Radical Nephrectomy For Tumors Research Articles

Trends and predictors of changes in renal function after radical nephrectomy for renal tumours

BackgroundChronic kidney disease (CKD) is a common postoperative complication in patients who undergo radical nephrectomy for renal tumours. However, the factors influencing long-term renal function require further investigation.ObjectiveThis study was designed to investigate the trends in renal function changes and risk factors for renal function deterioration in renal tumour patients after radical nephrectomy.MethodsWe monitored changes in renal function before and after surgery for 3 years. The progression of renal function was determined by the progression and degradation of CKD stages. Univariate and multivariate logistic regression analyses were used to analyse the causes of renal function progression.ResultsWe analysed the data of 329 patients with renal tumours who underwent radical nephrectomies between January 2013 and December 2018. In this study, 43.7% of patients had postoperative acute kidney injury (AKI), and 48.3% had CKD at advanced stages. Further research revealed that patients’ renal function stabilized 3 months after surgery. Additionally, renal function changes during these 3 months have a substantial impact on the progression of long-term renal function changes in patients.ConclusionAKI may be an indicator of short-term postoperative changes in renal function. Renal function tests should be performed in patients with AKI after radical nephrectomy to monitor the progression of functional impairment, particularly within the first 3 months after radical nephrectomy.

Nurse-led renal cell carcinoma clinic: a single center review.

In 2015 our centre introduced a nurse-led renal cell cancer follow-up protocol and clinic for patients who have undergone partial or radical nephrectomy for organ-confined kidney tumours. The main aims of this clinic were to improve healthcare efficiency and standardize follow-up processes. The primary objective was to assess the effectiveness of a nurse-led renal cell cancer follow up clinic in regard to surveillance protocol compliance and the timely identification and appropriate management of recurrences. A secondary objective was to evaluate this locally developed follow up protocol against the current European Association of Urology (EAU) guidelines surveillance protocol. All patients who underwent a partial or radical nephrectomy between 2015 and 2021 at a single Western Australia institution for a primary renal malignancy were included. Data was collected from local clinical information systems and protocol adherence, recurrence characteristics and management were assessed. The current EAU guidelines were applied to the cohort to assess differences in risk-stratification and theoretical outcomes between the protocols. After a mean follow up period of 31.2 months (range 0-77 months), 75.5% (185/245) of patients had all follow up imaging and reviews within 1 month of the timeframe scheduled on the protocol. 17.1% (42/245) had a delay in their follow up of more than a month at some stage, 5.7% (14/245) did not attend for follow up but had documented attempts to facilitate their compliance, and 0.4% (1/245) were lost to follow up with no evidence of attempted contact. 15.5% (38/245) of patients had recurrence of malignancy detected during follow up and these were all discussed in a multi-disciplinary team (MDT) meeting. The recurrence rate was 2.5% (3/119) for low risk, 17.7% (14/79) for intermediate risk, and 44.7% (21/47) for high risk patients when they were re-stratified according to EAU risk categories. No recurrences were detected through ultrasound (USS) or chest x-ray (CXR) in this cohort and our protocol tended to place patients in higher risk-stratification groups as compared to current EAU guidelines. Nurse-led renal cell cancer follow up is a safe, reliable and effective clinical framework that has significant benefits in regard to resource utilization. USS and CXR are ineffective in detecting recurrence and Computerized tomography (CT) should be considered the imaging modality of choice for this purpose. The EAU surveillance protocol appears superior to our protocol, and we have therefore transitioned to the EAU guideline protocol going forward.

Erratum: Tubular and Glomerular Size by Cortex Depth as Predictors for Progressive Chronic Kidney Disease after Radical Nephrectomy for Tumor.

Erratum: Tubular and Glomerular Size by Cortex Depth as Predictors for Progressive Chronic Kidney Disease after Radical Nephrectomy for Tumor.

Diagnostic performance of multiparametric magnetic resonance imaging in the differentiation of clear cell renal cell cancer.

This study aimed to evaluate the diagnostic performance of multiparametric magnetic resonance imaging (mpMRI) in the differentiation of renal cell carcinoma (RCC) subtypes. This is a retrospective diagnostic performance study, in which the diagnostic performances of mpMRI features were evaluated to differentiate clear cell RCC (ccRCC) from non-clear cell RCC (non-ccRCC). Adult patients who were evaluated using a 3-Tesla dynamic contrast-enhanced mpMRI before undergoing partial or radical nephrectomy for possible malignant renal tumors were included in the study. Signal intensity change percentages (SICP) between contrast-enhanced phases and pre-administration period for both the tumor and normal renal cortex, and tumor-to-cortex enhancement index (TCEI); tumor apparent diffusion coefficient (ADC) values; tumor-to-cortex ADC ratio; and a scale which was developed according to the tumor signal intensities on the axial fat-suppressed T2-weighted Half-Fourier Acquisition Single-shot Turbo spin Echo (HASTE) images were used in ROC analysis to estimate the presence of ccRCC in the patients. The reference test positivity was the histopathologic examination of the surgical specimens. Ninety-eight tumors from 91 patients were included in the study, and 59 of them were ccRCC, 29 were pRCC, and 10 were chRCC. The mpMRI features that had the three highest sensitivity rates were excretory phase SICP, T2-weighted HASTE scale score, and corticomedullary phase TCEI (93.2%, 91.5%, and 86.4%, respectively). However, those with the three highest specificity rates were nephrographic phase TCEI, excretory phase TCEI, and tumor ADC value (94.9%, 94.9%, and 89.7%, respectively). Several parameters on mpMRI showed an acceptable performance to differentiate ccRCC from non-ccRCC.

Impact of comorbidities on acute kidney injury and renal function impairment after partial and radical tumor nephrectomy

Background To test for the impact of patient comorbidities and medical risk factors on kidney function after partial (PN) or radical nephrectomy (RN) in renal cell carcinoma (RCC) patients with normal preoperative renal function. Materials and Methods From January 2011 to December 2014, 195 consecutive RCC patients with a preoperative estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73 m2 underwent PN or RN. Stratification was performed according to postoperative acute kidney injury (AKI) vs. no AKI. Moreover, logistic regression models tested for risk factors predicting postoperative AKI and subsequent new-onset chronic kidney disease (eGFR < 60 or < 45 ml/min/1.73 m2). Results Of all eligible patients, 127 (65.1%) exhibited AKI. AKI patients underwent more frequently RN (44.9 vs. 13.2% PN) and harbored more often preoperative diabetes (17.3 vs. 5.9% no diabetes), hypertension (46.5 vs. 23.5% no hypertension) and larger median tumor size (4.5 vs. 2.5 cm, all p < 0.05) than non-AKI patients. Moreover, after median follow-up of 14 months, 18.9% of AKI patients exhibited an eGFR < 60 ml/min/1.73 m2 vs. 7.4% non-AKI patients (p = 0.01). In multivariable models, hypertension and RN were risk factors for postoperative AKI (both p < 0.01). Age > 60 years and RN as well as preoperative diabetes were risk factors for postoperative eGFR < 60 or < 45 ml/min/1.73 m2 (all p < 0.05), respectively. Conclusions Postoperative AKI is a non-negligible event especially after RN that can be further triggered by comorbidities such as diabetes and hypertension. Comorbidities should be considered in clinical decision-making for RCC surgery and patients need to be counseled about the increased risk of consecutive renal function impairment.

36 - Partial versus radical nephrectomy for T1 renal tumours in octogenarians: Analysis from the British Association of Urological Surgeons Nephrectomy Audit

36 - Partial versus radical nephrectomy for T1 renal tumours in octogenarians: Analysis from the British Association of Urological Surgeons Nephrectomy Audit

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 ...

PD11-07 NATURAL HISTORY OF RADIOLOGIC TROCAR SITE HERNIA FOLLOWING ROBOTIC NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD11)1 Apr 2020PD11-07 NATURAL HISTORY OF RADIOLOGIC TROCAR SITE HERNIA FOLLOWING ROBOTIC NEPHRECTOMY Alireza Ghoreifi*, Gilbert Whang, Khoa Tran, Tapas Tejura, Simin Hajian, Benjamin Liu, Jie Cai, Xiaomeng Lei, Mohammad Aslzare, Madeleine Burg, Steven Cen, Mihir Desai, Monish Aron, Inderbir Gill, Vinay Duddalwar, and Hooman Djaladat Alireza Ghoreifi*Alireza Ghoreifi* More articles by this author , Gilbert WhangGilbert Whang More articles by this author , Khoa TranKhoa Tran More articles by this author , Tapas TejuraTapas Tejura More articles by this author , Simin HajianSimin Hajian More articles by this author , Benjamin LiuBenjamin Liu More articles by this author , Jie CaiJie Cai More articles by this author , Xiaomeng LeiXiaomeng Lei More articles by this author , Mohammad AslzareMohammad Aslzare More articles by this author , Madeleine BurgMadeleine Burg More articles by this author , Steven CenSteven Cen More articles by this author , Mihir DesaiMihir Desai More articles by this author , Monish AronMonish Aron More articles by this author , Inderbir GillInderbir Gill More articles by this author , Vinay DuddalwarVinay Duddalwar More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000845.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is no available data on the natural history of radiologic trocar site hernia (TSH) especially in urologic surgeries. The aim of this study is to evaluate the incidence and natural history of radiologic TSH in patients who underwent robotic partial or radical nephrectomy. METHODS: We retrospectively reviewed the records of patients who underwent robotic partial or radical nephrectomy for kidney tumor at USC between January 2011 and April 2017. All pre and postoperative imagings were re-reviewed for detection of TSH per Tonouchi classification by three uro-radiologists with high Intra Class Correlation (ICC=0.94, 95% CI 0.86-0.97). Patients who developed hernia were followed up and classified into stable or progressive group (Figure 1). Progressive TSH was defines as either significant size change, upgrading per Tonouchi classification, or becoming symptomatic. RESULTS: A total of 247 patients (169 partial and 78 radical nephrectomy) were included in the study. Pathologic stage was T1 (74.5%), T2 (5.7%), T3 (19.4%), and T4 (0.4%). The incidence of radiologic TSH was 27.53%, graded as early-onset (35.3%), late-onset (51.5%) and bowel/fat-containing (13.2%). The locations were midline (58.8%: including ≥ 10 mm assistant port), anterolateral (36.8%), and posterior (4.4.%). The incidence of TSH was not different between partial and radical nephrectomy cases (26.6% and 29.5%, p=0.43). Median time to radiologic TSH was 1.7 years (IQR 0.84-2.52). During the follow up of 68 patients who developed hernia, 33 (48.5%) had progressive TSH. Median time to progression was 1.5 years (IQR 0.68-2.01). On multivariable analysis, adjuvant therapy was an independent predictor for radiologic hernia development (HR 3.23, 95% CI 1.44-7.27, p=0.005). Pathologic T stage ≥ 2 and history of open abdominal surgery were also significantly associated with hernia progression (HR 3.93, 95% CI 1.74-8.89, p=0.001 and HR 3.47, 95% CI 1.53-7.93, p=0.003, respectively). CONCLUSIONS: Radiologic TSH following robotic partial or radical nephrectomy is common. Progression rate is as high as 50% with median time to progression of 1.5 years. Adjuvant therapy is an independent predictor for TSH development, while higher stage and history of open abdominal surgery are associated with TSH progression Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e256-e256 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alireza Ghoreifi* More articles by this author Gilbert Whang More articles by this author Khoa Tran More articles by this author Tapas Tejura More articles by this author Simin Hajian More articles by this author Benjamin Liu More articles by this author Jie Cai More articles by this author Xiaomeng Lei More articles by this author Mohammad Aslzare More articles by this author Madeleine Burg More articles by this author Steven Cen More articles by this author Mihir Desai More articles by this author Monish Aron More articles by this author Inderbir Gill More articles by this author Vinay Duddalwar More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement PDF downloadLoading ...

Survival outcomes in patients with large (≥7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: Results of a multicenter cohort with long-term follow-up.

BackgroundDoes the dogma of nephron sparing surgery (NSS) still stand for large renal masses? Available studies dealing with that issue are considerably biased often mixing imperative with elective indications for NSS and also including less malignant variants or even benign renal tumors. Here, we analyzed the oncological long-term outcomes of patients undergoing elective NSS or radical tumor nephrectomy (RN) for non-endophytic, large (≥7cm) clear cell renal carcinoma (ccRCC).MethodsProspectively acquired, clinical databases from two academic high-volume centers were screened for patients from 1980 to 2010. The query was strictly limited to patients with elective indications. Surgical complications were retrospectively assessed and classified using the Clavien-Dindo-classification system (CDS). Overall survival (OS) and cancer specific survival (CSS) were analyzed using the Kaplan-Meier-method and the log-rank test.ResultsOut of in total 8664 patients in the databases, 123 patients were identified (elective NSS (n = 18) or elective RN (n = 105)) for ≥7cm ccRCC. The median follow-up over all was 102 months (range 3–367 months). Compared to the RN group, the NSS group had a significantly longer median OS (p = 0.014) and median CSS (p = 0.04).ConclusionsIn large renal masses, NSS can be performed safely with acceptable complication rates. In terms of long-term OS and CSS, NSS was at least not inferior to RN. Our findings suggest that NSS should also be performed in patients presenting with renal tumors ≥7cm whenever technically feasible. Limitations include its retrospective nature and the limited availability of data concerning long-term development of renal function in the two groups.

Partial versus radical nephrectomy for T1b-2N0M0 renal tumors: A propensity score matching study based on the SEER database

PurposeControversy continues on the tailored therapy for patients with larger renal cell carcinoma (RCC). We investigated whether partial nephrectomy (PN) can improve patient prognosis compared to radical nephrectomy (RN) and the indications for each approach in patients with T1b-2N0M0 RCC.Materials and methodsA total of 9907 patients were identified from the Surveillance, Epidemiology, and End Results database from 2004 to 2012. Propensity scores were used to balance the selection bias of undergoing PN. Overall (OS) and cancer-specific survival (CSS) of patients undergoing PN and RN were compared. Cases were subdivided to investigate the advantages of each procedure.ResultsOverall, 1418 (14.3%) patients underwent PN. Before matching, PN led to better OS and CSS than RN in both Kaplan-Meier analysis and Cox regression (each p<0.01). For 1412 matched cohorts, PN was no longer associated with significantly better OS (HR: 1.19, 95% CI: 0.98–1.44), but still with a better CSS (HR: 1.66, 95% CI: 1.18–2.27) compared with RN. Further subgroup analysis indicated that patients, who were male, single living, old than 65 years, with T1b stage or clear-cell histologic type, may obtained more oncologic benefit from PN compared to RN.ConclusionsWhen tumor localization and technical feasibility have been taken into account, similar long-term survival was achieved in overall among two nephrectomy modalities, but patients, who were male, old than 65 years, with T1b stage or clear-cell histologic type, got a better survival after receiving PN compared to RN.

Factors associated with acutely elevated serum creatinine following radical tumour nephrectomy: the Correlates of Kidney Dysfunction-Tumour Nephrectomy Database study.

BackgroundTo identify factors associated with acutely elevated serum creatinine (SCr) within 7 days of radical tumour nephrectomy.MethodsThe study population consisted of 130 consecutive patients managed for renal tumours. The primary outcome was acute kidney injury (AKI) (defined as SCr increase ≥50% above baseline), assessed using multivariable logistic regression analysis. The secondary outcome was SCr percentage increase, assessed using multivariable linear regression analysis.ResultsFollowing nephrectomy, the mean percentage increase in SCr in the first week was 55%±29%, and 77 (59%) patients experienced AKI. Independent predictors of AKI post-nephrectomy were male gender [adjusted odds ratio (OR): 2.67; 95% confidence interval (95% CI): 1.01, 6.93], urine albumin-creatinine ratio (OR: 0.66; 95% CI: 0.47, 0.91), preoperative estimated glomerular filtration rate (eGFR) (OR: 1.03; 95% CI: 1.00, 1.05), laparoscopic nephrectomy (OR: 3.02; 95% CI: 1.00, 9.12), and non-clear cell renal cell carcinoma (RCC) (OR: 2.93; 95% CI: 1.04, 8.29). Independent predictors of a SCr increase were male gender (β: 12.0; 95% CI: 2.69, 21.3), urine albumin-creatinine ratio (β: –3.36; 95% CI: –6.55, –0.16), preoperative eGFR (β: 0.38; 95% CI: 0.10, 0.66), laparoscopic nephrectomy (β: 12.7; 95% CI: 1.05, 24.3) and obesity (β: 9.94, 95% CI: 0.61, 19.3).ConclusionsMale gender, albuminuria, eGFR and laparoscopic nephrectomy independently associated with acutely elevated serum creatinine following radical tumour nephrectomy.

Matched Comparison Between Partial Nephrectomy and Radical Nephrectomy for T2 N0 M0 Tumors, a Study Based on the National Cancer Database

To compare overall survival (OS) and immediate postoperative outcomes between partial and radical nephrectomy (RN) for T2 N0 M0 tumors and identify significant factors for poor OS. Using the National Cancer Database, we identified patients with T2 N0 M0 renal cancer between 2004 and 2009 who were treated with partial or radical nephrectomy. The partial and RN groups were statistically matched by demographics and tumor characteristics. We used Cox multiple regression to identify significant factors for all-cause mortality and plotted survival curves for both groups. We compared immediate postoperative outcomes between groups by χ2 test and independent samples t-test. After statistical matching, there were 527 patients in each group, with high similarities in age, gender, race, comorbid status, tumor size, histology, and grade. RN was associated with a higher risk of all-cause mortality (hazard ratio: 5.289; p < 0.001) than partial nephrectomy (PN), after adjusting for all available covariates. PN had significantly better OS than RN, with log-rank, Breslow, and Tarone-Ware tests consistently showing p-values of <0.001. Old age, high comorbidity index, and high Fuhrman grade were associated with increased risks of all-cause mortality, while papillary and chromophobe tumors had decreased risks. PN was associated with more positive surgical margins (PSM) than RN (4.4% vs 2.5%, p < 0.001). T2 N0 M0 tumors treated with PN had better OS than those treated with RN, despite more PSM. Age, comorbidity index, histologic subtypes, and Fuhrman grade had significant impacts on OS.

Radical nephrectomy for large renal tumors: evaluate perioperative and oncological outcomes of stage T2a and T2b

Radical nephrectomy for large renal tumors: evaluate perioperative and oncological outcomes of stage T2a and T2b

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

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

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

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

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.

527 Incidence of cardiovascular events after tumour nephrectomy in young patients – a single center, matched pair analysis between donor nephrectomy and radical tumour nephrectomy comprising a long term follow-up

527 Incidence of cardiovascular events after tumour nephrectomy in young patients – a single center, matched pair analysis between donor nephrectomy and radical tumour nephrectomy comprising a long term follow-up

Preoperative evaluation of renal cell carcinoma by using 18F-FDG PET/CT.

PurposeThis study aimed to characterize the FDG uptake of renal cell carcinoma (RCC) by the pathological subtype and nuclear grade.Patients and MethodsWe retrospectively identified patients who underwent 18F-FDG PET and subsequent partial or radical nephrectomy for renal tumors. The relationships of the SUV of renal tumor with subtypes, nuclear grade, and clinicopathological variables were investigated.ResultsNinety-two tumors were analyzed, including 52 low-grade (G1 and G2) and 18 high-grade (G3 and G4) clear cell RCC; 7 chromophobe, 5 papillary, and 1 unclassified RCC; and 9 benign tumors (7 angiomyolipoma and 2 oncocytoma). The SUVs of high-grade clear cell RCC (mean ± SD, 6.8 ± 5.1) and papillary RCC (6.6 ± 3.7) were significantly higher than that of the controls (2.2 ± 0.3). The SUV of high-grade clear cell RCC was higher than that of low-grade tumors (median, 4.0 vs. 2.2; P < 0.001). The optimal SUV cutoff value of 3.0 helped to differentiate high-grade from low-grade clear cell RCC, with 89% sensitivity and 87% specificity. On multiple regression analysis, a high grade was the most significant predictor of SUV for clear cell RCC.ConclusionsFDG uptake higher than that observed in normal kidney tissues suggests a high-grade clear cell RCC or papillary RCC subtype. FDG-PET using SUV may have a role in prediction of pathological grade of renal tumor.

Partial vs radical nephrectomy for T1 renal tumours: an analysis from the British Association of Urological Surgeons Nephrectomy Audit.

To analyse and compare data from the British Association of Urological Surgeons Nephrectomy Audit for perioperative outcomes of partial (PN) and radical nephrectomy (RN) for T1 renal tumours. UK consultants were invited to submit data on all patients undergoing nephrectomy between 1 January and 31 December 2012 to a nationally established database using a standard pro forma. Analysis was made on patient demographics, operative technique, and perioperative data/outcome between PN and RN for T1 tumours. Overall, data from 6 042 nephrectomies were reported of which 1 768 were performed for T1 renal tumours. Of these, 1 082 (61.2%) were RNs and 686 (38.8%) were PNs. The mean age of patients undergoing PN was lower (PN 59 years vs RN 64 years; P < 0.001) and so was the WHO performance score (PN 0.4 vs RN 0.7; P < 0.001). PN for the treatment of T1a tumours (≤4 cm) accounted for 55.6% of procedures, of which 43.9% were performed using a minimally invasive technique. For T1b tumours (4-7 cm), 18.9% of patients underwent PN, in 33.3% of which a minimally invasive technique was adopted. The vast majority of RNs for T1 tumours were performed using a minimally invasive technique (90.3%). Of the laparoscopic PNs, 30.5% were robot-assisted. There was no significant difference in overall intraoperative complications between the RN and PN groups (4% vs 4.3%; P = 0.79). However, PN accounted for a higher overall postoperative complications rate (RN 11.3% vs PN 17.6%; P < 0.001). RN was associated with a markedly reduced risk of severe surgical complications (Clavien Dindo classification grade ≥3) compared with PN even after adjusting for technique (odds ratio 0.30; P = 0.002). Operation time between RN and PN was comparable (141 vs 145 min; P = 0.25). Blood loss was less in the RN group (mean for RN 165 vs PN 323 mL; P < 0.001); however, transfusion rates were similar (3.2% vs 2.6%; P = 0.47). RN was associated with a shorter length of stay (median 4 vs 5 days; P < 0.001). A direct comparison between robot-assisted and laparoscopic PN showed no significant differences in operation time, blood loss, warm ischaemia time, and intraoperative and postoperative complications. PN was the method of choice for treatment of T1a tumours whereas RN was preferred for T1b tumours. Minimally invasive techniques have been widely adopted for RN but not for PN. Despite the advances in surgical technique, a substantial risk of postoperative complications remains with PN.

Partial versus radical nephrectomy for renal tumours ≤7 cm: The debate continues.

Partial versus radical nephrectomy for renal tumours ≤7 cm: The debate continues.