Nephrectomy For Tumors Research Articles

PE24 - Robotic partial nephrectomy for high-complexity tumour

PE24 - Robotic partial nephrectomy for high-complexity tumour

Cryoablation versus Partial Nephrectomy for Clinical T1b Renal Tumors: A Matched Group Comparative Analysis

BackgroundThe traditional treatment for a cT1b renal tumor has been radical nephrectomy. However, recent guidelines have shifted towards partial nephrectomy (PN) in selected patients with cT1b renal tumors. Furthermore, practitioners have extended the role of cryoablation (CA) to treat cT1b tumors in selected patients. ObjectiveTo evaluate the efficacy of CA compared to PN for cT1b renal tumors. Design, setting, and participantsWe performed a retrospective review of patients who underwent either renal CA (laparoscopic or percutaneous) or PN (robot-assisted) for a cT1b renal mass (>4cm and ≤7cm) between November 1999 and August 2014. To reduce the inherent biases of a retrospective study, CA and PN groups were matched on the basis of key variables: tumor size, Charlson comorbidity index (CCI), age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, preoperative serum creatinine, preoperative estimated glomerular filtration rate (eGFR), gender, and solitary kidney. The matching algorithm was 1:1 genetic matching with no replacement. Outcome measurements and statistical analysisSurvival analysis was performed only for patients diagnosed with renal cell carcinoma according to histopathologic evaluation of a tumor biopsy or resected tumor specimen. Recurrence-free, overall, and cancer-specific survival were analyzed using Kaplan-Meier survival curves. Survival outcomes were compared between groups using the log-rank test. Results and limitationsA total of 31 patients were treated using CA and 161 using PN during the study period. After matching, there was no significant difference between the PN and CA groups for tumor size (4.6 vs 4.3cm; p=0.076), CCI (6 vs 6; p=0.3), RENAL score (9 vs 8; p=0.1), age (68 vs 68 yr; p=0.9), BMI (30 vs 31kg/m2; p=0.2), ASA score (3 vs 3; p=0.3), preoperative creatinine (1.2 vs 1.4mg/dl; p=0.2), preoperative eGFR (63 vs 53ml/min/1.73 m2; p=0.2), and proportion of patients with a solitary kidney (19% vs 32%; p=0.4). The total postoperative complication rate was higher for PN than for CA (42% vs 23%; p=0.10). There was no significant difference in percentage eGFR preservation between PN and CA (89% vs 93%; p=0.5). The rate of local recurrence was significantly higher for CA than for PN (p=0.019). There was no significant difference in cancer-specific mortality (p=0.5) or overall mortality (p=0.15) between the CA and PN groups. ConclusionsPatients treated with CA for cT1b renal tumors had a significantly higher rate of local cancer recurrence at 1 yr compared to those treated with PN. Until further studies are performed to clearly define the role of CA in cT1b renal tumors, CA should be reserved for patients with imperative indications for nephron-sparing surgery who cannot be subjected to the risks of more invasive PN. Patient summaryWe evaluated the efficacy of renal cryoablation compared to partial nephrectomy for clinical T1b renal tumors. The cryoablation and partial nephrectomy groups were matched to provide a better comparison. We concluded that renal cryoablation had a higher rate of local cancer recurrence.

Dysgerminoma developing from an ectopic ovary in a patient with WAGR syndrome: A case report.

WAGR syndrome is caused by an 11p13 deletion and includes Wilms' tumor, aniridia, genitourinary anomalies and mental retardation. We encountered a case of a dysgerminoma originating in an ectopic ovary in a woman with WAGR syndrome. Our patient was a 24-year-old nulliparous woman who was diagnosed with WAGR syndrome. The patient had undergone left nephrectomy for a Wilms' tumor and postoperative chemotherapy at the age of 7 months. She also had a history of glaucoma surgery in both eyes, and was followed up at the Department of Pediatrics for diabetes mellitus, hypertension, liver dysfunction and hyperuricemia. The patient was investigated for oliguria and had elevated levels of blood urea nitrogen (45 mg/dl) and creatinine (5.4 mg/dl); she was admitted to the hospital with acute renal failure and a computed tomography scan revealed a pelvic tumor with a long axis of 10 cm that was obstructing the right ureter. Following insertion of a ureteral stent, the tumor was removed. The tumor had developed in the retroperitoneal space independent of the ovaries. The right adnexa were normal. The tumor was histopathologically diagnosed as dysgerminoma. Follicles were found in part of the tumor; it was thus hypothesized that the tumor developed from an ectopic ovary. The patient was administered etoposide after surgery, and has been recurrence-free for 4 years since treatment.

Fetal rhabdomyomatous nephroblastoma: diagnosis and therapy

Objective To explore the characteristic clinical profiles and treatment modalities of Fetal rhabdomyomatous nephroblastoma(FRN). Methods A retrospective study was conducted for 14 FRN patients from Jan.2000 to Oct.2015.Their clinical data were collected including clinical presentations, pathology and treatment modalities.There were 8 males and 6 females with a mean age of 23 months. There were 3 cases at left side and right side 5 cases, bilateral 6 cases. 2 patients were classified as stageⅠ, 1 stageⅡ, 5 stageⅢ and 6 stageⅤ. Abdominal mass was the main clinical presentation in 11 patients, and 1 case with hematuria, 1 with abdominal pain, and 1 with vomit. Most tumors showed cysts or completely solid from the ultrasonography. Computed tomographic scan revealed a large inhomogeneous enhancement tumor from the kidney pole with necrotic, cystic, bleeding or calcification. Ultrasonography and Computed tomography(CT) had no different performance from Wilms' tumor.9 patients received preoperative chemotherapy, and the response was none in all of them. 8 unilateral patients underwent tumor nephrectomy and another 4 had nephron-sparing surgery. Results Pathology showed that FRN contained more than 70% of fetal rhabdomyomatous tissue. Immunohistochemistry had no specificity, most FRN shows Desmin(+ ) and Myogenin(+ ). Bilateral FRN tumors were seen in 2, one side with FRN and another side with nephroblastomatosis were seen in 3, one side with FRN and another side with Wilm's tumor was seen in 1 patient. Postoperative pathology confirmed FRN in all 14 cases.All patients received postoperative chemotheraphy: Act-D and VCR for 6 month(stageⅠ), Act-D and VCR for 15 month(stageⅡ), Act-D+ VCR+ ADR and radiotherapy for 15 month(stageⅢ). During follow-up of 6 months to 15 years, 10 of them were alive without tumor and no evidence of recurrence. Conclusions FRN is a rare histologic variant of Wilm's tumor with less aggressive behavior.FRN usually has a huge volume and is bilateral with a poor responder to preoperative chemotherapy, but it is associated with a generally favorable outcome. Surgery and chemically treatment appears the effective measure. Key words: Fetal rhabdomyomatous nephroblastoma; Wilms'tumor; Pathology; Therapy

Predicting complications in partial nephrectomy for T1a tumours: does approach matter?

To assess differences in complications after robot-assisted (RAPN) and open partial nephrectomy (OPN) among experienced surgeons. We identified patients in our institutional review board-approved, prospectively maintained database who underwent OPN or RAPN for management of unifocal, T1a renal tumours at our institution between January 2011 and August 2015. The primary outcome measure was the rate of 30-day overall postoperative complications. Baseline patient factors, tumour characteristics and peri-operative factors, including approach, were evaluated to assess the risk of complications. Patients who underwent OPN were found to have a higher rate of overall complications (30.3% vs 18.2%; P = 0.038), with wound complications accounting for the majority of these events (11.8% vs 1.8%; P < 0.001). Multivariable logistic regression analysis showed the open approach to be an independent predictor of overall complications (odds ratio 1.58, 95% confidence interval 1.03-2.43; P = 0.035). Major limitations of the study include its retrospective design and potential lack of generalizability. The open surgical approach predicts a higher rate of overall complications after partial nephrectomy for unifocal, T1a renal tumours. For experienced surgeons, the morbidity associated with nephron-sparing surgery may be incrementally improved using the robot-assisted approach.

Association of FOXM1 expression with tumor histology and prognosis in Wilms tumor: Potential for a new prognostic marker

Wilms tumor (WT) is the most common pediatric renal malignancy. A recent ontogenic model suggests that undifferentiated tumor state, and hence poor prognosis, in WT is determined by stabilization of β-catenin in the nucleus. Forkhead box M1 (FOXM1) is a downstream component of the Wnt pathway and promotes nuclear localization of β-catenin. As elevation of FOXM1 gene expression is prognostic in various types of malignancy, we hypothesized that high FOXM1 expression in WT is associated with undifferentiated histology and thus poor prognosis. In the current study, the expression of FOXM1 mRNA was determined in 46 WT specimens and 11 renal tissue controls from patients undergoing tumor nephrectomy, and these data were assessed with regard to clinicopathological parameters. The results demonstrated an upregulation of FOXM1 in WT by 10-fold compared to normal tissue. Expression differed significantly between controls and tumors of intermediate- and high-risk histopathology (P<0.001, Kruskal-Wallis), and distinguished normal tissue from tumors of good and adverse clinical outcome (P<0.001, Kruskal-Wallis). Notably, FOXM1 expression was significantly lower (P=0.009) in patients that received preoperative doxorubicin. These results suggest that FOXM1 may serve as a companion diagnostic factor for doxorubicin-based therapies in WT.

Is there a difference in clinicopathological outcomes of renal tumor between young and old patients? A multicenter matched-pair analysis

Objective: The aim of this study was to investigate the influence of age at diagnosis on tumor characteristics and cancer-specific survival (CSS) in renal cell carcinoma (RCC).Materials and methods: Data of patients who underwent radical or partial nephrectomy for renal tumor between 2003 and 2011 at multiple institutions were collected. Patients were divided into two groups according to age at diagnosis: 20–39 years and 40–79 years. To adjust for potential baseline confounders, propensity score matching was performed.Results: All included data showed that young RCC patients presented with renal tumors that had a more favorable histological subtype, were localized, smaller in size, and had a lower Fuhrman nuclear grade. The 5 year CSS rates were 95.5% and 90.5% in the young and old patient groups, respectively (log rank p = 0.019). After matching on the propensity score, the two groups with RCC had 302 patients each. Because the groups were matched on covariates, there were no significant differences in the pathological proportion, tumor size, Fuhrman nuclear grade and clinical T stage. The 5 year CSS rates were 95.5% and 94.7% in the young and old patient groups, respectively (log rank p = 0.184).Conclusion: After adjusting for potential biases, there was no significant difference in prognosis between young and old patients with RCC.

01 - Zero ischemic sutureless laparoscopic minimal margin partial nephrectomy for renal tumours with soft coagulation: Preliminary results

01 - Zero ischemic sutureless laparoscopic minimal margin partial nephrectomy for renal tumours with soft coagulation: Preliminary results

Incidence of Cardiovascular Events after Nephrectomy - A Single Centre, Matched Pair Analysis between Donor and Tumour Nephrectomy in a Long Term Follow-Up

Introduction: The study aimed to compare the incidence of cardiovascular events (CVEs) after donor nephrectomy (DN) and radical tumor nephrectomy (RN), according to an estimated glomerular filtration rate (eGFR), were evaluated over time. Materials and Methods: Follow-up was collected for DN who underwent surgery from 1998 to 2007 for CVE and renal function. All DN were matched for age to patients treated by RN or adenoma enucleation (control group), who were eligible for DN. eGFR was estimated using the Cockgroft-Gould formula. Patients with preoperative comorbidities were excluded. Results: Thirty DN (median age 48.9 years) were included with a median follow-up of 138.5 months (interquartile range 119-159). No significant differences in patients' characteristics were found preoperatively (p > 0.5). Four out of 30 DN developed a CVE (3 myocardial infarctions (MI), 1 stroke), 2 of 30 patients in the control group (both MI) and 8 of 30 RN patients (6 MI, 2 strokes, p > 0.05). Arterial hypertension developed in 14 DN (46.7%), in 12 (40%) after RN and in 15 controls. The CVE occurred after a median time of 68 months (5-231) and were related to a drop of ∼30% in the eGFR irrespective of the group. Conclusion: Decline of renal function after nephrectomy is the main risk factor for CVE. Close monitoring of renal function and new onset hypertension is warranted.

Robotic-assisted laparoscopic partial nephrectomy in clinical T1B renal tumors – Single center experience

Robotic-assisted laparoscopic partial nephrectomy in clinical T1B renal tumors – Single center experience

Renal Cell Carcinoma: When is a Partial, Organ-preserving Nephrectomy Possible and Reasonable?

In Switzerland about 900 people a year are newly diagnosed with a kidney tumour. This is about 3 % of all cancer cases in this country. Because of the abundent diagnostic examinations carried out (MR, CT, US), kidney tumours are often coincidentally found. In recent years the organ-sparing therapy has moved to the foreground for kidney tumours of <4 cm. This is increasingly true for larger lesions of 4–7 cm diameter. Organ-sparing kidney surgery has replaced the radical nephrectomy for tumours up to 7 cm because of the superior post-op quality of Life and the total survival rate. In addition, the control of oncological parameters, maintenance of kidney function, low morbidity and reproducibility of the method are existant and can be achieved using this organ-sparing therapy.

Segmental arterial mapping during pediatric robot-assisted laparoscopic heminephrectomy: A descriptive series

The incidence of innocent moiety injury during heminephrectomy is estimated to be 4-5%. This complication can have long-term consequences for the child. Selective arterial mapping (SAM) with indocyanine green (ICG)-aided near infrared fluorescence (NIRF) imaging using the Firefly™ system on the da Vinci(®) surgical robotic console has proven to be valuable in robotic partial nephrectomy for adult renal tumors. However, there is nothing in the literature for using this technique in pediatric robot-assisted laparoscopic heminephrectomy (RALHN). To present a descriptive series of children who had SAM RALHN using ICG-aided NIRF imaging. To determine the feasibility of using ICG-aided NIRF SAM during RALHN, and to study if real-time delineation of the selective arterial anatomy of the upper and lower moieties would be helpful or change the immediate outcomes of the surgery. A descriptive series of six children who received RALHN at the present institution. Selective arterial mapping was performed safely without toxicity or vascular complications; it did not extend the operative time and did not change the complexity of the operation. As shown in the summary table below, SAM added value by increasing safety of the operation. The individual operation cost increase of using SAM was only related to the single-use vial of ICG. Inadvertent injury to the innocent moiety in pediatric heminephrectomy is seldom noted intraoperatively, and many times only becomes evident postoperatively when there is acute ischemia or a chronic reduction in renal function. Although there is no replacement for good surgical technique and judgment, SAM during RALHN is a useful real-time way of alerting the surgeon to unexpected anatomy, and possible unintended or occult injury to the innocent moiety that could have devastating short-term and long-term consequences to the child, despite immediate recovery from surgery. This report achieved its aim of reporting the feasibility of SAM on a small descriptive series of children who had RALHN.

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Aug 2016This Month in Adult Urology Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.05.001AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Adult Urology." The Journal of Urology, 196(2), pp. 295–296 References 1 : Systemic nonurological symptoms in patients with overactive bladder. J Urol2016; 196: 467. Abstract, Google Scholar 2 : Somatic comorbidity in women with overactive bladder syndrome. J Urol2016; 196: 473. Link, Google Scholar 3 : Autonomic testing in women with chronic pelvic pain. J Urol2016; 196: 429. Abstract, Google Scholar 4 : Analysis of gut microbiome reveals significant differences between men with chronic prostatitis/chronic pelvic pain syndrome and controls. J Urol2016; 196: 435. Link, Google Scholar 5 : Positive surgical margins increase risk of recurrence after partial nephrectomy for high risk renal tumors. J Urol2016; 196: 327. Link, Google Scholar 6 : Prognostic value of percent Gleason grade 4 at prostate biopsy in predicting prostatectomy pathology and recurrence. J Urol2016; 196: 405. Link, Google Scholar 7 : A pilot study to evaluate the role of magnetic resonance imaging for prostate cancer screening in the general population. J Urol2016; 196: 361. Link, Google Scholar 8 : Prospective quality of life in men choosing active surveillance compared to those biopsied but not diagnosed with prostate cancer. J Urol2016; 196: 392. Link, Google Scholar 9 : The efficacy of multiparametric magnetic resonance imaging and magnetic resonance imaging targeted biopsy in risk classification for patients with prostate cancer on active surveillance. J Urol2016; 196: 374. Link, Google Scholar © 2016 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 196Issue 2August 2016Page: 295-296 Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

Tuberous sclerosis complex: Hamartin and tuberin expression in renal cysts and its discordant expression in renal neoplasms

Tuberous sclerosis complex (TSC) results from mutation of TSC1 or TSC2 that encode for hamartin and tuberin. It affects the kidneys often in advance of extra-renal stigmata. We studied 14 TSC cases, and 4 possible TSC cases with multiple angiomyolipomas (AMLs) for hamartin and tuberin protein expression to determine if the staining profile could predict mutation status or likelihood of TSC with renal-limited disease. The 18 cases included 15 nephrectomies and 1 section of 6 TSC-associated renal cell carcinomas (RCC). Controls included the non-neoplastic kidney in 5 tumor nephrectomies, 4 sporadic cases of AML and 6 clear cell RCCs. In the 14 TSC cases, 9 had AMLs, 9 had RCCs, 5 had polycystic kidney disease and 8 had eosinophilic cysts (EC) lined by large eosinophilic cells. The controls and study cases showed luminal staining of proximal tubules (PT) and peripheral membrane staining in distal tubules/collecting ducts for hamartin and cytoplasmic staining for tuberin. Eosinophilic cysts had a luminal PT-like stain with hamartin and a cytoplasmic reaction for tuberin. Hamartin stained myoid cells in all AMLs. Tuberin was negative in all but 1AML, an epithelioid AML. All but 1 RCC were positive for tuberin; 13 RCCs (7 TSC/6 non-TSC) were negative for hamartin and 4 showed a weak reaction. We conclude that the ECs of TSC are proximal tubule-derived. The hamartin and tuberin staining profiles of AMLs and most RCCs are reciprocal precluding prediction of the mutation in TSC, and fail to predict if a patient with multifocal AML has TSC.

American Confederation of Urology (CAU) experience in minimally invasive partial nephrectomy.

To describe the perioperative and oncology outcomes in a series of laparoscopic or robotic partial nephrectomies (PN) for renal tumors treated in diverse institutions of Hispanic America from the beginning of their minimally invasive (MI) PN experience through December 2014. Seventeen institutions participated in the CAU generated a MI PN database. We estimated proportions, medians, 95% confidence intervals, Kaplan-Meier curves, multivariate logistic and Cox regression analyses. Clavien-Dindo classification was used. We evaluated 1501 laparoscopic (98%) or robotic (2%) PNs. Median age: 58years. Median surgical time, warm ischemia and intraoperative bleeding were 150, 20min and 200cc. 81% of the lesions were malignant, with clear cell histology being 65% of the total. Median maximum tumor diameter is 2.7cm, positive margin is 8.2%, and median hospitalization is 3days. One or more postoperative complication was recorded in 19.8% of the patients: Clavien 1: 5.6%; Clavien 2: 8.4%; Clavien 3A: 1.5%; Clavien 3B: 3.2%; Clavien 4A: 1%; Clavien 4B: 0.1%; Clavien 5: 0%. Bleeding was the main cause of a reoperation (5.5%), conversion to radical nephrectomy (3%) or open partial nephrectomy (6%). Transfusion rate is 10%. In multivariate analysis, RENAL nephrometry score was the only variable associated with complications (OR 1.1; 95% CI 1.02-1.2; p=0.02). Nineteen patients presented disease progression or died of disease in a median follow-up of 1.37years. The 5-year progression or kidney cancer mortality-free rate was 94% (95% CI 90, 97). Positive margins (HR 4.98; 95% CI 1.3-19; p=0.02) and females (HR 5.6; 95% CI 1.7-19; p=0.005) were associated with disease progression or kidney cancer mortality after adjusting for maximum tumor diameter. Laparoscopic PN in these centers of Hispanic America seem to have acceptable perioperative complications and short-term oncologic outcomes.

Treatment for T1a Renal Cancer Substratified by Size: “Less is More”

Due to the widespread use of computerized tomography, the diagnosis of small renal cancers (3 cm or less) within the T1a classification continues to increase. Current treatment of these tumors includes radical nephrectomy, partial nephrectomy and thermal ablation. We used the SEER (Surveillance, Epidemiology, and End Results) Program to compare treatment modalities for these cancers based on 1 cm increments in tumor size. We examined overall survival, cancer specific survival, survival from cardiovascular disease and race based treatment disparities. In the SEER database we identified 17,716 renal cancers 3 cm or less diagnosed from 2005 to 2010 treated with radical nephrectomy, partial nephrectomy or thermal ablation. Overall survival, cancer specific survival and cardiovascular survival were determined for each treatment group, and then substratified by size in centimeters, tumor grade, age, geographical location and ethnicity. Survival was analyzed using Kaplan-Meier methods, multivariate proportional hazards models and a propensity score weighted approach. Overall survival, cancer specific survival and cardiovascular survival were better for partial nephrectomy than radical nephrectomy in all circumstances. Thermal ablation showed equivalent overall survival to partial nephrectomy for tumors 2 cm or less. Notably, radical nephrectomy for renaltumors 3 cm or less was applied in a disparately larger number of black patients (OR 1.63, 95% CI 1.47-1.81) and Hispanic patients (OR 1.28, 95% CI1.14-1.44). Radical nephrectomy should be avoided for all tumors 3 cm or less. For renal cancers 2 cm or less partial nephrectomy and thermal ablation are equally effective. For tumors 2.1 to 3 cm partial nephrectomy is better than thermal ablation. We identified significant racial treatment disparities that negatively impact survival in black and Hispanic patients.

Trends in the use of partial nephrectomy for cT1 renal tumors: Analysis of a 10-yr European multicenter dataset

AimAlthough extensively addressed in US registries, the utilization rate of Partial Nephrectomy has been poorly addressed in European settings. Our aim is to evaluate the impact of hospital volume on the use of PN for cT1 renal tumors. Methods2526 patients with cT1N0M0 renal tumors treated with either PN or radical nephrectomy at 10 European centres in the last decade were included in the analysis. Joinpoint regression analysis was used to identify significant changes over time in linear slope of the trend for each center. The correlation between yearly caseload and the slopes was assessed with the non-parametric Spearman test. Coincident pairwise tests and regression analyses were used to generate and compare the trends of high-volume (HV), mid-volume (MV) and low-volume (LV) groups. ResultsYearly caseload was significantly associated with increased use of PN (R = 0.69, p = 0.028). The utilization rate of PN was stable at LV centres (p = 0.67, p = 0.7, p = 0.76, for cT1, cT1a, and cT1b tumors, respectively), while increased significantly at MV (p = 0.002, 0.0005 and 0.007, respectively) and HV centers (all p < 0.0001). Regression analysis confirmed the trends for HV and MV as significantly different from those observed in LV centres (all p ≤ 0.002) and highlighted significant differences also between MV and HV centres (all p ≤ 0.03). ConclusionsWe confirmed the association between caseload and the use of PN for cT1 tumors. Our findings suggest that a minimum caseload might turn the tide also in LV centres while a selective referral to HV centers for cT1b tumors should be considered.

Pre-treatment neutrophil-to-lymphocyte ratio predicts tumor pathology in newly diagnosed renal tumors.

The neutrophil-to-lymphocyte ratio (NLR) predicts adverse outcomes after surgical treatment for clear cell renal cell carcinoma (ccRCC). However, its ability to distinguish aggressive from indolent renal tumors remains unknown. We therefore evaluated the association between NLR and pathologic outcomes at nephrectomy. From 1995 to 2008, 2402 patients underwent radical or partial nephrectomy for localized renal tumors. Of these, 2039 had an NLR within 90days prior to surgery. Comparisons of NLR by tumor size, histologic subtype, and nuclear grade were evaluated. Benign renal masses had a significantly lower NLR than malignant tumors (median 2.92 vs. 3.12; p=0.037) with the greatest difference noted among renal lesions >7cm (median 2.79 vs. 3.87; p<0.001). There was a significant difference in NLR among RCC subtypes (p=0.002), with cystic ccRCC demonstrating the lowest (median 2.48) and collecting duct RCC the highest NLR (median 5.99). Moreover, there was a significant increase in NLR with larger tumor size and greater nuclear grade (p<0.001). Specifically, in patients with ccRCC, an incremental increase in tumor size (≤4cm=2.80, >4 but ≤7cm=3.09 and >7cm=3.95) and nuclear grade (G1=2.68, G2=2.87, G3=3.48, and G4=5.18) was associated with greater NLR (p<0.001). An elevated NLR is associated with RCC pathology, higher-grade tumors, and more aggressive histologic subtypes at the time of nephrectomy. Therefore, NLR appears to be a preoperative marker of biologically aggressive RCC and may be useful in predicting malignancy and guiding management among patients with suspicious renal tumors.

AB151. Meta-analysis: comparison of partial nephrectomy and radiofrequency ablation in small renal tumors

ObjectiveComparison of partial nephrectomy and radiofrequency ablation in small renal tumorsMethodsWe searched through the major medical databases such as PubMed, EMBASE, Medline, Science Citation Index, Web of Science and Chinese National Knowledge Infrastructure Database (CNKI) and Database of Chinese Ministry of Science & Technology (Wanfang) for all published studies without any limit on language until May 2015. The following search terms were used: partial nephrectomy, radiofrequency ablation, renal cell carcinoma, small renal tumor or mass. Furthermore, additional related studies were manually searched in the reference lists of all published reviews and retrieved articles.ResultsIn this meta-analysis, there are not statistically differences between groups in 5y-DFS, recurrence rate and complications between RFA and PN. However, RFA has a lower rate of percentage change of decease rate in GFR than PN in terms of short-mediate follow-up time. Ultimately, the role of RFA and PN for small renal tumor remains to be defined and, ideally, this novel approach should be compared with PN in a well-designed, large, prospective, randomized and matched study before gaining wider acceptance.ConclusionsIn this meta-analysis, there are not statistically differences between groups in 5y-DFS, recurrence rate and complications between RFA and PN. However, RFA has a lower rate of percentage change of decease rate in GFR than PN in terms of short-mediate follow-up time. Ultimately, the role of RFA and PN for small renal tumor remains to be defined and, ideally, this novel approach should be compared with PN in a well-designed, large, prospective, randomized and matched study before gaining wider acceptance.

Trends of acute kidney injury after radical or partial nephrectomy for renal cell carcinoma

ObjectivesTo investigate the prevalence, temporal trends, and predictors of postoperative acute kidney injury (AKI) in a large cohort of patients with renal cell carcinoma treated with radical or partial nephrectomy. MethodsBetween January 1998 and December 2010, patients who underwent radical or partial tumor nephrectomy were identified within the Nationwide Inpatient Sample. First, prevalence and temporal trends of AKI were analyzed. Second, predictors of AKI were identified using multivariable regression analyses. Third, associations between AKI and in-hospital complications, length of stay, hospital costs, and in-hospital mortality were evaluated using logistic regression models adjusted for clustering. ResultsOf total 253,046 patients, 5.5% (14,303 in radical and 3,525 in partial nephrectomy) experienced AKI. Rates of AKI significantly increased from 2.0% in 1998 to 10.4% in 2010 (P<0.001). Predictors of AKI included male sex, radical nephrectomy, more contemporary years (2004–2010), older age, black race, higher comorbidities, higher preoperative chronic kidney disease stage, Medicare insurance status, and nephrectomy at urban hospitals (all P<0.01). Postoperative AKI during hospitalization was associated with an increased rate of in-hospital mortality, any complications, transfusion, prolonged length of stay, and higher hospital costs (all P<0.001). ConclusionsRising rates of in-hospital AKI after radical and partial nephrectomy were observed. Increasing awareness of AKI, identification of patients at risk before surgery, early postoperative AKI diagnosis, collaboration with nephrologists, implementation of renoprotective strategies, long-term renal functional follow-up, and a well-designed prospective study, may be warranted.