Radical Partial Nephrectomy Research Articles

Partial nephrectomy provides equivalent oncologic outcomes and better renal function preservation than radical nephrectomy for pathological T3a renal cell carcinoma: A meta-analysis.

ABSTRACTPurpose:Radical nephrectomy (RN) is the standard surgical type for pathological stage T3a (pT3a) renal cell carcinoma (RCC). Recently, some studies have suggested equivalence between partial nephrectomy (PN) and RN for oncologic control and have shown the benefits of PN for better renal function. We conducted this meta-analysis to assess oncologic outcomes, perioperative outcomes and renal function between two groups among patients with pT3a RCC.Materials and methods:PubMed, Scopus, Web of Science, Science Direct, Ovid MEDLINE, The Cochrane Library, Embase and Google Scholar were searched for eligible articles. The endpoints of the final analysis included overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), surgical complications, operative time, estimated blood loss (EBL), serum creatinine and estimated glomerular filtration rate (eGFR).Results:Twelve studies of moderate to high quality, including 14.152 patients, were examined. PN showed superiority for renal functional preservation, providing higher eGFR (WMD=12.48mL/min; 95%CI: 10.28 to 14.67; P <0.00001) and lower serum creatinine (WMD=-0.31mg/dL; 95%CI: −0.40 to −0.21; P <0.00001). There were no significant differences between PN and RN regarding operative time, EBL, surgical complications, OS, RFS and CSS. Despite inherent selection bias, most pooled estimates were consistent in sensitivity analysis and subgroup analysis. More positive margins were found in the PN group (RR=2.42; 95%CI: 1.25-4.68; P=0.009).Conclusions:PN may be more suitable for treating pT3a RCC than RN because it provides a similar survival time (OS or RFS) and superior renal function. Nevertheless, this result is still disputed, and more high-quality studies are required.

Nefrectomía parcial vs enucleación tumoral

Antecedentes y objetivo: La cirugía conservadora de nefronas se ha convertido en la técnica quirúrgica estándar para masas renales de pequeño tamaño, desbancando la tradicional nefrectomía radical. El objetivo del estudio es comparar nefrectomía parcial y enucleación tumoral en función de morbilidad y resultados oncológicos.&#x0D; Material y métodos: Estudio de cohortes retrospectivo de pacientes sometidos a nefrectomía parcial o enucleación en el Hospital Clínico Universitario Lozano Blesa de Zaragoza, entre agosto de 2011 y octubre de 2019. Variables demográficas, clínicas, quirúrgicas y resultados oncológicos han sido analizadas.&#x0D; Resultados: 48 pacientes fueron seguidos 36.1±28.0 meses. Los pacientes sometidos a enucleación tumoral, respecto al grupo de nefrectomía parcial presentaron valores inferiores de sangrado medio (117.7±95.1 ml y 221±293.1 ml, p=0.488), isquemia (46% y 95%, p&lt;0.001), tiempo de isquemia medio (24.6±7.2 min y 25.1±10.4 min, p=0.844) y complicaciones (11.5% y un 22.7%, p=0.442) respectivamente. No se observó recidiva local.&#x0D; Conclusiones: Ambos grupos son comparables en cuanto a estadio tumoral, presentando en el grupo de enucleación un menor sangrado, menor necesidad de clampaje vascular y un tiempo de isquemia similar al grupo de nefrectomía parcial. Ambas técnicas son seguras a nivel oncológico, con una baja tasa de márgenes afectos. Ambas técnicas presentan una baja morbilidad postoperatoria.

Renal function after nephron-sparing surgery versus radical nephrectomy in localized renal cell carcinoma (T1)

Objective: To evaluate renal function (GFR) after radical nephrectomy compared to partial nephrectomy in stage T1 renal cell carcinoma patients between 2005 and 2015. Material and Method: Retrospective chart review of 409 patients who were diagnosed with renal cell carcinoma (T1) and treated with radical nephrectomy (RN) or partial nephrectomy (PN) between 2005 and 2015 (RN=136, PN=92); 228 patients with pathologically confirmed pT1 remained for analysis and were then evaluated for their estimated glomerular filtration rate (eGFR) after the surgery. Results: There were a total of 228 (149 males and 79 females) T1 RCC patients; 136 patients were T1a with RN (57.8%) and 92 with PN (42.2%). Median follow-up was 58 months and 35 months for the RN and PN groups. From the analysis, post-operative eGFR of the RN group was decreased from 77.49 to 59.61 ml/min/1.73m2 and the PN group was decreased from 78.85 to 69.9 ml/min/1.73m2. The comparative eGFR between the 2 groups at 1 month had a significant difference (p-value&lt;0.05). eGFR at 3 months (50.24 in RN vs 64.67 in PN), 6 months (47.98 vs 64.51), 3 years (48.79 vs 67.22) and 5 years (52.63 vs 73.59) were also significantly altered between the 2 groups. The tumor recurrence rate was not significantly different between RN and PN. Conclusion: We found that patients treated with PN had superior post-operative renal function compared with RN. However, there was no difference in the tumor recurrence rate between the 2 groups after a follow-up of 10 years.

Partial nephrectomy preserves renal function without increasing the risk of complications compared with radical nephrectomy for renal cell carcinomas of stages pT2-3a.

To compare the operative and functional result of partial and radical nephrectomy in renal cell carcinomas of stages pT2-3a. Consecutive patients with renal cell carcinoma of stages pT2-3a, cN0 and cM0, who underwent partial or radical nephrectomy between January 2005 and October 2019 at a tertiary care center were included. Data were collected retrospectively. End-points included severe postoperative complications (Clavien-Dindo classification ≥3), acute and chronic renal function impairment, and overall survival. Uni- and multivariable outcome analyses were based on logistic regression. A total of 158 patients were included (110 radical nephrectomy and 48 partial nephrectomy). Over time, partial nephrectomy was increasingly used. A RENAL score ≥10 was the only independent predictor influencing the surgical approach (radical nephrectomy vs partial nephrectomy, odds ratio 8.62, 95% confidence interval 3.32-22.37, P<0.001). No significant differences in complications for radical nephrectomy versus partial nephrectomy were found (12.7% vs 8.3%, P=0.424). Renal function was better preserved in the partial nephrectomy group (the latest chronic kidney disease stage ≥3: radical nephrectomy 73% vs partial nephrectomy 41%, P=0.005). The surgical approach was a significant factor for chronic kidney disease (odds ratio 51.07, 95% confidence interval 3.57-730.59, P=0.004). Overall survival did not significantly differ between radical nephrectomy and partial nephrectomy (mean overall survival 85.86months, 95% confidence interval 3.83-78.36 vs 81.28months, 95% confidence interval 4.59-72.29, P=0.702). In selected patients, partial nephrectomy can be used in large or locally advanced renal cell carcinoma. Compared with radical nephrectomy, it allows better preservation of renal function without harboring an increased risk of severe postoperative complications.

Patient-Reported Quality of Life and Convalescence After Minimally Invasive Kidney Cancer Surgery

ObjectiveTo better characterize recovery after minimally invasive kidney surgery, we present a study describing patient-reported health-related quality of life (HRQOL) following minimally invasive radical nephrectomy (RN) and partial nephrectomy (PN). MethodsPatients who underwent minimally invasive PN or RN for renal cancer were invited to enroll in a prospective, patient-reported HRQOL study using the Convalescence and Recovery Evaluation (CARE) instrument and Short Form-12. Patients completed questionnaires at baseline, 2, 4, 8, and 12 weeks after surgery. Mixed repeated measures model were used to assess time effect on HRQOL scores and predictors of scores within each surgery groups. ResultsOne hundred seventy-seven patients were included in the study: 50 had RN and 127 had PN. At 2 weeks, both groups had significant decreases in Overall CARE, as well as the Pain, Gastrointestinal, and Activity domain scores which remained slightly below baseline at 4 weeks. At 4 weeks only 50% of patients in both the RN and PN cohorts returned to baseline overall CARE score. By 12 weeks 82% returned to baseline overall CARE score in the RN group while 76% of patients did so in the PN group. ConclusionConvalescence after minimally invasive renal surgery can often extend beyond 4 weeks post-treatment in PN and RN subjects. This information may be used to provide more accurate preoperative counseling in an attempt to improve overall patient satisfaction.

Single-port robotic partial and radical nephrectomies for renal cortical tumors: initial clinical experience.

To describe our institution's initial experience with radical (RN) and partial nephrectomy (PN) using the SP robotic system. The recent FDA approval of the da Vinci® SP robotic platform has led to its use in minimally invasive approaches to urologic malignancies. There are little data on its feasibility and safety after implementation for radical and partial nephrectomy. All patients who underwent PN or RN using the SP system at our institution were reviewed. All PNs were performed off-clamp. Patient demographics, preoperative imaging, operative approaches, and perioperative outcomes were collected and analyzed. Sixteen patients underwent PN (n = 13) or RN (n = 3) utilizing the SP robotic system between January 2019 and June 2019. Average age was 58.6 ± 13.9 and 61.0 ± 1.7years in each group, respectively. A retroperitoneal approach was performed in 7 (53.8%) PN patients and 1 (33.3%) RN patient. A transperitoneal approach was performed in 6 (46.1%) PNs and 2 (66.7%) RNs. Mean operative time and median estimated blood loss for PN was 176.9 ± 64.0min and 200 (50-800) ml compared to 176.3 ± 73.8min and 50 (50-400) ml for RN. There was one operative conversion (7.7%) to an open approach in the PN group. Length of hospital stay postoperatively averaged 1.9 ± 1.3days and 3.3 ± 1.2days for patients undergoing partial and radical nephrectomy, respectively. SP partial and radical nephrectomies through transperitoneal and retroperitoneal approaches appear to be feasible surgical techniques in the management of cortical renal masses. Off-clamp PN is also a feasible approach using the SP system. However, further study is needed to establish its safety and use in renalsurgeryacross multiple institutions and larger patient cohorts.

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.

Clinical impact of segmental renal vein invasion on recurrence in patients with clinical T1 renal cell carcinoma undergoing partial nephrectomy.

This study evaluated the clinical significance of pathological factors associated with T3a upstaging according to the American Joint Committee on Cancer/Union for International Cancer Control 8th edition TNM-staging system in patients with clinical T1 renal cell carcinoma undergoing definitive surgery. We retrospectively investigated 418 patients with renal cell carcinoma who underwent partial or radical nephrectomy at our institution between 2006 and 2016. Surgical specimens were grossly and microscopically re-reviewed with respect to extrarenal extension patterns by two urological pathologists. Kaplan-Meier analysis and Cox regression were used to determine the impact of the factors associated with pathological stage T3a on recurrence-free survival. Harrell's c-index was used to compare the prognostic accuracy of the current and previous staging systems. Overall, the 5-year recurrence-free survival was 94.5% (median follow-up duration, 60.8months). Of 418 patients, 46 (11.0%) were upstaged to pathological stage T3a, including 12/267 (4.5%) and 34/151 (22.5%) in the partial and radical nephrectomy groups, respectively. Among these upstaged patients, partial nephrectomy was significantly associated with a higher recurrence rate than radical nephrectomy (5-year recurrence-free survival: 48.9 vs. 83.9%, P = 0.0172). Although perinephric fat invasion had the highest c-index in all patients (0.580-0.679), microscopic segmental renal vein invasion was a significant predictor of recurrence in patients undergoing partial nephrectomy (c-index, 0.60). Assessing microscopic segmental renal vein invasion, which has been included in the current staging system recently, is essential to accurately predict the oncological outcome in the era of partial nephrectomy for clinical T1 renal cell carcinoma.

Clinicopathologic features and prognostic analyses of locally recurrent renal cell carcinoma patients after initial surgery

To evaluate the clinicopathologic features and potential prognostic predictors of locally recurrent renal cell carcinoma patients after initial surgery. Authors retrospectively analyzed data extracted from 81 patients who were treated for postoperative locally recurrence of renal cell carcinoma from January 2006 to June 2016 in the Department of Urology, Peking University First Hospital. Postoperative locally recurrence of renal cell carcinoma was defined as disease recurring in the remnant kidney, renal fossa, adjacent abdomen, ipsilateral adrenal and retroperitoneal lymph nodes. In the study, 81 patients were finally included, of whom 43 were initially treated in our hospital and 38 were initially treat in other centers. Partial nephrectomy (PN) was performed for 38 cases (26 in our hospital and 12 in other hospitals) as initial treatment and radical nephrectomy (RN) was conducted for the remnant 43 cases (17 in our hospital and 26 in other hospitals). Overall median recurrence time was 26 months (range: 3-164 months), in which 26 months (range: 3-55 months) for PN cases and 30 months (range: 4-164 months) for RN cases (P=0.009). Sixty-nine patients had single site recurrence, including remnant kidney (n=29), renal fossa (n=20), abdomen (n=4), ipsilateral lymph nodes (n=5), ipsilateral adrenal (n=11), while 12 patients had multiple sites recurrence. Seventy-eight patients were managed by complete surgical resection, while three patients were managed by radiofrequency ablation. Postoperative pathological diagnoses included clear cell carcinoma (n=72), papillary renal cell carcinoma (n=8, 7 cases with type 1, 1 case with type 2) and Xp11 translocation/TFE3 gene fusion renal cell carcinoma (n=1). Complete pathologic information of the initial surgery could be extracted from 43 patients who were initially treated in our hospital. Seventeen patients with initial radical nephrectomy were staged as T1a (n=4), T1b (n=2), T2a (n=1), T3a (n=8), and T3b (n=2). Twenty-six patients with initial partial nephrectomy were staged as T1a (n=18), T1b (n=7), and T3a (n=1). For PN cohort, the patients with T1a stage disease had longer median recurrence time than those with beyond T1a stage disease, and the difference was significant (29 months vs. 18 months, P=0.041). At the end of the follow-up, 58 patients were alive, 4 died and 19 lost the follow-up. Overall, 3-year and 5-year disease free survival rates were 81.9%, and 53.6%, respectively. The present research reported a large-scale single central experience of locally recurrent renal cell carcinoma. The recurrence time of the PN group is shorter than that of the RN group. For patients after PN surgery, median recurrence time is longer for patients with T1a stage tumor when compared with those with stage beyond T1a. Patients can obtain relative long-term survival after complete secondary surgery resection.

Predictors of the Transition from Off to On Clamp Approach during Ongoing Robotic Partial Nephrectomy: Data from the CLOCK Randomized Clinical Trial.

We sought to identify predictive factors of the transition from off clamp to on clamp robotic partial nephrectomy following an intraoperative decision. In the multicenter, randomized, prospective CLOCK (CLamp vs Off Clamp the Kidney during robotic partial nephrectomy) trial 152 and 149 of the 301 patients with a localized renal mass were assigned to undergo off clamp and on clamp robotic partial nephrectomy, respectively. Surgery was done at a total of 7 referral institutions by 1 surgeon per institution. A localized renal mass was defined as having a R.E.N.A.L. (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, location relative to polar lines, hilar) score less than 10. Surgeons had similar experience with at least 100 previous robotic partial nephrectomies. All patients underwent a preoperative and a 6-month renal scan. The current study deals with one of the secondary end points of the trial, comparing cases finalized as clampless (off robotic partial nephrectomy group) with those which were converted (shift robotic partial nephrectomy group). Of the 152 patients randomized to off clamp 61 (40%) were shifted to clamp with a median ischemia time of 15 minutes. In the shift robotic partial nephrectomy group the masses were larger (3.5 vs 2.2 cm) and more complex (R.E.N.A.L. score 7 vs 6). A significant association with transition was found for tumor diameter (OR 1.4) and the R.E.N.A.L. score continuously (OR 1.4) and when recoded in groups, including 4-no risk (referent OR 1), 5-6-low risk (OR 1.8), 7-8-intermediate risk (OR 3.6) and 9 or greater-high risk (OR 6.6). The shift robotic partial nephrectomy group had longer operative time, higher blood loss and increased performance of 2-layer renorrhaphy. No significant differences were noted in postoperative complications or renal function after 6 months. The transition from off to on clamp robotic partial nephrectomy is associated with renal mass diameter and complexity. Under the specific conditions of the current trial no harm was related to this decision.

Analysis of perioperative parameters and renal function in elderly patients with clinical T1-T2 renal masses treated by partial nephrectomy and radical nephrectomy

Objective To compare the perioperative parameters and renal function in patients, whose aged was 65 year-old or above, with clinical T1-2 renal tumors undergoing partial nephrectomy (PN) or radical nephrectomy (RN). Methods A retrospective review of 469 patients, who underwent RN and PN in our center, was conducted from January 2012 to November 2018, icluding 247 in the RN group and 222 in the PN group. The RN group consisted of 170 male and 77 female patients, with the mean age of (70.96±5.21) year-old. 126 cases were found that the tumor located on the right side, with the median diameter of (4.93±2.03)cm. The median BMI, median R. E.N.A.L. score and pre-operation eGFR of the RN group were (24.4±3.1)kg/m2, 8.39±1.45) and (80.23±15.14) ml/(min·1.73m2), respectively. The PN group consisted of 150 male and 72 female patients, with the mean age of (70.23±4.62) years old. 108 patients had tumors on the left side while 114 on the right side, with the median diameter of (3.17±1.41) cm. The median BMI, median R. E.N.A.L score and pre-operation eGFR of the PN group were (23.5±3.2) kg/m2, (6.69±1.81) and (82.83±14.36) ml/(min·1.73m2), respectively. No statistical difference was noticed in the age, gender, tumor location and BMI between RN group and PN group(P>0.05). The PN group had smaller tumors and lower R. E.N.A.L. scores than the RN group(P<0.05). Various parameters were compared between the PN and RN groups, including operative duration, surgical procedure, intraoperative blood loss, perioperative blood transfusion, drainage tube removal time, postoperative duration of hospitalization, pathological results, the renal function immediately after surgery and at 1 month, 1 year, 2 years, 3 years, 4 years, 5 years after surgery, and the incidence of chronic renal dysfunction. Results Significant differences were found in multiple variables between the two cohorts, such as operative duration [(115.70±39.69)min in RN vs.(132.26±49.02) min in PN], estimated intraoperative blood loss [(45.85±55.93)days in RN vs. (66.60±61.55)ml in PN], drainage tube removal time [(4.38±1.71)days in RN vs.(4.86±1.61)days in PN], duration of postoperative hospitalization [(5.14±1.65)days in RN vs.(5.52±1.32)days in PN](P 0.05). Compared with the RN cohort, the PN cohort had higher eGFR immediately after surgery [(74.08±18.31)ml/(min·1.73m2) vs.(52.58±14.21) ml/(min·1.73m2)], 1 month after surgery [(76.11±18.34)ml/(min·1.73m2) vs.(53.78±15.03)ml/(min·1.73m2)] and at the last follow-up [(73.92±18.59)ml/(min·1.73m2)vs.(52.35±16.13)ml/(min·1.73m2)](P<0.001). Compared with those of the RN cohort, the incidences of eGFR<45 ml/(min·1.73m2) of the PN cohort were lower immediately after surgery [9.01% (20/222) vs. 31.9% (79/247)], 1 month after surgery [7.87% (14/178) vs. 27.31% (62/227)], 1 year after surgery [8.96% (13/145) vs.38.75% (62/160)], 2 years after surgery [9.89% (9/91) vs. 31.57% (42/133)], 3 years after surgery [13.21%(7/53) vs. 30.61% (30/98)], 4 years after surgery [16.21% (6/37) vs. 30.26% (23/76)] and 5 years after surgery [18.18% (4/22) vs. 31.11% (14/45)](P<0.001). Conclusion The perioperative risk of PN in the treatment of elderly patients aged 65 and above with clinical cT1-2 renal tumor is controllable. PN could better retain renal function for those patients and reduce the risk of postoperative chronic renal insufficiency. Key words: Elderly; Renal cell carcinoma; Partial nephrectomy; Radical nephrectomy; Renal function

Partial nephrectomy vs cryoablation for T1a renal cell carcinoma: A comparison of survival benefit stratified by tumour size

ObjectiveWe compared the impact on survival outcomes of partial nephrectomy (PN) and cryoablation (CA) for patients diagnosed with T1a renal cell carcinoma (RCC). Patients and MethodsAmong patients diagnosed between 2004 and 2014 in the Surveillance, Epidemiology and End Results program, we identified histologically confirmed T1aN0M0 RCC treated with PN (n = 17644) or CA (n = 868). Propensity score matching (PSM) was performed. Kaplan-Meier method, Cox proportional hazards model were used to calculate cancer specific mortality (CSM) and overall mortality (OM) in the unmatched and matched cohort, and in subgroups based on tumour size (< 2 cm, 2-3 cm, 3-4 cm). Sensitivity analyses were performed. ResultsA total of 18512 patients were identified: PN (93.88%) and CA (6.12%). In the propensity-score matched cohort, for tumours ≤ 2 cm, the CA and PN groups had similar CSM (HR: 1.41, 95% CI: 0.32–6.31, p = 0.65) and OM (HR 0.97, 95%CI: 0.47–2.01, p = 0.93). For tumours 2-3 cm, CA was associated with similar CSM (HR 1.64, 95%CI: 0.67–4.03, p = 0.28) but higher OM (HR 2.05, 95%CI: 1.35–3.11, p < 0.001), compared with PN. For tumours 3-4 cm, CA was associated with increased CSM (HR: 3.76, 95% CI: 1.62–8.69, p = 0.002) and OM (HR 2.17, 95%CI: 1.48–3.18, p < 0.001). ConclusionFor RCC ≤ 2 cm, PN and CA are equal in survival outcomes. For RCC 2-4 cm, PN may have a possible advantage over CA.

Cryoablation versus Partial Nephrectomy for Clinical Stage T1 Renal Masses: A Systematic Review and Meta-Analysis.

Introduction: Cryoablation has been considered as the most efficacious ablative alternative to partial nephrectomy (PN) for selected patients. Our objective is to assess the existing evidence relating to the safety and efficacy of cryoablation compared with PN for clinical T1 renal masses.Materials and Methods: A comprehensive search of PMC, EMBASE, and the Cochrane Library was conducted to identify studies containing comparison of cryoablation and PN. By utilizing those included studies, a systematic review and cumulative meta-analyses were performed to assess the safety and efficacy between cryoablation and PN for T1 renal masses.Results: 17 retrospective studies providing available data were included in our study. Significant differences were found about all oncological variables including all-cause death, cancer-specific death, metastasis and local-recurrence (p < 0.001, p = 0.03, p < 0.001, and p < 0.001, respectively) between the PN group and the cryoablation group. The mean difference between two groups for percent estimated glomerular filtration rate decrease and creatinine increase was -4.84 and 0.15 respectively (p < 0.001 and p = 0.006, respectively). The incidences of overall and postoperative complications in the PN group were significantly higher than that in the cryoablation group (p = 0.001 and p < 0.001, respectively), but the result about intraoperative complications didn't show a significant difference between the two groups (p = 0.53).Conclusions: Comparing with PN, cryoablation for clinical T1 renal tumors is associated with poorer oncological outcomes, but the existing disadvantages are accompanied by lower rate of overall and postoperative complications and superior renal functional preservation. For patients with imperative indications for nephron-sparing surgery who can't risk more invasive PN, cryoablation could be an attractive option. Owing to the inherent limitations of eligible studies, conclusions drawn from our meta-analyses should be interpreted cautiously and be confirmed further with well-designed randomized controlled trials with extensive follow-up length.

Predictors of renal function after open and robot-assisted partial nephrectomy: A propensity score-matched study.

To investigate parameters predicting short- and long-term renal function after open partial nephrectomy and robot-assisted partial nephrectomy. Medical records of 896 patients who underwent open partial nephrectomy or robot-assisted partial nephrectomy from 2004 to 2017 at a single large-volume institution were retrospectively reviewed. Propensity score matching of open partial nephrectomy and robot-assisted partial nephrectomy group was carried out with a ratio of 1:1. Postoperative outcomes were compared, and multivariate logistic regression was carried out to identify the parameters influencing acute kidney injury and chronic kidney disease progression. No significant differences in preoperative characteristics were observed between the two study groups after matching. Robot-assisted partial nephrectomy was significantly associated with a longer warm ischemic time (P<0.001) yet, estimated blood loss, positive surgical margin, rates of major postoperative complications and chronic kidney disease progression were significantly lower in the robot-assisted partial nephrectomy group (P<0.001, 0.033, <0.001, <0.001, and 0.005, respectively). Multivariate analysis showed robot-assisted partial nephrectomy was more favorable than open partial nephrectomy in terms of preserving renal function. Patients with a higher baseline estimated glomerular filtration rate were significantly associated with a greater risk of acute kidney injury (odds ratio 1.036; 95% confidence interval 1.021-1.052; P<0.001), but a decreased risk of chronic kidney disease progression (odds ratio 0.975; 95% confidence interval 0.955-0.994; P=0.011). Other independent predictors of chronic kidney disease progression were warm ischemic time (P=0.025), age (P=0.035), body mass index (P=0.041) and diabetes mellitus (P=0.035). Baseline estimated glomerular filtration rate, warm ischemic time and surgery type are independent predictors of both acute kidney injury and chronic kidney disease progression. Robot-assisted partial nephrectomy is more favorable than open partial nephrectomy for reducing estimated blood loss, positive surgical margin, major postoperative complications and renal function preservation.

Comparation of radiofrequency ablation and partial nephrectomy for the treatment of early small renal cell cancer: a Meta-analysis

Objective To systematically compare the clinical efficacy of radiofrequency ablation and partial nephrectomy in the treatment of early small renal cell carcinoma. Methods The clinical data of radiofrequency ablation and partial nephrectomy in the treatment of small renal cell carcinoma were searched in PubMed, EMBASE, CNKI Digital Library and Wanfang Database from the inception to be March 2017. The relevant literature search strategy, inclusion and exclusion criteria were established by two independent researchers, meanwhile, the quality of the included literature was evaluated. The tumor diameter, length of hospital stay, postoperative complications, renal function injury (glomerular filtration rate decline) and local recurrence control rate were calculated by RevMan 5.3 software. Results A total of 17 retrospective cohort studies met the criteria and were included in the our research. Early small renal cell carcinoma in 3253 cases, of which 1158 cases in radiofrequency ablation group, 2095 cases in partial nephrectomy group. The results of this meta-analysis showed that radiofrequency ablation and partial nephrectomy had no statistically significant difference in tumor diameter [WMD = -0.23, 95% CI (-0.53, 0.07), P=0.13]. The radiofrequency ablation was significantly better than partial nephrectomy in terms of the length of hospital stay [WMD=-2.35, 95% CI (-3.04, -1.65), P<0.00001], postoperative complications [OR=0.31, 95%CI(0.19, 0.51), P<0.0001] and renal function injury (glomerular filtration rate decline) [WMD=-5.61, 95%CI(-8.76, -2.45), P=0.0005]. However, the partial nephrectomy had a significant advantage in postoperative local recurrence control [OR=1.87, 95% CI (1.25, 2.81), P=0.002] than radiofrequency ablation. Conclusions Although radiofrequency ablation has significant advantages in the days of hospitalization, postoperative complications and protection of glomerular filtration rate, partial nephrectomy still has some advantages in the control of local recurrence of the renal cell carcinoma. Key words: Kidney Neoplasms; Nephrectomy; Catheter Ablation; Meta-Analysis

Functional outcomes of nephron-sparing surgery for renal cell carcinoma T1b–T2 stage

Aim. To compare the functional outcomes of radical nephrectomy (NE) and partial nephrectomy (PN) in patients with T1b-T2 renal cell carcinoma (RCC). Materials and methods. A retrospective assessment of the functional results of 167 patients with RCC clinical stage T1b-T2N0M0, which were operated in period from 2012 to 2015 were done. PN was performed in 79 patients (47.0%), NE – 88 (53.0%). Functional results were evaluated by determining the rate of glomerular filtration (GFR) using the Cockroft–Holt’s formula. Results. In the PN and NE group, the GFR before surgery was 99.3 and 93.4 ml/min/1.73 m2 (p=0.284), after 7 days 86.3 and 76.5 ml/min/1.73 m2 (p=0.021), after 1 year after surgery 82.1 and 70.1 ml/min/1.73 m2 (p=0.0003), respectively. 1 After 1 year after surgery GFR decreased in the group of PN by 13.0%, in the group of NE – by 21.4% (p = 0.003). Also, after NE, the number of patients with III–IV stage of chronic kidney disease (CKD) increased by 21.2% (p=0.0023), after PN – did not change. Conclusions. Retrospective evaluation of functional results of surgical treatment of T1b-T2 RCC in the early postoperative period and 1 year after surgery demonstrated that PN provides better preservation of functional renal parenchyma and renal function, as well as a decrease of the number of patients with clinically significant CKD, compared to NE.

Comparison of Radical Nephrectomy and Partial Nephrectomy for T1 Renal Cell Carcinoma: A Meta-Analysis

Objective: To contrast the clinical effects and complications for the treatment of T1 renal carcinoma in partial nephrectomy (PN) and radical nephrectomy (RN). Methods: Multiple databases were adopted to search relevant studies, and articles that eventually satisfied the inclusion criteria were included. All meta-analyses were conducted with the Review Manager 5.0, and to estimate the quality of each article, risk of bias table was performed. Results: In the end, 13 studies including 13,269 patients were involved, which eventually satisfied the eligibility criteria. The number of samples in the PN group and the RN group were 6,145 and 7,124 respectively. The results of heterogeneity test suggested that the operating time (mean difference [MD] = –13.02, 95% CI [–14.15 to –11.89], p < 0.00001; p for heterogeneity < 0.00001, I² = 100%), glomerular filtration rate (GFR) at 24 h after surgery (MD = 11.28, 95% CI [10.71–11.85], p < 0.00001; p for heterogeneity < 0.000001, I²= 98%), and recurrence (OR 0.99, 95% CI [0.51–1.93], p = 0.97; p for Heterogeneity = 0.73, I² = 0%) were significantly different, while differences in GFR at 24 h before surgery (MD = 0.59, 95% CI [0.06–1.12], p = 0.03; p for heterogeneity < 0.000001, I² = 76%) between PN and RN were insignificant. Conclusion: This study demonstrated that clinical efficacy of RN was better than that of PN to some extent, but PN was a quicker recovery and less harmful therapy.

Nephron sparing surgery in tumours greater than 7 cm

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

Outcomes of pathologic stage T3a renal cell carcinoma up-staged from small renal tumor: emphasis on partial nephrectomy

BackgroundThe prognosis of patients with pathologic stage T3a renal cell carcinoma (RCC) that is up-staged from a small renal tumor remains controversial. We evaluated the prognosis of patients with RCC who were up-staged from clinical stage T1 to pathologic stage T3a.MethodsWe retrospectively reviewed the data of 3431 patients who were surgically treated for clinical stage T1 RCC. The survival outcomes were compared using Kaplan-Meier and Cox proportional analyses.ResultsAmong the clinical stage T1 patients, 215 (6.3%) were finally up-staged to pathologic stage T3a. Patient age (HR 1.302, 95% CI 1.018–1.046, p < 0.001), tumor diameter (HR 1.686, 95% CI 1.551–1.834, p < 0.001), and hilar location (HR 1.765, 95% CI 1.147–2.715, p = 0.010) were significantly associated with upstaging. Kaplan-Meier analyses showed significantly shorter recurrence-free, cancer-specific and overall survivals (all p < 0.001) in patients who were up-staged. Multivariate Cox analyses revealed pathologic upstaging as an independent predictor of shorter recurrence-free (HR 2.195, 95% CI 1.459–3.300, p < 0.001), cancer-specific (HR 2.238, 95% CI 1.252–4.003, p = 0.007), and overall survivals (HR 1.632, 95% CI 1.029–2.588, p = 0.037). Subgroup analysis of pathologic stage T3a showed no significant difference in survival of the partial nephrectomy group when compared to the radical nephrectomy group (all p > 0.5).ConclusionsPatients up-staged from clinical stage T1 to pathologic stage T3a RCC showed shorter survival outcomes than those without upstaging. However, partial nephrectomy, compared with radical nephrectomy, showed comparable outcomes in patients who were up-staged.

PD16-09 PARTIAL NEPHRECTOMY CONVERTING TO RADICAL NEPHRECTOMY: IMPACT OF PATIENT AND SURGICAL FACTORS

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III1 Apr 2018PD16-09 PARTIAL NEPHRECTOMY CONVERTING TO RADICAL NEPHRECTOMY: IMPACT OF PATIENT AND SURGICAL FACTORS Akbar Ashrafi, Peter Mekhail, Ricardo Brandina, Grant Redrow, Mihir Desai, Inderbir Gill, and Monish Aron Akbar AshrafiAkbar Ashrafi More articles by this author , Peter MekhailPeter Mekhail More articles by this author , Ricardo BrandinaRicardo Brandina More articles by this author , Grant RedrowGrant Redrow More articles by this author , Mihir DesaiMihir Desai More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Monish AronMonish Aron More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.821AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intraoperative conversion of partial nephrectomy to radical nephrectomy may be related to tumor complexity, patient or surgical factors. The aim of this study was to describe the causes for conversion and assess for patient and surgical predictors of conversion in patients undergoing partial nephrectomy at a high-volume academic center. METHODS We identified all patients who were scheduled to have robotic, laparoscopic or open partial nephrectomy at our institution between January 2011 and December 2014. The intraoperative reason for conversion to radical nephrectomy was collated from retrospective review of operative notes. Several variables were analyzed including, age, gender, Charlson co-morbidity score, ASA score, tumor size, procedure type, renal function and complication data. Multivariable logistic regression was used to identify independent predictors for conversion. RESULTS A total of 878 patients were scheduled for partial nephrectomy (PN). The rate of conversion to radical nephrectomy (RN) was 3.6% (n=32). The most common reasons for conversion were invasion of hilar structures in 12 patients (38%), insufficient residual kidney in 11 (35%), excessive intraoperative bleeding in 4 (13%), suspected positive margin in 2 patients (13%) and anesthesiology-related in 1 patient. Patients that were converted had similar preoperative eGFR (73 vs 79 mL/minute/1.73 m2, p=0.2), rates of diabetes (34% vs 23%, p=0.1), mean Charlson co-morbidity score (1.1 vs 1.5, p=0.2) and mean ASA score (2.3 vs 2.5, p=0.3). Patients that had conversion to RN were more likely to be older (mean age 67 vs 61, p=0.02), have hypertension (81% vs 62%, p=0.03) and have larger tumors (mean size 5.2 vs 3.2cm, p<0.01). In the robot-assisted PN group, 10 of 628 cases were converted (1.6%) compared to 4 of 45 cases in open PN (8.2%) and 18 of 173 in the laparoscopic PN group (9.4%, p<0.01). On multivariable logistic regression, tumor size (OR 1.2), hypertension (OR 2.8) and robotic surgery (OR 0.14) were independent predictors of conversion. There were no differences in the complication (3% vs 12%, p=0.2) or malignancy rate (81% vs 78%, p=0.7) though postoperative eGFR was significantly lower in patients that had conversion compared to the PN group (40 vs 65 mL/minute/1.73 m2, p<0.01). CONCLUSIONS Intraoperative conversion of partial nephrectomy to radical nephrectomy was most commonly due to invasion of hilar structures or insufficient residual kidney in this series. Conversion was associated with hypertension and larger tumor size, and increased the risk of chronic kidney disease postoperatively. Robot-assisted partial nephrectomy reduced the risk of conversion compared to the open or laparoscopic approach. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e319-e320 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Akbar Ashrafi More articles by this author Peter Mekhail More articles by this author Ricardo Brandina More articles by this author Grant Redrow More articles by this author Mihir Desai More articles by this author Inderbir Gill More articles by this author Monish Aron More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...