Hilar Tumors Research Articles

Extended-right hepatectomy for hilar tumors: The double hanging technique

Extended-right hepatectomy for hilar tumors: The double hanging technique

Off-clamp robot-assisted partial nephrectomy for purely hilar tumors: Technique, perioperative, oncologic and functional outcomes from a single center series

ObjectivesPurely hilar lesions and those abutting the main renal artery or vein may be significantly different in terms of surgical complexity, requiring different resection strategies. To describe surgical technique and to assess its safety, oncologic and functional outcomes of a single centre experience of Off-Clamp Robotic Partial Nephrectomy (Off-C RPN) for purely hilar renal masses. MethodsThe Institutional Review Board renal cancer database was queried for: “robotic”, “partial nephrectomy” and “hilar”. Baseline imaging was reviewed for all cases to strictly select patients with purely hilar tumors, defined as tumors arising into the renal hilum without any exophytic growth. Off-C RPN with straight access to the hilum was performed in all cases. We reported baseline, perioperative, oncologic and functional outcomes of the institutional series of purely hilar masses treated with Off-C RPN. ResultsBetween 2011 and 2019, 680 Off-C RPN were performed. Overall, 20 cases were classified as “hilar” renal tumors. Ten lesions abutting the main renal artery or vein were excluded leaving 10 purely hilar cases for analysis. Median operative time was 85 (range 68–115) minutes. No high-grade complications occurred. One patient (10%) required blood transfusion. At a median follow-up of 27 months, one renal recurrence and one newly onset Chronic Kidney Disease stage 3A was observed. ConclusionsRPN for purely hilar tumors has been poorly addressed and distinguishing purely hilar from tumors abutting the hilar vessels may have significant technical implications. In tertiary referral centers, Off-C RPN for purely hilar tumors provides excellent perioperative, oncologic and functional outcomes.

Trifecta and pentafecta outcomes following robot-assisted partial nephrectomy for hilar versus nonhilar tumors: A propensity-matched analysis.

Introduction:Hilar tumors are a unique subset of complex renal masses posing a potential surgical challenge during partial nephrectomy. The outcomes of hilar masses have not been compared to non-hilar renal masses of similar RENAL nephrometry score (RNS). In this study, we analyzed the outcomes of hilar versus nonhilar masses after a propensity score matching.Methods:Prospectively maintained database of patients who underwent robot assisted PN between November 2014 and December 2018 was abstracted for hilar and nonhilar tumors. We performed propensity matching for baseline variables such as age, sex, body mass index, comorbidities, preoperative glomerular filtration rate, and RNS for each patient on the basis of propensity scores.Results:We included 48 patients with hilar tumors and 153 with nonhilar tumors. On propensity matching, 41 patients were included in each group. The mean operative time (162.4 ± 48.9 min vs. 144.1 ± 38.8 min, P = 0.48), warm ischemia time (29.0 ± 8.8 min vs. 24.4 ± 8.2 min, P = 0.12), and the estimated blood loss (201.8 ± 184.7 ml vs. 150.6 ± 160.5 ml, P = 0.37) were not significantly different between the hilar and the nonhilar groups. Trifecta was achieved in only 14/41 (34.1%) of the patients in the hilar group as compared to 24/41 (58.5%) in the nonhilar group (P = 0.027). Logistic regression analysis identified that hilar location of the tumors was not an independent predictor of overall complications (OR 6.37, confidence interval [CI] 0.5–69.4, P = 0.4), trifecta (OR 0.38, CI 0.14–1.0, P = 0.051), and pentafecta outcomes (OR 0.4, CI 0.1–1.51, P = 0.17).Conclusions:Hilar location was associated with poorer trifecta outcomes compared to the nonhilar tumors. However, hilar location per se was not an independent predictor of overall complications and trifecta and pentafecta outcomes.

PD64-06 REDO ROBOTIC PARTIAL NEPHRECTOMY FOR RECURRENT RENAL MASSES: A MULTI-INSTITUTIONAL ANALYSIS

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy VI (PD64)1 Sep 2021PD64-06 REDO ROBOTIC PARTIAL NEPHRECTOMY FOR RECURRENT RENAL MASSES: A MULTI-INSTITUTIONAL ANALYSIS Alp T. Beksac, Umberto Carbonara, Mahmoud Abou Zeinab, Sij Hemal, Margaret Meagher, Alessandro Tafuri, Gabriele Tuderti, Alessandro Antonelli, Riccardo Autorino, Giuseppe Simone, Ithaar Derweesh, and Jihad Kaouk Alp T. BeksacAlp T. Beksac More articles by this author , Umberto CarbonaraUmberto Carbonara More articles by this author , Mahmoud Abou ZeinabMahmoud Abou Zeinab More articles by this author , Sij HemalSij Hemal More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Alessandro TafuriAlessandro Tafuri More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Alessandro AntonelliAlessandro Antonelli More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Ithaar DerweeshIthaar Derweesh More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002108.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As the experience with robotic partial nephrectomy (RPN) grows, the indications have expanded to incorporate previously operated ipsilateral kidneys with recurrent renal masses. We sought to analyze the outcomes of redo RPN in patients with a recurrent renal mass. METHODS: Using a multi-institutional series, the data of 72 patients who underwent RPN for a recurrent renal mass between 2010 and 2020 was retrospectively analyzed. Patients with familial renal cell carcinoma and multiple renal tumors were excluded. Major complication defined by Clavien grade >2. Median follow up was 28.5 months. Baseline demographics, clinical and tumor characteristics, perioperative and postoperative outcomes are reported. RESULTS: Our cohort consisted of a combination of previous thermal ablation, laparoscopic, open and robotic surgeries. Median RENAL score was 8. In our cohort, 20% had hilar tumors and 9.7% had a solitary kidney. Partial nephrectomy 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 due to bleeding. Transfusion rate was 5.9% and major complication rate was 8.3%. Median length of stay was 3 days. Acute kidney injury was 35.1% at discharge, however eGFR preservation was 90.8% at one year follow up. Positive surgical margin rate was 9.5%. Recurrence was seen in 14 patients (15.2%), however only one patient had local recurrence (1.4%). CONCLUSIONS: In experienced hands, RPN is an effective approach to treat recurrent renal masses with promising perioperative and functional outcome. Patients should be carefully monitored for distant recurrence. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1145-e1146 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alp T. Beksac More articles by this author Umberto Carbonara More articles by this author Mahmoud Abou Zeinab More articles by this author Sij Hemal More articles by this author Margaret Meagher More articles by this author Alessandro Tafuri More articles by this author Gabriele Tuderti More articles by this author Alessandro Antonelli More articles by this author Riccardo Autorino More articles by this author Giuseppe Simone More articles by this author Ithaar Derweesh More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement Loading ...

V04-05 ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR HIGHLY COMPLEX ENDOPHYTIC TUMOR: A NOVEL RENORRHAPHY CLOSURE

You have accessJournal of UrologyAdrenal & Renal Oncology I (Nephron Sparing Surgery) (V04)1 Sep 2021V04-05 ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR HIGHLY COMPLEX ENDOPHYTIC TUMOR: A NOVEL RENORRHAPHY CLOSURE Jennifer Espinales and Firas Petros Jennifer EspinalesJennifer Espinales More articles by this author and Firas PetrosFiras Petros More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002000.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiple suture techniques have been proposed for renal closure for endophytic tumors during robot-assisted partial nephrectomy (RAPN). There is no consensus for preferred closure technique and this decision is at the discretion of the surgeon. This video demonstrates a novel approach of closure in a completely endophytic, highly complex tumor without the need for bolster. METHODS: A da Vinci Xi Robot was used for RAPN. After using intraoperative ultrasound to aid in tumor identification and define borders of resection, tumor was dissected free from normal parenchyma. Following the resection, a central defect was present over the renal pelvis. Inner renorrhaphy of resection borders was performed with 3-0 V-loc suture. Once the hilar vessels were unclamped, no significant active bleeding was noted from the resection bed. The capsular layer was performed using Weck-renorrhaphy sutures of 2-0 Vicryl suture to close the remaining portion of exposed renal parenchyma in a C-shaped horizontal mattress using sliding-clip renorrhaphy without using bolsters. Tisseel and Fibrillar hemostatic agents were applied to the resection bed and hilum. RESULTS: Surgical outcome revealed warm ischemia time (WIT) was 23 times, estimated blood loss (EBL) was 40 mL, and console time was 160 minutes. Parenchymal preservation was approximately 90%. Pathology showed pT1a clear-cell renal cell carcinoma with negative margins. There were no intraoperative or postoperative complications, and the patient was discharged on post-operative day 1. An 18-month follow-up showed no evidence of recurrence with normal renal function. CONCLUSIONS: RAPN is technically feasible for highly complex endophytic and hilar tumors that would otherwise be managed with radical nephrectomy. For select cases such as our case, we presented a novel renorrhaphy closure with C-shaped horizontal mattress as a valuable-asset for robotic surgeons to achieve an excellent clinical, oncological and functional outcome. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e292-e292 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jennifer Espinales More articles by this author Firas Petros More articles by this author Expand All Advertisement PDF downloadLoading ...

Functional and Oncological Outcomes of Renal Surgery for Hilar Tumors: Informing the Decisions in Risk-Adapted Management

To describe the safety and efficacy of partial nephrectomy (PN) in comparison to radical nephrectomy (RN) for surgically managed renal hilar tumors. We retrospectively reviewed institutional records of patients with a small (<5 cm) solitary renal (hilar or non-hilar) mass who underwent PN or RN between 2008 and 2018. Hilar tumors were defined as those at medial position, abutting the renal vessels. Recurrence-free, cancer-specific, and overall survival were estimated using the Kaplan-Meier method. Of 1,951 eligible patients, 399 had hilar tumors (292 scheduled for PN, 107 RN) and 1,552 had non-hilar tumors (scheduled for PN). We found no significant differences in survival measures between hilar and non-hilar tumors in patients selected for PN. Patients scheduled for PN for hilar tumors had higher rates of ≥grade II postoperative surgical complications compared to patients scheduled to receive PN for non-hilar tumors (13% vs 8.6%; log-rank P=.018) and non-statistically significantly elevated rates of ≥grade II complications compared to patients scheduled for RN for hilar tumors (13% vs 6.5%; difference 6%, 95% CI 0.4%, 13%; log-rank P=.07). PN for hilar and non-hilar renal masses (<5cm) experience comparable oncologic outcomes though increased risk of complications for hilar masses. PN for hilar tumors was associated with better renal function and overall survival with non-statistically elevated risk of grade II or higher complications than RN. A renal tumor located at the hilum should not be a contra-indication for performing PN.

V37 - Robot Assisted Partial Nephrectomy using Intra-Arterial Renal Hypothermia for Highly Complex Endophytic or Hilar Tumors: Case series and Description of Surgical Technique

V37 - Robot Assisted Partial Nephrectomy using Intra-Arterial Renal Hypothermia for Highly Complex Endophytic or Hilar Tumors: Case series and Description of Surgical Technique

Robotic-assisted laparoscopic tumor enucleation is a feasible technique for renal hilar tumors: A retrospective study.

Retrospective data were collected from 173 consecutive patients who underwent RAE for localized renal tumors (cT1-cT2N0M0) at our hospital between September 2014 and November 2019. Seventy-five patients had renal hilar tumors and 98 patients had nonhilar tumors. There were no statistical differences between the hilar and nonhilar groups in operation time (190 [115-390] vs. 190 [110-390] min, p = 0.889), warm ischemia time (26 [12-60] vs. 27 [17-41] min, p = 0.257), hospital stay duration (8 [3-16] vs. 7.5 [4-18] days, p = 0.386), renal function (estimated glomerular filtration rate, 102.5 [29.4-144] vs. 101.3 [64.2-134.7] ml/min/1.73 m2 , p = 0.631); creatinine level, (76 [43-169] vs.78.5 [50-281.3] µmol/L, p = 0.673), perioperative complications rate, or surgical margin status. However,patients with hilar tumors lost significantly more blood than did those with nonhilar tumors (250 [50-1500] vs. 200 [20-1200] ml, p = 0.007). During the follow-up period (median, 30 months), three patients in each group experienced recurrence. The 5-year recurrence-free rates were 93.0% and 95.4% in the hilar and nonhilar tumor groups, respectively (p = 0.640). For experienced robot laparoscopists, RAE is a safe, effective, and feasible procedure for renal hilar tumors, without increased risk of positive surgical margins or worse midterm oncologic outcomes compared with nonhilar tumors.

Visceral fat is associated with high-grade complications in patients undergoing minimally invasive partial nephrectomy for small renal masses.

Introduction:Minimally invasive partial nephrectomy is standard of care treatment for small renal masses.Objective:We evaluated the relationship between subcutaneous and visceral obesity with high-grade postoperative 30-day complications in patients undergoing minimally invasive partial nephrectomy.Methods:We retrospectively identified 98 patients at our institution from 2014 to 2017 who underwent laparoscopic or robotic-assisted partial nephrectomy due to suspected renal cell carcinoma. Patients were stratified based on presence or absence of high-grade (Clavien ≥ IIIa) 30-day postoperative complications. Means were compared with the independent t test and proportions with chi-square analysis. Multivariate logistic regression was performed to determine independent predictors of high-grade 30-day complications.Results:Mean nephrometry score was 6.7 with 21 (21.4%) patients having hilar tumors. Mean estimation of blood loss was 207 mL, mean operating time was 223 min, and mean warm ischemia time was 23 min. The majority of patients had clear renal cell carcinoma (n = 83, 84.7%) and pT1a disease (n = 76, 77.6%) with negative margins (n = 89, 90.8%) on pathology. There were 5 (5.1%) patients who experienced a high-grade postoperative 30-day complication. Mean visceral fat index was an independent predictor of high-grade 30-day complications (odds ratio: 1.02; 95% confidence interval: 1.002–1.03; p = 0.027).Conclusions:Visceral obesity should be considered as a prognostic indicator of outcomes in patients undergoing surgical treatment for a small renal mass.

Contrast-Enhanced Ultrasound for Intraoperative Tumor Contour Definition During Complex Partial Nephrectomy

Contrast-enhanced ultrasound (CEUS) is an imaging modality that utilizes a non-nephrotoxic, intravascular microbubble agent to capture real-time perfusion of the target organ. CEUS has demonstrated utility for the evaluation and surveillance of indeterminate renal lesions in patients who are unable to receive conventional contrast agents, yet its potential utility in renal surgery remains poorly defined in the current literature. We present a series of 4 patients who underwent successful intraoperative CEUS during partial nephrectomy (PN) to help define renal mass contour and proximity to vascular structures in an attempt to optimize renal function after PN. All cases were endophytic with moderate-high complexity (R.E.N.A.L. scores>9). CEUS was safely performed in all cases providing excellent tumor contour definition. In one case, CEUS provided better visualization of tumor proximity within the hilum than conventional US, facilitating surgical resection and reconstruction. In another case, CEUS provided better definition of tumor contour, allowing wedge resection rather than heminephrectomy. Margins were negative in all cases. The average global renal function preserved following PN was 90%. While grey-scale US with color Doppler is usually sufficient for intraoperative tumor visualization, CEUS can be considered during PN for complex endophytic, infiltrative or hilar tumors where accurate delineation of tumor contour is critical.

Endoscopic metal stenting for malignant hilar biliary obstruction: an update meta-analysis of unilateral versus bilateral stenting.

IntroductionMalignant hilar biliary obstruction (MHBO) can arise in patients with malignant hilar hepatobiliary tumors or lymph nodules. Most MHBO patients are not suitable for surgical resection due to the advanced tumor stage. The only palliative treatment available is provided by endoscopic or percutaneous stenting.AimTo compare the efficacy of endoscopic unilateral versus bilateral metal stent insertion for treating MHBO.Material and methodsA search of the PubMed, Embase, and Cochrane Library databases identified all relevant studies published until June 2020. The meta-analysis was undertaken using RevMan v5.3.ResultsWe identified 154 studies initially, eight of which were used in our meta-analysis. The eight studies included 818 MHBO patients treated using either endoscopic unilateral (n = 396) or bilateral (n = 422) metal stenting. No significant differences were observed between the two groups in clinical success rate (OR = 2.64; p = 0.18), complication rate (OR = 0.63; p = 0.46), or OS (HR = 1.03; p = 0.53). The bilateral group had a lower stent dysfunction rate without significance (OR = 1.43; p = 0.09). Significantly longer stent patency was observed in the bilateral group (HR = 1.28; p = 0.01). Technical success rate was significantly higher in the unilateral group (OR = 0.26; p = 0.04). Funnel plot analysis indicated an absence of publication bias related to the selected study endpoints.ConclusionsOur meta-analysis indicated that endoscopic unilateral stenting had a greater technical success rate for MHBO patients than bilateral stenting. However, the bilateral stenting could achieve longer stent patency.

Use of posterior radial nephrotomy in laparoscopic enucleation of renal hilar tumors.

Centrally located completely endophytic renal hilar tumors pose a technical challenge, especially during a minimally invasive surgery. Relation of the tumor to the renal vasculature decides the approach. Tumors placed anterior to the vasculature can be approached in the anterior trans-hilar manner. However, tumors placed posterior to the vasculature need a posterior approach, which is quite a difficult maneuver during transperitoneal laparoscopy. Adequate exposure to access the resection plane is the key principle. We describe a laparoscopic technique for enucleation of such tumors, applying the surgical principle of radial nephrotomy in the intersegmental plane which is usually performed to remove renal stones.

Comparison of Robot-Assisted and Laparoscopic Partial Nephrectomy for Renal Hilar Tumors: Results from a Tertiary Referral Center

Objective: To compare perioperative, functional, and oncologic outcomes between robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) for renal hilar tumors. Methods: We retrospectively reviewed patients who underwent minimally invasive partial nephrectomy for renal hilar tumors at our institution between January 2014 and August 2018. The entire cohort was divided into two groups according to surgical approach: RAPN and LPN group. Perioperative, functional, and oncologic outcomes of the two groups were collected and compared. Results: A total of 116 patients with renal hilar tumors were identified, including 52 patients who underwent RAPN and 64 patients who underwent LPN, respectively. Demographic baseline characteristics were similar in two groups. There were no differences between the RAPN and LPN groups for operative time, transfusion rate, conversion rate, surgical margin, perioperative complication, and hospital stay. Compared with the LPN group, the RAPN group was associated with significant less estimated blood loss (100 vs 150 mL; p < 0.001), shorter warm ischemia time (20.3 vs 24.5 minutes; p = 0.001), and higher direct cost (p < 0.001). Percentage of estimated glomerular filtration rate change at 6 months after surgery was lower in RAPN group than LPN group (10.4% vs 15.2%; p = 0.020). No significant difference was observed between the two groups in terms of oncologic outcomes. Conclusions: For hilar tumors, both RAPN and LPN were safe and feasible surgical treatments. RAPN might be associated with superior perioperative outcomes (less estimated blood loss and shorter warm ischemia time) and better postoperative renal functional preservation. RAPN might be the preferred option when condition permits for renal hilar tumors.

Outcomes of gasless laparoendoscopic single-port partial nephrectomy in 356 consecutive patients: Feasibility of a clampless and sutureless technique.

To investigate the outcomes and feasibilities of gasless laparoendoscopic single-port clampless sutureless partial nephrectomy. We reviewed 356 consecutive patients with primary unilateral non-metastatic renal masses who underwent gasless laparoendoscopic single-port partial nephrectomy (2011-2018), which was performed retroperitoneally using a three-dimensional flexible endoscope, without vascular clamping or renorrhaphy in principle. The median tumor size was 2.5cm, and 213 (60%), 105 (29%), and 38 (11%) patients had peripheral, central, and hilar tumors, respectively. Clampless and sutureless partial nephrectomy was accomplished in 337 patients (95%), while eight (2%) and 16 (4%) patients required vascular clamping and renorrhaphy, respectively. The median operative time and blood loss were 220min and 266mL, respectively; eight patients (2%) received blood transfusion. Clavien-Dindo grade 3a complications occurred in 27 patients (8%); all these patients had urinary leakage treated with ureteral stent placement, one of whom also developed a postoperative pseudoaneurysm. Among 324 patients diagnosed with renal cell carcinoma, six (2%) had positive surgical margins, and one (0.3%) and seven (2%) developed metastatic and local recurrences, respectively. During a median follow-up of 54months, no patient died from kidney cancer. The median percent decrease in estimated glomerular filtration rate at 3months after surgery was 5.7%. No patient experienced postoperative acute renal failure, while one patient with preexisting renal impairment started dialysis at 70months after surgery. Clampless and sutureless partial nephrectomy can be safely accomplished in most patients undergoing gasless laparoendoscopic single-port surgery, yielding favorable oncological and functional outcomes.

Perioperative outcomes in patients undergoing robot-assisted partial nephrectomy: Comparative assessments between complex and non-complex renal tumors.

The aim of this study was to investigate the effects of renal tumor complexity on perioperative outcomes in patients receiving robot-assisted partial nephrectomy (RAPN). This study included 153 consecutive patients with cT1 renal masses undergoing RAPN and analyzed their perioperative outcomes, particularly tumor complexity. In this series, cT1b, completely endophytic, hilar, and cystic tumors were considered complex tumors. Patients with tumors that met at least one of the complex criterion were placed in the complex tumor group; patients with tumors that did not meet any of the complex criteria were placed in the non-complex tumor group. Of the 153 patients, 54 (35.3%) had complex tumors; specifically, 18 (11.8%) had cT1b tumors, 15 (9.8%) had completely endophytic tumors, 28 (18.3%) had hilar tumors, and 8 (5.2%) had cystic tumors. The non-complex group included 99 patients (64.7%). The complex tumor group had significantly longer warm ischemia and console times than the non-complex tumor group, but there was no significant difference between them in the achievement of the trifecta. Both warm ischemia and console times were significantly correlated with the number of complex factors. Multivariate analyses of complex factors demonstrated that completely endophytic and cT1b tumors were independently associated with warm ischemia time and console time, respectively. For patients with complex tumors, RAPN may be a feasible procedure with acceptable perioperative outcomes. However, special attention should be paid to long warm ischemia and console times, particularly in those with completely endophytic and/or cT1b tumors.

Video 10 - Selective Segmental Renal Artery Clamping During Retro and Trans-Peritoneal Robotic-Assisted Laparoscopic Partial Nephrectomy for Hilar Tumours: Technique and Outcome

Video 10 - Selective Segmental Renal Artery Clamping During Retro and Trans-Peritoneal Robotic-Assisted Laparoscopic Partial Nephrectomy for Hilar Tumours: Technique and Outcome

Robotic Partial Nephrectomy for Completely Endophytic and Hilar Renal Tumors

Abstract Introduction: Robot-assisted partial nephrectomy can be challenging in patients with completely endophytic tumors because of the difficulties in observation of the tumor. Endophytic tumors...

Effectiveness of bronchial arterial embolization using N-butyl-2-cyanoacrylate for local control of pulmonary hilar or mediastinal tumors that are refractory to chemotherapy

PurposeTo investigate local control and survival after bronchial artery embolization (BAE) using N-butyl-2-cyanoacrylate (NBCA) for pulmonary hilar or mediastinal tumors that are refractory to chemotherapy or chemoradiotherapy. MethodThis is a single center retrospective study involving 42 patients treated between 2015 and 2018 for pulmonary hilar or mediastinal tumors (primary tumors in 5 and metastatic ones in 37). Tumor histology was sarcoma in 22 and carcinoma in 20 patients. All patients had shown tumor progression regardless of previous chemotherapy (n = 37) or chemoradiotherapy (n = 5). Thirty-seven patients (88 %) had respiratory symptoms, such as cough, dyspnea, and hemoptysis. BAE was performed using NBCA to shrink tumors for extending life expectancy. Target tumors were followed with computed tomography at 1,3, and 6 months after BAE. Endpoints included the best tumor response within 6 months as well as overall survivals in patients with and without tumor responses. ResultsBest local responses within 6 months were complete response (CR) in 1 patient, partial response (PR) in 16, stable disease (SD) in 24, and progressive disease (PD) in 1; the CR/PR rate was 40 % (17/42). Median follow-up period was 13 months (range:1−43). Overall survival in patients with CR/PR was significantly better than in those with SD/PD (p = 0.006); with 3-year survival rates of 45 % (8/17) and 0% (0/25), respectively. ConclusionsBAE using NBCA has potential promise for shrinking hilar and/or mediastinal tumors that are refractory to chemotherapy or chemoradiotherapy, and may also improve overall survival in patients who respond.

V070 - Robotic partial nephrectomy for complex hilar tumors: Tips & tricks

V070 - Robotic partial nephrectomy for complex hilar tumors: Tips & tricks

V004 - Robot assisted partial nephrectomy for hilar tumors: Technique, perioperative, oncologic and functional outcomes from a single center series

V004 - Robot assisted partial nephrectomy for hilar tumors: Technique, perioperative, oncologic and functional outcomes from a single center series