Open Partial Nephrectomy Research Articles

Microwave Thermal Ablation versus Open Partial Nephrectomy for the Treatment of Small Renal Tumors in Patients Over 70 Years Old.

Background and objectives: Microwave thermal ablation (MWT) is one of the treatment options for kidney cancer. However, for patients over 70 years old the safety and oncological efficacy of this treatment is still controversial. The goal of this study was to compare MWT with open partial nephrectomy (OPN) and to find out whether MWT is preferable in maintaining patient renal function and reducing the risk of postoperative complications. Materials and Methods: Depending on the treatment choice, all patients were divided into two groups: an MWT group and an open kidney resection (OPN) group. Data have been retrospectively collected for 7 years, starting with January 2012 up to January 2019. A total number of 33 patients with exophytic, single small renal masses were treated with either OPN (n = 18) or MWT (n = 15). All patients had histologically proven T1 kidney cancer. MWT was performed for patients who refused to have OPN or in those cases where the collecting system, renal calyx, and great vessels were free from tumor margins of more than 1 cm. Results: In the MWT group a median (IQR) patients’ age was 75 years (71–79) years, in the OPN group—71.5 (70–75) years, p = 0.005. A median (IQR) Charleston comorbidity index in the MWT group was 7.5 (5–10) and in the same way in the OPN group it was 5.22 (5–6), p = 0.005. A median (IQR) estimated glomerular filtration rate (eGFR) before surgery was higher in the MWT group 59.9 (49.5–73.8) mL/min/1.73 m2 vs. 46.2 (42.7–65.8) mL/min/1.73 m2 in the OPN group, p = 0.12. Three days following the surgery a median (IQR) eGFR was 56.45 (46.6–71.9) in MWT group mL/min/1.73 m2 vs. 43.45 (38.3–65) mL/min/1.73 m2) in the OPN group, p = 0.30. A median (IQR) of primary hemoglobin level was lower in the MWT group compared with the OPN group (134.5 (124–140) g/L vs. 125 (108–138) g/L), p = 0.41. However, after the surgery a median (IQR) lower hemoglobin level was detected in the OPN group (123.5 (111–134) g/L vs. 126 (112–135)), p = 0.53. The median (IQR) duration of the procedure in MWT group was shorter compared with the OPN group (26 (25–30) min vs. 67.5 (55–90) min), p < 0.0001. A median (IQR) hospitalization time was shorter in MWT group (3 (2–3) days vs. 89 (7–11.5) days), p < 0.0001. Pain by the visual analogue scale (VAS) scale the first day after surgery was significantly lower—median (IQR) in the MWT group was 2 (1–3) vs. 4 (3–6)), p = 0.008. Treatment failure rate was numerically higher in MWT (1/15 vs. 0/18, p = 0.56). Conclusions: Pain level on the next day after surgery, mean number of hospitalization and operation time were significantly lower in the MWT group than in the OPN group. The blood loss estimated glomerular filtration rate and oncologic data between the two groups was not statistically significant.

Impact of Curative Effect of Laparoscopic and Open Partial Nephrectomy for Complex Renal Tumours on Renal Function.

To explore the effect and safety of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) in the treatment of complex renal tumours and to compare renal function in the perioperative period. Comparative study. Departments of Urology and Cardiovascular Medicine, Affiliated Hospital of Hebei University, from July 2016 to June 2018. A total of 168 complex renal tumour patients with renal tumour scoring system scores (R.E.N.A.L) <7 and tumour stages of T1aN0M0~TlbN0M0 (diameter of tumour <7 cm without metastasis) were chosen. The patients were classified into the retroperitoneal laparoscopic partial nephrectomy (RLPN) group and open partial nephrectomy (OPN) group, comprising 84 patients in each group. Intraoperative and postoperative characteristics of both groups were compared. Statistical analysis of the occurrence rate of postoperative complications was conducted. Renal function indicators, including serum urea (UREA), creatinine (Cr), uric acid (UA) and glomerular filtration rate (GFR), were evaluated one day before the operation and one week after the operation. The differences between the two groups in intraoperative renal warm ischaemia time (WIT) and postoperative drainage time were not statistically significant. Compared with OPN group, RLPN group had shorter recovery time of gastrointestinal function, less use of analgesics and longer hospital stay. The difference in the recent occurrence rate of complications was not statistically significant. The differences between the two groups in UREA, Cr, UA and GFR one day before the operation and one week after the operation were not statistically significant (p>0.05). The Cr and UA levels of both groups improved significantly after the operation, and the GFR level declined significantly. The differences were statistically significant compared with preoperation levels (p<0.05). The effect and safety of RLPN in the treatment of complex renal tumours are equal to those of open operations. Laparoscopic surgery involves a small operative wound and contributes to renal function recovery, allowing patients to recover quickly; however, laparoscopic surgery has high technical requirements for its operators.

SC7 - Does the surgical technique impact the oncologic outcomes after partial nephrectomy? A comparison between open, laparoscopic and robotic approach in a single high-volume tertiary center

INTRODUCTION AND OBJECTIVES:To compare the oncologic outcomes of patients who underwent Open partial nephrectomy (OPN), Laparoscopic partial nephrectomy (LPN) and Robotic partial nephrectomy (RPN) ...

SC58 - Perioperative morbidity of open, laparoscopic and robotic partial nephrectomy: A prospective multicenter observational study (RECORd2)

SC58 - Perioperative morbidity of open, laparoscopic and robotic partial nephrectomy: A prospective multicenter observational study (RECORd2)

Role Of Robot-Assisted Partial Nephrectomy For Renal Cell Carcinomas In The Purpose Of Nephron Sparing.

IntroductionSurgery remains the standard treatment for localized renal cell carcinomas, and partial nephrectomy is considered before radical nephrectomy with the aim of preserving renal function. This study aimed to compare robot-assisted and open partial nephrectomy for the purpose of nephron sparing.Materials and methodsWe retrospectively enrolled consecutive patients who received partial nephrectomy at a single tertiary medical center from January 2008 to January 2015. Medical records and radiographic images were reviewed. We analyzed the patients’ general characteristics, underlying disease, complications, length of hospital stay, renal tumor complexity, surgery type, renal function, and specimen and tumor size. A comparison between open and robot-assisted nephrectomy groups was performed.ResultsA total of 136 patients were enrolled, with a male to female ratio of 2:3 and a mean age of 57.8 years. Of these, 71 and 65 patients received open and robot-assisted surgery, respectively. Compared with the open group, patients who underwent robot-assisted surgery were significantly younger (56.0 versus 60.1 years old), had a longer operative time (303 versus 224 min), and a lower kidney ischemic time (33.4 versus 46.9 min). Given similar tumor sizes, the tumor-to-excision ratio was significantly higher in the robot-assisted group (51.7% versus 39.8%), and the excisional volume loss (EVL) was smaller (12.7 versus 19.6 mL). Preoperative glomerular filtration rate and EVL were significant predictors of long-term renal function preservation in the multivariate analysis.ConclusionWhen performing partial nephrectomy, a robot-assisted procedure could increase the accuracy of excision without increasing the risk of positive surgical margin. Lower EVL could assist in better long-term postoperative renal function preservation.

Early Single-Center Experience with Robotic Partial Nephrectomy Using the da Vinci Xi: Comparative Assessment with Conventional Open Partial Nephrectomy

Background: The objective of this study was to evaluate our experience with robot-assisted partial nephrectomy (RAPN) in comparison with conventional open partial nephrectomy (OPN). Patients and Methods: This study included 37 and 50 patients undergoing OPN and RAPN for small renal masses, respectively. A single surgeon performed RAPN for all 50 cases using the da Vinci Xi. Trifecta was defined as satisfying all of the following 3 criteria: ischemic time of ≤ 25 minutes, negative surgical margin and no major postoperative complications. Results: After adjusting patient variables by 1:1 propensity-score matching, 37 patients were included in each group, and no significant differences in major clinicopathological characteristics were noted between these 2 groups. RAPN was significantly superior to OPN with respect to operative time, estimated blood loss and postoperative length of hospital stay. The rate of trifecta achievement was significantly higher in the RAPN group than in the OPN group (91.9 vs. 62.2%). Furthermore, the operative procedure and R.E.N.A.L. nephrometry score were found to be independently associated with trifecta outcome by multivariate analysis of the entire cohort. Conclusions: Although this is our early experience with 50 initial cases, RAPN using the da Vinci Xi resulted in more favorable perioperative outcomes than OPN.

Contemporary Perioperative Morbidity and Mortality Rates of Minimally Invasive vs Open Partial Nephrectomy in Obese Patients with Kidney Cancer.

Aims: To compare early postoperative morbidity and mortality rates in obese patients (body mass index ≥30 kg/m2) who underwent minimally invasive partial nephrectomy (MIPN) vs open partial nephrectomy (OPN), utilizing the National Surgical Quality Improvement Program (NSQIP) database. Materials and Methods: The NSQIP database was queried to identify obese patients who underwent either MIPN or OPN between 2008 and 2016. Patient demographics, comorbidities, operative time (OT), length of stay (LOS), and 30-day postoperative complications, readmissions, and mortality rates were recorded and compared between the two groups. Multivariable logistic regression analysis was used to determine the adjusted odds of early postoperative complications in MIPN vs OPN. Results: A total of 6041 obese MIPN patients and 3064 obese OPN patients were identified. Mean OT (minutes ± standard deviation) was longer for MIPN vs OPN (197.2 ± 71.0 vs 189.6 ± 82.4, p < 0.001), while mean LOS (3.8 ± 2.8 days vs 5.8 ± 3.5 days, p < 0.001) and 30-day complications (8.5% vs 19.8%, p < 0.001) were lower. No difference in 30-day postoperative mortality rates between MIPN (0.4%) and OPN (0.5%) was observed (p = 0.426). In the adjusted analysis, the odds of any complication within 30 days in the MIPN group were 61% lower, blood transfusion 73% lower, pneumonia 38% lower, sepsis 70% lower, acute renal failure 64% lower, superficial surgical site infection 40% lower, and reoperation 47% lower, compared with OPN patients. Conclusions: When compared with OPN in obese patients, the likelihood of 30-day postoperative morbidity was significantly lower in MIPN patients. However, the odds of 30-day mortality rates were similar between the groups.

Robotic surgery does not affect upstaging of T1 renal masses.

Partial nephrectomy is the mainstay of treatment for localized kidney cancer. A proportion of patients are upstaged post-operatively to locally advanced disease (pT3a). We aimed to identify the incidence of upstaging to pT3a during partial nephrectomy and its relationship to a robotic approach. The National Cancer Database was queried for patients diagnosed with cT1M0 disease between 2010 and 2015 who underwent an open or robotic partial nephrectomy with final stage pT1-3a. Our primary outcome was rate of upstaging to pT3a in patients undergoing partial nephrectomy and secondary outcomes were stage migration, rate of positive margins, and overall survival (OS). The relationship between open and robotic surgery was examined. Logistical regression and Kaplan-Meier analyses were performed. Of 68,976 patients identified, 5.9% of patients were upstaged from cT1 to pT3a post-operatively. The incidence of upstaging to pT3a disease has increased from 5.7% in 2010 to 6.9% in 2015. Similarly, the proportion of patients undergoing a robotic approach is also increasing (31.6-64.4%); however, a robotic approach is not associated with pT3a upstaging on multivariable analysis. The probability of being upstaged was significantly proportional to increasing tumor size (OR 2.634-11.641, p < 0.05). pT3a disease was associated with a significant increase in positive margins (10.7% vs 5.0%, p < 0.001). Interestingly, pT3a patients with positive margin had worsened survival (5-year OS 75.5% vs 65.9%, p < 0.001). A robotic surgical approach to partial nephrectomy does not increase risk of upstaging to pT3a disease. Those who are upstaged have increased risk of positive margins and associated risk of decreased survival.

Lessons learned from clinical outcome and tumor features of patients underwent selective artery embolization due to postoperative bleeding following 2076 partial nephrectomies: propensity scoring matched study.

To evaluate the clinical and tumor characteristics in patients undergoing selective artery embolization (SAE) for bleeding after partial nephrectomy (PN). We retrospectively evaluated patients who underwent SAE from 2076 patients who underwent PN. The clinical and tumor characteristics of these patients were analyzed using entire data and propensity score matching (PSM). 76 patients who underwent PN (control, n = 38 patients; SAE, n = 38) were enrolled in PSM. SAE was performed in 41 patients who underwent open (19/1171), laparoscopic (4/60), and robot-assisted PN (18/845). The median period from PN to SAE was 12days (interquartile range 8-24day). The most common symptom of 31 (75.61%) patients was gross hematuria, followed by flank pain (3/41). Follow-up imaging revealed large pseudoaneurysm in 7 asymptomatic patients. The main reason for SAE on angiography was pseudoaneurysm (32/41), followed by arteriovenous fistula (5/41). Technical and clinical success was achieved in all patients. There was no statistical difference in the estimated glomerular filtration rate after 1year, surgical methods, or baseline characteristics between the two groups. Conversely, there was statistically significant difference in ischemic time in the entire data and PSM. In the embolization group, renal masses showed statistically significant endophytic (p = 0.006) and posterior (p = 0.028) characteristics. SAE is an effective method for controlling postoperative bleeding while preserving renal function after PN. And, we suggest more attentive postoperative surveillance about vascular complications in patients with longer ischemia time or renal masses with endophytic and posterior locations.

Renal artery pseudoaneurysm after open partial nephrectomy for renal cell carcinoma

Renal artery pseudoaneurysm is a well-described complication of open and laparoscopic partial nephrectomy. Delayed bleeding from a renal artery pseudoaneurysm is rare after open partial nephrectomy. Here, we present a 75-year-old man who, 14 days after undergoing an open right partial nephrectomy for an endophytic 4.5 cm tumor, developed painless macroscopic hematuria. Prompt computer tomography angiography imaging, followed by therapeutic angio-embolization of segmental renal artery with coils, treated the pseudoaneurysm successfully. Renal artery pseudoaneurysm can be treated rapidly, effectively, and with minimal patient morbidity via percutaneous renal artery embolization.

WITHDRAWN: Double primary carcinoid tumors of the kidney

Abstract Primary renal carcinoid tumor is extremely rare. Because of its similar presentation with other renal tumors, 14.5% were initially misdiagnosed. A 37-year-old female was referred to our department due to incidentally finding of left kidney tumor by sonography. She didn't present flank pain or gross hematuria, also absence of positive physical findings. The patient's general blood routine, urine routine, and renal function examination were all within normal limits. Abdomen computed tomography showed two soft tissue mass within left kidney. The larger renal tumor was about 3.8 cm in size, mild contrast enhancement and small cystic foci abutting renal sinus. The smaller renal mass was exophytic with same image characteristics. The subsequent kidney magnetic resonance imaging reported two lesions had persistent high diffusion-weighted imaging signal intensity, which strongly favor solid neoplasm. Differential diagnosis included renal cell carcinioma, benign adenoma and Wilm's tumor. Hence, frozen section of the smaller renal nodule was sent for pathologist, and it reported no evidence of obvious malignancy. We later performed open partial nephrectomy. The final pathology reported two well-differentiated grade 1 neuroendocrine (carcinoid) tumors. Immunohistochemistry showed these two lesions were strong positive for synaptophysin and neuron-specific enolase (NSE), but negative for WT-1 and vimentin, which were consistent with features of neuroendocrine tumor. Two weeks after operation, patient's serum creatinine was within normal limits. Abdomen computed tomography reported no specific lymph node involvement after 6 months. Primary renal carcinoid tumors are usually found incidentally, and nephron-sparing surgery whenever possible remains the standard treatment of choice.

A Modified Surgical Technique Using Cyanoacrylate Glue and Parenchymal Restoration Sutures without Tissue Approximation in Patients with Renal Tumors Who Underwent Open Partial Nephrectomy

A Modified Surgical Technique Using Cyanoacrylate Glue and Parenchymal Restoration Sutures without Tissue Approximation in Patients with Renal Tumors Who Underwent Open Partial Nephrectomy

Retroperitoneal Robot-Assisted Partial Nephrectomy in Obese Patients.

Objectives: To report our experience with retroperitoneal robotic-assisted partial nephrectomy (RAPN) in obese patients. Patients and Methods: From April 2012 to December 2018, 127 patients with body mass index (BMI) ≥30 kg/m2 underwent RAPN, of whom 110 patients had retroperitoneal RAPN. We reviewed the patients' demographic, operative data, perioperative and postoperative complications, and postoperative histology. Results: The median BMI was 33.1 kg/m2 (interquartile range [IQR] 31.5-36.6). The median age of the patients was 59 years. The mean histological size of tumor was 32.2 mm (IQR 23.8-40). The median total surgical time was 130 minutes (IQR 110-176) with a median warm ischemia time of 22.0 minutes. The tumor was located anteriorly in 25% of the cases. The median R.E.N.A.L.* nephrometry score was 6. The median estimated blood loss was 30 mL (IQR 10-80). Three cases were converted to open partial nephrectomy because of bleeding (2.7%). Four patients and one patient returned within 30 days with postoperative complications Clavien-Dindo classification grade 2 and 3a, respectively. Two patients needed perioperative blood transfusion because of bleeding. The median length of stay was 1 day (IQR 1-2). Conclusion: Retroperitoneal RAPN is feasible in patients with high BMI and provides good surgical access to treat nonanterior renal masses. Retroperitoneal RAPN is associated with less blood loss, shorter surgical time, and warm ischemia time when compared with transperitoneal RAPN studies.

Trifecta Outcomes in Open, Laparoscopy or Robotic Partial Nephrectomy: Does the Surgical Approach Matter?

This retrospective study evaluated perioperative outcomes of open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robot-assisted partial nephrectomy (RAPN) and identified predictive factors of Trifecta achievement for renal tumors that underwent partial nephrectomy (PN) in a single institutional cohort. The study involved patients who underwent PN from January 2011 to July 2018. Trifecta was defined as absence of perioperative complications, no positive surgical margins, and ischemia time <30 min. Fifty-five PN procedures were reviewed: 28 OPN, 14 LPN, and 13 RAPN. OPN, LPN and RAPN had similar median tumor size (5.75, 5.25, and 5 cm), nephrometry score (7, 6, and 6), and preoperative creatinine (1.09, 1.1, and 1.1 mg/dl, respectively). Blood loss was higher for OPN (550 ml) than for LPN (400 ml) and RAPN (300 ml), P = 0.042. Drain was removed after 6 days in OPN which was higher than LPN and RAPN (4.5 and 4 days, respectively), P = 0.008. OPN, LPN, and RAPN had similar median operative time (190, 180, and 180 min, respectively), P = 0.438. Median postoperative stay for OPN, LPN, and RAPN was 5, 6.5, and 10 days, respectively. Trifecta outcomes of 73.1%, 64.3%, and 61.53% were achieved in OPN, LPN, and RAPN, respectively, P = 0.730. It was concluded that Trifecta outcomes had no significant difference among OPN, LPN, and RAPN. LPN can produce as good results as RAPN. Keeping in mind the cost-effectiveness, LPN holds an important position in developing countries where expenditure by patient is a major factor.

The superiority of contact surface area as a predictor of renal cortical volume change after partial nephrectomy compared to RENAL, PADUA and C-index: an approach using computed tomography-based renal volumetry

Objective: To evaluate the renal cortical volume (RCV) change after nephron sparing surgery and the predictive value of the nephrometry score in RCV preservation after partial nephrectomy.Materials and methods: Overall, 162 patients with renal tumors that were treated with open partial nephrectomy were retrospectively analyzed. The contact surface area (CSA), RENAL, PADUA and C-index scores were obtained from a preoperative CT scan. The RCV of the tumor-bearing kidney was measured preoperatively and postoperatively using dedicated software. The correlation between the four nephrometry scores and perioperative parameters were evaluated and the scores were compared in terms of their ability to predict a reduction in the RCV.Results: All scores showed a significant association with reduction in RCV (all p < 0.001), percent reduction in RCV (all p < 0.001) and estimated blood loss (all p < 0.05). Only the CSA and PADUA scores showed a significant association with percent reduction in eGFR (p = 0.038 and p = 0.026, respectively). On multivariate analysis, the CSA, PADUA and C-index scores independently affected the percent reduction in RCV (p = 0.003, p = 0.025 and p = 0.013, respectively). On ROC curve analysis, CSA was a better independent predictor of a greater than 10% and 20% reduction in the RCV (AUC 0.87 and 0.72, respectively).Conclusion: CT-based RCV measurement successfully differentiated the RCV change after partial nephrectomy. Compared to the other three nephrometry scores, CSA was a superior predictor of RCV change in the operated kidney.

71 - Microwave thermal ablation versus open partial nephrectomy in treatment small renal tumors between patients over 70 years old

71 - Microwave thermal ablation versus open partial nephrectomy in treatment small renal tumors between patients over 70 years old

77 - Event-free survival in patients after open partial nephrectomy for RCC in a solitary kidney

77 - Event-free survival in patients after open partial nephrectomy for RCC in a solitary kidney

28 - Outcomes of robotic versus open partial nephrectomy: Results of a single institution series

28 - Outcomes of robotic versus open partial nephrectomy: Results of a single institution series

PD16-05 ETIOLOGIES AND TRENDS OF 30-DAY READMISSION IN MAJOR UROLOGICAL PROCEDURES: A COMPARISON OF OPEN VS. MIS APPROACH

INTRODUCTION AND OBJECTIVES:This study analyzes trends and etiologies in 30-day readmission rates for major urological procedures, specifically radical prostatectomy (RP), radical nephrectomy (RN), and partial nephrectomy (PN).METHODS:We utilized the New York Statewide Planning and Research Cooperative System (SPARCS) database from 2006 to 2015 to identify all RP (ICD-9: 60.5), RN (ICD-9: 55.5), and all PN (ICD-9: 55.4). Minimally invasive surgery (MIS) was identified using the laparoscopic modifier (ICD-9: 54.21). Patient level data was collected for all patients who were readmitted during the first 30 days after discharge and trends were compared.RESULTS:The 30-day readmission rate for open RP was 864 (4%) compared to 1013 (4%) for MIS RP (p<.001). The 30-day readmission rate for open RN was 2184 (12%) compared to 509 (9%) for MIS RN (p<.001). The 30-day readmission rate for open PN was 781 (8%) compared to 376 (6%) for MIS PN (p<.001). The major etiology of 30-day readmission was genitourinary in natur...

1053 - Robot-assisted partial nephrectomy is associated with early recovery of renal function: Comparison of open, laparoscopic, and robot-assisted partial nephrectomy using diethylene triamine penta-acetic acid (DTPA) renal scintigraphy

1053 - Robot-assisted partial nephrectomy is associated with early recovery of renal function: Comparison of open, laparoscopic, and robot-assisted partial nephrectomy using diethylene triamine penta-acetic acid (DTPA) renal scintigraphy