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Giornale Italiano Di Nefrologia :... Jun 2022Renal cell carcinoma (RCC) is the most common type of urogenital cancer. It has a mortality rate of 30-40% and is more commonly seen in men than women. In addition to... (Review)
Review
Renal cell carcinoma (RCC) is the most common type of urogenital cancer. It has a mortality rate of 30-40% and is more commonly seen in men than women. In addition to gender, other risk factors of RCC include obesity, hypertension, smoking, and chronic kidney disease. Following the improvements in diagnostic tests, such as CT and MRI imaging, the incidence of patients diagnosed with RCC has rapidly increased over the past decades. The most common type of RCC, based on histological and molecular subtypes, is clear cell carcinoma which occurs frequently due to mutations in the VHL gene. Nephron-sparing surgery is a selective technique to maintain kidneys in patients while radical nephrectomy and partial nephrectomy are used to remove small tumors. In addition to surgical approaches, adjuvant therapy and targeted therapy are applied in patients with metastatic RCC. In this review, we give an overview of the most recent research on RCC which would help physicians to better manage patients with RCC.
Topics: Carcinoma, Renal Cell; Combined Modality Therapy; Female; Humans; Kidney; Kidney Neoplasms; Male; Nephrectomy
PubMed: 35819037
DOI: No ID Found -
International Braz J Urol : Official... 2021
Topics: Carcinoma, Renal Cell; Humans; Kidney Neoplasms; Medical Oncology; Nephrectomy
PubMed: 33848069
DOI: 10.1590/S1677-5538.IBJU.2020.0149.1 -
International Journal of Surgery... Dec 2016Laparoscopic partial nephrectomy (LPN) compares favorably to traditional open nephron-sparing surgery (NSS) in terms of oncologic and surgical principles for kidney... (Review)
Review
Laparoscopic partial nephrectomy (LPN) compares favorably to traditional open nephron-sparing surgery (NSS) in terms of oncologic and surgical principles for kidney tumors. Studies have shown the modality to be feasible with similar oncologic efficacy and superior renal functional outcomes compared with laparoscopic radical nephrectomy (LRN) for tumors. The main advantages of LPN include marked improvements in estimated blood loss, decreased surgical site pain, shorter postoperative convalescence, better cosmesis, and nephron preservation. This review article evaluates the literature regarding LPN and discusses the main steps of the operation, the perioperative workup and management, surgical complications, and its role in the surgical management of kidney masses.
Topics: Humans; Kidney Neoplasms; Laparoscopy; Nephrectomy; Perioperative Care; Treatment Outcome
PubMed: 27109204
DOI: 10.1016/j.ijsu.2016.04.028 -
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 -
Urologia Internationalis 2020Laparoscopic partial nephrectomy and robot-assisted partial nephrectomy are attracting increased attention from urologists. They can achieve the same effect of oncology... (Review)
Review
Laparoscopic partial nephrectomy and robot-assisted partial nephrectomy are attracting increased attention from urologists. They can achieve the same effect of oncology control as radical nephrectomy; moreover, they can offer better preservation of renal function, thus obtaining long-term living benefits. The indications are also expanding, making it possible for larger and more difficult tumors. Laparoscopic partial nephrectomy and robot-assisted partial nephrectomy can be performed by transperitoneal and retroperitoneal approaches, with their individual advantages and limitations. In addition, the renal tumor scoring systems have been widely used and studied in laparoscopic partial nephrectomy and robot-assisted partial nephrectomy. In -order to better preserve renal function, the zero-ischemia technique is widely used. The application of intraoperative imaging technology provides convenience and greater benefits. Besides, whether minimal invasive partial nephrectomy can be performed without stop antiplatelet treatment is still disputed. Clinicians perform substantial exploration and practice to achieve the "trifecta" of surgery: complete resection of the tumor, maximum protection of renal function, and no complications.
Topics: Carcinoma, Renal Cell; Humans; Kidney Neoplasms; Laparoscopy; Nephrectomy; Robotic Surgical Procedures
PubMed: 32759603
DOI: 10.1159/000508519 -
Annals of Transplantation Oct 2020BACKGROUND The treatment of complex tumors in non-functioning renal transplants requiring surgical extirpation is challenging. Here, we report the largest series of...
BACKGROUND The treatment of complex tumors in non-functioning renal transplants requiring surgical extirpation is challenging. Here, we report the largest series of patients who underwent transplant radical nephrectomy for renal cell carcinoma (RCC) and transplant radical nephroureterectomy for urothelial cell carcinoma (UCC) in their transplanted kidneys. MATERIAL AND METHODS From 2004 to 2018, 10 patients underwent transplant radical nephrectomy (7 patients) and nephroureterectomy (3 patients). Retrospective analyses, in terms of complications, oncological recurrence, and survival, of peri-operative and long-term outcomes, were performed. RESULTS Out of the 10 patients, 7 had RCC and 3 had UCC. No intraoperative mortality occurred. Three patients presented with Clavien-Dindo grade IIIa or greater within 30 days of surgery. Two patients died within 60 days of surgery, both due to vascular events: one due to myocardial infarction and one due to stroke. Two other patients died: one after 2.9 years, due to myocardial infarction, and the other after 6 years, due to unknown reasons. At the 7-year follow-up, there was a 60% overall survival rate. For all patients, average survival post-nephrectomy was approximately 4.5 years, including the 6 living patients and 4 deceased patients. Importantly, there was no observed cancer recurrence. CONCLUSIONS This study reports outcomes of the largest series of transplant radical nephrectomy and nephroureterectomy for malignancies of renal allografts. In the optimized setting, extirpative surgeries appear safe, with favorable long-term oncological and survival outcomes.
Topics: Female; Humans; Kidney Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Nephrectomy; Nephroureterectomy; Retrospective Studies; Survival Analysis; Treatment Outcome; Ureteral Neoplasms
PubMed: 33093437
DOI: 10.12659/AOT.925865 -
Cancer Control : Journal of the Moffitt... Jul 2015Minimally invasive surgical techniques have revolutionized the surgical management of kidney cancer. Current evidence suggests that the surgical developments gained by... (Review)
Review
BACKGROUND
Minimally invasive surgical techniques have revolutionized the surgical management of kidney cancer. Current evidence suggests that the surgical developments gained by traditional laparoscopy have been advanced by the robotic platform, particularly as it has been applied to techniques for nephron preservation.
METHODS
The medical literature from peer-reviewed journals was reviewed to evaluate the feasibility and efficacy of robotic-assisted surgery in the management of renal cell carcinoma. Particular attention was paid to studies comparing robotic-assisted surgery with more traditional surgical techniques. In this review, we have highlighted the evolution of robotic assistance for renal surgery as it pertains to renal oncology. The differing approaches to standard surgeries are discussed as well as current trends to improve perioperative outcomes.In addition, we have reviewed the application of robotic assistance to more complex cases and highlight technological advancements that have pushed the boundaries of surgical care.
RESULTS
Robotic-assisted renal surgery is effective for appropriately selected patients. Robotic-assisted radical nephrectomy provides equivalent outcomes to traditional open and laparoscopic approaches, albeit with added financial burden. Robotic-assisted partial nephrectomy - through either transperitoneal or retroperitoneal access - can provide superior outcomes to laparoscopic approaches due to several technical advantages,including improved instrument articulation.
CONCLUSIONS
Robotic assistance has transformed the delivery of surgical care to the patient with renal cell carcinoma. For renal surgery, morbidity and patient satisfaction are potentially improved when using robotic platforms compared with open and traditional laparoscopic approaches without compromising oncological control, and this is particularly true for nephron-sparing surgery.
Topics: Humans; Kidney Neoplasms; Nephrectomy; Robotic Surgical Procedures
PubMed: 26351884
DOI: 10.1177/107327481502200306 -
Scientific Reports Feb 2021We evaluated the recurrence after radical and partial nephrectomy in patients with RENAL nephrometry score [RENAL] ≥ 10. A total of 474 patients (radical... (Observational Study)
Observational Study
We evaluated the recurrence after radical and partial nephrectomy in patients with RENAL nephrometry score [RENAL] ≥ 10. A total of 474 patients (radical nephrectomy [RN, n = 236] & partial nephrectomy [PN, n = 238]) in a single tertiary referral institution from December 2003 to December 2019 were assessed. Functional outcomes, defined as estimated glomerular filtration rate changes, relapse pattern, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were evaluated using propensity score-matched analysis. The predictors of recurrence and survival were assessed by Cox-regression analysis. 44 patients in the RN group and 88 in the PN group were included without significant differences in preoperative clinical factors after matching. The PN patients achieved significantly higher renal function preservation rates (p < 0.001). There were five recurrences in RN and six in PN. The PN patients revealed 5-year RFS rate (86.8%), 5-year CSS rate (98.5%), and 5-year OS rate (98.5%) comparable to the RN patients (RFS: 88.7% [p = 0.780], CSS: 96.7% [p = 0.375], and OS: 94.3% [p = 0.248]). Patients with a body mass index (BMI) ≥ 23 had lower 5-year RFS rates (85.5%) and OS rates (95.6%) than those with BMI < 23 (RFS: 90.0% [p = 0.195], OS: 100% [p = 0.117]) without significance. The significant predictor of recurrence was the pathologic T stage (hazard ratio [HR] 3.99, 95% confidence [CI] 1.10-14.50, p = 0.036). The significant predictor of death was the R domain of the RENAL (HR 3.80, 95% CI 1.03-14.11, p = 0.046). PN, if technically feasible, could be considered to preserve renal function in patients with RENAL ≥ 10. Nonetheless, PN needs to be implemented with caution in some patients due to the higher potentiality for recurrence and poor survival.
Topics: Adult; Aged; Carcinoma, Renal Cell; Disease-Free Survival; Female; Glomerular Filtration Rate; Humans; Kidney Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Nephrectomy; Organ Sparing Treatments; Propensity Score; Proportional Hazards Models; Risk Assessment; Survival Rate
PubMed: 33536492
DOI: 10.1038/s41598-021-82700-8 -
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 -
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