (operative time, warm ischemia time (WIT), estimated blood loss (EBL), intra-operative and post-operative complications (IOC and POC) and pathologic variables (pathology, subtype and Fuhrman grade).
RESULTS
A total of 27 patients underwent LPN for a T2 renal mass at our institution between 2005 and early 2016 of which 19 were males. The mean age was 66 (52-72). All procedures were transperitoneal with 16 on the right and 11 on the left. Median operative time was 200 minutes (IQR 181-236) and median WIT 19 minutes (IQR 16-23). EBL was 125mL (IQR 75-175). One case was converted to laparoscopic radical nephrectomy due to suspected tumor thrombus in the renal vein. Surgical margins were positive in one renal tumor in a patient with multiple tumors. There was a total of 2 IOC (7.4%) and 3 POC (11%) classified as Clavien grade 3.
CONCLUSIONS
To our knowledge, this series is the first to describe the outcomes of LPN for cT2 renal masses. In our series, LPN for larger renal masses appears feasible with favorable perioperative outcomes. Additional data are needed to further explore the benefits of minimally invasive surgical approaches to larger renal masses.
Topics: Aged; Female; Humans; Kidney Neoplasms; Laparoscopy; Male; Middle Aged; Neoplasm Staging; Nephrectomy; Perioperative Care; Retrospective Studies; Treatment Outcome; Tumor Burden
PubMed: 28792194
DOI: 10.1590/S1677-5538.IBJU.2016.0642 -
The Kaohsiung Journal of Medical... Nov 2013The surgical, oncologic, and functional outcomes were retrospectively compared of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) for the... (Comparative Study)
Comparative Study
The surgical, oncologic, and functional outcomes were retrospectively compared of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) for the treatment of renal masses. Between January 2006 and November 2011, 115 LPNs and 97 OPNs were performed. The patients' demographics were matched. Their intraoperative and postoperative data, oncologic and renal function outcomes were compared. Surgical time, renal arterial occlusion time, estimated blood loss, and postoperative hospitalization days were shorter in the LPN group (p < 0.01). The total complications were comparable; however, LPN had a higher intraoperative complication due to 12 subcutaneous emphysemas. The LPN group was followed up with a mean time of 29.3 ± 14.4 months and the OPN group with a mean time of 31.2 ± 12.6 months. All patients survived and no distant relapse or metastasis were observed. Kaplan-Meier estimates of 60-month local recurrence-free survival were comparable with 92.4% after LPN and 93.8% after OPN, respectively (p = 0.57). The reduction of glomerular filtration rate was more obvious after LPN at the 3-month follow-up (p < 0.01), but similar between the two groups at the 30.2-month follow-up. LPN provides similar results in oncologic and functional outcomes when compared to OPN. Long-term observations are still required to the oncologic and function outcomes.
Topics: Adult; Female; Humans; Kidney Neoplasms; Laparoscopy; Male; Middle Aged; Nephrectomy
PubMed: 24183357
DOI: 10.1016/j.kjms.2013.01.021 -
The Journal of Urology May 2010Partial nephrectomy may be underused compared with radical nephrectomy in elderly patients due to concerns about higher complication rates. We determined if the...
PURPOSE
Partial nephrectomy may be underused compared with radical nephrectomy in elderly patients due to concerns about higher complication rates. We determined if the association of age and perioperative outcomes differed between nephrectomy types.
MATERIALS AND METHODS
We identified patients who underwent radical or partial nephrectomy between January 2000 and October 2008. Using multivariable methods we determined whether the relationship between age and risk of postoperative complications, estimated blood loss or operative time differed by nephrectomy type.
RESULTS
Of 1,712 patients 651 (38%) underwent radical nephrectomy and 1,061 (62%) underwent partial nephrectomy. Patients treated with partial nephrectomy had higher complication rates than those who underwent radical nephrectomy (20% vs 14%). In a multivariable model age was significantly associated with a small increase in risk of complications (OR for 10-year age increase 1.17, 95% CI 1.04-1.32, p = 0.009). When including an interaction term between age and procedure type, the interaction term was not significant (p = 0.09), indicating there was no evidence the risk of complications associated with partial vs radical nephrectomy increased with advancing age. There was no evidence that age was significantly associated with estimated blood loss or operative time.
CONCLUSIONS
We found no evidence that elderly patients experience a proportionally higher complication rate, longer operative times or higher estimated blood loss from partial nephrectomy than do younger patients. Given the advantages of renal function preservation we should expand the use of nephron sparing treatment to renal tumors in elderly patients.
Topics: Age Factors; Aged; Blood Loss, Surgical; Female; Humans; Kidney Neoplasms; Logistic Models; Male; Middle Aged; Nephrectomy; Postoperative Complications; Retrospective Studies; Time Factors
PubMed: 20299040
DOI: 10.1016/j.juro.2009.12.101 -
Journal of Endourology 2005With continuing rapid changes in endourology, we conducted a new survey of practice trends and expanded our sampling to include non-American urologists. (Comparative Study)
Comparative Study
BACKGROUND AND PURPOSE
With continuing rapid changes in endourology, we conducted a new survey of practice trends and expanded our sampling to include non-American urologists.
MATERIALS AND METHODS
The survey was done via the Internet using the database for the 2003 World Congress of Endourology. Approximately 1100 surveys were sent, and responses were received from 193 urologists, who had been in practice for a mean of 9.9 years (median 8 years). Of these, 52% spend >50% in endourology, and 48% devote >20% of their practice to laparoscopy.
RESULTS
More than half of the respondents (56%) perform laparoscopic partial nephrectomy (LPN), and 65% chose LPN as the procedure of choice for patients with an uncomplicated 3-cm renal mass. The majority obtain vascular control, most commonly by clamping the renal artery only. Most respondents do not use ureteral stents unless the collecting system is entered.
CONCLUSIONS
These results and a review of the literature indicate a growing acceptance among endourologists of LPN as the procedure of choice for patients with small renal masses who are to undergo nephron-sparing surgery. Disagreement remains concerning the role and type of vascular control, the use of hemostatic agents, and the value of stents when the collecting system is entered.
Topics: Data Collection; Humans; Laparoscopy; Nephrectomy; Retrospective Studies; Urology; Workforce
PubMed: 15735377
DOI: 10.1089/end.2005.19.21 -
International Braz J Urol : Official... 2018The aim of our study is to present early outcomes of our series of retroperitoneal-RAPN (Robot Assisted Partial Nephrectomy).
OBJECTIVES
The aim of our study is to present early outcomes of our series of retroperitoneal-RAPN (Robot Assisted Partial Nephrectomy).
MATERIALS AND METHODS
From September 2010 until December 2015, we performed 81 RAPN procedures (44 at left kidney and 37 at right). Average size was 3cm (1-9). Average PADUA score 7.1 (5-10). Average surgical time (overall and only robot time), ischemia time, blood loss, pathological stage, complications and hospital stay have been recorded.
RESULTS
All of the cases were completed successfully without any operative complication or surgical conversion. Average surgical time was 177 minutes (75-340). Operative time was 145 minutes (80-300), overall blood loss was 142cc (60-310cc). In 30 cases the pedicle was late clamped with an average ischemia time of 4 minutes (2-7). None of the patient had positive surgical margins at definitive histology (49pT1a, 12pT1b, 3pT2a, 2pT3a). Hospital stay was 3 days (2-7).
CONCLUSIONS
The retroperitoneal robotic partial nephrectomy approach is safe and allows treatment of even quite complex tumors. It also combines the already well known advantages guaranteed by the da Vinci® robotic surgical system, with the advantages of the retroperitoneoscopic approach.
Topics: Female; Humans; Kidney Neoplasms; Male; Middle Aged; Nephrectomy; Retroperitoneal Space; Robotic Surgical Procedures; Treatment Outcome
PubMed: 29211396
DOI: 10.1590/S1677-5538.IBJU.2017.0104 -
Current Oncology (Toronto, Ont.) Oct 2023Acute kidney injury (AKI) after robot-assisted partial nephrectomy (RAPN) is a robust surrogate for chronic kidney disease. The objective of this study was to evaluate...
BACKGROUND
Acute kidney injury (AKI) after robot-assisted partial nephrectomy (RAPN) is a robust surrogate for chronic kidney disease. The objective of this study was to evaluate the association of ischemia type and duration during RAPN with postoperative AKI.
MATERIALS AND METHODS
We reviewed all patients who underwent RAPN at our institution since 2011. The ischemia types were warm ischemia (WI), selective artery clamping (SAC), and zero ischemia (ZI). AKI was defined according to the Risk Injury Failure Loss End-Stage (RIFLE) criteria. We calculated ischemia time thresholds for WI and SAC using the Youden and Liu indices. Logistic regression and decision curve analyses were assessed to examine the association with AKI.
RESULTS
Overall, 154 patients met the inclusion criteria. Among all RAPNs, 90 (58.4%), 43 (28.0%), and 21 (13.6%) were performed with WI, SAC, and ZI, respectively. Thirty-three (21.4%) patients experienced postoperative AKI. We extrapolated ischemia time thresholds of 17 min for WI and 29 min for SAC associated with the occurrence of postoperative AKI. Multivariable logistic regression analyses revealed that WIT ≤ 17 min (odds ratio [OR] 0.1, < 0.001), SAC ≤ 29 min (OR 0.12, = 0.002), and ZI (OR 0.1, = 0.035) significantly reduced the risk of postoperative AKI.
CONCLUSIONS
Our results confirm the commonly accepted 20 min threshold for WI time, suggest less than 30 min ischemia time when using SAC, and support a ZI approach if safely performable to reduce the risk of postoperative AKI. Selecting an appropriate ischemia type for patients undergoing RAPN can improve short- and long-term functional kidney outcomes.
Topics: Humans; Acute Kidney Injury; Glomerular Filtration Rate; Ischemia; Kidney Neoplasms; Nephrectomy; Robotics; Treatment Outcome
PubMed: 37999118
DOI: 10.3390/curroncol30110698 -
International Journal of Surgery... Dec 2016Advancement in surgical management of urolithiasis has revolved around improvements in technology. Urologists have been at the forefront on embracing new technology and... (Review)
Review
Advancement in surgical management of urolithiasis has revolved around improvements in technology. Urologists have been at the forefront on embracing new technology and passing on the benefits to the patients. Da Vinci robotic system has contributed significantly in improving the outcomes of minimally invasive procedures especially those requiring complex resections and reconstruction. Endourological and percutaneous techniques have established superiority in management of urolithiasis and majority of the patients are ideal candidates for such procedures. However, in certain stone disease indications like simultaneous pyeloplasty-pyelolithotomy, robotic assisted procedure has established superiority, at least in the developed world. Other indications like complex pyelolithotomy and stone extraction with simultaneous partial nephrectomy are being continuously documented. Large, multi-institutional studies to evaluate the effective advantages of the robotic approach against well-established methodologies in the treatment of stone disease are required. However the wider availability of robotic system in areas where stone disease is endemic continues to be the biggest challenge.
Topics: Humans; Kidney; Nephrectomy; Robotic Surgical Procedures; Urolithiasis
PubMed: 27856354
DOI: 10.1016/j.ijsu.2016.11.031 -
The Canadian Journal of Urology Apr 2017To review oncological and functional outcomes for partial nephrectomy in the setting of T2 tumors. (Review)
Review
INTRODUCTION
To review oncological and functional outcomes for partial nephrectomy in the setting of T2 tumors.
MATERIALS AND METHODS
We performed a comprehensive literature review on partial nephrectomy for T2 tumors, focusing on major primary series reporting oncological and functional outcomes, as well as complication rates in the last 10 years.
RESULTS
Recent series have reported comparable oncological outcomes between partial nephrectomy and radical nephrectomy for ≥ T2 tumors. However, most of these studies are retrospective in design with small sample sizes. With regard to functional outcomes, partial nephrectomy outperforms radical nephrectomy. However, outcomes are dependent on the amount of residual renal parenchyma left after partial nephrectomy for larger tumors. Partial nephrectomy is associated with an increased rate of complications when compared to radical nephrectomy, but in experienced hands this increase tends to remain at an acceptable level. There are few studies that have investigated the role of minimally invasive surgery (MIS) in the setting of T2 tumors. Although MIS techniques may be underutilized for management of T2 tumors, it is a feasible approach in highly selected patients.
CONCLUSIONS
Partial nephrectomy has emerged as an acceptable alternative for surgical management of T2 renal tumors over the last decade. Nephron-sparing surgery demonstrates similar oncological outcomes compared to radical nephrectomy and can be considered even for larger tumors in carefully selected patients whenever feasible.
Topics: Humans; Kidney Neoplasms; Neoplasm Staging; Nephrectomy; Postoperative Complications; Recovery of Function; Treatment Outcome
PubMed: 28436354
DOI: No ID Found