Patients Undergoing Radical Nephrectomy Research Articles

Novel Blood Indicators of Progression and Prognosis in Renal Cell Carcinoma: Red Cell Distribution Width-to-Lymphocyte Ratio and Albumin-to-Fibrinogen Ratio.

Objective To evaluate the value of preoperative red cell distribution width-to-lymphocyte ratio (RLR) and albumin-to-fibrinogen ratio (AFR) to the prognosis of patients after renal cell carcinoma (RCC). Methods From 2012 to 2016, a total of 273 RCC patients underwent radical nephrectomy or partial nephrectomy. This study retrospectively analyzed this group of patients. X-tile software was used to determine the optimal values of RLR and AFR in the peripheral blood. The nomogram constructed with independent factors was used to predict the survival outcome of the patients after RCC. Results The RLR of the RCC group was higher than that of the normal control group (P=0.002), whereas the AFR of the RCC group was lower than that of the normal control group (P < 0.001). RLR and AFR are related to tumour type and tumour-node-metastasis (TNM) stage (P < 0.05 for all). Cox regression analysis showed that the independent prognostic factors affecting overall survival and disease-free survival in the RCC group were symptom, tumour type, TNM stage, Fuhrman grade, RLR, and AFR (P < 0.05 for all). The nomogram constructed by multiple factors has better predictive power for patients after RCC. Conclusion Preoperative RLR and AFR can serve as potential biomarkers to predict the prognosis of postoperative RCC patients and improve the predictability of patient recurrence and survival.

Primary primitive neuroectodermal tumor of the kidney: A rare case report and review of literature

Primitive neuroectodermal tumors (PNET) is an aggressive, rapidly progressing and metastatic tumor. It rarely arises from the kidney and has an incidence of less than 1%. These are usually mistaken for a wide variety of other small round cell tumors. Young adults and children are commonly affected and have an aggressive course. These tumors are mistaken for a wide variety of other small round cell tumors. Here is a case of a 52-year-old female, who presented with flank pain and gross hematuria. The contrast-enhanced computerized tomogram (CECT) revealed a renal mass with a tumor thrombus extending to the renal vein, inferior vena cava, and the right side of the heart. The patient underwent radical nephrectomy along with IVC thrombectomy and chemotherapy. The sections from formalin-fixed surgical specimens were paraffin-embedded and stained with H &amp; E stain. Immunohistochemistry (IHC) was performed.Histology revealed small round to oval cells with hyperchromatic nucleus and very scanty cytoplasm. Frequent mitotic figures were noted. Few rosettes were seen at places. Tumor was seen invading the perirenal adipose tissue. The tumor thrombus extended into the right atrium and the right ventricle. IHC evaluation revealed the tumor cells showed a strong positivity for CD99, synaptophysin, neuron-specific enolase, vimentin, and were negative for CD45, pan-cytokeratin, and desmin. Thus, the histological examination and IHC helped in getting a definite diagnosis of PNET involving the kidney. The patient has been undergoing chemotherapy. PNET has an aggressive clinical course with a poor prognosis. Renal PNET bears many similarities to other small round cell tumors; hence it is important to review the histologic features and immunostaining for definitive diagnosis. Due to the rarity of the disease, there is no standard guideline regarding its management. Achieving accurate diagnosis facilitates the prolongation of survival with definitive treatment.

Transabdominal approach for renal cell carcinoma with supradiaphragmatic tumor thrombus: description of a modified technique and indications for treatment.

ObjectiveWe investigated the safety and effectiveness of a modified transabdominal approach for renal cell carcinoma (RCC) with a supradiaphragmatic inferior vena cava (IVC) tumor thrombus (TT).MethodsEight patients underwent radical nephrectomy with removal of a supradiaphragmatic IVC-TT through an abdominal incision using a transdiaphragmatic approach in Peking University Third Hospital from April 2015 to January 2018. We modified this technique using a Foley catheter balloon to avoid piggyback liver mobilization.ResultsAll patients underwent successful operations. The median operative time was 7 hours 23 minutes. The median estimated blood loss was 2963 mL. All patients received a blood transfusion with a median blood infusion volume of 2162 mL. Two patients with Budd–Chiari syndrome developed postoperative ascites and hydrothorax due to non-watertight repair of the diaphragm. During a follow-up of 11 to 44 months, only one patient died of liver metastasis and four patients developed distant metastasis without recurrence in the IVC.ConclusionsThe modified transabdominal approach described herein has an encouraging safety profile and provides a surgical option for treatment of RCC with a supradiaphragmatic IVC-TT. More evidence concerning the beneficial role of this procedure will be elucidated in further studies.

A Contemporary Analysis of the 30-day Morbidity and Mortality Associated With Cytoreductive Nephrectomy

ObjectiveTo examine the rates of adverse surgical outcomes in patients undergoing cytoreductive nephrectomy (CN) compared to patients undergoing radical nephrectomy in the nonmetastatic setting using a large administrative database. MethodsPatients in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) who underwent a radical nephrectomy between 2011 and 2016 were included. Patients were stratified by the preoperative variable of presence or absence of metastatic cancer. Perioperative outcomes were compared. A multivariable logistic regression analysis was performed to test the association between patients with metastatic cancer and perioperative morbidity and 30-day mortality. ResultsThere were 15,869 total patients included in this analysis of whom 1322 (8%) patients had metastatic cancer. Of the entire cohort, the majority of patients were over 60 years old (58%) and 9621 (61%) were male. Seventy-three of the patients were Caucasian. Patients with metastatic cancer had more minor (P< .01) and major (P< .01) complications, a higher rate of reoperation (P< .01), and a higher rate of unplanned readmissions (P< .01). Finally, the cohort with metastatic cancer had a higher rate of postoperative 30-day mortality (P< .01) than patients without metastatic cancer. ConclusionPatients undergoing a CN have significantly worse perioperative outcomes than patients undergoing a radical nephrectomy without evidence of metastases. Careful surgical risk stratification and appropriate patient counseling should be undertaken when selecting candidates for CN.

Primary ewing sarcoma/primitive neuroectodermal tumor of the kidney

Abstract Background Primary renal Ewing/PNET (primitive neuroectodermal tumor) is a rare yet highly aggressive tumor affecting mainly the young population. The first case described of primary renal Ewing/PNET was in 1975 by Seemayer et al. Ever since then, this entity has been a dilemma for pathologists to diagnose. Both clinical presentation and radiological imaging are nonspecific; patients are generally presenting with nonspecific symptoms such as abdominal mass/pain or hematuria and with radiology that shows a heterogeneous renal mass. Also, under the microscope, the pathologist is faced with a sea of tumor cells having small round blue cell morphology. Case presentation A 16 years old male, presented to the emergency department of King Fahd University Hospital with gross painless hematuria and right flank pain for the last two months. Contrast-enhanced computerized tomography scan (CT-scan) showed a large heterogeneous right kidney mass with a large central cystic component. Also, a left subpleural lung nodule and para-aortic lymphadenopathy were identified. The patient underwent radical nephrectomy. Under the microscopic, a hypercellular lesion consisting of solid sheets of small blue round cells was identified. The immunohistochemical profile of the neoplastic cells showed positive reactivity for CD99 (diffuse membranous staining), S100, and Vimentin. Fluorescent in situ hybridization (FISH) analysis of EWSR1 break-apart showed evidence of a 22q12 rearrangement. So, the final diagnosis of primary kidney Ewing sarcoma was established based on clinical, pathological, and molecular results. He received five cycles of adjuvant chemotherapy. The patient has been in regular follow-up CT scans, which has been showing no new lesions, the last of which was done January 2020. Conclusion We report this case of renal Ewing/PNET to enrich the pool of reported cases in the literature of this rare entity. These tumors, in general, have unfavorable prognosis. Early accurate diagnosis and appropriate management, can have a significant impact on the patient prognosis. Fortunately, like in the presented case, the patient had complete remission, which is rare for this tumor. Thus, we emphasize that pathologists and clinicians should have a low threshold of suspicion for diagnosing this entity, especially in this age group.

Retrospective analysis of outcomes in patients with clear cell sarcoma of the kidney: A tertiary single-institution experience

BackgroundClear cell sarcoma of the kidney (CCSK) is a rare and aggressive tumor. This study aims to describe the clinical characteristics and outcomes of CCSK patients in one of the largest pediatric medical centers in China. MethodsWe included all patients diagnosed with CCSK between January 2008 and March 2019 at the Children’s Hospital of Chongqing Medical University, China. The patients’ demographics, clinical presentation, and management were reviewed. Follow-up was continued until December 2019. ResultsIn total, 41 CCSK patients (66% male) with a median age of 24 months (range 3-108 months) were identified. The stage distributions of stages I, II, III and IV were 42%, 34%, 24% and 0%, respectively. Preoperative chemotherapy was administered to 7/41 patients. All patients underwent radical nephrectomy and postoperative chemotherapy. The median number of lymph nodes sampled was 4 (range 1–12). Radiotherapy was applied in 8/41 patients. The 5-year event-free survival (EFS) and overall survival (OS) were 63.9% and 78.8%, respectively. Of the 41 patients, 11 patients experienced relapse at a median time of 19 months (range 5-72 months). The most common site of recurrence was the tumor bed (9/11). Young age was a significant adverse prognostic factor for EFS. ConclusionsThe overall outcome of CCSK patients in our hospital is poorer than that in developed regions. More research is needed to clarify the underlying causes of poorer outcomes in young patients and improve outcomes. Type of studyRetrospective study. Level of evidenceLEVEL IV.

Renal Hemangioblastoma with Mixed Mullerian tumour of endometrium: A tale of two rare primary tumours

IntroductionRenal hemangioblastoma (RH) is a very rare benign tumour. Hemangioblastoma most commonly occurs in the central nervous system (CNS), and only few cases of RH have been reported as they occur most commonly as asymptomatic masses found incidentally. Mixed Mullerian tumour (MMT) of the uterus is a rarer and aggressive form of uterine malignancy. The detection of two primary rare tumours incidentally is a rare entity.Case presentationA 50-year-old female presented with abnormal uterine bleeding which on endometrial sampling was diagnosed as a rare variety of endometrial cancer, i.e. MMT or uterine carcinosarcoma. On preoperative imaging, a renal mass was also detected which was highly vascular and was mimicking renal cell carcinoma (RCC). Fine needle aspiration cytology (FNAC) was done from the renal mass to differentiate between RCC and metastasis, but it showed only blood cells. Patient underwent staging laparotomy for endometrial cancer and frozen section examination of the renal mass which was inconclusive with few atypical cells, and thus, patient underwent radical nephrectomy too. Histopathological examination revealed it to be a RH which is a very rare benign tumour.DiscussionRH is a rare benign tumour which does not require any treatment in majority of the patients. Only 26 cases of RH outside the CNS have been reported till date. MMT is a rare aggressive uterine tumour with an incidence of 1–2 % of all uterine neoplasms, which metastasizes early, and thus, early identification and treatment is the key. RH needs to be differentiated from RCC to avoid over treatment. Morphological findings are similar in RCC and RH; preoperative FNAC, PET scan, and intraoperative frozen section can be utilized to differentiate the two, in well-circumcised tumours and high index of suspicion. Occurrence of renal mass as an incidental finding in the preoperative work up of uterine malignancy directed us to the differentials of metastasis or another histologically distinct primary tumour. The presence of two rare primary tumours, i.e. RH and MMT in the same patient which are unrelated, is a rare entity.

Re: Prediction of Significant Estimated Glomerular Filtration Rate Decline after Renal Unit Removal to Aid in the Clinical Choice between Radical and Partial Nephrectomy in Patients with a Renal Mass and Normal Renal Function.

No AccessJournal of UrologyUrological Survey1 Jul 2020Re: Prediction of Significant Estimated Glomerular Filtration Rate Decline after Renal Unit Removal to Aid in the Clinical Choice between Radical and Partial Nephrectomy in Patients with a Renal Mass and Normal Renal Function M. Pilar LagunaMD, PhD M. Pilar LagunaM. Pilar Laguna More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001054AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Prediction of Significant Estimated Glomerular Filtration Rate Decline after Renal Unit Removal to Aid in the Clinical Choice between Radical and Partial Nephrectomy in Patients with a Renal Mass and Normal Renal Function." The Journal of Urology, 204(1), p. 181 Suggested Reading : Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol 2000; 163: 442. Link, Google Scholar : Does partial nephrectomy result in a durable overall survival benefit in the Medicare population?J Urol 2012; 188: 2089. Link, Google Scholar : Renal mass and localized renal cancer: AUA guideline. J Urol 2017; 198: 520. Link, Google Scholar : Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis. J Urol 2012; 188: 51. Link, Google Scholar : Chronic kidney disease due to surgical removal of nephrons: relative rates of progression and survival. J Urol 2014; 192: 1057. Link, Google Scholar : Prediction of post-operative eGFR in patients undergoing radical nephrectomy: harder than it looks (on scans) (abstract PD23-06). J Urol, suppl., 2019; 201: e395. Google Scholar : Prognostic nomogram for renal insufficiency after radical or partial nephrectomy. J Urol 2006; 176: 472. Link, Google Scholar © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 204Issue 1July 2020Page: 181-181 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information M. Pilar Laguna More articles by this author Expand All Advertisement PDF downloadLoading ...

Microbiome within Primary Tumor Tissue from Renal Cell Carcinoma May Be Associated with PD-L1 Expression of the Venous Tumor Thrombus.

Objective To perform a proof of concept microbiome evaluation and PD-L1 expression profiling in clear-cell renal cell carcinoma (cc-RCC) with associated tumor thrombus (TT). Methods After IRB approval, six patients underwent radical nephrectomy (RN) with venous tumor thrombectomy (VTT). We collected fresh tissue specimens from normal adjacent, tumor, and thrombus tissues. We utilized RNA sequencing to obtain PD-L1 expression profiles and perform microbiome analysis. Statistical assessment was performed using Student's t-test, chi-square, and spearman rank correlations using SPSS v25. Results We noted the tumor thrombus to be mostly devoid of diverse microbiota. A large proportion of Staphylococcus epidermidus was detected and unknown if this is a surgical or postsurgical contaminant; however, it was noted more in the thrombus than other tissues. Microbiome diversity profiles were most abundant in the primary tumor compared to the thrombus or normal adjacent tissue. Differential expression of PD-L1 was examined in the tumor thrombus to the normal background tissue and noted three of the six subjects had a threshold above 2-fold. These three similar subjects had foreign microbiota that are typical residents of the oral microbiome. Conclusion Renal tumors have more diverse microbiomes than normal adjacent tissue. Identification of resident oral microbiome profiles in clear-cell renal cancer with tumor thrombus provides a potential biomarker for thrombus response to PD-L1 inhibition.

Renal cell carcinoma with IVC tumour thrombus: A study of clinico-pathological outcomes

To evaluate the experience of RCC with IVC thrombus in terms of impact of clinical and pathological factors, level of thrombus and complications on outcome of the disease . Seventeen patients underwent radical nephrectomy and IVC tumour thrombectomy during 2012 to 2015 at our tertiary health care centre, clinico -pathological data from these patients were retrospectively analysed. Of the 17 patients (male: female: 3:1), the mean age was 57 years. The tumour thrombus extension was level I in 58%, level II in 29%, level III in 11%. In our series, the mean blood loss in levels I – III tumour thrombus were1863 mL, 3380 mL, 3250 ml respectively.Clavien dindo complications were -grade I in 1 case, grade II in 7 cases, grade III in 2 cases, grade IV in 3 cases. Pathological examination demonstrated that 13 out of 17 patients had clear cell carcinoma, five patients had higher grade(3, 4)and three had perinephric and IVC wall invasion. There was no perioperative hospital mortality. Two patients were lost to followup, one patient died due to extensive metastatic disease after 4 year, all other are under regular followup. Radical nephrectomy with IVC thrombectomy remains a challenging procedure. Multiple histopathological variables especially tumour stage and grade have a strong impact on the morbidity and mortality and also help in stratifying the subgroup in which adjuvant therapy is essential. With detailed perioperative planning and multidisciplinary efforts, surgical resection is the definitive treatment of choice for patients of RCC with IVC tumour thrombus.

Renal protective effects of dexmedetomidine in patients undergoing radical nephrectomy

Background Acute kidney injury (AKI) after radical nephrectomy is a serious complication that increases morbidity and mortality rates. Early detection and prevention of this complication are very important. A novel biomarker named neutrophil gelatinase-associated lipocalin (NGAL) can play an important role in early diagnosis of AKI. Recent studies have been published on the favorable effects of dexmedetomidine on renal functions. Objective The aim was to evaluate the possible renal protective effects of dexmedetomidine regarding urine output, creatinine clearance, serum cystatine C, NGAL in patients undergoing radical nephrectomy. Patients and methods A randomized double-blind, placebo-controlled study was conducted on 30 adult patients scheduled for radical nephrectomy. The patients were randomly allocated into two equal groups. Dexmedetomidine group (D group) received dexmedetomidine 0.8 µg/kg intravenously over 10 min as a loading dose, and then it was infused at a rate of 0.4 µg/kg/h. Placebo group (P group) received normal saline instead of dexmedetomidine in the same volume (ml) and rate (ml/h). In both groups, fentanyl (0.5 µg/kg) boluses were given if blood pressure or heart rate (HR) showed 20% increase from the baseline reading to control the hemodynamics. Vital signs [HR and mean arterial blood pressure (MABP)] were recorded before induction, after induction, after intubation, intraoperatively every 10 min till the end of surgery, and postoperatively every 2 h during the first 24 h. Urine output was assessed intraoperatively every 1 h and postoperatively every 4 h in the first 48 h. Serum creatinine, urinary creatinine, and creatinine clearance were assessed 24 h before surgery, 24 h after urinary catheter insertion after induction of anesthesia, and 24–48 h postoperatively. Cystatine C and NGAL were assessed after induction of anesthesia and after 24 h and 48 h postoperatively. Sedation was assessed during the first 5, 15, 30, and 60 min in the recovery room by the investigator using a five-point sedation scale. Postoperative pain was assessed using the visual analog scale, based on 0–10 points, every hour in the first 4 h postoperatively and then every 4 h in the first postoperative day. Results There was a significant decrease in HR and MABP in the dexmedetomidine group compared with placebo group. Urine output showed significant difference between the two groups in all studied periods except for the first hour. Urine output was higher in dexmedetomidine group, and seven patients in the placebo group needed lasix. Serum creatinine values, creatinine clearance, and cystatine C showed no statistically significant difference between the two groups in the three studied periods. NGAL values were similar after induction but were significantly different between the two groups after 24 and 48 h, with values higher in the placebo group. Sedation was different between the two groups in all studied periods except after 5 min. Patients in dexmedetomidine group were more sedated compared with the placebo group. Dexmedetomidine had postoperative analgesic effect represented by low visual analog scale score. Conclusion Dexmedetomidine proved to be effective in the prophylaxis of postoperative AKI after radical nephrectomy in terms of NGAL values but did not affect renal functions in terms of serum creatinine, creatinine clearance, and cystatine C. Dexmedetomidine in the used dose did not have adverse effects on MABP and HR. In addition to renal protection, dexmedetomidine proved to have sedative and analgesic properties.

Effect of Nursing Teaching Guideline on Patient Anxiety before Radical Nephrectomy at Assiut University Hospital

Background: Radical nephrectomy is the standard treatment of choice for localized renal cell carcinoma. Ensuring that patients’ informational needs have been met before radical nephrectomy set the stage for successful management and improves recovery. Aims: Evaluate the effect of nursing teaching guideline on the level of anxiety before radical nephrectomy. Research design: True experimental research design (Pre-test and post-test). Setting: Assiut Urology and Nephrology Hospital. Patients: Sixty adult patients undergoing radical nephrectomy were distributed into two equal groups (study and control groups) 30 patients for each. Tools: (I) Patient assessment sheet, (II) State-Trait Anxiety Inventory for Adult, and (III) The designed nursing teaching guideline for patients undergoing radical nephrectomy. Results: Statistically significant differences were found between study and control groups regarding preoperative anxiety levels (P < 0.01). Conclusion: The levels of preoperative anxiety significantly reduce associated with preoperative nursing teaching guideline provision.

Selecting the Best Elements from Previous Kidney Tumor Scoring Systems to Restructure Efficient Predictive Models for Surgery Type

Objective: The aim of this work was to select the best elements from previous scoring systems to restructure efficient predictive models for surgery type. Methods: Sixteen elements were selected from 7 systems (RENAL, PADUA, DAP, ZS, NephRO, ABC, and CI). They were divided into 6 categories (tumor max. size, exophytic/endophytic, correlation with collecting system or sinus, tumor location, contact situation with the parenchyma, invasion depth). Three elements, selected from 3 different categories, were integrated to establish a total of 320 new models. According to AUC rank, optimized models were developed, and these models were divided into 3 sections. An analysis of the distribution of the 6 categories was made to explore the predictive capacities of the models. Results: A total of 166 consecutive patients were included. Seventy-five patients underwent radical nephrectomy operations. The AUC of the 7 systems ranged from 0.81 to 0.844. Three optimized models (AUC 0.88) were developed to predict surgery type. These optimized models were composed of DAP (D), PADUA, (sinus), and ABC; DAP (D), RENAL (N), and ABC; NePhRO (O), PADUA (UCS), and ABC. Two categories (“exophytic/endophytic,” p < 0.001; “correlation with collecting system or sinus,” p = 0.001) were nonuniformly distributed. Conclusions: Seven systems held good predictive power for surgery type. Three optimized models were developed. “Correlation with collecting system or sinus” is a critical factor for predicting surgery type.

Renal fossa recurrence after radical nephrectomy: Current management, and oncological outcomes

Introduction and objectivesKidney cancers represent 2% of cancers worldwide; the most common type is renal clear cell carcinoma (RCC). Surgical treatment remains the only effective therapy for localized renal cell carcinoma. Approximately 20% to 38% of patients undergoing radical nephrectomy (RN) for localized RCC will have subsequent disease progression, with 0.8% to 3.6% of local recurrences within the ipsilateral retroperitoneum (RFR). The main objective of this study is to evaluate prognostic features, oncological outcomes, and current management for renal fossa recurrence in patients with history of RN for RCC. Materials and methodsWe retrospectively analyzed 733 patients who underwent open or laparoscopic RN for unilateral T1-T4 N0 M0 RCC between 2010 and 2016 at the Urology Department of Hospital Italiano de Buenos Aires. ResultsDuring the mentioned period, of a total of 733 RNs (open/laparoscopic), 561 patients with RCC were included in the study. After a median follow-up time of 24 months (12–36) (interquartile range), 21 (3.74%) patients out of 561, developed renal fossa recurrence. Of these, 13 (2.31%) patients were diagnosed with isolated local renal fossa recurrence and different treatment approaches were adopted; 11 patients underwent open surgical resection, 1 patient laparoscopic surgical resection, and 1 case was treated with cryoablation.Regarding cancer-specific survival, estimated 4-year cancer-specific survival in patients without RFR, with isolated RFR (iRFR) and not isolated RFR (niRFR) was 82.7% (CI 95% 70.2–95.2), 69.2% (IC 44.2–94.2) and 0%, respectively (log rank test P < 0.0001 being niRFR group different to others. Non isolated RFR was a death risk factor with a HR of 11.4 (4.8–27.2) compared with iRFR or no recurrence. Overall, 51% (IC 26.6–71.2) of patients with any RFR died at 4 years follow-up. ConclusionAlthough RFR is a rare condition, in the absence of distant metastatic disease, aggressive surgical resection should be our aim. High pathological tumoral stage at original nephrectomy and high tumoral grade are independent risk factors for RFR. This group of patients needs closer follow-up to detect earlier recurrences and decide a treatment strategy.

Modified Makuuchi incision in the surgical treatment of renal tumors: Initial results.

To evaluate the modified Makuuchi incision in the surgical treatment of renal tumors. A total of 29 patients with renal tumors were operated using the modified Makuuchi incision. Patients' age ranged from 48 to 72 years. Twenty-three patients were male, and 6 patients were female. Renal tumors affected the right side in 22 patients and the left side in 7 patients. Twenty-six patients underwent radical nephrectomy, while 3 patients underwent partial nephrectomy. A perfect exposure was achieved with this incision in the surgical field. No serious complications such as bleeding or other organ injuries happened during the surgery. Blood transfusion during surgery was unnecessary. Additional use of analgesics due to wound pain during the postoperative period was not required. Incision-related complications, such as wound infection and wound dehiscence, did not occur in the early postoperative period. Patients had no complaints about the cosmetic appearance of their abdomen due to the incision. Incisional hernia was not observed in patients. This type of incision provided a perfect exposure of the field in the surgical treatment of renal tumors.

SC263 - Evaluation of renal volume and adipose tissue distribution as predictors of acute kidney injury in patients undergoing radical nephrectomy

SC263 - Evaluation of renal volume and adipose tissue distribution as predictors of acute kidney injury in patients undergoing radical nephrectomy

Surgical management for local retroperitoneal recurrence of 33 renal cell carcinoma patients underwent radical nephrectomy

Objective: To investigate the therapeutic effects of surgical management for local retroperitoneal recurrence of renal cell carcinoma after radical nephrectomy. Methods: Clinical and follow-up data of 33 cases of local recurrence after radical nephrectomy in Renji Hospital from January 2010 to April 2018 were retrospectively analyzed. Results: In these 33 patients, 25 was male and 8 was female; The median age was 54 years old. The pathological stage of radical nephrectomy included 14 cases of pT1-2N0M0 stage, 16 cases of pT3-4 N0M0 stage, and 3 cases of pN1 stage. Only 4 relapsing patients had symptoms, the others were all found to have recurrence by imaging examination during follow up period of postoperation.The median recurrence time for all patients was 30 months, and the median diameter of recurrent tumors was 4.5 cm.Twenty-nine patients underwent complete resection of local recurrent lesions, and 4 patients whose recurrent lesions could not be completely resected converted receive palliative surgery. The median intraoperative blood loss was 500 ml and the median hospital stay after surgery was 4 days. Clavien grade Ⅰ-Ⅱ complications occurred in 5 patients after surgery, and no serious complications of Clavien grade Ⅲ-Ⅴ complications occurred. Six patients received postoperative adjuvant target therapy and distant metastasis occurred in one patient.In the 27 patients without adjuvant target therapy, postoperative distant metastases occurred in 12 patients. The median survival time for all patients after local recurrence surgery was 31 months. The 1-year and 3-year survival rates were 86.8% and 36.9%, respectively. Conclusions: The rigorous imaging examination after radical nephrectomy can detect local recurrent lesions as early as possible in most relapsing patients and imaging examination can predict the integrity of surgical resection of local recurrence.Although intraoperative bleeding of resection of local recurrence is relatively high, the operation is safe and the postoperative complications are controllable. Postoperative adjuvant therapy may also provide better survival benefit for patients with local recurrence.

Surgical management of renal cell carcinoma with associated tumor thrombus extending into the inferior vena cava: A 10-year single-center experience.

Renal cell carcinoma (RCC) is a tumor that has a tendency of vascular invasion by extending to the inferior vena cava (IVC) after the renal vein. The total resection of the renal tumor and tumor thrombus is considered the optimal treatment. In our study, we aimed to present the results related to 34 consecutive cases of RCC with tumor thrombus. Of the 442 patients diagnosed with renal tumors between January 2008 and January 2018, 34 (7.6%) had tumor thrombus over the renal vein extending to the IVC. The data of the 34 patients with tumor thrombus were retrospectively reviewed and included in the study. All the 34 patients underwent radical nephrectomy with tumor thrombectomy. The presence of thrombus was evaluated using contrast-enhanced abdominal tomography, magnetic resonance imaging, or color Doppler ultrasonography. The level of thrombus was classified using the Mayo Clinic tumor thrombus classification. Surgery was performed transperitoneally through a modified Chevron incision and mostly in collaboration with other clinics. Complications were classified according to the Clavien system. Of the 34 patients, 22 were males and 12 were females. The mean follow-up period was 36±27.2 months in patients who had a mean age of 61±10.9 years. The mean tumor size was 10.5±3.3 cm. The number of patients according to the thrombus levels I, II, and III were 20, 9, and 5, respectively. The average blood loss was 744±285.4 mL. Radical surgery for all patients who had direct invasion to the vena cava wall and/or level II and III was performed by gastrointestinal and cardiothoracic surgeons. Cardiopulmonary bypass was not performed in any patient. Minor complications (Clavien grades 1-2) were seen in 8 (23.5%) patients, while 2 (5.8%) patients had major complications (Clavien grades 3-5). The mean follow-up period was 36 months (range, 6-72 months). The overall 5-year survival rate was 85.2%. We think that radical nephrectomy and caval thrombectomy is a safe and effective method in patients with RCC without tumor exceeding the diaphragmatic level. We believe that the surgical success rate can be increased using a multidisciplinary approach in selected cases.

Role of MRI in staging and surgical planning and its clinicopathological correlation in patients with renal cell carcinoma.

Background and Aims:Radiological evaluation of renal cell carcinoma (RCC) is used for non-invasive staging for better surgical planning. However, the correlation of radiological staging using magnetic resonance imaging (MRI) with histopathological findings has not been done so far. The aim of this study is to assess the role of MRI in pre-operative staging of RCC in patients undergoing radical nephrectomy and nephron sparing surgery (NSS) and correlate it with histopathological findings.Settings and Design:This prospective observational study was conducted from February 2015 to October 2016 at a tertiary care hospital in northern India.Methods:MR imaging was done on 3 Tesla MR scanner (Signa Hdxt General Electrics, Milwaukee, USA). Preoperative staging was based on 2010 TNM staging system. The preoperative parameters in MRI were tumor size, detection/breach of pseudocapsule, tumor extension into perirenal fat and detection of tumor venous thrombus. The staging on MRI was compared with surgical and pathological staging.Statistical Analysis Used:The agreement between these three staging methods was determined using the kappa statistics (0.0-0.2, poor; 0.2-0.4, fair; 0.4-0.6, moderate; 0.6-0.8, good; 0.8-1.0, excellent).Results:30 patients with suspected RCC underwent NSS (n = 10) and radical nephrectomy (n = 20). Mean tumor size was 9.66 ± 2.99 cm in the radical nephrectomy group and 4.06 ± 1.16 cm in the NSS group. There was perfect agreement between MRI, surgical and pathological staging for breach of pseudocapsule (κ =1.0, Percentage of Agreement = 100%, P < 0.05). In none of the patients, MRI missed extension beyond the Gerota's fascia or presence of venous thrombus.Conclusion:MRI staging of RCC is an accurate predictor of the surgical and pathological stage and has the potential to become a useful tool for preoperative identification of patients with RCC who can undergo NSS.

Influence of lymph node dissection in patients undergoing radical nephrectomy for non-metastatic renal cell carcinoma: a systematic review and meta-analysis.

Whether lymph node dissection (LND) should be performed concomitantly with radical nephrectomy (RN) for non-metastatic renal carcinoma has still been controversial recently. We conducted a meta-analysis assessing oncologic outcomes of radical nephrectomy with lymph node dissection (LND) and without lymph node dissection (non-LND) in non-metastatic renal cell carcinoma (NMRCC). A systematic review was performed until April 2018 using a comprehensive search in PubMed, EMBASE, and Cochrane Library databases to identify eligible comparative studies. A formal meta-analysis was performed for studies comparing radical nephrectomy with LND and radical nephrectomy with non-LND for cT1-T4NxM0 tumors. Furthermore, a subgroup analysis for locally advanced renal cell carcinoma (cT3-T4NxM0) was conducted. Thirteen studies on patients with LND and non- LND were identified and included in the analysis. LND group did not have a significantly better survival than non-LND group for cT1-T4NxM0 tumors (HR 0.93, 95% CI 0.78-1.11, p=0.45), However, in the subgroup of locally advanced renal cell carcinoma (cT3-T4NxM0), it showed a significantly better OS rate in patients who had undergone LND compared to those without LND (HR 0.73, 95% CI 0.60-0.90; p=0.003). LND offers better cancer control and better long-term survival in locally advanced renal cell carcinomas (cT3-T4NxM0). This conclusion should be confirmed by a prospective randomized clinical trial.