Nephrectomy For Tumors Research Articles

Estimated glomerular filtration rate after nephrectomy for Wilms tumor

The aim of this study was to assess long-term residual kidney function after unilateral nephrectomy for non-syndromic Wilms tumor (NSWT). Of the patients who underwent one-sided NSWT at Tohoku University Hospital between 1977 and 2003, nine were followed up until age ≥18years. For these nine patients, we retrospectively evaluated estimated glomerular filtration rate (eGFR) in childhood (3-10years old), adolescence (11-17years old) and adulthood (≥18years). Mean age at the last follow up was 23.0years. Tumor classification was as follows: stage I tumor, n=6; stage II tumor, n=3; mixed-type nephroblastoma, n=8; and congenital mesoblastic nephroma, n=1. Mean eGFR was 101.3±21.2 mL/min/1.73 m2 in childhood, 106.0±32.1 mL/min/1.73 m2 in adolescence and 100.5±20.7 mL/min/1.73 m2 in adulthood. Therefore, no significant change in eGFR was observed over the three life stages evaluated. Further, none of the patients met the diagnostic criteria for chronic kidney disease by early adulthood. eGFR after unilateral nephrectomy in patients with NSWT remained ≥60 mL/min/1.73 m2 during the transition from childhood to early adulthood, with no development of chronic kidney disease or end-stage kidney failure.

75 - Oncological results of simple enucleation versus partial nephrectomy in clinical T1 renal tumors: Our experience

75 - Oncological results of simple enucleation versus partial nephrectomy in clinical T1 renal tumors: Our experience

OUTCOME OF STAGE T1 RENAL CELL CARCINOMA TREATED WITH PARTIAL NEPHRECTOMY: INITIAL EXPERIENCES FROM A TEACHING HOSPITAL IN BANGLADESH

Background: Renal cell carcinoma accounts for 85% of all solid tumors of the kidney. For many years, radical nephrectomy was the stan­dard treatment for RCC. Partial nephrectomy has gradual­ly replaced radical nephrectomy over the past decade, es­pecially for T1 stage renal cell carcinoma. However, the benefit of partial nephrectomy on oncolog­ic outcomes is not well known.Objective: to investigate the clinical outcome of partial nephrectomy on T1 renal cell carcinoma. Methods: This prospective observational study was conducted in a single unit of urology department of Dhaka Medical College Hospital, Bangladesh from the period September 2014 to September 2017. Fourteen patients underwent partial nephrectomy during this period with renal mass based on eligibility criteria. Two follow up was done at three months and six months. Result: Mean age of the patients undergoing surgery was 52.0± 3.8 (46.0 to 57.0 years) years. For the majority of the patients, tumour size was in a range of 3-7 cm. Average operative time was 90 minutes and mean ischaemic time was 16.5 ± 4.6 minutes (14.5 to 21.0 minutes). Histopathological reports correlated with clinical diagnosis and showed adequate surgical clear margin in every case. There was no recurrence of tumour noticed during the two follow up periods. The different investigation did not reveal the impaired renal functional test during the follow-up period. Conclusion: The clinical outcome of partial nephrectomy was found better in this study. Partial nephrectomy has the potential to replace radical nephrectomy for managing T1 tumours. However, there are some controversies regarding the post-operative oncological outcome. More studies are recommended to investigate the effect of partial nephrectomy for T1 tumours.

AB073. Application of IQQA three-dimensional reconstruction technique in precise laparoscopic or robotic-assisted laparoscopic partial nephrectomy for renal hilar tumors

BackgroundTo evaluate the feasibility and effectiveness of the application of IQQA three-dimensional reconstruction technique in precise laparoscopic or robot-assisted laparoscopic partial nephrectomy (LPN or RAPN) for renal hilar tumors.MethodsThe study retrospectively reviewed 11 patients with hilar tumors from February 2016 to February 2017. Of the 11 patients, 4 were women and 7 were men, with an average age of 51.3 years (range, 38 to 70 years). The average tumor size was 3.1 cm (range, 1.7 to 4.3 cm). For tumor stage, nine patients were in T1a stage and two patients were in T1b stage. The average R.E.N.A.L score was 8.7 (range, 7 to 10). The mean preoperative glomerular filtration rate (GFR) was 40.6 mL/min (range, 32 to 45 mL/min). IQQA three-dimensional reconstruction technique was applied for the purpose of precise navigation and resection of the tumors. Multivariate analysis was used to identify predictors of warm ischemia time, estimated blood loss, major perioperative complications, and postoperative renal function.ResultsAll 11 laparoscopic or robot-assisted laparoscopic hilar partial nephrectomies were successfully completed without conversion to a hand-assisted or an open approach. Under the navigation of IQQA, all tumors were found precisely at the first time during surgeries. The final pathologic examination revealed that all the 11 patients were clear cell renal cell carcinomas. The mean operative time was 142 minutes (range, 90 to 230 minutes), with a mean warm ischemia time of 24.3 minutes (range, 17 to 33 minutes). The estimated blood loss was 146 mL (range, 50 to 400 mL). No intraoperative complications occurred. Two patients suffered from postoperative complications. One patient with gross hematuria was recovered by consistent bladder irrigation. The other patient with postoperative hemorrhage needed transfusion. All patients had negative margins on the final pathologic examination. At a mean follow-up period of 3 months, the mean GFR is 22.5 mL/min (range, 13 to 34 mL/min) without any disease recurrence.ConclusionsWith peculiar features, such as accurate location, complete resection and fewer perioperative complications, the application of IQQA three-dimensional reconstruction technique in precise partial nephrectomy represents a safe and effective procedure for hilar tumors.

PJY12 - Robotic partial nephrectomy for clinical stage T1 tumors: Experience in 73 cases

PJY12 - Robotic partial nephrectomy for clinical stage T1 tumors: Experience in 73 cases

A Multi-Institutional Propensity Score Matched Comparison of Transperitoneal and Retroperitoneal Partial Nephrectomy for cT1 Posterior Tumors

To compare the perioperative and renal functional outcome between transperitoneal and retroperitoneal robotic partial nephrectomy (TP-RPN and RP-RPN) in the largest cohort to date of RP-RPN for posterior tumors. We identified 519 patients who met eligibility criteria and underwent TP-RPN (n = 357, 68.8%) or RP-RPN (n = 162, 31.2%) for a posteriorly located cT1 tumor. Patients were propensity score (PS) matched on preoperative and tumor-specific characteristics. Perioperative outcome and renal function outcome at median follow-up 22 months were compared. Between the PS matched TP-RPN (n = 157, 50%) and RP-RPN (n = 157, 50%) patients, operative time (OT) (185.0 versus 157.0, P < .001) was longer in TP-RPN versus RP-RPN patients. No significant differences in ischemia time (P = .618), blood loss (P = .178), positive surgical margins (P = .501), overall postoperative complications (P = .861), or progression of chronic kidney disease stage at median 22 months (P = .599) were identified. Length of stay (LOS) was reduced in RP-RPN patients (P = .017), but was not different once an institution used a postoperative day (POD)-1 discharge protocol (P = .579). Operative times were similar between groups in patients with obesity (P = .293) or a cT1b renal mass (P = 908). RP-RPN for posterior tumors resulted in reduced OT and a shorter LOS compared to TP-RPN. When surgeons aimed to routinely discharge patients on POD-1, the surgical approach did not influence LOS. Operative time was similar between RP and TP-RPN among patients with obesity or a cT1b renal mass. All other measures, including ischemia time, blood loss, margin rates, complications, and renal function, did not differ between the two approaches.

Benign Multicystic Peritoneal Mesothelioma in a Male Patient with Previous Wilms’ Tumor: A Case Report and Review of the Literature

Benign multicystic peritoneal mesothelioma (BMPM) is a rare condition, more common in females of reproductive age, which arises from the peritoneal mesothelium. A 33-year-old male presented to our unit with abdominal pain and constipation. His past medical history included a previous unilateral nephrectomy for Wilms' tumor and the previous incidental finding of some intra-abdominal cystic formations at the level of the mesentery. After performing a CT scan, an exploratory laparotomy was done and a voluminous cystic mesenteric mass, composed of 3 confluent formations, was observed. Some other similar but significantly smaller lesions were found. An en bloc resection of the mesenteric mass together with the corresponding intestinal loops, an appendicectomy, and some peritoneal biopsies were performed. The postoperative period was complicated by a peritonitis due to dehiscence of the intestinal anastomosis, which required another operation, and a delayed return of normal bowel function, which was resolved through prokinetic therapy. Through histological examination, a BMPM was diagnosed. At 8 months of follow-up, the patient is free of symptoms. BMPM exact etiopathogenesis still remains uncertain. Given his high recurrence rate, a long-term follow-up is recommended.

Development and Internal Validation of a Nomogram for Predicting Renal Function after Partial Nephrectomy

Loss of renal function can be a clinically impactful event after partial nephrectomy (PN). We aimed to create a model to predict loss of renal function in patients undergoing PN. Data for 1897 consecutive patients who underwent PN with warm ischemia between 2008 and 2017 were extracted from our institutional database. Loss of renal function was defined as upstaging of chronic kidney disease in terms of the estimated glomerular filtration rate (eGFR) at 3 mo after PN. A nomogram was built based on a multivariable model comprising age, sex, body mass index, baseline eGFR, RENAL score, and ischemia time. Interval validation and calibration were performed using data from 676 patients for whom complete data were available. Receiver operator characteristic (ROC) curves with 1000 bootstrap replications were plotted, as well as the observed incidence versus the nomogram-predicted probability. We also applied the extreme training versus test procedure known as leave-one-out cross-validation. After internal validation, the area under the ROC curve was 76%. The model demonstrated excellent calibration. At an upstaging cutoff of 27% probability, upstaging was predicted with a positive predictive value of 86%. Patient summaryIn this report, we created a model to predict postoperative loss of renal function after partial nephrectomy for renal tumors. Inputting baseline characteristics and ischemia time into our model allows early identification of patients at higher risk of renal function decline after partial nephrectomy with good predictive power.

Leptin and its receptor: can they help to differentiate chromophobe renal cell carcinoma from renal oncocytoma?

One of the challenges in differentiating chromophobe renal cell carcinoma (chRCC) from benign renal oncocytoma (RO) is overlapping morphology between the two subtypes. The aim of this study was to investigate the usefulness of expression of leptin (Ob) and its receptor (ObR) in discriminating chRCC from RO. Sections from paraffin-embedded, formalin-fixed tumour nephrectomy specimens of 45 patients, made up of 30 chRCC (15 eosinophilic variant and 15 non-eosinophilic variant) and 15 RO, were used in this study. Samples (30) of clear cell RCC (ccRCC), the most common histological subtype, were used to verify staining patterns found by others in our cohort of Australasian patients. Matched morphologically normal non-cancer kidney tissues were included for each specimen. Sections were batch-immunostained using antibodies against Ob and ObR. Stained sections were digitally scanned using Aperio ImageScope, and the expression pattern of Ob and ObR was studied. In this cohort, male to female ratio was 2:1; median age was 64 (45-88 years); and median tumour size was 3.8 cm (range 1.2-18cm). There were 47 (62.7%) T1, seven T2, 20 T3 and one T4 stage RCC. Two patients with ccRCC presented with metastases. Nuclear expression of Ob was significantly higher in RO compared with chRCC. The increased nuclear expression of Ob in RO compared with chRCC may be a useful aid in the difficult histological differentiation of RO from chRCC, especially eosinophilic variants of chRCC.

Periprocedural outcome after laparoscopic partial nephrectomy versus radiofrequency ablation for T1 renal tumors: a modified R.E.N.A.L nephrometry score adjusted comparison.

Comparable oncological outcomes have been seen after surgical nephrectomy and thermal ablation of renal tumors recently. However, periprocedural outcome needs to be assessed for aiding treatment decision. To compare efficacy rates and periprocedural outcome (technical success, session time, hospitalization time, and complications) after renal tumor treatment with laparoscopic partial nephrectomy (LPN) or radiofrequency ablation (RFA). The initial experience with 49 (treated with LPN) and 84 (treated with RFA) consecutive patients for a single renal tumor (diameter ≤ 5 cm, limited to the kidney) during 2007-2014 was evaluated. Patient and tumor characteristics, efficacy rates, and periprocedural outcome were collected retrospectively. The stratified Mantel Haenzel and Van Elteren tests, adjusted for tumor complexity (with the modified R.E.N.A.L nephrometry score [m-RNS]), were used to assess differences in treatment outcomes. Primary efficacy rate was 98% for LPN and 85.7% for RFA; secondary efficacy rate was 93.9% for LPN and 95.2% for RFA; and technical success rate was 87.8% for LPN and 100% for RFA. Median session (m-RNS adjusted P < 0.001; LPN 215 min, RFA 137 min) and median hospitalization time were longer after LPN (m-RNS adjusted P < 0.001; LPN 5 days, RFA 2 days). Side effects were uncommon (LPN 2%, RFA 4.8%). Complications were more frequent after LPN (m-RNS adjusted P < 0.001; LPN 42.9%, RFA 10.7%). Both methods achieved equivalent secondary efficacy rates. RFA included several treatment sessions, but session and hospitalization times were shorter, and complications were less frequent than for LPN. The differences remained after adjustment for renal tumor complexity.

Development of a postoperative care pathway for children with renal tumors

To identify the factors associated with a shorter postoperative stay, as an initial step to develop a care pathway for children undergoing extirpative kidney surgery. This study retrospectively reviewed patients managed with upfront open radical nephrectomy for renal tumors between 2005 and 2016 at a pediatric tertiary care facility. Univariate and multivariate logistic regression were performed to identify factors associated with early discharge (by postoperative day 4). A total of 84 patients met inclusion criteria. Median age was 28.1 months (range 1.8-193.1). Thirty-four (40.5%) patients had a nasogastric tube postoperatively. The patients were advanced to a clear liquid diet on a median postoperative day 2 (range 0-7) and regular diet on a median postoperative day 3 (range 1-8). Median time from surgery to discharge was 5 days (range 2-12), with 38 (45.2%) discharged early. Univariate and multivariate logistic regression analyses showed that earlier resumption of regular diet (OR 0.523, P=0.028) was positively associated with early discharge. Other analyzed factors were not significant (see Table). Timely initiation of adjuvant therapy is a specific requirement of Children's Oncology Group (COG) protocols. Chemotherapy and radiation therapy are ideally initiated simultaneously, as early as possible, within 2 weeks of surgery. Thus, factors that can facilitate early discharge from the hospital can maximize protocol adherence with respect to timing of adjuvant therapy initiation and optimize patient outcome. This study shed light on several postoperative factors and how these relate to postoperative stay and recovery. Specifically, tumor size, pre-operative bowel preparation, extent of lymph node sampling, stage, operative time, estimated blood loss, surgical service, postoperative nasogastric tube use, transfusion, and chemotherapy prior to discharge were not associated with discharge timing. Early re-feeding was associated with early discharge. Thus, it seems reasonable that, when developing a postoperative care pathway for these patients, these factors be considered and specifically encourage early re-feeding. In pediatrics, data on early recovery after surgery protocols are limited, and high-quality studies are unavailable. Within pediatric urology, early recovery after surgery protocols in children undergoing major urologic reconstruction have been shown to reduce hospital stay and can decrease complication rates. It seems reasonable that a similar pathway can be applied to children undergoing radical nephrectomy for suspected malignancy. For children with renal tumors who underwent radical nephrectomy, early re-feeding was associated with a shorter time to discharge. Use of bowel preparation and nasogastric tube did not appear to shorten time to discharge. These data are important for developing postoperative care pathways for these patients.

Toward a Flexible Variable Stiffness Endoport for Single-Site Partial Nephrectomy.

Laparoscopic partial nephrectomy for localized renal tumors is an upcoming standard minimally invasive surgical procedure. However, a single-site laparoscopic approach would be even more preferable in terms of invasiveness. While the manual approach offers rigid curved tools, robotic single-site systems provide high degrees of freedom manipulators. However, they either provide only a straight deployment port, lack of instrument integration, or cannot be reconfigured. Therefore, the current main shortcomings of single-site surgery approaches include limited tool dexterity, visualization, and intuitive use by the surgeons. For partial nephrectomy in particular, the accessibility of the tumors remains limited and requires invasive kidney mobilization (separation of the kidney from the surrounding tissue), resulting in patient stress and prolonged surgery. We address these limitations by introducing a flexible, robotic, variable stiffness port with several working channels, which consists of a two-segment tendon-driven continuum robot with integrated granular and layer jamming for stabilizing the pose and shape. We investigate biocompatible granules for granular jamming and demonstrate the stiffening capabilities in terms of pose and shape accuracy with experimental evaluations. Additionally, we conduct in vitro experiments on a phantom and prove that the visualization of tumors at various sites is increased up to 38% in comparison to straight endoscopes.

Clinical and Pathology Findings Associate Consistently with Larger Glomerular Volume.

Background Glomerular volume increases when demand exceeds nephron supply, which may lead to glomerulosclerosis. It is unclear if determinants of glomerular volume are consistent between populations that differ by severity of comorbidities.Methods We studied kidney biopsy specimens from living kidney donors (n=2453) and patients who underwent radical nephrectomy for a renal tumor (n=780). We scanned specimen sections into high-resolution digital images, manually traced glomerular profiles, and calculated mean glomerular volumes using the Weibel-Gomez stereologic formula (separately for nonsclerosed glomeruli and globally sclerosed glomeruli). We then assessed the relationship of glomerular volume with age, clinical characteristics, and nephrosclerosis on biopsy specimen.Results Compared with kidney donors, patients with tumors were older and more frequently men, obese, diabetic, or hypertensive, had more glomerulosclerosis and interstitial fibrosis on biopsy specimen, and had 12% larger nonsclerosed glomeruli (P<0.001). In both populations, male sex, taller height, obesity, hypertension, and proteinuria associated with larger nonsclerosed glomeruli to a similar extent. In patients with tumors, diabetes, glomerulosclerosis >25%, and interstitial fibrosis >25% also associated with larger nonsclerosed glomeruli. Independent clinical predictors of larger nonsclerotic glomeruli were family history of ESRD, male sex, taller height, obesity, diabetes, and proteinuria. After adjustment for these characteristics, nonsclerotic glomerular volume did not differ between populations and was stable up to age 75 years, after which it decreased with age. Many of these findings were also evident with globally sclerotic glomerular volume.Conclusions Characteristics associated with glomerular volume are consistent between patient populations with low and high levels of comorbidity.

Outcomes of Robot-assisted Partial Nephrectomy for Clinical T2 Renal Tumors: A Multicenter Analysis (ROSULA Collaborative Group)

BackgroundWhile partial nephrectomy (PN) represents the standard surgical management for cT1 renal masses, its role for cT2 tumors is controversial. Robot-assisted PN (RAPN) is being increasingly implemented worldwide. ObjectiveTo analyze perioperative, functional, and oncological outcomes of RAPN for cT2 tumors. Design, setting, and participantsRetrospective analysis of a large multicenter, multinational dataset of patients with nonmetastatic cT2 masses treated with robotic surgery (ROSULA: RObotic SUrgery for LArge renal mass). InterventionRobotic-assisted PN. Outcome measurements and statistical analysisPatients’ demographics, lesion characteristics, perioperative variables, renal functional data, pathology, and oncological data were analyzed. Univariable and multivariable regression analyses assessed the relationships with the risk of intra-/postoperative complications, recurrence, and survival. Results and limitationsA total of 298 patients were analyzed. Median tumor size was 7.6 (7–8.5) cm. Median RENAL score was 9 (8–10). Median ischemia time was 25 (20–32) min. Median estimated blood loss was 150 (100–300) ml. Sixteen patients had intraoperative complications (5.4%), whereas 66 (22%) had postoperative complications (5% were Clavien grade ≥3). Multivariable analysis revealed that a lower RENAL score (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.21–0.65, p=0.02) and pathological pT2 stage (OR 0.51, 95% CI 0.12–0.86, p=0.001) were protective against postoperative complications. A total of 243 lesions (82%) were malignant. Twenty patients (8%) had positive surgical margins. Ten deaths and 25 recurrences/metastases occurred at a median follow-up of 12 (5–35) mo. At univariable analysis, higher pT stage was predictive of a likelihood of recurrences/metastases (p=0.048). While there was a significant deterioration of renal function at discharge, this remained stable over time at 1-yr follow-up. The main limitation of this study is its retrospective design. ConclusionsRAPN in the setting of select cT2 renal masses can safely be performed with acceptable outcomes. Further studies are warranted to corroborate our findings and to better define the role of robotic nephron sparing for this challenging indication. Patient summaryThis report shows that robotic surgery can be used for safe removal of a large renal tumor in a minimally invasive fashion, maximizing preservation of renal function, and without compromising cancer control.

Survival outcomes in patients with large (≥7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: Results of a multicenter cohort with long-term follow-up.

BackgroundDoes the dogma of nephron sparing surgery (NSS) still stand for large renal masses? Available studies dealing with that issue are considerably biased often mixing imperative with elective indications for NSS and also including less malignant variants or even benign renal tumors. Here, we analyzed the oncological long-term outcomes of patients undergoing elective NSS or radical tumor nephrectomy (RN) for non-endophytic, large (≥7cm) clear cell renal carcinoma (ccRCC).MethodsProspectively acquired, clinical databases from two academic high-volume centers were screened for patients from 1980 to 2010. The query was strictly limited to patients with elective indications. Surgical complications were retrospectively assessed and classified using the Clavien-Dindo-classification system (CDS). Overall survival (OS) and cancer specific survival (CSS) were analyzed using the Kaplan-Meier-method and the log-rank test.ResultsOut of in total 8664 patients in the databases, 123 patients were identified (elective NSS (n = 18) or elective RN (n = 105)) for ≥7cm ccRCC. The median follow-up over all was 102 months (range 3–367 months). Compared to the RN group, the NSS group had a significantly longer median OS (p = 0.014) and median CSS (p = 0.04).ConclusionsIn large renal masses, NSS can be performed safely with acceptable complication rates. In terms of long-term OS and CSS, NSS was at least not inferior to RN. Our findings suggest that NSS should also be performed in patients presenting with renal tumors ≥7cm whenever technically feasible. Limitations include its retrospective nature and the limited availability of data concerning long-term development of renal function in the two groups.

Robotic Partial Nephrectomy for a Peripheral Renal Tumor.

Partial nephrectomy (PN) is the preferred surgical treatment for T1 renal tumors whenever technically feasible. When properly performed, it allows preservation of nephron mass without compromising oncologic outcomes. This reduces the postoperative risk of renal insufficiency, which translates into better overall survival for the patients. PN can be technically challenging, because it requires the surgeon to complete the tasks of tumor excision, hemostasis and renorrhaphy, all within an ischemic time of preferably below 30 minutes. The surgeon needs to avoid violating the tumor margins while leaving behind the maximal parenchymal volume at the same time. Variations such as zero ischemia, early unclamping, and selective clamping have been developed in an attempt to reduce the negative impact of renal ischemia, but inevitably add to the steep learning curves for any surgeon. Being able to appreciate the fine details of each surgical step in PN is the fundamental basis to the success of this surgery. The use of the robotic assistance allows a good combination of the minimally invasive nature of laparoscopic surgery and the surgical exposure and dexterity of open surgery. It also allows the use of adjuncts such as concurrent ultrasound assessment of the renal mass and intraoperative fluorescence to aid the identification of tumor margins, all with a simple hand switch at the console. Robot-assisted laparoscopic PN is now the most commonly performed type of PN in the United States and is gaining acceptance on the global scale. In this video, we illustrate the steps of robot-assisted laparoscopic PN and highlight the technical key points for success.

Partial Nephrectomy in Central Renal Tumors.

Nephron-sparing surgery, especially through a minimally invasive approach, is increasingly being performed for incidentally detected renal masses with excellent outcomes. Tumors in central location remain a surgical challenge during nephron-sparing surgery. In this chapter, we discuss the minimally invasive management of these tumors, which include complex hilar tumors and endophytic central tumors, with a focus on surgical technique. The key to management of these tumors is to maintain good preoperative hydration, achieving adequate exposure of tumor, and the use of intraoperative ultrasound to plan the resection plane. Individual vessels may be ligated as they enter close to the tumor. Careful renorrhaphy is essential, especially in hilar tumors, which have major blood vessels at the base of the tumor. Selective use of near infrared fluorescence imaging, on-demand ischemia, early unclamping, enucleoresection techniques, and intracorporeal hypothermia may help minimize, or reduce the effect of warm ischemia.

Is Robot-assisted Surgery Contraindicated in the Case of Partial Nephrectomy for Complex Tumours or Relevant Comorbidities? A Comparative Analysis of Morbidity, Renal Function, and Oncologic Outcomes

BackgroundAvailable comparisons between open partial nephrectomy (OPN) and robot-assisted partial nephrectomy (RAPN) are scarce, incomplete, and affected by non-negligible risk of bias. ObjectiveTo compare RAPN and OPN. Design, setting, and participantsThis was an observational study of 472 patients diagnosed with a cT1–2cN0cM0 renal mass and treated with RAPN or OPN assessed in two prospective institutional databases. Outcome measurements and statistical analysisThe study outcomes were morbidity, complications, warm ischaemia time, renal function, positive surgical margins, and oncologic outcomes. Propensity score matching for age at diagnosis, gender, Charlson comorbidity index, preoperative estimated glomerular filtration rate (eGFR), single kidney status, tumour size and side, total PADUA score, any individual PADUA score item, and year of surgery was used to account for baseline confounders. The effect of surgical approach was estimated using linear and logistic regressions for continuous and categorical outcomes. An interaction test was used for subgroup analyses. Results and limitationsRelative to OPN, RAPN was associated with lower rates for overall (21% vs 36%; p<0.0001) and major (3% vs 9%; p=0.03) complications. This benefit was consistent in patients with high PADUA scores, high CCI, large tumours, and low preoperative eGFR (all p>0.05, interaction test). No difference between the groups was observed for warm ischaemia time, postoperative and 1-yr eGFR, and positive surgical margins (all p>0.05). After median follow-up of 41 mo, there was no difference between the groups for the 5-yr rates of local recurrence-free, systemic progression-free, and disease-free survival (all p>0.05). ConclusionsRAPN is associated with overall better perioperative morbidity and lower rates of complications, regardless of characteristics such as tumour complexity and patient comorbidity status. Functional and oncologic outcomes are equal after RARP and OPN. Patient summaryRobot-assisted partial nephrectomy is associated with a better morbidity profile than open partial nephrectomy (OPN) and provides the same cancer control and renal function preservation observed after OPN.

Nephron sparing surgery in tumours greater than 7 cm

Partial nephrectomy (PN) is the gold standard treatment for renal cell carcinomas under 4cm. No robust data exists to recommend PN for tumours>7cm (cT2). The objective of this work is to evaluate the results of PN for cT2 tumours. All patients who underwent PN or radical nephrectomy (RN) for cT2 tumours between 2000 and 2013 at our institution have been included. Patient demographics, postoperative data including renal function, morbidity, mortality and oncologic outcomes were reviewed retrospectively and compared using χ2 test, Mann-Whitney test, Kaplan-Meier method and log rank test. We included 130 patients, 49 (38%) in the PN group and 81 (62%) in the RN group, with a median follow-up of 42 months [19-69]. Variation of postoperative renal function at day 5 and last recorded value was significantly different between the groups (P=0.03 and P<0.001). The PN group had a significantly higher complication rate as compared with RN group (37% versus 14%, P=0.002). There were no significant differences between the two groups for overall, recurrence free and specific survival (P=0.55, P=0.55, P=0.24, respectively). In univariate analysis, the type of surgery (PN versus RN) was not associated with a significant difference of oncologic outcome (margins, survival). PN can be offered for cT2 tumours with oncological outcomes similar to RN. Despite an increased morbidity, it remains acceptable with the demonstrated advantage of preservation of renal function. 4.

Effects on serum cortisol and inflammatory factor of laparoscopic partial nephrectomy for renal tumors

Objective To discuss the effects on serum cortisol (cortisol, Cor) and inflammatory factor of laparoscopic partial nephrectomy for renal tumors. Methods From 2014 May to November 2016, 106 patients with renal tumors in our hospital were divided into control group and experimental group according to the draw method , 53 cases of each group, the patients in the control group underwent open partial nephrectomy, the experimental group underwent laparoscopic partial nephrectomy. Operation indicators, Cor, tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6) and c-reactive protein (CRP), 5-hydrocarbon serotonin (5-HT) and visual analogue scale (VAS), tumor markers before and after surgery, and postoperative complications between two groups were compared. Results Operation time was no difference between the two groups (P>0.05), the bleeding, exhaust time, length of hospital stay of experimental group were better than control group (P 0.05). After surgery, the Cor, TNF-α, IL-6, CRP, 5-HT, VAS of experimental group were lower than the control group (P 0.05). The complication rate of experimental group was lower than the control group (P<0.05). Conclusions Laparoscopic nephre- ctomy for renal tumors can increase the serum cortisol and inflammation factor, but the above indicators are lower than open nephrectomy, and the pain is lighter. Key words: Kidney Neoplasms; Nephrectomy; Laparoscopes; Hydrocortisone; Inflammation