Nephrectomy For Tumors Research Articles

V58 - ICG marked off-clamp robotic partial nephrectomy for endophytic renal tumors: Proof of concept and initial series

V58 - ICG marked off-clamp robotic partial nephrectomy for endophytic renal tumors: Proof of concept and initial series

1040 - Perioperative, functional and oncological outcomes of robot-assisted partial nephrectomy for cT2 renal tumors: A multicenter analysis (The ROSULA project)

1040 - Perioperative, functional and oncological outcomes of robot-assisted partial nephrectomy for cT2 renal tumors: A multicenter analysis (The ROSULA project)

1049 - Combined use of 3D reconstruction plus near-infrared fluorescence during robot-assisted partial nephrectomy for pT1b tumors: Operative and early functional results based on renal scan

1049 - Combined use of 3D reconstruction plus near-infrared fluorescence during robot-assisted partial nephrectomy for pT1b tumors: Operative and early functional results based on renal scan

515 - ICG marked off-C robotic partial nephrectomy for endophytic renal tumors: Proof of concept and initial series

515 - ICG marked off-C robotic partial nephrectomy for endophytic renal tumors: Proof of concept and initial series

3:09 PM Abstract No. 241 Small renal tumor percutaneous ablation versus nephrectomy: treatment and clinical outcomes in a single-center Canadian cohort

3:09 PM Abstract No. 241 Small renal tumor percutaneous ablation versus nephrectomy: treatment and clinical outcomes in a single-center Canadian cohort

Partial versus radical nephrectomy for T1b-2N0M0 renal tumors: A propensity score matching study based on the SEER database

PurposeControversy continues on the tailored therapy for patients with larger renal cell carcinoma (RCC). We investigated whether partial nephrectomy (PN) can improve patient prognosis compared to radical nephrectomy (RN) and the indications for each approach in patients with T1b-2N0M0 RCC.Materials and methodsA total of 9907 patients were identified from the Surveillance, Epidemiology, and End Results database from 2004 to 2012. Propensity scores were used to balance the selection bias of undergoing PN. Overall (OS) and cancer-specific survival (CSS) of patients undergoing PN and RN were compared. Cases were subdivided to investigate the advantages of each procedure.ResultsOverall, 1418 (14.3%) patients underwent PN. Before matching, PN led to better OS and CSS than RN in both Kaplan-Meier analysis and Cox regression (each p<0.01). For 1412 matched cohorts, PN was no longer associated with significantly better OS (HR: 1.19, 95% CI: 0.98–1.44), but still with a better CSS (HR: 1.66, 95% CI: 1.18–2.27) compared with RN. Further subgroup analysis indicated that patients, who were male, single living, old than 65 years, with T1b stage or clear-cell histologic type, may obtained more oncologic benefit from PN compared to RN.ConclusionsWhen tumor localization and technical feasibility have been taken into account, similar long-term survival was achieved in overall among two nephrectomy modalities, but patients, who were male, old than 65 years, with T1b stage or clear-cell histologic type, got a better survival after receiving PN compared to RN.

Laparoscopic nephrectomy for Wilms' tumor: Can we expand on the current SIOP criteria?

Wilms' tumor now has a good overall prognosis with open radical nephrectomy having been the mainstay of surgical treatment. Recently laparoscopic nephrectomy (LN) has been growing in popularity. The aim of our study was to review our indications and outcomes for laparoscopic resections for Wilms' tumor and compare indications with International Society of Paediatric Oncology (SIOP) criteria for LN. Patient demographics, preoperative management, surgical data, respect of SIOP criteria, complications, disease outcome, and follow-up were recorded on consecutive children who underwent nephrectomy for Wilms' tumor. Fifty-four consecutive children with Wilms' tumor underwent a nephrectomy; 20 had a LN (Table). Nine of 20 (45%) patients who had LN did not meet SIOP criteria for LN. No patients had an intraoperative tumor rupture and one patient had positive margins because of preoperative rupture. There were two conversions: one caused by difficulty accessing the renal hilum and the other caused by difficulty maintaining oxygen saturations. There was one local recurrence. SIOP criteria are conservative and safe. Indications can be extended for teams experienced in surgical oncology and laparoscopy after agreement at a multidisciplinary meeting (MDM).

Robot-Assisted Partial Nephrectomy for Multiple Renal Tumors: A Vattikuti Collective Quality Initiative Database Analysis

Abstract Introduction: Patients with multiple renal tumors may have a higher chance of metachronous contralateral renal tumors.1 Owing to this, efforts must be made to utilize nephron sparing surgery in these cases, wherever possible. Longer ischemia times are expected because of resection and reconstruction of multiple defects. The outcomes of robot-assisted partial nephrectomy (RAPN) for this indication have previously been reported to be comparable with solitary tumors.2,3 However, other series have shown an increased complication rate.4 The three goals of surgery are to remove all the tumor with acceptable ischemia time and low complication rate. This video shows the technique and outcomes of RAPN for multiple tumors in a single operative session in a multi-institutional setting. Materials and Methods: Retrospective analysis of the Vattikuti Collective Quality Initiative prospective database was done. A total of 501 patients underwent RAPN from November 2014 till January 2017 at 14 institutions in 9 c...

Overall survival and oncological outcomes after partial nephrectomy and radical nephrectomy for cT2a renal tumors: A collaborative international study from the French kidney cancer research network UroCCR

Partial nephrectomy (PN) is recommended as first-line treatment for cT1 stage kidney tumors because of a better renal function and probably a better overall survival than radical nephrectomy (RN). For larger tumors, PN has a controversial position due to lack of evidence showing good cancer control. The aim of this study was to compare the results of PN and RN in cT2a stage on overall survival and oncological results. A retrospective international multicenter study was conducted in the frame of the French kidney cancer research network (UroCCR). We considered all patients aged≥18 years who underwent surgical treatment for localized renal cell carcinoma (RCC) stage cT2a (7.1-10cm) between 2000 and 2014. Cox and Fine-Gray models were performed to analyze overall survival (OS), cancer specific survival (CSS) and cancer-free survival (CFS). Comparison between PN and RN was realized after an adjustment by propensity score considering predefined confounding factors: age, sex, tumor size, pT stage of the TNM classification, histological type, ISUP grade, ASA score. A total of 267 patients were included. OS at 3 and 5 years was 93.6% and 78.7% after PN and 88.0% and 76.2% after RN, respectively. CSS at 3 and 5 years was 95.4% and 80.2% after PN and 91.0% and 85.0% after RN. No significant difference between groups was found after propensity score adjustment for OS (HR 0.87, 95% CI: 0.37-2.05, P=0.75), CSS (HR 0.52, 95% CI: 0.18-1.54, P=0.24) and CFS (HR 1.02, 95% CI: 0.50-2.09, P=0.96). PN seems equivalent to RN for OS, CSS and CFS in cT2a stage kidney tumors. The risk of recurrence is probably more related to prognostic factors than the surgical technique. The decision to perform a PN should depend on technical feasibility rather than tumor size, both to imperative and elective situation. 4.

Innovations in surgical treatment of pediatric solid tumors

The overall survival of children with solid tumors has shown a substantial increase in the past decades due to progress in all of the disciplines involved in the treatment. The poor prognosis for advanced stages of disease and the morbidity related to therapeutic procedures are still achallenge. Innovations in the surgical treatment of solid tumors can contribute to increase the survival rate of affected children and to decrease the treatment-related morbidity. Considering these aspects, the successful implementation of innovations is described based on four examples. (1) Tumor nephrectomy has long been the standard surgical procedure for Wilms tumor/nephroblastoma. Modifications of the surgical technique allow anephron-sparing resection of the tumor and thereby reducing the long-term effects of nephrectomy. (2) According to the protocols of the International Society of Pediatric Oncology (SIOP) liver transplantation should be used for high-risk hepatoblastoma. Virtual imaging methods based on new software processors enable amore accurate and individual planning of the surgical procedure and an organ-saving extended tumor resection which avoids a transplantation. (3) Mutilating surgical procedures are sometimes necessary for a curative treatment of rhabdomyosarcoma. By combining surgery and brachytherapy mutilating surgical procedures for urogenital rhabdomyosarcomas can be avoided. (4) Pulmonary metastatic nodules can become accessible to minimally invasive resection if CT-guided marking by coil wire is preoperatively performed. In selected cases thoracotomy will be avoided and due to ashorter postoperative course, the time to the subsequent adjuvant chemotherapy will be reduced.

Medical renal disease in tumor nephrectomies: The silent killer.

In tumor nephrectomy specimens, the evaluation of the normal renal parenchyma is often overlooked. A patient with both end-stage renal diseases (ESRDs) with a renal cell carcinoma is more likely to die of the ESRD rather than cancer. At the time of nephrectomy, a pathologist has a large amount of tissue available to him to comment upon the presence of disease in the nonneoplastic kidney. Hence, this study was undertaken with the idea of characterizing disease in the nonneoplastic kidney at the time of tumor nephrectomy. A two-year retrospective study was carried out on all tumor nephrectomies and partial nephrectomies. Glomerular, tubulointerstitial, and vascular compartments were evaluated for abnormalities. Twenty-four cases were included in the study. A total of 17 cases showed abnormalities in the nonneoplastic renal parenchyma. In the glomeruli, two cases showed IgA nephropathy, one case showed segmental sclerosis, and one case showed the presence of cellular crescents. A single case showed diabetic glomerulosclerosis. Interstitial fibrosis and tubular atrophy were noted in seven cases. Fifteen cases showed intimal sclerosis and medial hypertrophy and six cases showed nodular hyalinosis. Tumor nephrectomy specimens may very often show the presence of various nonneoplastic diseases. Hypertensive and diabetic renal disease are the major contributors, although primary glomerular diseases may also be present. At the time of the evaluation of a renal tumor on nephrectomy specimen, the status of the nonneoplastic kidney may become as an important predictor of clinical outcome as the tumor itself.

Nephrectomy in children with wilms' tumor: 15 years of experience with "Tumor Delivery Technique".

Background:The contemporary surgical approach to Wilms' tumors follows that used in adults with renal cell carcinomas, namely, early occlusion of the renal vessels and then removal of the kidney as an intact mass. For years, the surgical approach at our institution has been different, starting with blunt separation of the kidney from the surrounding tissues, followed by its delivery outside the abdominal cavity while it is only attached to the major blood vessels which are subsequently ligated. We aimed to present this “tumor delivery technique” and evaluate its outcomes.Materials and Methods:We retrospectively reviewed medical records of children who underwent nephrectomy for Wilms' tumor using “tumor delivery technique.” All procedures were performed by the same team, according to the same surgical principles.Results:Between 2000 and 2015, 36 children were operated. Median age was 31 months (interquartile range [IQR]: 6–45 mo), and median maximal tumor diameter was 10 cm (IQR: 8–13.9 cm). Tumors were located to the right side in 47%, left side in 42%, and bilateral in 11%. Twelve children have received preoperative neoadjuvant chemotherapy. Capsular disruption and tumor spillage were documented in 4 cases (11%).Conclusions:“Tumor delivery technique” is an easy and safe approach which might reduce the overall complication rates and the incidence of intraoperative tumor spillage.

Impact of learning curve on the perioperative outcomes following robot-assisted partial nephrectomy for renal tumors.

Introduction:Robot-assisted partial nephrectomy (RAPN) is an established, minimally invasive technique to treat patients with renal masses. The aim of this study was to assess the learning curve (LC) of RAPN, evaluate its impact on perioperative outcomes following RAPN and to study the role of surgeon experience in achieving “trifecta” outcomes following RAPN.Methods:We prospectively analyzed the clinical and pathological outcomes of 108 consecutive patients who underwent RAPN for renal tumors from January 2012 to December 2016 by a laparoscopy trained surgeon with no prior robotic experience. We used warm ischemia time (WIT) <20 min, operative time <120 min, and blood loss <100 ml as endpoints for plotting the LCs. Trifecta was analyzed in relation to our LC.Results:Surgeon experience was found to correlate with WIT, operative time, and blood loss. Overall 18.5% of patients developed complications. Complication rate reduced with increasing surgeon experience. LC was 44 cases for WIT ≤20 min, 44 cases for operative time <120 min, and 54 cases for blood loss <100 ml. Trifecta outcome was achieved in 67.6% patients overall and was found to correlate with increasing surgeon experience. Improvement in trifecta outcomes continued to occur beyond the LC.Conclusions:RAPN is a viable option for nephron-sparing surgery in patients with renal carcinoma. For a surgeon trained in laparoscopy, acceptable perioperative outcomes following RAPN can be achieved after an LC of about 44 cases. Increasing surgeon experience was associated with improved “trifecta” achievement following RAPN.

Management of Small Renal Masses.

With the ubiquitous use of cross-sectional abdominal imaging in recent years, the incidence of small renal masses (SRMs) has increased, and the evaluation and management of SRMs have become important clinical issues. Diagnosing a mass in the early stages theoretically allows for high rates of cure but simultaneously risks overtreatment. In the past 20 years, surgical treatment of SRMs has transitioned from radical nephrectomy for all renal tumors, regardless of size, to elective partial nephrectomy whenever technically feasible. Additionally, newer approaches, including renal mass biopsy, active surveillance for select patients, and renal mass ablation, have been increasingly used. In this chapter, we review the current evidence-based papers covering aspects of the diagnosis and management of SRMs.

Robotic cold ischemia achieves comparable functional outcomes to open cold ischemia during partial nephrectomy for complex kidney tumors.

Objectives:To compare the perioperative and functional outcomes after open and robotic partial nephrectomy performed with cold ischemia.Methods:A retrospective chart review was completed of consecutive patients who underwent partial nephrectomy with renal hypothermia between January 2011 and September 2016. The study cohort included both open (Open Cold Ischemia, OCI; n=170) and robotic (Robotic Cold Ischemia, RCI; n=31) patients with complex renal masses (R.E.N.A.L. score >7) who did not meet exclusion criteria. A modified intracorporeal technique 1 was utilized for the introduction of ice slush at the time of hilar clamping in the RCI group. Statistical testing was performed to compare key perioperative and functional outcomes after ensuring equilibration of both groups by clinicodemographic criteria.Results:Both groups were statistically equivalent with respect to baseline characteristics. Median GFR preservation postoperatively was 86.7% for the open group and 86.6% in the robotic group (p=0.49). Cold ischemia time (CIT) in the open group was 35 minutes compared to 28 minutes (p = 0.03) in the robotic group. LOS was significantly shorter by 2 days (p < 0.01) in the robotic group. Positive margins was noted to be 17 (10%) in the open group and 2 (6.5%) patients in the robotic group (p=0.48).Conclusions:We demonstrate an effective and simplified method of intracorporeal ice cooling during robotic partial nephrectomy. Our data suggests that results with this approach compare favorably to open cold ischemia technique. Intracorporeal ice cooling can be considered when performing complex partial nephrectomies with ischemia times expected to exceed 25 minutes.

Perianesthetic Management of Laparoscopic Kidney Surgery.

Laparoscopic kidney surgery is commonly used for living donor, partial, and total tumor nephrectomy. The successful emergence of laparoscopic technique was justified by the many benefits offered such as reduced blood loss, tissue trauma, pain, and hospital stay. However, this comes at the expense of physiologic changes and complications secondary to pneumoperitoneum, surgical technique, and patient positioning with significant challenges in anesthetic management. A variety of laparoscopic approaches (transperitoneal, retroperitoneal, hand-assisted, robotic) are used with some having advantages over others. The kidneys are particularly sensitive to hemodynamic changes and pneumoperitoneum. Controversies in perioperative fluid administration exist. New modalities for postoperative pain control have been suggested. Laparoscopic kidney surgery is associated with multiple physiologic changes and adverse events but offers advantages of reduced postoperative pain, faster recovery, and shorter hospital stay. Understanding these physiologic changes and related anesthetic considerations is key for safe patient outcome.

The pathological evaluation of nonneoplastic kidney disorder in tumor nephrectomy specimens.

Renal cell carcinoma (RCC) comprises 2%-3% of all visceral and 80%-85% of all adult kidney malignancies. Nephrectomy is the treatment of choice for renal tumors. The accurate pathological evaluation of nonneoplastic renal parenchyma in nephrectomy specimens is important for subsequent management. Eighty-two patients with RCC who underwent surgery at Imam Khomeini Hospital, Urmia, Iran, from April 2006 to February 2015 were studied. Paraffin blocks of the hospital archives were stained by hematoxylin and eosin (H and E) and periodic acid-Schiff staining. Microscopic examination was performed on nontumoral portions that were in the farthest possible distance from the tumor. Out of total 82 cases, 24 (29.3%) had normal renal parenchyma and 58 (70.7%) had pathological changes in renal parenchyma. The most frequent pathological findings were vascular sclerosis with parenchymal scarring and pyelonephritis. Other findings include focal and diffuse mesangial hypercellularity, eight; focal segmental glome-rulonephritis, five; membranoproliferative glomerulonephritis, three; and membranous glome-rulonephritis, two. Parenchymal scarring and vascular change included 36% of clear cell type, 41% of papillary type, and 53.8% of chromophobe type. Although there is not any statistical relation between the gender of patients and pathological findings, there was an obvious correlation between age and pathological findings. Before the age of 55 years, vascular sclerosis with parenchymal scarring and glomerular diseases and then chronic pyelonephritis are more prevalent.Evaluation of pathological changes in nonneo-plastic renal parenchyma is an essential step in recognizing patients at risk of accelerated functional failure of the single remaining kidney, particularly in patients with a background of chronic vascular injury associated with diabetes or hypertension.

The unique characteristics of intussusception after renal tumor surgery in children

Abstract Introduction To further optimize survival rates as well as quality of cure for pediatric kidney tumors, attention for treatment related morbidity and mortality has become increasingly important. Intussusception is a rare but important complication after tumornephrectomy in children, causing morbidity, mortality and prolonged hospitalization. In this study, we describe two recent cases in our institute and provide a comprehensive review of the literature. Methods For our narrative review, we searched for all reported cases of post tumor nephrectomy intussusception published until November 2016, using Pubmed and Embase libraries. Results A total of 52 pediatric renal tumor cases who developed intussusception after tumor nephrectomy were identified. Median age was 23 months (range 3–84). Median time of onset was postoperative day 6 (range 1–18). Of 41 patients described in detail, only 4/41 were ileocolic, the others suffered from a small bowel intussusception. Most frequent presenting symptom was bilious vomiting. Preceding treatment approach was documented in 47 cases; i.e. preoperative chemotherapy had been administered to 10/47 patients. In 29 of 30 well documented cases, successful manually reduction during re-laparotomy was described and only 1 patient needed resection. All patients survived without recurrence of intussusception. Conclusion In pediatric renal tumor patients, small bowel obstruction seems to reflect mostly post nephrectomy intussusception cases in contrast to the ileocolic idiopathic intussusceptions that are observed in healthy children. Symptoms of intussusception mimic chemotherapy related toxicity and general post-surgical symptoms, thereby initiating a significant delay in diagnosis. Awareness of intussusception after renal tumor surgery is warranted.

The Effect of Patient and Surgical Characteristics on Renal Function After Partial Nephrectomy.

The purpose of the study was to identify patient and disease characteristics that have an adverse effect on renal function after partial nephrectomy. We conducted a retrospective review of 387 patients who underwent partial nephrectomy for renal tumors between 2006 and 2014. A line plot with a locally weighted scatterplot smoothing was generated to visually assess renal function over time. Univariable and multivariable longitudinal regression analyses incorporated a random intercept and slope to evaluate the association between patient and disease characteristics with renal function after surgery. Median age was 60 years and most patients were male (255 patients [65.9%]) and white (343 patients [88.6%]). In univariable analysis, advanced age at surgery, larger tumor size, male sex, longer ischemia time, history of smoking, and hypertension were significantly associated with lower preoperative estimated glomerular filtration rate (eGFR). In multivariable analysis, independent predictors of reduced renal function after surgery included advanced age, lower preoperative eGFR, and longer ischemia time. Length of time from surgery was strongly associated with improvement in renal function among all patients. Independent predictors of postoperative decline in renal function include advanced age, lower preoperative eGFR, and longer ischemia time. A substantial number of subjects had recovery in renal function over time after surgery, which continued past the 12-month mark. These findings suggest that patients who undergo partial nephrectomy can experience long-term improvement in renal function. This improvement is most pronounced among younger patients with higher preoperative eGFR.

Re: Positive Surgical Margins and Local Recurrence After Simple Enucleation and Standard Partial Nephrectomy for Malignant Renal Tumors: Systematic Review of the Literature and Meta-analysis of Prevalence

Re: Positive Surgical Margins and Local Recurrence After Simple Enucleation and Standard Partial Nephrectomy for Malignant Renal Tumors: Systematic Review of the Literature and Meta-analysis of Prevalence