Partial Nephrectomy For Tumors Research Articles

MP47-16 MICROWAVE ABLATION VERSUS PARTIAL NEPHRECTOMY FOR SMALL RENAL MASSES

You have accessJournal of UrologyCME1 Apr 2023MP47-16 MICROWAVE ABLATION VERSUS PARTIAL NEPHRECTOMY FOR SMALL RENAL MASSES Jessica Qiu, Emmett H. Kennady, Chris Ballantyne, Clinton Yeaman, John Morgan, Anthony Denovio, Matthew B. Clements, J. Patrick Mershon, Iman Richie, Tracey L Krupski, Noah S. Schenkman, and Jennifer M. Lobo Jessica QiuJessica Qiu More articles by this author , Emmett H. KennadyEmmett H. Kennady More articles by this author , Chris BallantyneChris Ballantyne More articles by this author , Clinton YeamanClinton Yeaman More articles by this author , John MorganJohn Morgan More articles by this author , Anthony DenovioAnthony Denovio More articles by this author , Matthew B. ClementsMatthew B. Clements More articles by this author , J. Patrick MershonJ. Patrick Mershon More articles by this author , Iman RichieIman Richie More articles by this author , Tracey L KrupskiTracey L Krupski More articles by this author , Noah S. SchenkmanNoah S. Schenkman More articles by this author , and Jennifer M. LoboJennifer M. Lobo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Thermal ablation (TA) is a widely accepted approach for T1a renal masses < 3 cm in size, with a gap in research of masses sized 3-4 cm. While much literature focuses on radiofrequency ablation (RFA) as the primary TA modality, a growing body of literature is showing the safety and efficacy of microwave ablation (MWA). In this study we aim to compare the oncological and renal function outcomes of MWA compared to partial nephrectomy (PN) in two small renal mass (SRM) tumor size groups, <3 cm and 3-4 cm. METHODS: This study included retrospective data from 2009-2015 and prospective data since 2015 from a single-institution database. Patient demographics, renal mass characteristics, and treatment outcomes were collected. Survival curves and hazard analysis were used to assess oncological outcomes. Changes in eGFR and CKD stage following surgery were used to assess renal function outcomes. RESULTS: A total of 91 PN and 130 MWA patients matched the inclusion criteria. For both tumor sizes, median age and Charlson Comorbidity Index (CCI) of MWA patients were greater than PN, while median length of stay was shorter . No difference in local recurrence free survival was found between treatment modalities on survival analysis for masses < 3 cm (p=0.56) and sized 3-4 cm (p=0.15). No difference in local recurrence free survival was found between treatment modalities on hazard analysis for masses < 3 cm (p=0.56) and sized 3-4 cm (p=0.70). Pre-operative renal function was significantly lower in patients undergoing MWA for both tumor sizes, however there was no significant difference in the post-operative change in renal function between MWA and PN for tumors up to 4 cm. CONCLUSIONS: While MWA patients are older and have more comorbidities, oncological outcomes and renal preservation were comparable between MWA and PN for SRMs < 3 cm and 3-4 cm. Our findings suggest that MWA can be used as a safe and effective alternative to PN for SRM tumors up to 4 cm. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e650 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica Qiu More articles by this author Emmett H. Kennady More articles by this author Chris Ballantyne More articles by this author Clinton Yeaman More articles by this author John Morgan More articles by this author Anthony Denovio More articles by this author Matthew B. Clements More articles by this author J. Patrick Mershon More articles by this author Iman Richie More articles by this author Tracey L Krupski More articles by this author Noah S. Schenkman More articles by this author Jennifer M. Lobo More articles by this author Expand All Advertisement PDF downloadLoading ...

MP42-13 A CONTEMPORARY EXPERIENCE WITH PARTIAL NEPHRECTOMY FOR PATIENTS WITH A SOLITARY KIDNEY: A SINGLE INSTITUTION ANALYSIS

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III (MP42)1 Sep 2021MP42-13 A CONTEMPORARY EXPERIENCE WITH PARTIAL NEPHRECTOMY FOR PATIENTS WITH A SOLITARY KIDNEY: A SINGLE INSTITUTION ANALYSIS Stanley Weng, Renzo DiNatale, Andrew Silagy, Kyrollis Attalla, Kate Weiss, Angela Yoo, Nicole Benfante, Jonathan Coleman, A Ari Hakimi, and Paul Russo Stanley WengStanley Weng More articles by this author , Renzo DiNataleRenzo DiNatale More articles by this author , Andrew SilagyAndrew Silagy More articles by this author , Kyrollis AttallaKyrollis Attalla More articles by this author , Kate WeissKate Weiss More articles by this author , Angela YooAngela Yoo More articles by this author , Nicole BenfanteNicole Benfante More articles by this author , Jonathan ColemanJonathan Coleman More articles by this author , A Ari HakimiA Ari Hakimi More articles by this author , and Paul RussoPaul Russo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002063.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with renal tumors in a solitary kidney can represent a challenge to urologists. These patients will typically be offered partial nephrectomy (PN) to spare renal parenchyma and preserve kidney function. We sought to characterize postoperative kidney function and oncologic outcomes based on preoperative estimated glomerular filtration rate (GFR) within this unique cohort of patients. METHODS: We queried our institutional database for patients who had solitary kidneys and underwent subsequent PN with available preoperative GFRs. To assess postoperative renal function, each patient’s monthly average GFR trajectory was plotted, from the immediate preoperative GFR through twelve months postoperatively. Locally weighted scatterplot smoothing was then used to observe trends. New baseline GFR was defined as the maximum GFR obtained within six months after surgery. Overall survival (OS) and cancer-specific survival (CSS) estimates were calculated from the time of nephrectomy to death or last follow-up using the Kaplan-Meier method. RESULTS: We identified 145 patients with a median age of 62 years [IQR:57,71]. Nearly two-thirds (65%) of patients had hypertension and 14% had diabetes. Prior to PN, 96 (66%) patients had a GFR less than 60ml/min/1.73m2. Median preoperative GFR was 52ml/min/1.73m2 [IQR:44,65]. Median tumor size was 3cm [IQR:2,4]. More patients received open surgery compared to minimally invasive surgery (89% vs 11%). 63% of PNs were performed on-clamp with a median clamp time of 36 minutes [IQR:26,47]. Temporary hemodialysis was required in twelve patients (8%) after surgery. Notably, patients with preoperative GFR ≥ 60ml/min/1.73m2 had a larger decrease in baseline GFR (14 vs 5, Wilcoxon rank-sum, p=0.002) but had a higher median new baseline GFR (58 vs 41, Wilcoxon rank-sum, p <0.001) by six months (Figure 1). After a median follow-up of 65 months, no CSS (log-rank, p=0.4) and OS (log-rank, p=0.2) survival differences were observed between these two groups. CONCLUSIONS: PNs for tumors in a solitary kidney can be a safe and effective management strategy that allows patients to be rendered tumor free. Although the detrimental impact of this procedure on kidney function is indisputable, many patients are able to recover to new stable baseline levels by six months post-op. Source of Funding: The Sidney Kimmel Center for Prostate and Urologic Cancers and in part through the NIH/NCI Cancer Center Support Grant P30 CA008748 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e776-e777 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stanley Weng More articles by this author Renzo DiNatale More articles by this author Andrew Silagy More articles by this author Kyrollis Attalla More articles by this author Kate Weiss More articles by this author Angela Yoo More articles by this author Nicole Benfante More articles by this author Jonathan Coleman More articles by this author A Ari Hakimi More articles by this author Paul Russo More articles by this author Expand All Advertisement PDF DownloadLoading ...

Robotic and open partial nephrectomy for tumors in a solitary kidney

Introduction and objective: Traditionally, patients with renal masses in solitary kidneys were managed with an open partial nephrectomy. With improving techniques, robotic-assisted partial nephrectomy in the setting of a solitary kidney is increasingly utilized. The objective of this study was to compare open partial nephrectomy and robotic-assisted partial nephrectomy outcomes in solitary kidney patients. Methods: A retrospective study of 536 total patients who underwent partial nephrectomy between 2004–2016 was performed. Of these patients, 23 had a renal mass in a solitary kidney. Patient demographics, perioperative values, and surgical outcomes were analyzed using descriptive statistics to compare open partial nephrectomy to robotic-assisted partial nephrectomy. Results: Of the 23 patients in the cohort, 52% ( n=12) underwent open partial nephrectomy and 48% ( n=11) underwent robotic-assisted partial nephrectomy. Patient characteristics were not significantly different. The mean (standard deviation) nephrometry score was 6.9 (1.8) for open partial nephrectomy and 6.1 (1.9) for robotic-assisted partial nephrectomy ( p=0.290). The mean (standard deviation) pre-operative creatinine was 1.2 (0.3) in open partial nephrectomy and 1.5 (0.4) in robotic-assisted partial nephrectomy, which did not reach statistical significance ( p=0.110). No difference in postoperative kidney function, Clavien grade 3 or higher complication rate, blood loss, or hospitalization length was noted. Conclusion: Although traditionally patients with a tumor in a solitary kidney are counseled to undergo open partial nephrectomy, robotic-assisted partial nephrectomy is a safe alternative with no decrease in postoperative renal function when compared with a similar cohort of patients undergoing open partial nephrectomy in a solitary kidney. Level of evidence: Level II

Treatment Trends and Long-Term Survival Associated with Cryotherapy and Partial Nephrectomy for Small Renal Masses in the National Cancer Database Using Propensity Score Matching.

Objective: Trends in the utilization of ablative therapy are unknown for the treatment of small renal masses. Our goal is to utilize the National Cancer Database (NCDB) to both assess the utilization of ablative therapies and long-term survival. Materials and Methods: The NCDB captures 70% of all cancer cases in the United States and was queried between 1998 and 2012 for renal cell carcinomas that were treated with ablative therapy, partial nephrectomy (PN), or radical nephrectomy. The analysis was limited to clinical stage T1a. Propensity score matching was used in 1:1 fashion. Kaplan-Meier survival analysis and a Cox proportional hazards model were used to compare overall survival (OS) for cryotherapy and PN. Results: A total of 119,240 cases of clinical stage T1a renal masses were treated between 1998 and 2012. Cryotherapy peaked at 927 (9.1%) cases in 2010 and had 913 (8.4%) in 2012. PN accounted for 18% of the cases in 1998, but surpassed the utilization of nephrectomy in 2008. By 2012, PN accounted for 6766 (62%) of renal mass cases. After matching, Kaplan-Meier OS was lower for cryotherapy compared with PN at 24 (94.5% vs 96.5%), 48 (86.8% vs 90.9%), and 96 months (66.0% vs 74.9%). Cryotherapy also had a lower OS (hazard ratio 1.46; p < 0.001) on adjusted analysis. Conclusion: Cryotherapy for small renal masses plateaued at 9% utilization in 2009. Cryotherapy had a lower OS than PN for tumors >2 cm on adjusted analysis, but this result should be used with caution until confirmed in randomized studies.

Laparoscopic partial nephrectomy for tumors 7cm and above. Perioperative outcomes.

ABSTRACTPurpose:To assess and report the outcomes of laparoscopic partial nephrectomy) LPN) for T2 renal masses.Materials and Methods:Retrospective review of patients undergoing LPN for clinically localized renal masses ≥7cm between the years 2005-2016. Descriptive analyses were generated for demographics, lesion characteristics, perioperative variables (operative time, warm ischemia time (WIT), estimated blood loss (EBL), intra-operative and postoperative complications (IOC and POC) and pathologic variables (pathology, subtype and Fuhrman grade).Results:A total of 27 patients underwent LPN for a T2 renal mass at our institution between 2005 and early 2016 of which 19 were males. The mean age was 66 (52-72). All procedures were transperitoneal with 16 on the right and 11 on the left. Median operative time was 200 minutes (IQR 181-236) and median WIT 19 minutes (IQR 16-23). EBL was 125mL (IQR 75-175). One case was converted to laparoscopic radical nephrectomy due to suspected tumor thrombus in the renal vein. Surgical margins were positive in one renal tumor in a patient with multiple tumors. There was a total of 2 IOC (7.4%) and 3 POC (11%) classified as Clavien grade 3.Conclusions:To our knowledge, this series is the first to describe the outcomes of LPN for cT2 renal masses. In our series, LPN for larger renal masses appears feasible with favorable perioperative outcomes. Additional data are needed to further explore the benefits of minimally invasive surgical approaches to larger renal masses.

Outcomes After Cryoablation Versus Partial Nephrectomy for Sporadic Renal Tumors in a Solitary Kidney: A Propensity Score Analysis

BackgroundWhile partial nephrectomy (PN) is considered the standard approach for a tumor in a solitary kidney, percutaneous cryoablation (PCA) is emerging as an alternative nephron-sparing option. ObjectiveTo compare outcomes between PCA and PN for tumors in a solitary kidney. Design, setting, and participantsPatients who underwent PCA or PN between 2005 and 2015 for a single primary renal tumor in a solitary kidney were identified using Mayo Clinic Registries. Exclusion criteria were inherited tumor syndromes and salvage procedures. InterventionPCA and PN. Outcome measurements and statistical analysisTo achieve balance in baseline characteristics, we used inverse probability of treatment weighting (IPTW) based on propensity to receive treatment. The risk of having a post-treatment complication and percent drop in estimated glomerular filtration rate (eGFR), as well as the risks of local/ipsilateral recurrence, distant metastasis, and cancer-specific mortality, were compared between groups using logistic, linear, and Fine-and-Gray competing risk regression models. Results and limitationsThe cohort included 118 patients (PCA: 54; PN: 64) with a median follow-up of 47 mo (interquartile range 18, 74). In unadjusted analyses, PCA was associated with a lower risk of complications (15% vs 31%; odds ratio [OR]=0.38; 95% confidence interval [CI] 0.15, 0.96; p=0.04). However, upon accounting for baseline differences with IPTW adjustment, there was no longer a significant difference in the risk of complications (28% vs 29%; OR=0.95; 95% CI 0.53, 1.69; p=0.9). There were no significant differences between PCA and PN in percentage drop in eGFR at discharge (mean: 11% vs 16%; β=–5%; 95% CI –13, 3; p=0.2) or at 3 mo (12% vs 9%; β=3%; 95% CI –3, 10; p=0.3). Likewise, no significant differences were noted in local recurrence (HR=0.87; 95% CI 0.38, 1.98; p=0.7), distant metastases (HR=0.60; 95% CI 0.30, 1.20; p=0.2), or cancer-specific mortality (HR=1.13; 95% CI 0.32, 3.98; p=0.8). Limitations include the sample size, given the relative rarity of renal masses in solitary kidneys. ConclusionsOur study found no significant difference in complications, renal function outcomes, and oncologic outcomes between PN and PCA for patients with a tumor in a solitary kidney. Validation in a larger multi-institutional analysis may be warranted. Patient summaryPartial nephrectomy (surgery) and percutaneous cryoablation are both options for treating a kidney tumor while preserving the normal portion of the kidney. In patients with a tumor in their only kidney, we found no difference in the risk of complications, kidney function outcomes, or cancer control outcomes between these two approaches.

Comparison of radiofrequency ablation and partial nephrectomy for tumor in a solitary kidney

BackgroundTo estimate oncologic and functional outcomes for radiofrequency ablation (RFA) versus partial nephrectomy (PN) for tumors in a solitary kidney.MethodsNineteen patients with sporadic renal cell carcinoma in a solitary kidney were treated with RFA, and 21 patients were treated with PN between November 2008 and September 2015. Basic demographic information including age, gender, operative and pathological data, complications, renal function, oncological outcomes, was obtained for each patient. Statistical analysis was done to test for the correlation of clinical and pathological features, renal function outcomes, as well as oncological outcomes of RFA and PN. All statistical tests were 2-sided, and p-value < 0.05 was considered significant. Statistical analyses were performed using SPSS 19.0.ResultsNo significant differences were indicated between the RFA and PN with respect to mean patient age, tumor size, as well as intraoperative or postoperative complications. The mean length of hospitalization (P = 0.019) and mean operative time (P = 0.036) was significantly shorter in RFA, with the median estimated blood loss being greater in PN (P = 0.001). The mean serum creatinine level 24 h following operation were significantly higher than preoperative creatinine in PN (P = 0.009), but did not reach statistical significance in RFA. Local recurrence were detected in only 1 patient (5%) in PN and 3 patients (18.75%) in RFA (P = 0.4). One patient developed pulmonary metastasis and one exhibited tumor persistence in RFA, none were present in PN.ConclusionsRadiofrequency Ablation and Partial Nephrectomy for Tumors in a Solitary Kidney were all safe and effective, with each method having distinct advantages. It is the decision of the patient and urologist to pick the best approach.

MP55-05 PARTIAL NEPHRECTOMY IN THE TREATMENT OF RENAL TUMORS WITH CONCOMITANT VENOUS TUMOR THROMBOSIS (VTT) OF RENAL VEIN BRANCHES: RETROSPECTIVE, MULTI-CENTER ANALYSIS OF PERIOPERATIVE, FUNCTIONAL, AND ONCOLOGIC OUTCOMES

MP55-05 PARTIAL NEPHRECTOMY IN THE TREATMENT OF RENAL TUMORS WITH CONCOMITANT VENOUS TUMOR THROMBOSIS (VTT) OF RENAL VEIN BRANCHES: RETROSPECTIVE, MULTI-CENTER ANALYSIS OF PERIOPERATIVE, FUNCTIONAL, AND ONCOLOGIC OUTCOMES

Outcomes of Laparoscopic and Robotic Partial Nephrectomy for Large (&gt;4 Cm) Kidney Tumors: Systematic Review and Meta-Analysis

The aim of this study was to assess the outcomes of minimally invasive (laparoscopic and robotic) partial nephrectomy (MIPN) for large renal masses. A systematic literature review was performed up to September 2016 using multiple search engines to identify studies comparing MIPN for tumors larger than 4cm (>cT1a) with MIPN for tumors smaller than 4cm (cT1a). The preferred reporting items for systematic reviews and meta-analyses (PRISMA) criteria were used for article selection. Baseline demographics and surgical, functional, and oncological parameters were extracted from the included studies whenever available. An overall analysis including all studies was performed, then sensitivity analyses were performed for studies on laparoscopic partial nephrectomy (PN) only, and, finally, for studies on robotic PN only. Overall, 13 case-control studies comparing the outcomes of PN in tumors <4cm (n=4441) with those of PN for tumors >4cm (n=1024) were included. Warm ischemia time was shorter for the <4cm group [weighted mean difference (WMD) 3.75min; 95% confidence interval (CI) -6.4 to -0.7; p=0.01] and the odds of perioperative complications was lower [odds ratio (OR) 0.62; 95% CI 0.5-0.8; p<0.001]. There were no significant differences in terms of postoperative estimated glomerular filtration rate (WMD 4.2ml/min; 95% CI 0.45-8.97; p=0.08), as well as onset of postoperative chronic kidney disease (risk ratio 0.71; 95% CI 0.48-1.04; p=0.08). In addition, no difference was found in the likelihood of positive surgical margins (OR 0.74; 95% CI 0.43-1.28; p=0.29). MIPN represents a viable treatment option for renal masses larger than 4cm (higher than cT1a) as it offers good functional outcomes, without increased risk of positive surgical margins. An increased rate of complications should be taken into account when approaching these tumors.

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 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.

417 Robot-assisted partial nephrectomy in tumors ≥ pT1b - a feasibility study according to the MIC system

417 Robot-assisted partial nephrectomy in tumors ≥ pT1b - a feasibility study according to the MIC system

Efficacy of Partial Nephrectomy for Renal Tumors &amp;gt;4 cm: Comparison With Renal Tumors ≤4 cm

Partial nephrectomy has become a treatment of choice for clinical T1a renal masses. Some international guidelines suggest that partial nephrectomy can be applied also in clinical T1b tumors. The aim of this study was to evaluate the feasibility of partial nephrectomy for tumors larger than 4 cm. We reviewed the medical records of 1280 patients who underwent partial nephrectomy and had pathologically confirmed malignancy. Patients were categorized into two groups by the size of tumors on computed tomography image, with a cutoff value of 4 cm. The oncologic and functional outcomes were compared between the two groups. Recurrence-free survival after surgery was estimated using the Kaplan-Meier method. Of the 1280 patients, 203 patients (15.9%) had renal tumors larger than 4 cm. There were significantly more exophytic tumors (P &amp;lt; 0.001) and the R.E.N.A.L. scores were significantly higher (P &amp;lt; 0.001) in partial nephrectomy &amp;gt;4 cm. Mean ischemic times were significantly different (P &amp;lt; 0.001). After 24 months, mean creatinine level between partial nephrectomy &amp;gt;4 cm and partial nephrectomy ≤4 cm was not different significantly (P = 0.554). And the percent changes of glomerular filtration rate after partial nephrectomy were not different at last follow-up (P = 0.082). The 5-year recurrence-free survival rates were 96.6% in partial nephrectomy ≤4 cm, and 94.5% in partial nephrectomy &amp;gt;4 cm (P = 0.416). Based on the present findings, partial nephrectomy for tumors larger than 4 cm showed comparable feasibility and safety to partial nephrectomy for tumors ≤4 cm considering oncologic and functional outcomes, despite longer operative and ischemic time.

Reconstructive kidney surgery for organ-preserving therapy of renal tumors.

Background: The objective of this study was to evaluate differences in various clinical endpoints in patients with reconstructive surgery by renal partial nephrectomy for tumors up to 4 cm compared to tumors larger than 4 cm.Material and methods: A total of 170 partial renal resection patients that presented malignant tumors were included in the retrospective study. Data was analyzed retrospectively based on internal clinic files, as well as a questionnaire to enhance the follow-up clinical outcomes data obtained. The most important outcomes determined included post-operative renal function, intra- and post-operative complications, local recurrence rate and total survival time.Results: The local recurrence rate was 6.1% for tumors up to 4 cm in size, compared to 14.9% for tumors that were larger than 4 cm. Compared to results for partial resection of T1a tumors, results for partial resection of tumors larger than 4 cm are worse in terms of post-operative renal function (p=0.007), as well as in terms of a total complications rate (p=0.048). It is important to note that there was not only a higher risk of post-operative bleeding that required transfusions (p=0.012), but also a higher risk of a hypertensive episode during the post-operative period reviewed (p=0.022). In addition, the total survival time for patients presenting tumors of up to 4 cm in size was significantly better (p=0.003). Conclusion: The results of our retrospective study of 170 patients that underwent partial renal resection after the diagnosis of malignant tumors, is that partial renal resection presents an oncologicaly safe surgical solution with low local recurrence rates. Additionally, partial resection in case of tumors that are larger than 4 cm showed worse post-operative renal function, a higher complications rate and a worse survival rate.

PE39: Use of 3D HD auxiliary monitor by bedside assistant results in shorter console-time and ischemia-time in robot-assisted laparoscopic partial tumor-nephrectomy

Recently, we have shown that connecting live three-dimensional (3D) monitors to all three available Da Vinci® robot (Intuitive) generations improved the impression of shared perception for the whole surgical team. Standardized dry lab experiments revealed that delicate teamwork was faster (up to 40%) when using the 3D monitor [1]. We now studied whether introduction of 3D auxiliary monitor for the assistants at the operating table indeed had a positive impact for robot-assisted laparoscopic partial tumor-nephrectomies (RAL-PN). In order to exclude possible learning curve effects, we examined the data of 26 procedures of 1 experienced surgeon and team members where in every case the same standardized surgical procedure was performed.

Evaluation of Renal Mass Biopsy Risk Stratification Algorithm for Robotic Partial Nephrectomy—Could a Biopsy Have Guided Management?

We evaluated a published biopsy directed small renal mass management algorithm using a large cohort of patients who underwent robotic partial nephrectomy for tumors 4 cm or smaller. A simplified algorithm of biopsy directed small renal mass management previously reported using risk stratified biopsies was applied to 1,175 robotic partial nephrectomy cases from 5 academic centers. A theoretical assumption was made of perfect biopsies that were feasible for all patients and had 100% concordance to final pathology. Pathology risk groups were benign, favorable, unfavorable and intermediate. The algorithm assigned favorable or intermediate tumors smaller than 2 cm to active surveillance and unfavorable or intermediate 2 to 4 cm tumors to treatment. Higher surgical risk patients were defined as ASA® 3 or greater and age 70 years or older. Patients were assigned to the pathology risk groups of benign (23%), favorable (13%), intermediate (51%) and unfavorable (12%). Patients were alsoassigned to the management groups of benign pathology (275, 23%), activesurveillance (336, 29%) and treatment (564, 48%). Most of the 611 (52%) patients in the benign or active surveillance groups were low surgical risk andhad safe treatment (2.6% high grade complications). A biopsy may not havebeen feasible or accurate in some tumors that were anterior (378, 32%), hilar (93,7.9%) or less than 2 cm (379, 32%). Of 129 (11%) high surgical risk patients the biopsy algorithm assigned 70 (54%) to benign or active surveillance groups. The theoretical application of a biopsy driven, risk stratified smallrenal mass management algorithm to a large robotic partial nephrectomy database suggests that about half of the patients might have avoided surgery. Despite the obvious limitations of a theoretical assumption of all patients receiving a perfect biopsy, the data support the emerging role of renal mass biopsies to guide management, particularly in high surgical risk patients.

V21 “Zero ischemia” robot assisted partial nephrectomy for tumors with high nephrometry score

V21 “Zero ischemia” robot assisted partial nephrectomy for tumors with high nephrometry score

Robotic Partial Nephrectomy: Complex Hilar Mass

Introduction: Partial nephrectomy is currently the gold standard for definitive treatment of small renal masses. Robotic partial nephrectomy has allowed for the resection of increasingly more complex tumors. In the past, partial nephrectomy for completely endophytic tumors was routinely done through an open approach. However, advancement in laparoscopic ultrasound and robotics has allowed for resection of endophytic tumors more effectively. At our center, we have been performing robotic partial nephrectomy for tumors of increasing complexity, with higher nephrometry scores. We present our technique in the accompanying video. Materials and Methods: A 36-year-old male was found to have a 3.3 × 3.1 solid mass with solid enhancement in the midpole of the right kidney. The mass was completely endophytic, with a R.E.N.A.L. score of 10ah. His preoperative creatinine was 0.76 mg/dL and estimated glomerular filtration rate (eGFR) was >60 mL/minutes/1.73 m2. A decision was made to proceed with a robotic partial nephrectomy. Our positioning and port placement have been previously described for a partial nephrectomy. We docked the robot over the patient's right shoulder, using a three-armed approach. We used the laparoscopic ultrasound extensively to localize the tumor. A cap of normal parenchyma was first removed, and then the tumor was dissected off the hilum. We then performed our standard renorrhaphy technique. Results: Warm-ischemia time (WIT) was 35 minutes, and 70% of normal parenchyma was preserved. Estimated blood loss was 200 cc. There were no intraoperative complications. Final pathology revealed a 3.8 × 2.7-cm tumor, clear cell renal cell carcinoma, Fuhrman grade 3. The resection margins were negative. The patient's creatinine on discharge was 0.92 mg/dL, and eGFR was >60 mL/minutes/1.73 m2. A nuclear renogram is pending. Conclusions: Robotic partial nephrectomy for a completely endophytic hilar tumor is technically feasible. We incurred a longer WIT; however, we were able to preserve 70% of functional renal parenchyma with good short-term renal function. For this young patient, we feel this was a better alternative than performing a radical nephrectomy for his endophytic hilar tumor. Jihad H. Kaouk: Intuitive Surgical, Inc. (Consultant); Ethicon, Inc. (Speaker); Endocare, Inc. (Speaker). No competing financial interests exist for the other authors. Runtime of video: 9 mins 43 secs

Poorly Functioning Kidneys Recover from Ischemia after Partial Nephrectomy as Well as Strongly Functioning Kidneys

Poorly functioning kidneys may not recover from ischemia as well as strongly functioning kidneys. This could impact surgical approaches to partial nephrectomy. We analyzed the records of 155 consecutive patients treated with partial nephrectomy who underwent appropriate studies to facilitate analysis of function and parenchymal mass in the operated kidney, including computerized tomography and glomerular filtration rate measurement within 2 months preoperatively and 4 to 12 months postoperatively. Patients with a contralateral kidney also underwent renal scan in the same time frame to provide split renal function. Computerized tomography was done to measure functional parenchymal volume before and after partial nephrectomy. Recovery from ischemia, defined as percent glomerular filtration rate saved/percent volume saved, was considered 100% if all nephrons recovered from the ischemic insult. The median R.E.N.A.L. nephrotomy score was 8. Cold ischemia was used in 64 patients and limited warm ischemia was used in 91 (median 27 and 20minutes, respectively). The median percent glomerular filtration rate saved in the operated kidney was 80% and the median parenchymal volume saved was 83%. The overall median rate of recovery from ischemia was 95%, including 100% for cold ischemia and 92% for limited warm ischemia. Recovery from ischemia was approximately 100% and was similar for all strata ofpreoperative estimated glomerular filtration rates in the operated kidney (p=0.24), even in the warm ischemia subgroup. Our results suggest that the quantity of parenchyma preserved is the main determinant of the postoperative glomerular filtration rate after partial nephrectomy as long as limited warm ischemia or hypothermia is used. Even poorly functioning kidneys recover well from the ischemic insult proportionate tothe amount of parenchyma preserved.

Renal hypothermia achieved by in situ cold saline perfusion in robotic partial nephrectomy for tumor in a solitary kidney: initial experience

Renal hypothermia achieved by in situ cold saline perfusion in robotic partial nephrectomy for tumor in a solitary kidney: initial experience