Hilar Tumors Research Articles

A Novel Classification System of Renal Hilar Tumors for Surgical Guidance: Technique, Outcome, and Safety.

This study was designed to develop an innovative classification and guidance system for renal hilar tumors and to assess the safety and effectiveness of robot-assisted partial nephrectomy (RAPN) for managing such tumors. A total of 179 patients undergoing RAPN for renal hilar tumors were retrospectively reviewed. A novel classification system with surgical techniques was introduced and the perioperative features, tumor characteristics, and the efficacy and safety of RAPN were compared within subgroups. We classified the tumors according to our novel system as follows: 131 Type I, 35 Type II, and 13 Type III. However, Type III had higher median R.E.N.A.L., PADUA, and ROADS scores compared with the others (all p < 0.001), indicating increased operative complexity and higher estimated blood loss [180.00 (115.00-215.00) ml]. Operative outcomes revealed significant disparities between Type III and the others, with longer operative times [165.00 (145.00-200.50) min], warm ischemia times [24.00 (21.50-30.50) min], tumor resection times [13.00 (12.00-15.50) min], and incision closure times [22.00 (20.00-23.50) min] (all p < 0.005). Postoperative outcomes also showed significant differences, with longer durations of drain removal (77.08 ± 18.16h) and hospitalization for Type III [5.00 (5.00-6.00) d] (all p < 0.05). Additionally, Type I had a larger tumor diameter than the others (p = 0.009) and pT stage differed significantly between the subtypes (p = 0.020). The novel renal hilar tumor classification system is capable of differentiating the surgical difficulty of RAPN and further offers personalized surgical steps tailored to each specific classification. It provides a meaningful tool for clinical practice.

Robot-assisted Partial Nephrectomy for Hilar and Nonhilar Renal Masses: Comparison of Perioperative, Oncological, and Functional Results in a Multicentre Prospective Cohort (NEPRAH Study, UroCCR 175)

Background and objectiveA hilar location for a renal tumour is sometimes viewed as a limiting factor for safe partial nephrectomy. Our aim was to evaluate perioperative, oncological, and functional outcomes of robot-assisted partial nephrectomy (RAPN) for hilar tumours (RAPN-H) in comparison to RAPN for nonhilar tumours (RAPN-NH). MethodsWe conducted an observational, multicentre cohort study using prospectively collected data from the French Research Network on Kidney Cancer (UroCCR). The registry includes data for 3551 patients who underwent RAPN for localised or locally advanced renal masses between 2010 and 2023 in 29 hospitals in France. We studied the impact of a hilar location on surgery, postoperative renal function, tumour characteristics, and survival. We also compared rates of trifecta achievement (warm ischaemia time [WIT] <25 min, negative surgical margins, and no perioperative complications) between the groups. Finally, we performed a subgroup analysis of RAPN without vascular clamping. Variables were compared in univariable analysis and using multivariable linear, logistic, and Cox proportional-hazards models adjusted for relevant patient and tumour covariates. Key findings and limitationsThe analytical population included 3451 patients, of whom 2773 underwent RAPN-NH and 678 underwent RAPN-H. Longer WIT (β = 2.4 min; p < 0.01), longer operative time (β = 11.4 min; p < 0.01) and a higher risk of postoperative complications (odds ratio 1.33; p = 0.05) were observed in the hilar group. Blood loss, the perioperative transfusion rate, postoperative changes in the estimated glomerular filtration rate, and trifecta achievement rates were comparable between the groups (p > 0.05). At mean follow-up of 31.9 mo, there was no significant difference in recurrence-free survival (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.58–1.2; p = 0.3), cancer-specific survival (HR 1.1, 95% CI 0.48–2.6; p = 0.79), or overall survival (HR 0.89, 95% CI 0.52–1.53; p = 0.69). Conclusions and clinical implicationsPatient and tumour characteristics rather than just hilar location should be the main determinants of the optimal surgical strategy for hilar tumours. Patient summaryWe found that kidney tumours located close to major kidney blood vessels led to a longer operation and a higher risk of complications during robot-assisted surgery to remove the tumour. However, tumours in these locations were not related to a higher risk of kidney function loss, cancer recurrence, or death.

Centrality angle is a novel nephrometry score to predict tumor complexity and perioperative outcomes for partial nephrectomy

To propose the centrality angle (C-angle) as a novel simple nephrometry score for the evaluation of tumor complexity and prediction of perioperative outcomes in nephron-sparing surgery (NSS) for renal tumors. The analysis was based on 174 patients who underwent robot-assisted partial nephrectomy retrospectively. C-angle was defined as the angle occupied by the tumor from the center of the kidney in the coronal CT images. Other nephrometry scores were calculated and compared with C-angle. Associations between C-angle and perioperative outcomes were examined. Significant differences were found in C-angle between tumors greater and less than 4 cm, exophytic and endophytic tumors, and hilar and non-hilar tumors. C-angle was correlated with other nephrometry scores, including RENAL, PADUA, and C-index. Significant positive correlations with WIT, operation time, and EBL, and significant negative correlations with preserved eGFR. C-angle could predict perioperative complications. Patients with a C-angle > 45° had worse perioperative outcomes, including longer operative time, longer WIT, lower rate of preserved eGFR, and complications. C-angle can be used to evaluate the complexity of renal tumors and predict perioperative outcomes. C-angle can potentially be used for decision-making in the treatment of patients and to guide surgical planning of NSS.

Nephron sparing surgery for renal hilar tumours: short-term follow-up of predominantly robot-assisted surgery cohort

BackgroundHilar tumours are the renal tumours, which abut the renal artery or vein. Nephron sparing surgery (NSS) is of proven benefit among those with small renal masses. Hilar tumours are usually offered radical surgery due to the presumed difficulty in dissection, upgrading to tumour stage, and risk of conversion to radical surgery. We present our results of patients with hilar tumour undergoing nephron sparing surgery.MethodsWe performed a retrospective analysis of patients who underwent NSS for renal hilar tumours in our tertiary referral institute from June 2017 to December 2022. The case sheets of all the patients who had undergone NSS were analysed and their radiology images reviewed. Those with hilar tumours were analysed based on demographic characters, perioperative and postoperative and follow-up details.ResultsAmong a total of 21 patients undergoing partial nephrectomy, ten had hilar tumours. The median age was 43 years. Nine patients had robot-assisted partial nephrectomy and one underwent open partial nephrectomy. Seven patients had incidentally detected tumours. One had Grade 3 chronic kidney disease. The mean operative time and robot console time were 225 and 125 min, respectively. Median warm ischaemia time (WIT) was 36 min (25–48 min). One patient had grade 2 complication and two had grade 3 complication. Eight had clear cell renal cell carcinoma and one had positive margin. None had recurrence at a median follow-up of 38 months.ConclusionNephron sparing surgery, especially with robot-assisted approach, is feasible in hilar tumours with prognosis and complications similar to non-hilar tumours in short-term follow-up.

Single center experience using stereotactic body radiation therapy (SBRT) on orthotopic liver transplant protocol for unresectable cholangiocarcinoma

PurposeTo evaluate tolerability, pathologic response, and disease outcomes utilizing pre-operative stereotactic body radiation therapy (SBRT) followed by consolidation chemotherapy (CHT) prior to orthotopic liver transplant (OLT) in unresectable cholangiocarcinoma (CCA). MethodsThis was a retrospective chart review of patients treated on OLT protocol at a single tertiary center from 2012 to 2019. Patients received pre-operative SBRT (40–50 Gy in 5 fractions) followed by CHT until progression or OLT. Progression-free survival (PFS) and overall survival (OS) were compared via log-rank test and Cox proportional hazards regression. Results26 patients (84.6% hilar, 15.4% intrahepatic) were identified for analysis. Eight patients (30.8%) patients developed acute toxicity after SBRT, mostly grade 1 nausea. Nine (34.6%) patients underwent OLT of which 4 (44.4%) achieved a pathologic complete response (pCR). Five (55.6%) OLT patients, including 2 pCR, developed recurrence at a median time of 49.9 weeks after OLT. 3-year OS for the OLT and dropout cohort was 75% and 9%, respectively (p < 0.0001). OS in hilar tumors only was statistically different for those that achieved a pCR (p = 0.014). ConclusionsPre-operative SBRT is a well-tolerated and effective radiation technique as part of OLT protocol for unresectable CCA and conferred in a pCR rate of 44% within our cohort.

Trans-retro-peritoneal laparoscopic partial nephrectomy for posterior hilar tumor: technical feasibility and preliminary results.

Urologists still encounter challenges when it comes to the surgical management of tumors located on the posterior lip and posterior renal hilar region. We propose a trans-retro-peritoneal (TRP) technique to address the difficulties associated with posterior hilar tumors during retroperitoneal laparoscopic partial nephrectomy (LPN). Its efficacy was evaluated in a retrospective case-control study. The patients with posterior hilar tumors (≤7 cm) that underwent retroperitoneal LPN were included. The TRP technique allowed the posterior hilar tumor completely visible by incising the ventral peritoneum and rotating kidney ventrally during retroperitoneal LPN, which was applied in 36 cases, while the conventional retroperitoneal LPN was performed in 22 cases. Perioperative data were analyzed to evaluate the efficacy of TRP-LPN. In TRP-LPN group, the TRP technique was successfully performed in all the patients without converting to open surgery or radical nephrectomy. The warm ischemia time was significantly shorter in TRP-LPN group than conventional LPN group (20.3 vs. 28.5 min, P<0.001). Furthermore, the mean estimated blood loss in TRR-LPN group was significantly less than that in conventional LPN group (86.5 vs. 90.9 mL, P<0.05). The mean operation time and recovery time of gastrointestinal function were similar between two groups. No severe complications occurred, and no positive surgical margin was found. The rate of Trifecta achievement was 50.0% (18/36) and 31.8% (7/22) respectively for TRP-LPN and conventional LPN (P=0.175). After mean follow-up of 21 months, no recurrence or metastasis occurred in all cases. Our findings, as demonstrated by the Trifecta outcomes, support the feasibility and efficacy of TRP-LPN in managing posterior renal hilar tumors. This approach may be considered as an efficient option for surgical management of such tumors.

ASO Author Reflections: Microwave Ablation-Assisted Clampless and Sutureless Technique for Renal Hilar Tumors.

ASO Author Reflections: Microwave Ablation-Assisted Clampless and Sutureless Technique for Renal Hilar Tumors.

VE68 - Robot assisted partial nephrectomy using intra-arterial renal hypothermia for highly complex endophytic or hilar tumors: Case series and description of surgical technique

VE68 - Robot assisted partial nephrectomy using intra-arterial renal hypothermia for highly complex endophytic or hilar tumors: Case series and description of surgical technique

Off-clamp robot-assisted partial nephrectomy for renal hilar tumors.

Off-clamp robot-assisted partial nephrectomy for renal hilar tumors.

Diabetes, Obesity, and Pathological Upstaging in Renal Cell Carcinoma: Results From a Large Multi-institutional Consortium.

We sought to determine whether clinical risk factors and morphometric features on preoperative imaging can be utilized to identify those patients with cT1 tumors who are at higher risk of upstaging (pT3a). We performed a retrospective international case-control study of consecutive patients treated surgically with radical or partial nephrectomy for nonmetastatic renal cell carcinoma (cT1 N0) conducted between January 2010 and December 2018. Multivariable logistic regression models were used to study associations of preoperative risk factors on pT3a pathological upstaging among all patients, as well as subsets with those with preoperative tumors ≤4 cm, renal nephrometry scores, tumors ≤4 cm with nephrometry scores, and clear cell histology. We also examined association with pT3a subsets (renal vein, sinus fat, perinephric fat). Among the 4,092 partial nephrectomy and 2,056 radical nephrectomy patients, pathological upstaging occurred in 4.9% and 23.3%, respectively. Among each group independent factors associated with pT3a upstaging were increasing preoperative tumor size, increasing age, and the presence of diabetes. Specifically, among partial nephrectomy subjects diabetes (OR=1.65; 95% CI 1.17, 2.29), male sex (OR=1.62; 95% CI 1.14, 2.33), and increasing BMI (OR=1.03; 95% CI 1.00, 1.05 per 1 unit BMI) were statistically associated with upstaging. Subset analyses identified hilar tumors as more likely to be upstaged (partial nephrectomy OR=1.91; 95% CI 1.12, 3.16; radical nephrectomy OR=2.16; 95% CI 1.44, 3.25). Diabetes and higher BMI were associated with pathological upstaging, as were preoperative tumor size, increased age, and male sex. Similarly, hilar tumors were frequently upstaged.

Application of three-dimensional reconstruction of renal tumor vessels to guide laparoscopic partial nephrectomy of hilar tumors and non-hilar tumors under zero ischemia

ObjectiveTo investigate the safety and efficacy of three-dimensional reconstruction of renal tumor vessels to guide laparoscopic partial nephrectomy of hilar tumors and non-hilar tumors under zero ischemia. MethodsThe clinical data of 82 patients with renal cancer who underwent zero ischemia retroperitoneal laparoscopic partial nephrectomy in the department of urology of our hospital from January 2018 to January 2021 were retrospectively reviewed. The patients were divided into hilar group and non-hilar group. The clinical data of all patients were statistically analyzed by t-test or χ2. ResultsThere was no significantly difference in gender, age, tumor diameter and pathological stage between hilar and non-hilar tumor group. Most of the target vessels in the hilar tumor group were single targets, while most of the target vessels in the non-hilar tumor group were multiple targets (P<0.05). There was no significantly difference between the groups for mean operative time and length of stay. But hilar tumor group had significantly longer operation time (109.3 ± 9.2 vs. 90.3 ± 9.5 min, p<0.001). There was no significant difference in renal GFR and serum creatinine between the two groups. Hilar tumor group had no significantly difference of change of creatinine and GFR at post-operative 6 and 12 months as compared with non-hilar tumor group. There were no bleeding, urinary leakage, infection and other related complications in the two groups after 1 month follow-up. After 12 months of follow-up, there was no tumor recurrence and metastasis in the two groups. ConclusionThe application of three-dimensional renal tumor vascular reconstruction technology can better realize laparoscopic zero ischemia nephron sparing surgery. The target vessels of patients with hilar, single and early renal cancer are easier to find, which is more suitable for three-dimensional renal tumor vascular reconstruction technology to implement laparoscopic zero ischemia nephron sparing surgery.

Vascular injury during laparoscopic partial nephrectomy in a solitary kidney: management, outcome and audit

BackgroundVascular injury during laparoscopic partial nephrectomy is a dreadful complication. Though it is a commonly discussed complication, the literature on the circumstances leading to vascular injury, methods of managing the complication and reporting of final outcomes in those cases are limited. We report a case of vascular injury during laparoscopic partial nephrectomy for a hilar tumor in a solitary kidney. We highlight the management of the complication, present the outcome and review the surgical technique.Case presentationA 62-year-old male with solitary kidney presented with left renal hilar mass of size 4.4 × 3.8x3.6 cm. The renal nephrometry score was 10ph. The serum creatinine at the time of presentation to the hospital was 1.4 mg/dl. Laparoscopic partial nephrectomy was performed. The patient had severe intraoperative bleeding due to a segmental renal artery injury. The bleeding presented after hilar unclamping and was managed by intracorporeal vascular repair. The blood loss was around 500 ml. The postoperative period was uneventful without the need for hemodialysis. The histopathology report was suggestive of clear cell renal cell carcinoma with negative surgical margin. The follow-up magnetic resonance urogram did not show evidence of any arterial pseudoaneurysm or residual/recurrent tumor. At 18-month follow-up, the serum creatinine was 1.9 mg/dl and the patient did not have any complaints.ConclusionsComplication of vascular injury while performing laparoscopic partial nephrectomy for complex hilar tumors should be anticipated beforehand. Contingency plans to tackle this complication must be in place before attempting the surgery. Intracorporeal repair of vascular injury during laparoscopic partial nephrectomy is feasible when expertise is available. Low threshold for using endoscopic ultrasound, employing cold ischemia techniques, careful usage of hot cut during tumor resection and complete defatting of the kidney can all be considered ‘safe surgical practices’ during laparoscopic partial nephrectomy for complex hilar tumors. Following aforementioned ‘safe surgical practices’ helps in improving the outcomes and reducing the possibility of complication of vascular injury and helps in managing the complication effectively if it happens despite the precautions.

Can preoperative planning using IRIS™ three-dimensional anatomical virtual models predict operative findings during robot-assisted partial nephrectomy?

ObjectiveTo evaluate the predictive validity of IRIS™ (Intuitive Surgical®, Sunnyvale, CA, USA) as a planning tool for robot-assisted partial nephrectomy (RAPN) by assessing the degree of overlap with intraoperative execution. MethodsThirty-one patients scheduled for RAPN by four experienced urologists were enrolled in a prospective study. Prior to surgery, urologists reviewed the IRIS™ three-dimensional model on an iphone Operating System (iOS) app and completed a questionnaire outlining their surgical plan including surgical approach, and ischemia technique as well as confidence in executing this plan. Postoperatively, questionnaires assessing the procedural approach, clinical utility, efficiency, and effectiveness of IRIS™ were completed. The degree of overlap between the preoperative and intraoperative questionnaires and between the planned approach and actual execution of the procedure was analyzed. Questionnaires were answered on a 5-point Likert scale and scores of 4 or greater were considered positive. ResultsMean age was 65.1 years with a mean tumor size of 27.7 mm (interquartile range 17.5–44.0 mm). Hilar tumors consisted of 32.3%; 48.4% of patients had R.E.N.A.L. nephrometry scores of 7–9. On preoperative questionnaires, the surgeons reported that in 67.7% cases they were confident that they can perform the procedure successfully, and on intraoperative questionnaires, the surgeons reported that in 96.8% cases IRIS™ helped achieve good spatial sensation of the anatomy. There was a high degree of overlap between preoperative and intraoperative questionnaires for the surgical approach, interpreting anatomical details and clinical utility. When comparing plans for selective or off-clamp, the preoperative plan was executed in 90.0% of cases intraoperatively. ConclusionA high degree of overlap between the preoperative surgical approach and intraoperative RAPN execution was found using IRIS™. This is the first study to evaluate the predictive accuracy of IRIS™ during RAPN by comparing preoperative plan and intraoperative execution.

How far has robot-assisted partial nephrectomy reached?

Nephron-sparing surgery is the standard treatment for small renal mass (SRM). Nephron-sparing surgery has evolved from an open to a minimally invasive technique. Robot-assisted partial nephrectomy (RAPN) is the latest technique in this field and is reported to be safe and feasible, showing oncologically and functionally superior or compatible results compared with open and laparoscopic partial nephrectomy for SRM. This is not limited to only SRM but also applies to large and complex renal masses and other challenging situations. RAPN showed good oncological and functional outcomes for ≥clinical T2 renal tumors, complex renal masses (PADUA score ≥10, RENAL score ≥10), hilar renal tumors, and multiple renal tumors. In addition, the outcomes of RAPN in these challenging cases were not inferior to those in conventional cases. RAPN could also be applied to a number of challenging cases in which the open technique was considered first. RAPN showed good results in patients with a solitary kidney, horseshoe kidney, and in repeat surgeries. Furthermore, RAPN could be safely performed on obese, elderly, and pediatric patients. Finally, this review evaluates efficiency and utility of RAPN based on the results of challenging cases of renal masses and to project the future of RAPN.

Patterns of Recurrence and Progression for Unresectable Cholangiocarcinoma on Orthotopic Liver Transplant Protocol

<h3>Purpose/Objective(s)</h3> Neoadjuvant radiotherapy and chemotherapy (CHT) followed by orthotopic liver transplant (OLT) offers the highest chance of disease-free survival for patients with unresectable cholangiocarcinoma (CCA). The purpose of this study was to evaluate patterns of disease recurrence and progression in patients treated on OLT protocol. <h3>Materials/Methods</h3> Through retrospective chart review, we identified patients treated on institutional OLT protocol for unresectable intrahepatic or hilar CCA at a single academic institution from 2012-2019. Patients received SBRT to a total dose of 40 Gy in 5 fractions, delivered over 7-12 days followed by adjuvant CHT (gemcitabine/cisplatin, fluorouracil [5FU] or a capecitabine based regimen). Per protocol, restaging scans were obtained every 3 months until progression or OLT. <h3>Results</h3> Of 26 patients treated on protocol, nine underwent OLT (34.6%), of which six were male (66.7%), median age 51 (36-66), eight hilar tumors (88.9%), one intrahepatic (11.1%), and median size 2.85 cm (2.2-4.3). All patients were treated to 40 Gy in five fractions with a median PTV of 66.6 cc (30.4-202) and median time of 20.4 weeks (8.7-89.1) on adjuvant CHT. Median time from completion of SBRT to OLT was 61.4 weeks (26.6-97.6). Following OLT, four of nine (44.4%) achieved a pathologic complete response (ypT0) in the explanted liver, of which two patients developed recurrence (one at the porta hepatis, one in the lung). Five of nine OLT patients (55.6%) developed recurrent disease (three local, one local and distant, one distant) with median time to recurrence of 49.9 weeks (35.9-127.7) and median time to death of 124.0 weeks (39.3-200.9). Four patients remain in remission with median follow-up of 166.1 weeks (2.4-370.7). 17/26 patients did not proceed to OLT due to disease progression in 13 (10 local, 3 distant), with a median time to progression after SBRT of 37.0 weeks (3.7-81.4), death following recurrent cholangitis in three, and liver failure in one. Median OS for patients who underwent OLT versus those who did not was 172.2 (135.3-285.0) and 78.4 (26.1-219.6) weeks, respectively. <h3>Conclusion</h3> In this small group of patients with unresectable CCA treated with SBRT, CHT, and OLT, there were encouraging rates of pathologic complete response; however, a subset of patients will still develop disease recurrence. All patients who did not make it to OLT developed progression, illustrating a continued unmet need to improve therapeutic options for CCA.

S1802 Obstructive Jaundice Secondary to Hepatic Hilar Tuberculosis

Introduction: Tuberculosis is an infectious disease caused by mycobacterium tuberculosis. It usually involves the lung, but extrapulmonary involvement is not uncommon. Hepatobiliary tuberculosis is a rare form of extrapulmonary tuberculosis that can be mistaken for hepatic hilar malignant tumors. Case Description/Methods: A 38-year-old gentleman, originally from India, presented to the hospital with right upper quadrant pain for 10 days that was associated with itching, and dark urine; he had no history of fever or weight loss. He was a cigarette smoker but has no history of alcohol drinking; he was not taking any medications. On examination, he was vitally stable. His sclera was icteric, and his abdomen was soft with no tenderness. His laboratory investigations were remarkable for direct hyperbilirubinemia with elevated AST, ALT, and ALP (Table). His ultrasound abdomen showed mildly prominent central intrahepatic biliary duct and prominent upper CBD (measuring 9 mm) with no obvious cholelithiasis. Magnetic resonance cholangiopancreatography (MRCP) showed narrowing in the CBD with a cluster of necrotic conglomerate peripancreatic lymph nodes. Endoscopic ultrasound (EUS) demonstrated a 24x19 mm lesion that is adjacent to the pancreatic head and neck, at the liver hilum, compressing the proximal CBD (Figure). EUS-guided fine-needle biopsy showed necrotizing granulomatous inflammation. TB PCR and culture from the same lesion were positive, and the patient was started on an anti-TB medication regimen. Discussion: Extrapulmonary tuberculosis can be associated with pulmonary tuberculosis or occur in an isolated form. The absence of constitutional and pulmonary symptoms makes the diagnosis more challenging. Few cases reported compression of the common bile duct due to tubercular hilar adenopathy leading to obstructive jaundice. In such cases, the endoscopic ultrasound plays an important role in obtaining a tissue biopsy to establish the diagnosis and to exclude malignant hepatic hilar tumors that can present in a similar fashion.Figure 1.: Endoscopic ultrasound images showing the tuberculous lymphadenopathy in close proximity to the common bile duct. Table 1. - Laboratory investigations Laboratory test Patient's value Normal range WBC 6.50 × 109/L 4.5 - 11 Hgb 15.3 gm/dL 13.0 - 17.0 Platelet 298 × 109/L 150 - 400 Creatinine 1 mg/dL 0.7 to 1.3 Total bilirubin 79.70 µmol/L 3.50 - 24 Direct 46.30 µmol/L 0.0 - 5.10 ALT 478.20 U/L 0.0 - 40.0 AST 270 U/L 0 - 37 Alkaline phosphatase 413 U/L 40.0 - 129.0 CRP 11.20 mg/L 0.0 - 5.0 Hepatitis C Ab Non-reactive Non-reactive Hepatitis B Surface Ag Non-reactive Non-reactive

Robot-assisted versus conventional laparoscopic partial nephrectomy for renal hilar tumors: Parenchymal preservation and functional recovery.

To determine whether robot-assisted laparoscopic partial nephrectomy (RALPN) can benefit patients in terms of functional recovery in the treatment of renal hilar tumors compared to conventional laparoscopic partial nephrectomy (CLPN). Between January 2019 and July 2021, patients with hilar tumors who underwent partial nephrectomy (PN) were acquired at our center and were classified into RALPN and CLPN groups. Ipsilateral parenchymal volume (IPV) and glomerular filtration rate (GFR) were determined independently 3-5 days before and 3 months after PN using contrast-enhanced computed tomography and nuclear renal scans. Pearson correlation was used to determine the link between ipsilateral GFR preservation and IPV preserved. Concurrently, multivariable analysis was employed to determine characteristics associated with functional recovery. A total of 96 patients with hilar tumors were studied, of which 41 received RALPN and 55 received CLPN. Excisional parenchymal volume was 27 and 37 cm3 (p = 0.005) in RALPN and CLPN groups, respectively, and IPV preserved was 77% and 68% (p < 0.001). Furthermore, the ipsilateral GFR preserved was 77.7% and 75.3%, respectively (p = 0.003). On Pearson correlation, ipsilateral GFR preservation was linked with IPV preserved (r = 0.36, p < 0.001). According to a multivariate study, baseline GFR, IPV preserved, and surgical procedures (RALPN vs. CLPN) were significant factors influencing functional recovery. Our study suggests that RALPN, rather than CLPN, can achieve better functional recovery in the treatment of hilar tumors due to its ability to win more IPV preserved. RALPN should be recommended as the first-line treatment for hilar tumors, but randomized controlled trials are required to validate our findings.

Redo Robotic Partial Nephrectomy for Recurrent Renal Tumors: A Multi-Institutional Analysis.

Introduction: As the experience with robot-assisted partial nephrectomy (RAPN) grows, the indications have expanded to incorporate previously operated ipsilateral kidneys with recurrent renal masses. We sought to analyze the outcomes of redo RAPN in patients with a recurrent renal mass. Methods: Using a multi-institutional series, the data of 72 patients who underwent RAPN for a recurrent renal mass between 2010 and 2020 were retrospectively analyzed. Patients with familial renal cell carcinoma and multiple renal tumors were excluded. Major complication was defined by Clavien grade ≥3. The median follow-up was 28.5 months. Baseline demographics, clinical and tumor characteristics, and perioperative and postoperative outcomes are reported. Results: Our cohort consisted of a combination of previous thermal ablation (19.6%), laparoscopic (19.6%), open (26.1%), and robotic (34.8%) partial nephrectomy. The median R.E.N.A.L. score was 8. Twenty percent had hilar tumors and 9.7% had a solitary kidney. RAPN was completed in all cases. Two cases (2.8%) were converted to open surgery. None of the cases were converted to radical nephrectomy intraoperatively. One patient underwent radical nephrectomy postoperatively because of bleeding. Transfusion rate was 5.9% and major complication rate was 8.3%. Median length of stay was 3 days. Estimated glomerular filtration rate preservation was 78.7% at discharge and 90.8% at 1-year follow-up. Positive surgical margin rate was 8.3%. Overall, distant recurrence was seen in 11 patients (15.3%), however, only 1 patient had local progression (1.4%). Conclusion: In experienced hands, RAPN is an effective approach to treat select cases of locally recurrent renal masses with promising perioperative and functional outcomes. Patients should be carefully monitored for distant recurrence.

Commentary: A Retrospective Study on Using a Novel Single Needle Cone Puncture Approach for the Iodine-125 Seed Brachytherapy in Treating Patients With Thoracic Malignancy.

125 I seeds brachytherapy is increasingly used for various types of advanced cancers and the 14 therapeutic effects are well recognized (1). However, for the treatment of mediastinal tumors, it is 15 difficult to achieve accurate seed distribution and dose distribution. In a recent retrospective study, 16 Li et al.(2) developed a single needle cone puncture method for 125 I seed (SNCP-125 I) brachytherapy 17 for the treatment of thoracic malignancy. The study is especially of great significance in the treatment 18 of patients with lung hilar and mediastinal tumors, which offers an extremely effective therapeutic 19 approach. However, there are still some issues that we expect to discuss with the authors. 20 First of all, because the only one needle used in this technique repeatedly punctured through tumor 21 leision, the tumor cells carried by the needle will inevitably be brought to the needle path, which may 22 increase the risk of tumor needle path metastasis. Ryd

PD37-09 PREDICTIVE VALIDITY OF IRIS TM 3D ANATOMICAL MODELS DURING ROBOT ASSISTED PARTIAL NEPHRECTOMY

You have accessJournal of UrologyCME1 May 2022PD37-09 PREDICTIVE VALIDITY OF IRISTM 3D ANATOMICAL MODELS DURING ROBOT ASSISTED PARTIAL NEPHRECTOMY Nitin Sharma, Thomas Osinski, Thomas Frye, William Tabayoyong, Jonathan Bloom, Hani Rashid, Ahmed Ghazi, and Jean Joseph Nitin SharmaNitin Sharma More articles by this author , Thomas OsinskiThomas Osinski More articles by this author , Thomas FryeThomas Frye More articles by this author , William TabayoyongWilliam Tabayoyong More articles by this author , Jonathan BloomJonathan Bloom More articles by this author , Hani RashidHani Rashid More articles by this author , Ahmed GhaziAhmed Ghazi More articles by this author , and Jean JosephJean Joseph More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002595.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Successful RAPN is dependent to a large extent on meticulous preoperative surgical planning, based on review of 2-dimensional imaging. Several 3-dimensional virtual reality digital imaging models have demonstrated a useful preoperative planning and intraoperative navigation tool during RAPN. However, no studies have assessed the differences in preoperative plan to intraoperative execution (i.e., Predictive ability). Primary objective of this study was to evaluate the correlation between preoperative plan utilizing IRISTM and actual intraoperative findings during RAPN. METHODS: 22 patients scheduled for RAPN were enrolled in a prospective study with 5 urologists. Prior to surgery, urologists reviewed the IRIS 3D model on an iOS app and completed a survey outlining their surgical plan including approach, and ischemia technique as well as confidence in executing this plan. Postoperatively, questionnaires assessing the procedural approach, clinical utility, efficiency, and effectiveness of IRISTM were completed (Figure 1A). The degree of overlap between the preoperative planned approach including clamping technique and the actual intraoperative execution was evaluated (Figure 1B). Questionnaires were answered based on 5-point Likert scale and score 4 or greater were considered positive. RESULTS: Median age was 64 years with mean tumor size of 29.6 mm (17.5 mm–44.0 mm). 21% were hilar tumors with 63% of patients having RENAL score 7 and above. On preoperative questionnaires, 100% of surgeons reported confidence in anatomical interpretation and >90% were confident that they can perform procedure as planned. There was 100% overlap between preoperative and intraoperative questionnaires for surgical approach, interpreting anatomical details and clinical utility (Figure 1C). When comparing plan of clamping vs off or selective clamping the preoperative plan was executed in (11/12 patients) (91.7%) of cases intraoperatively. CONCLUSIONS: This is first study to evaluate clinical utility of IRIS during RAPN as well as to evaluate if preoperative anatomical details found on IRISTM models were sufficiently accurate during intraoperative execution. We found a great degree of overlap between preoperative clamping technique planned and actual clamping executed. Source of Funding: Intuitive Surgical © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e642 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nitin Sharma More articles by this author Thomas Osinski More articles by this author Thomas Frye More articles by this author William Tabayoyong More articles by this author Jonathan Bloom More articles by this author Hani Rashid More articles by this author Ahmed Ghazi More articles by this author Jean Joseph More articles by this author Expand All Advertisement PDF DownloadLoading ...