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Minerva Urology and Nephrology Aug 2022The aim of this study was to test for differences in cancer specific mortality (CSM) rates between radical nephrectomy (RN) and partial nephrectomy (PN) in pT3a nmRCC...
BACKGROUND
The aim of this study was to test for differences in cancer specific mortality (CSM) rates between radical nephrectomy (RN) and partial nephrectomy (PN) in pT3a nmRCC patients.
METHODS
Within the surveillance, epidemiology, and end results database (2005-2016), 13,177 pT3a patients treated with either PN or RN were identified. Before and after 1:2 ratio propensity score (PS)-match between PN and RN patients, cumulative incidence plot and competing risks regression (CRR) were used to test differences in CSM and other cause mortality (OCM) rates.
RESULTS
Relative to PN (N.=1615, 22.5%), RN patients harbored higher tumor size (72 vs. 38 mm; >70 mm 51 vs.10%), of more aggressive histology, collecting duct (0.4 vs. 0.2%) and sarcomatoid (2.3 vs.0.8%), of higher grade (51.0 vs. 37.5%). After PS-matching and OCM adjustment, 5-year CSM was 3-fold higher after RN than PN (P<0.01). Similarly, after PS matching and CSM adjustment, also 5-year OCM rates were higher after RN (HR: 1.59, P=0.0003).
CONCLUSIONS
PN does not appear to compromise the oncological outcomes in patients with pT3a or high-grade renal masses when compared with RN. Therefore, these concerns should not deter a surgeon from attempting PN when otherwise technically feasible.
Topics: Carcinoma, Renal Cell; Humans; Kidney Neoplasms; Nephrectomy; Propensity Score; Treatment Outcome
PubMed: 35147387
DOI: 10.23736/S2724-6051.22.04680-8 -
Medicine Aug 2021Renal cell carcinoma is one common type of urologic cancers. It has tendencies to invade into the inferior vena cava (IVC) and usually requires an open surgery...
Renal cell carcinoma is one common type of urologic cancers. It has tendencies to invade into the inferior vena cava (IVC) and usually requires an open surgery procedure. High rates of operative complications and mortality are usually associated with an open surgery procedure. The recently emerged robot-assisted laparoscopic radical nephrectomy (RAL-RN) and IVC tumor thrombectomy have shown to reduce operative related complications in patients with renal cell carcinoma.This case series study aimed to summarize technical utilization, perioperative outcomes, and efficacies of RAL-RN and IVC tumor thrombectomy in our hospital. A retrospective analysis was performed on clinical data from 20 patients who underwent RAL-RN and IVC tumor thrombectomy from January 2017 to December 2019 in our department.Patients had a median age of 59 years (interquartile range [IQR], 46-68). Four patients had renal neoplasm on left side and 16 on right side. Nineteen patients underwent RAL-RN (level 0: n = 2) or RAL-RN with IVC thrombectomy (n = 17) (level I: n = 3; level II: n = 12; and level III: n = 3) and 1 patient was converted into an open surgery. The median operative time was 328 minutes (IQR, 221-453). The estimated median blood loss was 500 mL (IQR, 200-1200). The median size of removed renal carcinoma was 67 cm2 (IQR, 40-91); the length of IVC tumor thrombus was 5 cm (IQR, 3-7). The postsurgery hospital length of stay was 6 days (IQR, 5-7). The complications included intestinal obstruction (n = 1), lymphatic fistula (n = 1), heart failure (n = 1), and low hemoglobin level (n = 1). The outcomes for patients after 16 months (IQR, 11-21) follow-up were tumor-free (n = 10), tumor progression (n = 4), loss of contact (n = 1), and death (n = 5).We concluded that RAL-RN and IVC thrombectomy renders good safety profiles including minimal invasiveness, low estimated median blood loss, short hospitalization, low morbidity, and quick renal function recovery. The long-term efficacy needs a further investigation.
Topics: Aged; Carcinoma, Renal Cell; Female; Humans; Kidney Neoplasms; Laparoscopy; Male; Medical Records; Middle Aged; Neoplastic Cells, Circulating; Nephrectomy; Retrospective Studies; Robotic Surgical Procedures; Thrombectomy; Vena Cava, Inferior
PubMed: 34414942
DOI: 10.1097/MD.0000000000026886 -
Archivio Italiano Di Urologia,... Sep 2018Nephron-sparing surgery (NSS) is of one of the most studied fields in urology due to the balancing between renal function preservation and oncological safety of the... (Review)
Review
INTRODUCTION
Nephron-sparing surgery (NSS) is of one of the most studied fields in urology due to the balancing between renal function preservation and oncological safety of the procedure. Aim of this short review is to report the state of the art of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during robotassisted partial nephrectomy (RAPN).
MATERIAL AND METHODS
We performed a literature review by electronic database on Pubmed about the use of intra-operative US in RAPN to evaluate the usefulness and the feasibility of this procedure.
RESULTS
Several studies analyzed the use of different US probes during RAPN. Among them some focused on using contrastenhanced ultra sonography (CEUS) for improving the dynamic evaluation of microvascular structure allowing the reduction of ischemia time (IT). We reported that nowaday the use of intraoperative US during RAPN could be helpful to improve the preservation of renal tissue without compromising oncological safety. Moreover, during RAPN there is no need for assistant to hand the US probe increasing surgeon autonomy.
CONCLUSIONS
The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument during this key step of the partial nephrectomy procedure. Moreover US could be useful to reduce ischemia time (IT). The advantages of nephron-sparing surgery over radical nephrectomy is well established with a pool of data providing strong evidence of oncological and survival equivalency. With the progressive growth of robot-assisted partial nephrectomy (RAPN) techniques, the use of several tools has been progressively developed to help the surgeon in the identification of masses and its vascular net. In this short review we tried to analyze the current use of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during RAPN.
Topics: Carcinoma, Renal Cell; Humans; Intraoperative Care; Kidney Neoplasms; Nephrectomy; Nephrons; Organ Sparing Treatments; Robotic Surgical Procedures; Ultrasonography
PubMed: 30362686
DOI: 10.4081/aiua.2018.3.195 -
Journal of Endourology May 2005In properly selected patients, partial nephrectomy yields oncologic efficacy similar to that of traditional radical nephrectomy. We have performed more than 415...
In properly selected patients, partial nephrectomy yields oncologic efficacy similar to that of traditional radical nephrectomy. We have performed more than 415 laparoscopic radical nephrectomies over the 5-year period beginning in September 1999. All patients undergo a three-dimensional CT scan with 3-mm sections prior to the operation. We generally prefer the transperitoneal approach, although for posterior tumors, a retroperitoneal approach is preferred. The kidney is dissected using standard technique. Intraoperative hydration is given to maintain diuresis. Detailed real-time ultrasonographic delineation of the tumor is obtained to facilitate planning of the resection. We prefer en-bloc hilar clamping. The renal capsule is scored circumferentially with the "L" hook electrocautery. Parenchymal incision and tumor resection is performed using heavy reuseable scissors. The base of the resection defect is closed using a running 2-0 Vicryl on a CT-1 needle. The water-tightness of pelvicaliceal repair is tested by repeat gentle injection of indigo carmine through a ureteral catheter. Next, the parenchyma is closed with 1 Vicryl on a CTX needle placed over an oxidized cellulose bolster. The specimen is extracted within an entrapment bag. Initially, a surgeon should be highly selective, including patients with small, mostly exophytic, tumors. With increasing comfort and experience, the criteria can expand.
Topics: Hemostasis, Surgical; Humans; Imaging, Three-Dimensional; Intraoperative Care; Kidney Neoplasms; Laparoscopy; Nephrectomy; Preoperative Care; Tomography, X-Ray Computed; Ultrasonography
PubMed: 15910254
DOI: 10.1089/end.2005.19.451 -
Clinical Journal of the American... Mar 2022Urinary stone disease has been associated with inflammation, but the specific cell interactions that mediate events remain poorly defined. This study compared...
BACKGROUND AND OBJECTIVES
Urinary stone disease has been associated with inflammation, but the specific cell interactions that mediate events remain poorly defined. This study compared calcification and inflammatory cell patterns in kidney tissue from radical nephrectomy specimens of patients without and with a history of urinary stone disease.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
Nontumor parenchyma of biobanked radical nephrectomy specimens from age- and sex-matched stone formers (=44) and nonstone formers (=82) were compared. Calcification was detected by Yasue staining and inflammatory cell populations by immunohistochemistry for CD68 (proinflammatory M1 macrophages), CD163 and CD206 (anti-inflammatory M2 macrophages), CD3 (T lymphocytes), and tryptase (mast cells). Calcifications and inflammatory cells were quantified in cortex and medulla using Image-Pro analysis software.
RESULTS
Calcification in the medulla of stone formers was higher than in nonstone formers (<0.001). M1 macrophages in the cortex and medulla of stone formers were greater than in nonstone formers (<0.001), and greater in stone former medulla than stone former cortex (=0.02). There were no differences in age, sex, body mass index, tumor characteristics (size, stage, or thrombus), vascular disease status, or eGFR between the groups. M2 macrophages, T lymphocytes, and mast cells did not differ by stone former status. There was a correlation between M1 macrophages and calcification in the medulla of stone formers (rho=0.48; =0.001) and between M2 macrophages and calcification in the medulla of nonstone formers (rho=0.35; =0.001). T lymphocytes were correlated with calcification in the cortex of both nonstone formers (rho=0.27; =0.01) and stone formers (rho=0.42; =0.004), whereas mast cells and calcification were correlated only in the cortex of stone formers (rho=0.35; =0.02).
CONCLUSIONS
Higher medullary calcification stimulated accumulation of proinflammatory rather than anti-inflammatory macrophages in stone formers.
Topics: Female; Humans; Kidney Calculi; Male; Nephrectomy; Urinary Calculi
PubMed: 35078782
DOI: 10.2215/CJN.11730921 -
Minerva Urologica E Nefrologica = the... Feb 2020Recent evidence suggests that the "oldest old" patients might benefit of partial nephrectomy (PN), but decision-making for this subset of patients is still... (Comparative Study)
Comparative Study
BACKGROUND
Recent evidence suggests that the "oldest old" patients might benefit of partial nephrectomy (PN), but decision-making for this subset of patients is still controversial. Aim of this study is to compare outcomes of robotic partial (RPN) or radical nephrectomy (RRN) for large renal masses in patients older than 65 years.
METHODS
We identified 417≥65 years old patients who underwent RRN or RPN for cT1b or ≥cT2 renal mass at 17 high volume centers. Propensity score match analysis was performed adjusting for age, ASA≥3, pre-operative eGFR, and clinical tumor size. Predictors of complications, functional and oncological outcomes were evaluated in multivariable logistic and Cox regression models.
RESULTS
After propensity score analysis, 73 patients in the RPN group were matched with 74 in the RRN group. R.E.N.A.L. Score (9.6±1.7 vs. 8.6±1.7; P<0.001), and high complexity (56 vs. 15%; P=0.001) were higher in the RRN. Estimated blood loss was higher in the RPN group (200 vs. 100 mL; P<0.001). RPN showed higher rate of overall complications (38 vs. 23%; P=0.05), but not major complications (P=0.678). At last follow-up, RPN group showed better functional outcomes both in eGFR (55.4±22.6 vs. 45.7±15.7 mL/min; P=0.016) and lower eGFR variation (9.7 vs. 23.0 mL/min; P<0.001). The procedure type was not associated with recurrence free survival (RFS) (HR: 0.47; P=0.152) and overall mortality (OM) (0.22; P=0.084).
CONCLUSIONS
RPN in elderly patients with large renal masses provides acceptable surgical, and oncological outcomes allowing better functional preservation relative to RRN. The decision to undergo RPN in this subset of patients should be tailored on a case by case basis.
Topics: Aged; Blood Loss, Surgical; Cohort Studies; Female; Glomerular Filtration Rate; Humans; Kidney Function Tests; Kidney Neoplasms; Male; Nephrectomy; Propensity Score; Robotic Surgical Procedures; Survival Analysis; Treatment Outcome
PubMed: 31527571
DOI: 10.23736/S0393-2249.19.03583-5 -
TheScientificWorldJournal Jan 2007The only possibility for cure in localized renal cell carcinoma (RCC) is surgery. Open radical nephrectomy (RN), as described by Robson, has long been the gold standard.... (Review)
Review
The only possibility for cure in localized renal cell carcinoma (RCC) is surgery. Open radical nephrectomy (RN), as described by Robson, has long been the gold standard. Nevertheless, as a consequence of the increased use of abdominal imaging modalities, a continuing stage migration towards small, low-grade RCC lesions has become evident during the last decades. Together with this stage migration, nephron-sparing surgery (NSS), less-invasive therapies (laparoscopic RN and NSS), and minimally invasive therapies (radiofrequency ablation [RFA], cryoablation) have been developed and are gaining popularity. The value of laparoscopic RN and open NSS are acknowledged worldwide, but the value of laparoscopic NSS, RFA, and cryoablation remains to be established. Despite this evolution, there is still a place for open surgery for localized RCC. Open NSS is, at present, considered the standard of care for localized RCC less than 4 cm, while open RN still has a place for larger lesions, certainly when an extended lymph node dissection or adrenalectomy is warranted, or when a tumor thrombus is extending into the inferior vena cava. This review provides the data that support open surgery in clear, selected cases of RCC.
Topics: Carcinoma, Renal Cell; Catheter Ablation; Cryosurgery; Humans; Kidney Neoplasms; Laparoscopy; Minimally Invasive Surgical Procedures; Nephrectomy; Practice Guidelines as Topic; Practice Patterns, Physicians'
PubMed: 17619756
DOI: 10.1100/tsw.2007.142 -
Scandinavian Journal of Urology 2022Renal tumor biopsy was provided in patients candidate to radical nephrectomy for a renal mass ≥4 cm, to evaluate treatment deviation.
PURPOSE
Renal tumor biopsy was provided in patients candidate to radical nephrectomy for a renal mass ≥4 cm, to evaluate treatment deviation.
METHODS
Between 2008 and 2017, 102 patients with a solid renal mass ≥4 cm with no distant metastases underwent preliminary renal tumor biopsy. We investigated the proportion of patients who proceeded with radical nephrectomy, variables predicting non-renal cell carcinoma (RCC) and concordance between biopsy findings and definitive pathology.
RESULTS
Median tumor size was 70 mm (IQR 55-110). Clinical stage was cT1b in 41, cT2 in 33, cT3 in 25 and cT4 in three patients. A median of three (IQR 2-3) renal tumor biopsies were taken with 16/18 Gauge needles in 97% of cases. Clavien grade I complications occurred in five cases. Malignant tumors were documented in 84 patients: 78 RCCs and six non-RCCs. Fifteen biopsies documented oncocytoma and three were non-diagnostic. Grade was reported in 50 RCCs: 42 (84%) were low and eight (16%) high grade. Eighty-three patients proceeded with radical nephrectomy; six non-RCC malignant tumors underwent combined and/or intensified treatment; 13 of 15 patients with oncocytoma did not undergo radical nephrectomy (eight underwent observation). Definitive pathology confirmed diagnosis in all cases. Grade concordance was 84%, considering two tiers (high vs low grade). No preoperative clinical variable predicted definitive pathology.
CONCLUSIONS
Renal tumor biopsy is a safe procedure that leads to radical nephrectomy in most tumors ≥4 cm. Nonetheless, 20% of patients exhibited non-RCC histology. Renal tumor biopsy should be considered in this setting.
Topics: Humans; Adenoma, Oxyphilic; Kidney Neoplasms; Carcinoma, Renal Cell; Nephrectomy; Biopsy; Retrospective Studies
PubMed: 35766193
DOI: 10.1080/21681805.2022.2092549 -
BMC Nephrology May 2024Chronic kidney disease (CKD) is a common postoperative complication in patients who undergo radical nephrectomy for renal tumours. However, the factors influencing...
BACKGROUND
Chronic kidney disease (CKD) is a common postoperative complication in patients who undergo radical nephrectomy for renal tumours. However, the factors influencing long-term renal function require further investigation.
OBJECTIVE
This study was designed to investigate the trends in renal function changes and risk factors for renal function deterioration in renal tumour patients after radical nephrectomy.
METHODS
We monitored changes in renal function before and after surgery for 3 years. The progression of renal function was determined by the progression and degradation of CKD stages. Univariate and multivariate logistic regression analyses were used to analyse the causes of renal function progression.
RESULTS
We analysed the data of 329 patients with renal tumours who underwent radical nephrectomies between January 2013 and December 2018. In this study, 43.7% of patients had postoperative acute kidney injury (AKI), and 48.3% had CKD at advanced stages. Further research revealed that patients' renal function stabilized 3 months after surgery. Additionally, renal function changes during these 3 months have a substantial impact on the progression of long-term renal function changes in patients.
CONCLUSION
AKI may be an indicator of short-term postoperative changes in renal function. Renal function tests should be performed in patients with AKI after radical nephrectomy to monitor the progression of functional impairment, particularly within the first 3 months after radical nephrectomy.
Topics: Humans; Nephrectomy; Male; Kidney Neoplasms; Female; Middle Aged; Acute Kidney Injury; Renal Insufficiency, Chronic; Postoperative Complications; Aged; Disease Progression; Risk Factors; Glomerular Filtration Rate; Kidney; Retrospective Studies; Kidney Function Tests
PubMed: 38773467
DOI: 10.1186/s12882-024-03601-2 -
The Cochrane Database of Systematic... Mar 2016This review is being updated and replaced following the publication of a protocol (Krabbe L‐M, Kunath F, Schmidt S, Miernik A, Cleves A, Walther M, Kroeger N. Partial... (Meta-Analysis)
Meta-Analysis Review
This review is being updated and replaced following the publication of a protocol (Krabbe L‐M, Kunath F, Schmidt S, Miernik A, Cleves A, Walther M, Kroeger N. Partial nephrectomy versus radical nephrectomy for clinically localized renal masses [Protocol]. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD012045. DOI: 10.1002/14651858.CD012045) for a new review with a narrower scope. It will remain withdrawn when the new review is published. The editorial group responsible for this previously published document have withdrawn it from publication.
Topics: Adult; Carcinoma, Renal Cell; Humans; Kidney Neoplasms; Laparoscopy; Nephrectomy; Randomized Controlled Trials as Topic
PubMed: 26945259
DOI: 10.1002/14651858.CD006579.pub3