Surgical Treatment Of Kidney Cancer Research Articles

Анализ функциональных результатов хирургического лечения рака почки

Анализ функциональных результатов хирургического лечения рака почки

Abstract B079: Neighborhood social vulnerability and disparities in time to kidney cancer surgical treatment in Arizona

Abstract Background: Hispanics and American Indians (AI) have a higher kidney cancer incidence and mortality in Arizona. This study assessed 1) whether racial and ethnic minority patients and patients from neighborhoods with high social vulnerability, measured using the social vulnerability Index (SVI), experience a longer time (in days) to surgical treatment for kidney cancer after clinical diagnosis, and 2) whether time to surgery, race and ethnicity, and neighborhood social vulnerability are associated with adverse pathology (upstaging to pT3), progression free survival (PFS), and overall survival (OS) in Arizona. Methods: Arizona Cancer Registry (2009-2018) data for kidney and renal pelvis cases were obtained. Logistic regression models were used to assess if SVI (<25, 25-49, 50-74, and ≥75 percentile) and race and ethnicity were associated with a longer time to surgical (>median time to surgery) and upstaging. Cox-regression hazard models were used to assess if time to surgery and SVI were associated with PFS and OS. Separate analyses were performed for each clinical stage (cT1a, cT1b, cT2, and cT3). Results: A total of 4,592 kidney and renal pelvis cases (16.6% Hispanics and 4.8% AI) were included. Hispanic and AI patients with T1 tumors had a longer time to surgery than NHW patients (median time of 56, 55, and 45 days respectively). In unadjusted models, Hispanic ethnicity was associated with a longer time to surgery for cT1a (OR 1.48, 95% CI:1.05-2.08) and cT1b (OR 1.87, 95% CI:1.14-3.07). Hispanic and AI patients were also more likely to live in neighborhoods with high SVI than NHW patients. Living in neighborhoods with high (≥75) versus low (<25) overall SVI increased odds of a longer time to surgical for cT1a (OR 1.54, 95% CI:1.02-2.31) and cT2 (OR 2.32, 95% CI:1.13-4.73) in adjusted models. In these adjusted models, Hispanic ethnicity was no longer significantly associated with time to surgery. Among cT1a patients, a longer time to surgery increased odds of upstaging to pT3 (OR 1.95, 95% CI: 0.99-3.84) and risk of mortality. A longer time to surgery was associated with PFS with HR 1.52 (95% CI: 1.17- 1.99) and OS with HR 1.63 (95% CI:1.26-2.11) even after adjusting for SVI. Living in neighborhoods with high concentrations of racial and ethnic minorities increased odds of upstaging (OR 2.88, 95% CI: 0.99-8.37) in cT1a and was associated with PFS in cT3 (HR 2.45, 95% CI: 1.01-4.77). Compared to patients living in neighborhoods with SVI<25, patients with cT1a and cT2 tumor living in neighborhoods with SVI≥75 had about a 60% increased risk of mortality (OS HR 1.57, 95% CI: 1.01-2.45 for cT1b and HR 1.66, 95%CI:1.07-2.57 for cT2). Conclusion: These findings demonstrate that high neighborhood social vulnerability is associated with increased time to surgery and risk of progression and mortality. Impact: Neighborhood-level social vulnerability partly accounts for kidney cancer disparities in Arizona. Interventions need to focus on neighborhoods with high social vulnerability to improve care coordination for kidney cancer. Citation Format: Celina I. Valencia, Patrick Wightman, Kristin Morrill, Chiu-Hsieh Hsu, Hina Arif-Tiwari, Eric Kauffman, Francine C. Gachupin, Juan Chipollini, Benjamin R. Lee, Ken Batai. Neighborhood social vulnerability and disparities in time to kidney cancer surgical treatment in Arizona [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B079.

Acute kidney injury and its predictors in surgery of malignant kidney tumors

Aim. To analyze our own results of the course of early postoperative period in patients who underwent surgical treatment of kidney tumors: partial nephrectomy (PN) and radical nephrectomy (RN) and to identify risk factors for the development of acute kidney injury (AKI).Materials and methods. The study included 399 patients, of which 276 patients (69.17 %) underwent PN, 123 (30.83 %) underwent RN. According to the clinical stage of the disease, patients in the PN and RN groups were distributed as follows: cT1a – 160 (91.95 %) and 14 (8.05 %), cT1b – 99 (61.11 %) and 63 (38.89 %) and cT2a – 17 (26.98 %) and 46 (73.02 %), respectively. Operations were performed with open (1.0 %), laparoscopic (39.35 %) and robot-assisted (59.65 %) accesses. AKI was evaluated by the changes in serum creatinine and glomerular filtration rate before surgery and 1–3 days after in accordance with KDIGO criteria.Results. The overall incidence of AKI after surgical treatment for kidney cancer at stages cT1a–cT2a was 27.57 %. The incidence of AKI after RN was 65.04 %, after PN – 11.23 %. At stages cT1a, cT1b, cT2a, after nephron-sparing surgery and radical treatment, this indicator was 9.37; 11.11; 29.41 % and 71.43; 63.49; 65.22 %, respectively. For warm ischemia time below 15 and 20 minutes, AKI incidence did not exceed 8.3 and 13.2 %, respectively. For warm ischemia time >30 min, a dramatic increase in AKI incidence was observed.Conclusion. To preserve kidney function, PN is the operation of choice in surgical treatment of kidney tumors at stages cT1–cT2a. After RN, AKI development was observed 6 times more often than after PN. The following statistically significant predictors of AKI after PN were identified: presence of initial chronic kidney disease in patients, tumor size, operative time above 190 minutes, type of kidney ischemia used, and warm ischemia time above 25 minutes.

Current Assessment of the Use of Angioembolization in Radical and Palliative Surgical Treatment of Kidney Cancer (Literature review)

The incidence of new cases of renal cell carcinoma (NCC) in recent years has been steadily increasing both in the world and in Ukraine, and is about 403,000 and 4,900 per year, respectively. This phenomenon is largely due to the growing popularity of imaging methods (ultrasound, CT, MRI) and increased life expectancy (NCC is associated with old age). The important role of the kidneys in homeostasis maintaining, biological features of NCC (long latent course, susceptibility to recurrence, the likelihood of synchronous/metachronous contralateral kidney damage, high probability of metastases at the time of primary diagnosis), high risk of complications of surgical interventions stimulate organ-preserving ablation techniques. Trans-arterial embolization (TAE) is one of them. Its use is justified by the hypervascular nature of NCC. Presumably, blocking the blood supply to the tumor can reduce intraoperative blood loss, tumor volume, severity of pain, and hematuria. To date, a number of publications of retrospective/pilot studies and meta-analyzes have emerged that highlight the role of TAE in the treatment of NCC. A non-systematic analysis of previous publications was conducted, which highlight the effects of trans-arterial embolization in neoadjuvant and palliative regimens in patients with NCC. Search for relevant publications was conducted by keywords in electronic databases and bibliographies of selected articles for analysis. The results of retrospective and prospective studies of TAE before kidney resection or radical nephrectomy (RNE) do not provide clear evidence in its favor. A number of studies have shown that neoadjuvant TAE allows to: reduce blood loss, reduce the duration of surgery, minimize injury to surrounding tissues, conduct a more complete eradication of the tumor, expand the indications for surgery, increase the rates of 5 and 10 years of cancer-specific survival after radical intervention. Other studies, on the other hand, have found no ability for TAE to improve cancer-specific and overall survival after RNE. Also, according to pilot data, TAE does not improve the results of surgical treatment of patients with NCC and inferior vena cava thrombosis. It was found that TAE before venacavatrombectomy is associated with greater: duration of surgery, perioperative mortality, frequency of postoperative complications. Percutaneous ablation in NCC T1 is comparable in results to radical surgical treatment, but is associated with a fairly high risk of bleeding (3.5–14%). It is shown that TAE (ethanol in combination with lipiodol or microspheres) before radiofrequency ablation (RA) to reduce the risk of bleeding and local recurrence in patients with an average tumor diameter of 3.6 cm (max – 9 cm). The rationality of the combined use of TAE and cryoablation has not been conclusively proven. In patients with inoperable tumors or with contraindications to surgery, TAE can effectively control symptoms, achieve cytoreduction, and increase life expectancy. The effectiveness of TAE in the control of symptoms in palliative mode reaches 68-75%. In pilot studies, it was found that the latest modifications of TAE with the addition of chemotherapeutics or radioactive substances in NCC can cause more pronounced cytoreduction according to CT with contrast. Randomized placebo-controlled, sufficiently sampled studies are mandatory to establish the indications and effects of TAE in patients with NCC.

Comparison of four transdiaphragmatic approaches to remove cavoatrial tumor thrombi: a pilot study.

IntroductionSurgical treatment of kidney cancer with a tumor thrombus spreading through the inferior vena cava (IVC) up to the right atrium remains a challenge.The aim of this article was to 1. assess the safety and feasibility of four transdiaphragmatic surgical approaches to the right atrium from the abdominal cavity; 2. to evaluate the feasibility of palpation and displacement of thrombi below the diaphragm.Material and methodsFour cadaveric specimens preserved with the Thiel method to assess each surgical access: 1) extrapericardial T-shaped diaphragmotomy, 2) extrapericardial T-shaped + circular diaphragmotomy, 3) transpericardial T-shaped diaphragmotomy with longitudinal pericardiotomy, 4) transpericardial T-shaped + circular diaphragmotomy with longitudinal and circular pericardiotomy.Different diameters and density of tumor thrombus simulators, placed at various levels from the cava-diaphragm junction, were used to evaluate the palpation and displacement of the thrombus. Two surgeons performed each assessment independently.ResultsApproaches 2, 3 and 4 were significantly better than approach 1, regarding the feasibility of palpation, according to both surgeons (surgeon 1 Chi-square 21.56, p = 0.001; surgeon 2 Chi-square 27.83, p <0.0001). Approach 1 also showed a significant higher number of impossible displacements recorded by both surgeons (surgeon 1 Chi-square 19.02, p = 0.004; surgeon 2 Chi-square 20.01, p = 0.003). Only surgeon 1 recorded a significant lower number of easy palpations at 4 cm from the cava-diaphragm junction (Chi-square 14.10, p = 0.007). There were no high-risk complications in any approach.ConclusionsThe transdiaphragmatic access to the right atrium from the abdominal cavity is feasible using three of the four surgical approaches. They are an adequate alternative to sternotomy.

Hemodynamics and functional state of the contralateral kidney in the early postoperative period after surgical treatment of kidney cancer

AIM: To study the hemodynamics and functional state of the renal tissue of the contralateral kidney in the early postoperative period after surgical treatment of kidney cancer.&#x0D; MATERIALS AND METHODS: The prospective study included 58 patients with renal cell carcinoma, 36 (62.1%) of whom underwent radical nephrectomy, and 22 (37.9%) underwent partial nephrectomy. Tumor sizes ranged from 1.0 to 12.0 cm. All patients before surgery and in the early postoperative period underwent ultrasound examination of the structure and size of the kidneys, Doppler ultrasonography of the renal vessels, biomicroscopy of the bulbar conjunctiva, measured peripheral blood pressure, determined the glomerular filtration rate (GFR) and performed a coagulogram. The control group included 16 healthy adults.&#x0D; RESULTS: In 83.3% of patients after radical nephrectomy and in 13.6% of patients after partial nephrectomy a tendency towards an increase in blood pressure compared with the initial values was noted by the 2-4th day after the operation. By the 5th day after surgery, the volume of the only kidney remaining after radical nephrectomy increased by an average of 4% (from 126.1 1.4 to 131.2 2.1 cm3, p 0.05), while after partial nephrectomy has not changed reliably. After surgery, a decrease in GFR was detected in 34 (58.6%; p 0.05) patients, including after radical nephrectomy (n = 28) up to 73.4 8.2 ml / min / 1.73 m2, after partial nephrectomy (n = 6) up to 98.2 3.4 ml / min / 1.73 m2. Doppler ultrasonography of the vessels of a single kidney in patients after radical nephrectomy showed a moderate increase in linear blood flow, an increase in the resistance index in the main trunk of the renal artery, and a decrease in the pulsation index in the segmental and arc arteries. In patients after partial nephrectomy in the contralateral kidney these changes were not observed. When performing biomicroscopy of the bulbar conjunctiva in 83.3% of patients after radical nephrectomy and in 13.6% of patients after partial nephrectomy, changes in the microvasculature were revealed: narrowing of arterioles, expansion of venules, slowing of venular and capillary blood flow. Before the operation and in the early postoperative period, the content of fibrinogen and soluble fibrin-monomer complex in the blood of patients with renal cell carcinoma was significantly higher than in the control group.&#x0D; CONCLUSIONS: In patients with renal cell carcinoma, changes in the contralateral kidney in the early postoperative period after radical nephrectomy are significantly more pronounced than after partial nephrectomy, and are accompanied by changes in systemic and local hemodynamics and kidney function. The results of the study confirm the feasibility of performing organ-preserving surgeries in patients with renal cell carcinoma.

Minimally invasive technologies for surgical treatment of kidney cancer

The OBJECTIVE was to analyze the developmental trends, possibilities and outcomes of applying minimally invasive technologies in surgical treatment for kidney cancer.METHODS AnD MATERIALS. The study included 368 surgeries for kidney tumors which were performed from 2012 to 2019. Partial nephrectomy (Pn) was performed in 228 (60.6 %) cases, radical nephrectomy (Rn) – in 148 (39.4 %) cases. Tumors of the stage cT1a detected in 148 (39.4 %), сТ1b – 145 (38.6 %), сT2a – 58 (15.4 %), сТ2b-cTxn1M1 – 25 (6.7 %) patients. Operations were performed using open (3.7 %), laparoscopic (50.3 %), robotic (46.0 %) approaches with assessment of surgical and oncological outcomes of treatment.RESULTS. The incidence rate of Pn in patients with kidney cancer at the stages cT1a, cT1b and cT2a was 89.9, 57.2 and 20.7 %. Rn was performed in all cases of tumor stage сТ2b-cTxn1M1. The frequency of Pn at the stages cT1a, cT1b and cT2a in 2019 exceeded 80 %. Minimally invasive technologies (MIT) for Pn was used in 98.3 %, for Rn – in 92.2 % of cases. The incidence rate of postoperative complications after Pn and Rn at stages сТ1а, сT1b, сТ2а was 14.3and 6.7, 16.9 and 3.2, 16.7 and 2.2 %, respectively. Complications after Rn at tumors of the stage cT2bcTxn1M1 occurred in 20.0 % of patients. Positive surgical margin (PSM) occurred after Pn for tumors of the stage cT1a in 0.7 % of cases; for cT1b – in 2.4 %; for cT2a and after Rn – was not determined.CONCLUSION. Our study demonstrates a steady tendency towards an increase in the number of MIT for kidney tumors, including when performing organ-preserving surgeries. Robot-assisted surgery allows to expand the indications to use a minimally MIT even in the most difficult clinical cases. The frequency of complications after RP compared with Rn is higher because the complexity of the operation increases, and these complications did not affect the outcome of treatment, taking into account the functional advantages provided for patients. The development and widespread introduction of minimally MIT into clinical practice is an evident and inevitable way to develop surgical treatment of kidney cancer.

Resection of a kidney tumor with superselective targeted balloon-occluded chemoembolization

Objective : to develop a method of laparoscopic resection of a kidney tumor with super selective balloon occlusion of the segmental renal artery and targeted chemoembolization. Another purpose is to estimate the degree of fixation of the chemotherapy drug in the kidney parenchyma. Materials and methods . The study included the results of experiments on 14 laboratory rabbits, who underwent an intra-arterial injection of the coloring substance of Ponceau S and there were determined its concentration in the renal parenchyma after fixation with a hemostatic suture for 8 days after the injection of the marker. Besides, there were included the results of 13 studies of the contrast substance of ultraravist and gadovist concentration in the renal tissue of patients after resection of the neoplasm with intra-arterial injection of the contrast substance into the parenchyma of the operated kidney. Results. The implemented study showed the presence of a high concentration of a substance injected into the renal artery and a hemostatic suture fixed to the wound edges in the kidney tissue for 6-8 days of the postoperative period. Conclusion . Laparoscopic resection of a malignant kidney tumor with a super-selective balloon occlusion of the segmental renal artery, supplemented by the injection of a targeted chemotherapy agent into the renal artery is a highly effective, safe and simple method of surgical treatment of kidney cancer with enhanced anti-relapse protection due to high concentrations of chemotherapy in the resection area.

Trends in the surgical management of renal cell carcinoma in a contemporary tertiary care setting.

Background:In the last three eras, the incidence of renal cell carcinoma (RCC) has increased, due to increased radiological studies. The expected 5-year survival rate has become better, associated with the identification of small size renal masses. However, this survival improvement may be secondary to improved surgical techniques and medical therapies for these malignancies.Objectives:The objective was to report the trends of clinical presentation, peri-operative, oncological outcomes, and surgical management trends for RCCs over the period.Methods:After Institutional Review Board approval, a retrospective study for adult patients was conducted, who presented with renal mass and were managed between 2008 and 2019. Variables, including demographics, perioperative and pathological outcomes analyzed using descriptive statistics for continuous variables reported as mean ± standard deviation and categorical variables values compared by Chi-square test. Survival Analysis calculated using the Kaplan-Meier method. The level of significance is set at P-value < 0.05.Results:A total of 588 patients underwent surgical treatment for kidney cancer from January 2008 to January 2019. 237 (40.30%) were females and 351 (59.69%) males. The clinical presentation was higher as an incidental diagnosis of 58.67%. 71.25% of patients were from outside Riyadh city. Pathology was mostly clear cell RCC 61.22% and grade 2 (57.48%). Tumor size, surgery time, and length of hospital stay showed a significant difference between the three periods (both P > 0.05). Robotic surgery performed more than open (P < 0.0001). There was no significant difference in the survival time, when compared to patients by the regions and when compared by the primary tumors (Log-Rank P = 0.4821). Patients from the Riyadh region (median = 54.0) had a significantly higher recurrence time (Log-Rank P < 0.0001).Conclusion:There was a rising trend in the incidence of RCC associated with comorbidities and incidental diagnosis. In our study period we found increase in the trend of minimal invasive approach. The size of the tumor, blood loss and operative time decreases over the period of time. The Robotic assisted nephrectomy approach has become increased over the period of time duration in present study.

Our Experience of Laparoscopic Partial Nephrectomy: Technique and Results

Laparoscopic partial nephrectomy (LPN) is considered an effective modern minimally invasive surgical intervention and is an alternative to open partial nephrectomy (OPN) in the surgical treatment of kidney cancer.The objective: to provide modern evidence of the effectiveness of LPN in the surgical treatment of patients and to describe the further evolution of this minimally invasive technique.Materials and methods. We prospectively analyzed the data of 63 patients who underwent LPN for clinically localized kidney cancer since September 2015 to October2019 in the urology clinic of theNationalMilitaryClinicalHospital «GVKG» of the Ukrainian Ministry of Defense. LPN was performed using anOlympus endoscopic stand. Clinical data were obtained through a prospective analysis of surgical interventions, including intra- and postoperative results and complications. Descriptive statistical analysis and a multivariate logistic regression model were used to predict surgical outcomes.Results. The average age of the patients was 60.7 years; the average preoperative tumor size was33.0 mm. According to the PADUA-scale, 22 (35.0 %) patients were categorized as low difficulty, 23 (36.5 %) to the intermediate difficulty category and 18 (28.5 %) to the high difficulty category. All patients had transperitoneal access. The average surgery time was 156 minutes. The average blood loss was 171 ml. Overall, significant postoperative complications occurred in 2 (3.2 %) patients (Clavien-Dindo &gt;2). We did not find any statistically significant differences between pre- and postoperative level of creatinine (p&lt;0.05). In general, optimal surgical results, including analysis of the surgical margin, degree of ischemia, and level of complications, were achieved in 44 (69.8 %) patients. During an average of 26 months of observation, only two local and two distant metastases were recorded. In the end, using the multivariate logistic regression model, it was revealed that the degree of complexity of the tumor was associated with a greater risk of obtaining a non-optimal surgical result.Conclusions. LPN is an effective minimally invasive alternative to OPN in the treatment of clinically localized renal cell carcinoma. We presented the current experience of the use of LPN in the surgical treatment of kidney cancer. LPN, as it turned out, is an effective and safe minimally invasive operation that provides optimal results in most patients with varying degrees of tumor complexity.

Evaluation of quality of life of patients after surgical treatment of kidney cancer

Background. Restoring the quality of life of patients to a level comparable to that of practically healthy people is the most important task of medicine in general. At this stage of development of science, the main goal in the treatment of malignant diseases remains the preservation of life. However, now in oncological practice, methods whose potential allows not only to preserve life as such, but also to ensure the high quality of this life in all its manifestations, are acquiring greater and greater significance.The objective of the study is to compare the quality of life of persons with localized kidney cancer in the early and late periods after surgical treatment by radical nephroectomy and laparoscopic resection of renal tissue.Materials and methods. A questionnaire survey using SF-36 (Short Form-36), designed for a comprehensive assessment of the quality of life associated with health.Results. The quality of life of patients with localized kidney cancer before treatment is reduced due to a number of physical and mental nature, limiting labor, domestic and social activity and causing a feeling of dissatisfaction with their lives in general. These problems are disorders of physical, social and emotional functioning, physical pain, deterioration of general and mental health, limitations of role functioning due to physical and emotional state. After surgical treatment with laparoscopic resection, complete satisfaction of patients with the quality of their life was achieved during the first 1–3 postoperative months; after radical nephroectomy – not earlier than 1–3 years.Conclusion. One of the advantages of laparoscopic resection over radical nephroectomy is a higher quality of life of patients in the early and late periods after the intervention.

National Norwegian Practice Patterns for Surgical Treatment of Kidney Cancer Tumors ≤7 cm: Adherence to Changes in Guidelines May Improve Overall Survival

BackgroundGuidelines on surgical treatment for kidney cancer (KC) have changed over the last 10 yr. We present population-based data for patients with KC tumors ≤7cm from 2008 to 2013 to investigate whether surgical practice in Norway has changed according to guidelines. ObjectiveTo assess the predictors of treatment and survival after KC surgery. Design, setting, and participantsWe identified all surgically treated KC patients with tumors ≤7cm without metastasis diagnosed during 2008–2013 (2420 patients) from the Cancer Registry of Norway. Outcome measurements and statistical analysisRelationships with outcomes were analyzed using joinpoint regression, multivariate logistic regression, Kaplan-Meier survival estimates, Cox regression, relative survival (RS), and competing-risk analyses. Results and limitationsThe mean follow-up was 5.2 yr. There was a 28% increase in the number of patients undergoing surgical treatment over the study period. Joinpoint regression revealed a significant annual increase in partial nephrectomy (PN) and a small reduction in radical nephrectomy (RN). PN increased from 43% to 66% for tumors ≤4cm and from 10% to 18% for tumors of 4.1–7cm. Minimally invasive (MI) RN increased from 53% to 72% and MI PN from 25% to 64%, of which 55% of procedures were performed with robotic assistance in 2013. The geographical distribution of treatment approaches differed significantly. Both PN and MI approaches were more frequent in high-volume hospitals. Cox regression analysis revealed that PN, age, and Fuhrman grade and stage were independent predictors of survival. There were no significant differences in cancer-specific survival (p=0.8). The 5-yr RS for T1a disease was higher after PN than after RN. ConclusionsThe rate of PN for tumors ≤7cm increased in the 6-yr study period. MI approaches increased for both RN and PN. This treatment shift coincides with the new guideline recommendations in 2010. The possible better survival for patients undergoing PN compared to RN indicates the importance of following evidence-based guidelines. Patient summaryThe use of partial nephrectomy and minimally invasive surgery for kidney cancer tumors increased in Norway from 2008 to 2013 according to population-based data, coinciding with guideline changes. The study illustrate that adherence to guidelines may improve patient outcomes.

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OBJECTIVES/SPECIFIC AIMS: More partial nephrectomies are performed every year as a surgical treatment for kidney cancer. However, this procedure remains technically challenging. Surgeons require a substantial number of cases before their performance plateaus. No established practice mode exists; thus, there is a need for training models to simulate real tumor excisions and kidney suturing. In this study, we seek to validate these silicone models using multiple simulations with urologists of different training levels. METHODS/STUDY POPULATION: We created silicone renal tumor models using 3D printed molds of a patient’s kidney with a mass. Medical students, urology residents, fellows, and attending surgeons are recruited to perform simulated partial nephrectomies on these models. Four trials are performed with a da Vinci surgical robot on 2 different days. We are evaluating surgeon performance and improvement using validated measures as well as operation-specific metrics. Operation-specific metrics include renal artery clamp time and surgical margins. Validated measures of self-assessed operative demand (NASA TLX) and reviewer-assessed surgical performance (GEARS) are also recorded across trials. RESULTS/ANTICIPATED RESULTS: The preliminary results of 2 medical students, 10 urology residents, 3 endourology fellows, and 2 attending urologists are reported here. Model face validity was evaluated on a 0–100 sliding scale anchored at unrealistic and realistic. Mean results thus far are 77.7 for overall feel, 82.7 for needle driving, 75.6 for cutting, and 73.2 for visual representation. Between trials 1 and 4 there was a mean reduction of 3.26 minutes in renal artery clamp time, and a 75% reduction in positive margins. There was a reduced incidence of positive surgical margins with advanced training stage. Fellows, residents, and medical students had positive tumor margins in 25%, 50%, and 75% of their trials, respectively. We expect to recruit 15 additional subjects for this study. Upon completion of data acquisition, more robust statistical comparisons and measures will be reported. DISCUSSION/SIGNIFICANCE OF IMPACT: Face validity measures indicate the model adequately represents reality. Preliminary data suggest improved surgical performance over the course of the training and better performance in urologists of higher training levels. This model may have potential for broader application and integration into minimally invasive surgery training programs.

Оценка влияния различных видов ишемии в хирургическом лечении рака единственной почки на прогрессию хронической болезни почек

Мета роботи: вперше провести оцінку впливу застосування різних видів ішемії в хірургічному лікуванні раку єдиної нирки на прогресію хронічної хвороби нирок.Матеріали і методи. Проведено ретроспективний аналіз результатів лікування 68 пацієнтів, яким було виконано резекцію з приводу нирково-клітинного раку (НКР) єдиної нирки. Всі хворі проходили стаціонарне лікування у відділенні пластичної та реконструктивної урологій Національного інституту раку, урологічному відділі Львівської обласної клінічної лікарні.Результати досліджень та їх обговорення. До проведення хірургічного лікування раку нирки (РН) на 2 стадії хронічної хвороби нирок (ХХН ) був один пацієнт першої групи, один пацієнт другої групи та 6 хворих третьої групи. Відповідно 3а стадію ХХН було діагностовано у 5 хворих першої групи, 4 хворих другої групи та 19 пацієнтів третьої групи. 3b стадію ХХН діагностовано у 4 хворих першої групи, 3 хворих другої групи та 12 хворих третьої групи. З четвертою стадією ХХН, до проведення хірургічного лікування, було 3 хворих першої групи, один хворий другої групи та 7 хворих третьої групи. 5 стадію ХХН спостерігали лише у 2 хворих третьої групи. Через три місяці після проведеного хірургічного лікування прогресування ХХН спостерігали у 3пацієнтів першої групи, що становило 23, 1 %. У 2хворих другої групи, що, відповідно, складало 22, 2 %. В третій групі дослідження через три місяці після проведеного хірургічного лікування прогресування ХХН спостерігали у 5 хворих, що становило 10, 9 % випадків.

Organ-preserving surgery for localized renal cell carcinoma: Current approaches.

e16077 Background: Introduction of modern organ-preservingapproaches in surgical treatment of kidney cancer is limited by the duration of warm ischemia used during the partial nephrectomy (PN), including surgery for elective indications. Some resection procedures require prolonged warm ischemia time resulting in acute kidney injury and development of renal failure in the postoperative period. The purpose of the study was to analyze the effectiveness of a new organ-preserving surgery method for kidney cancer. Methods: 46 patients with clinically localized renal cancer, R.E.N.A.L. score 6-10, underwent PN for elective indications. Patients were divided into two groups: the first group – 20 patients (8 patients – laparoscopic PN (LPN), 12 – open PN (OPN)) with bilateral perirenal procaine blockade (BPPB) before the resection. The second group included 26 patients (19- LPN, 7– OPN) receiving surgery without BPPB. BPPB was performed under US-control. 50 ml of 0.25% procaine solution was successively injected to the perinephric fat in upper, middle and lower kidney segments at both sides. Acute kidney injury (AKI) was diagnosed by serum creatinine level increase by 50% of the initial level and higher. Results: Patients in both groups were comparable by age – 58.35±7.5 (44–70) and 58.7±5.6 (50–65) years, and resection difficulty by R.E.N.A.L. score – 7.35±1.1 (6–10) and 7.15±1.2 (6–10), respectively. Median warm ischemia time did not differ significantly in both groups and was 20.0±2.99 (15–25) and 18.42±2.93 (15–25) min., respectively. Morphologically, all patients were diagnosed with renal cancer, surgical margins were negative. 9 (34.6%) patients of the second group developed AKI, while no AKI was registered in the first group. Urinary fistula and delayed bleeding were not observed. Conclusions: The results suppose renal protective effect of BPPB during partial nephrectomy for kidney cancer with warm ischemia time of 15-25-minutes.

Comorbidity Is a Competing Factor for Disease Recurrence Postnephrectomy.

There is a relation between tumor stage and grade with the risk of cancer recurrence in patients undergoing surgical treatment for kidney cancer. The association of patient comorbidity with disease recurrence is less well characterized. The objective of this study was to explore the association between comorbidity and the recurrence of kidney cancer. We performed a retrospective analysis of 263 patients who received a partial or radical nephrectomy from January 1, 2000 through April 30, 2013. Patient data included race, sex, body mass index, age-adjusted Charlson Comorbidity Index (aaCCI) score, tumor histology, tumor T classification, and Fuhrman grade. The primary outcome was cancer recurrence, either local or distant. Logistic regression was used to assess the association of these risk factors with the outcome. The median follow-up time was 19.6 months (interquartile range 5.2-53.7). There were 101 (38.4%) African American patients and 150 (57.0%) men. The median body mass index was 28.3 and the median aaCCI was 3.0. The Fuhrman grade was G1 in 9.5% of patients, G2 in 45.2%, G3 in 32.8%, and G4 in 12.5%. Nineteen (7.2%) patients experienced disease recurrence, including 13 (4.9%) patients with metastatic disease. The risk factors significantly associated with recurrence included Fuhrman grade (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.23-7.30), tumor T classification (OR 1.33, 95% CI 1.00-1.76), and CCI (OR 0.74, 95% CI 0.57-0.95). Physiologic factors, in addition to tumor characteristics, play a significant role in predicting cancer-specific survival in patients with kidney cancer. The reduced odds of recurrence with higher aaCCI may indicate that competing health factors have an impact before recurrence on survival in certain patients.

CLINICAL CASE OF SURGERY KIDNEY CANCER WITH TUMOR THROMBUS IN THE ATRIUM AND ISOLATED LIVER METASTASIS

Presents a clinical case of successful surgical treatment of kidney cancer with tumor thrombus of the inferior vena cava (IVC) to the level of the atrium, with simultaneous resection of segment I of the liver containing a single metastasis, in 57-year patient.

Surgical treatment of kidney cancer with extended inferior vena cava thrombosis: complications and long-term results

Objective. Analysis of factors affecting results of inferior vena cava (IVC) thrombectomy in patients with renal cell carcinoma. Materials and methods . Nephrectomy with thrombectomy from IVC was performed in 53 patients (31 (58.5 %) males and 22 (41.5 %) females) with extended thrombosis. Patient age was 35–76 years (mean age 58.7 ± 10.1 years). In 36 (68 %) patients stage Т3b was determined (mean thrombus length 5.28 ±0.32 cm), in 17 (32 %) patients – stage Т3с (mean thrombus length – 13.00 ±0.71 cm). Postoperative complications were evaluated in accordance with the Clavien–Dindo classification. Calculations were performed using statistics software SPSS Statistics 16. Results. No intraoperative complications were observed, mean blood loss was 714 (200–4000) ml. Use of the Cell Saver system allowed to perform reinfusion in the majority of patients. Blood transfusion of 200–500 ml was necessary in 15 patients. In 32 (60.3 %) patients no complications were observed. Grade I complications were observed in 2 (3.7 %) patients, grade II – in 15 (28.3 %) patients, IIIА grade – in 2 (3.7 %) patients, and grade IIIВ – in 1 (1.8 %) patient; there wasn’t any grade IV complications. Two (3.8 %) patients died of pulmonary artery thromboembolism. Correlation analysis has shown a high dependency of complications on thrombus size (r = 0.7) and blood loss volume (r = 0.6), and low dependency on tumor size (r = 0.44); complications weren’t affected by patients’ age (r = 0.1) or Karnofsky status (r = 0.0). Median overall survival was 48 months, 3-year survival was 57.1 %, median progression-free survival was 46 months, 3-year progression-free survival was 56.8 %; 90-day morbidity was absent. Three-year overall survival for рN0 was significantly higher than for рN1 (69 % vs. 25 %; р = 0.014). There was no difference in terms of survival between patients with supradiaphragmatic and subdiaphragmatic thrombi (р = 0.14). Conclusion . Results of our study show that surgical treatment of patients with renal cell carcinoma and extended IVC thrombosis is effective.

EO9 - When to perform a staging chest-CT scan before surgical treatment for kidney cancer

EO9 - When to perform a staging chest-CT scan before surgical treatment for kidney cancer

300 When to perform a staging chest-CT scan before surgical treatment for kidney cancer

300 When to perform a staging chest-CT scan before surgical treatment for kidney cancer