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Medicine Jan 2021Partial nephrectomy (PN) has been established as the standard treatment for T1 renal tumors, and postoperative hemorrhage due to vascular complications is a rare but...
Partial nephrectomy (PN) has been established as the standard treatment for T1 renal tumors, and postoperative hemorrhage due to vascular complications is a rare but potentially life-threatening complication reported after PN. Thus, this study evaluated the imaging and surgical factors associated with postoperative hemorrhage after PN and the clinical results of trans-arterial embolization. A retrospective review of the institutional PN database was performed from May 2012 to January 2019, revealing that we performed 810 PN procedures at our institution. In total, 12 patients were referred to the interventional radiology department for vascular complications after the procedure. Patients with and without transarterial embolization (TAE) were age- and sex-matched with 56 patients. Preoperative imaging characteristics and operative details were considered. Univariable and multivariable analyses were used to test their eventual association with the occurrence of hemorrhage. Furthermore, renal functions at diagnosis, after operation or embolization for TAE cases, and at the last follow-up were recorded. A diagnosis of hemorrhage was made at a median of 4 (range, 0-25) days after surgery. The majority of patients (50%) presented with gross hematuria. T test revealed higher renal tumor-parenchyma contact area (TPA) (P = .0407), Length-A (P = .0136), Length-P (P = .0267), operation time (P = .0214) and estimated blood loss (P = .0043) in patients with hemorrhage than in controls. Binary logistic regression analysis identified TPA (P = .048) and estimated blood loss (P = .042) as independent predictors for postoperative hemorrhage with an area under the ROC curve of 0.705 (64% sensitivity and 79% specificity). In conclusion, the occurrence of hemorrhage after PN was associated with a larger TPA and more estimated blood loss during the procedure. In patients who underwent selective TAE, renal function remained comparable with that of controls.
Topics: Computed Tomography Angiography; Embolization, Therapeutic; Female; Humans; Male; Middle Aged; Nephrectomy; Postoperative Hemorrhage; Predictive Value of Tests; Vascular Surgical Procedures
PubMed: 33545932
DOI: 10.1097/MD.0000000000023581 -
Journal of Korean Medical Science May 2021To compare open partial nephrectomy (OPN) and robot-assisted partial nephrectomy (RAPN) in the management of renal tumors larger than 4 cm. (Comparative Study)
Comparative Study
BACKGROUND
To compare open partial nephrectomy (OPN) and robot-assisted partial nephrectomy (RAPN) in the management of renal tumors larger than 4 cm.
METHODS
Clinical records of 220 patients who underwent OPN or RAPN for a single renal tumor ≥ 4.0 cm with a normal contralateral kidney were reviewed. After determining the propensity score, surgical parameters, functional outcomes, and oncological outcomes were compared between OPN (n = 67) and RAPN (n = 67) groups of patients.
RESULTS
The RAPN group had longer operation time (149.0 min vs. 173.3 min, = 0.030) and longer ischemic time (20.3 min vs. 29.4 min, = 0.001), but shorter hospital stay (8.2 days vs 6.0 days, = 0.001) than the OPN group. Estimated blood loss ( = 0.053), pain visual analog score at 1 day postoperatively ( = 0.194), and complications of grade III or higher ( = 0.403) were similar between OPN and RAPN groups. There was no radical conversion or positive surgical margin in either group. Mean change in 6-month estimated glomerular filtration rate was significantly better in the RAPN group (-8.2 vs. -3.1, = 0.027). There was no statistical difference in recurrence-free survival ( = 0.970) or cancer-specific survival ( = 0.345) between the two groups.
CONCLUSION
RAPN is a safe and feasible surgical modality comparable to OPN for managing renal tumors larger than 4 cm in terms of surgical, functional, and oncological outcomes.
Topics: Adult; Aged; Blood Transfusion; Carcinoma, Renal Cell; Female; Glomerular Filtration Rate; Humans; Kaplan-Meier Estimate; Kidney Neoplasms; Laparoscopy; Male; Middle Aged; Nephrectomy; Operative Time; Postoperative Complications; Propensity Score; Retrospective Studies; Robotic Surgical Procedures; Survival Rate; Treatment Outcome; Tumor Burden
PubMed: 34032028
DOI: 10.3346/jkms.2021.36.e135 -
Urologia Internationalis 2023To assess influencing factors on perinephric toxic fat (high Mayo Adhesive Probability [MAP] score) and the impact of high MAP scores on surgical complexity,...
INTRODUCTION
To assess influencing factors on perinephric toxic fat (high Mayo Adhesive Probability [MAP] score) and the impact of high MAP scores on surgical complexity, perioperative outcome, and surgical approach in patients with localized renal tumors undergoing open (OPN) and robot-assisted partial nephrectomy (RAPN).
METHODS
698 patients were included in this study. Based on preoperative imaging, adherent perinephric fat (APF) was assessed to define MAP scores. Regression analyses assessed influencing parameters for high MAP scores (≥3), predictors of surgical outcome, and influencing factors on surgical approach.
RESULTS
OPN was performed in 331 (47%) patients, and 367 (53%) patients underwent RAPN. Male gender (p < 0.001), age ≥65 (p < 0.001), and BMI ≥27.4 kg/m2 (p < 0.001) showed to be significantly influencing factors for the presence of APF. High MAP scores showed to be an influencing factor for a prolonged surgery duration (OR = 1.68, 95% CI 1.22-2.31, p = 0.002) and a significant predictor to rather undergo OPN than RAPN (OR = 1.5, 95% CI 1.05-2.15, p = 0.027).
CONCLUSION
Older, male patients with high BMI scores have a higher risk for APF. The presence of APF increases surgery time and may have an impact on decision making regarding the preferred surgical approach.
Topics: Humans; Male; Kidney; Nephrectomy; Kidney Neoplasms; Adipose Tissue; Robotic Surgical Procedures; Treatment Outcome; Retrospective Studies
PubMed: 36423583
DOI: 10.1159/000527090 -
Current Opinion in Urology Jan 2010Partial nephrectomy has become the standard of treatment for renal tumors less than 4 cm in size. Recent reports have even applied this technique for T1b lesions as... (Review)
Review
PURPOSE OF REVIEW
Partial nephrectomy has become the standard of treatment for renal tumors less than 4 cm in size. Recent reports have even applied this technique for T1b lesions as well. With advancement in minimally invasive techniques, laparoscopic and robotic surgeries are performed with the advantage of decreased morbidity while maintaining the same oncologic principles as those of open surgery.
RECENT FINDINGS
Feasibility studies confirmed that robot-assisted partial nephrectomy can be performed safely. Short-term outcomes are similar to those of laparoscopic and open partial nephrectomy. Complex renal tumors, such as hilar and endophytic lesions, have also been performed robotically.
SUMMARY
Robot-assisted partial nephrectomy is feasible with short-term results comparable to those of open and laparoscopic surgery. With challenges of pure laparoscopic surgery, robotic assistance may provide more opportunities for minimally invasive nephron-sparing surgery.
Topics: Humans; Laparoscopy; Nephrectomy; Nephrons; Robotics
PubMed: 19898240
DOI: 10.1097/MOU.0b013e3283337b76 -
BMC Urology Oct 2023Acute kidney disease (AKD) is believed to be involved in the transition from acute kidney injury (AKI) to chronic kidney disease in general populations, but little is...
PURPOSE
Acute kidney disease (AKD) is believed to be involved in the transition from acute kidney injury (AKI) to chronic kidney disease in general populations, but little is understood about this possibility among kidney surgical populations. This study aimed to elucidate the incidence of AKD after partial nephrectomy and risk factors that promote the AKI to AKD transition.
METHODS
From January 2010 to January 2020, this study retrospectively collected a dataset of consecutive patients with renal masses undergoing partial nephrectomy in 4 urological centers. Cox proportional regression analyses were adopted to identify risk factors that promoted the AKI to AKD transition. To avoid overfitting, the results were then verified by logistic least absolute shrinkage and selection operator (LASSO) regression. A nomogram was then constructed and validated for AKI to AKD transition prediction.
RESULTS
AKI and AKD occurred in 228 (21.4%) and 42 (3.9%) patients among a total of 1062 patients, respectively. In patients with AKI, multivariable Cox regression analysis and LASSO regression identified that age (HR 1.078, 1.029-1.112, p < 0.001), baseline eGFR (HR 1.015, 1.001-1.030, p < 0.001), RENAL score (HR1.612, 1.067-2.437, p = 0.023), ischemia time > 30 min (HR 7.284, 2.210-23.999, p = 0.001), and intraoperative blood loss > 300ml (HR 8.641, 2.751-27.171, p < 0.001) were risk factors for AKD transition. These five risk factors were then integrated into a nomogram. The nomogram showed excellent discrimination, calibration, and clinical net benefit ability.
CONCLUSION
Around 3.9% patients following partial nephrectomy would transit from AKI to AKD. Intraoperative blood loss and ischemia time need to be diminished to avoid on-going functional decline. Our nomogram can accurately predict the transition from AKI to AKD.
Topics: Humans; Retrospective Studies; Blood Loss, Surgical; Acute Kidney Injury; Nephrectomy; Risk Factors; Acute Disease; Ischemia
PubMed: 37794388
DOI: 10.1186/s12894-023-01325-3 -
The Journal of Urology Jun 2008The prognostic significance and optimal management of positive surgical margins following partial nephrectomy remain ill-defined. We combine data from 2 tertiary care...
PURPOSE
The prognostic significance and optimal management of positive surgical margins following partial nephrectomy remain ill-defined. We combine data from 2 tertiary care intuitions, and report predictors of positive surgical margins and long-term oncological outcomes for patients with positive surgical margins.
MATERIALS AND METHODS
Clinical, pathological and followup data on 1,344 patients undergoing 1,390 partial nephrectomies for kidney cancer were analyzed. Patients with positive surgical margins on final pathology were treated expectantly. Univariate and multivariable logistic regression models were fit to determine clinicopathological features associated with positive surgical margins. The Kaplan-Meier method was used to estimate freedom from local disease recurrence and metastatic progression. Cox proportional hazards models were used to assess whether positive surgical margin predicted local recurrence or metastatic disease adjusting for tumor size, pathological stage, histological subtype and presence of a solitary kidney.
RESULTS
Positive surgical margins were documented in 77 cases (5.5%). Decreasing tumor size and presence of a solitary kidney carried a significantly higher risk of positive surgical margins. The overall 10-year probability of freedom from local disease recurrence was 93% (95% CI 89, 95) and from metastatic progression 93% (95% CI 90, 95), with no significant difference between patients with positive vs negative margins (p = 0.97 and 0.18, respectively). Positive surgical margins were not associated with an increased risk of local recurrence or metastatic disease.
CONCLUSIONS
Positive surgical margins in partial nephrectomy specimens do not uniformly portend an adverse prognosis. While every effort should be taken to ensure clear margins, our data suggest that select patients with a positive surgical margin can be safely offered vigilant monitoring without compromising long-term disease-free survival.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Kidney Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Nephrectomy; Prognosis
PubMed: 18423758
DOI: 10.1016/j.juro.2008.01.100 -
Urologia Internationalis 2022Robot-assisted partial nephrectomy (RAPN) has been increasingly used for renal cell carcinoma in recent years. But the advantages of RARN over open partial nephrectomy... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Robot-assisted partial nephrectomy (RAPN) has been increasingly used for renal cell carcinoma in recent years. But the advantages of RARN over open partial nephrectomy (OPN) are still controversial.
METHODS
We searched the articles between 1997 and 2021 in PubMed, Web of Science, Cochrane Library, and EMbase databases. The parameters were perioperative outcomes including operating time (OT), warm ischemic time (WIT), estimated blood loss (EBL), positive surgical margin (PSM), preoperative and postoperative estimated glomerular filtration rate (eGFR), length of stay (LOS), and intraoperative and postoperative complications. Stata 13.0 software was used for the meta-analysis.
RESULTS
Seven studies with 2,646 patients (1,285 in RAPN vs. 1,361 in OPN) were included in the analysis. There were no significant differences in OT (WMD [95% confidence interval (CI)]: 0.14 [-0.33, 0.61], p = 0.570); WIT (WMD [95% CI]:0.28 [-0.13, 0.69], p = 0.187); PSM (odds ratio [OR] [95% CI]: 1.04 [0.37, 2.94], p = 0.944); preoperative eGFR (OR [95% CI]: 0.11 [-0.01, 0.23], p = 0.071); postoperative eGFR (OR [95% CI]: -0.11 [0.27, 0.04], p = 0.159); and intraoperative complications (OR [95% CI]: 0.13 [0.02, 1.04], p = 0.055) between 2 groups. But there were still less EBL (WMD [95% CI]: -0.67 [-1.07, -0.28], p = 0.001), shorter LOS (WMD [95% CI]: -1.09 [-1.86, -0.32], p = 0.005) and fewer postoperative complications (OR [95% CI]: 0.51 [0.38, 0.68], p = 0.000).
CONCLUSIONS
Compared with OPN, RAPN appears to achieve partly similar short-term functional outcomes. Meanwhile, some results are inconsistent with previous studies which seem to show that tumor type is also an important factor in comparison between RAPN and OPN, but the analysis is not carried out due to lack of complete data. Therefore, more high-quality random controlled trials are acquired.
Topics: Carcinoma, Renal Cell; Humans; Kidney Neoplasms; Margins of Excision; Nephrectomy; Postoperative Complications; Retrospective Studies; Robotic Surgical Procedures; Robotics; Treatment Outcome
PubMed: 35193139
DOI: 10.1159/000521881 -
Minerva Urologica E Nefrologica = the... Aug 2018There is no clear consensus as to the optimal method of entry in laparoscopic renal surgery and no reports have compared them in Urology. To analyze contemporary...
BACKGROUND
There is no clear consensus as to the optimal method of entry in laparoscopic renal surgery and no reports have compared them in Urology. To analyze contemporary practice patterns in entry technique and port placement for laparoscopic kidney surgery.
METHODS
We identified 60 high volume urological laparoscopic centers. A purpose-built questionnaire was sent to surgeons. The survey included 22 questions regarding access techniques and port configuration during laparoscopic kidney surgery. Data on were collected and retrospectively analyzed. Concordance among port configurations was assessed using Cohen's Kappa statistics.
RESULTS
The survey was sent to 60 surgeons and completed by 32 of them. Surgical procedures included were laparoscopic radical nephrectomy (1177 LRN/year) and laparoscopic partial nephrectomy (1047 LPN/year). The transperitoneal route was preferred (85%). Hasson technique was used for the access in 55% of the cases. Patient lateral recumbent position is the most frequently used during the port placement (41%). Although there is a high variability in the port positioning among the surgeons, in more than 90% of cases it was found a specific concordance in triangulation of optics and operating trocars. There were no significant differences between port configuration in LRN and LPN. Limitations include retrospective design and limited sample.
CONCLUSIONS
A standard port configuration has not been previously reported in urological literature. Our study suggests that the transperitoneal approach, the Hasson technique and a specific triangulation of optics and operating trocars have a significant concordance in some high volume laparoscopic urologic centers.
Topics: Health Care Surveys; Humans; Laparoscopy; Nephrectomy; Patient Positioning; Retrospective Studies; Surgeons
PubMed: 29969000
DOI: 10.23736/S0393-2249.18.03075-8 -
International Braz J Urol : Official... 2024Partial nephrectomies in the salvage setting after ablative or surgical therapy remain challenging cases that are underreported in the literature (1-5). The aim of this...
PURPOSE
Partial nephrectomies in the salvage setting after ablative or surgical therapy remain challenging cases that are underreported in the literature (1-5). The aim of this video is to demonstrate techniques for robotic salvage partial nephrectomy to manage recurrent renal cell carcinoma (RCC) after failed prior partial nephrectomy and primary cryotherapy.
MATERIALS AND METHODS
A 55-year-old man after previous robotic-assisted right partial nephrectomy presented with a 2.5 cm locally recurrent renal mass abutting the collecting system. A 59-year-old man with right renal cell carcinoma initially treated with cryoablation presented local recurrence. CT imaging demonstrated 2.6 cm right renal mass consistent with tumor recurrence at previous treatment site.
RESULTS
Both procedures were completed in under 180 minutes. Clamp time was 22 minutes after the previous partial nephrectomy and 25 minutes after previous cryotherapy. There were no perioperative complications. Pathology in both cases demonstrated pT1a clear cell RCC with negative margins. Both patients have since no evidence of recurrent disease on follow-up imaging at 1 and 2 years, respectively.
CONCLUSIONS
Salvage robotic partial nephrectomy should be considered as a feasible treatment option after failure of initial therapy-surgical or ablative. A salvage procedure is often more challenging than its standard therapy-naïve counterpart due to development of dense inflammation after previous interventions. Despite this, robotic partial nephrectomies in the salvage setting can be safely carried out with good surgical outcomes, particularly when utilizing intraoperative ultrasound to identify tumor margins and key anatomy.
Topics: Male; Humans; Middle Aged; Carcinoma, Renal Cell; Kidney Neoplasms; Robotic Surgical Procedures; Kidney; Nephrectomy; Treatment Outcome; Retrospective Studies
PubMed: 38598832
DOI: 10.1590/S1677-5538.IBJU.2024.0117 -
JAMA Surgery Oct 2021This cross-sectional study aims to develop validated models to estimate the probability of dialysis after nephrectomy and partial nephrectomy.
This cross-sectional study aims to develop validated models to estimate the probability of dialysis after nephrectomy and partial nephrectomy.
Topics: Aged; Cohort Studies; Female; Humans; Male; Middle Aged; Nephrectomy; Postoperative Complications; Predictive Value of Tests; Renal Dialysis; Renal Insufficiency; Risk Assessment
PubMed: 34232262
DOI: 10.1001/jamasurg.2021.2331