Partial Nephrectomy Versus Research Articles

Microwave Scissors-Based Sutureless Laparoscopic Partial Nephrectomy Versus Conventional Open Partial Nephrectomy in a Porcine Model: Usefulness and Complications

BackgroundThis study aimed to compare the benefits and safety of microwave scissors-based sutureless laparoscopic partial nephrectomy (MSLPN) with those of conventional open partial nephrectomy (cOPN).MethodsEach kidney in nine pigs underwent MSLPN using microwave scissors (MWS) via transperitoneal laparoscopy or cOPN via retroperitoneal open laparotomy. The kidney’s lower and upper poles were resected under temporary hilar-clamping. The renal calyces exposed during renal resections were sealed and transected using MWS in MSLPN and were sutured in cOPN. For MWS, the generator’s power output was 60 W. Data on procedure time (PT), ischemic time (IT), blood loss (BL), normal nephron loss (NNL), and extravasation during retrograde pyelogram were compared between the two techniques.ResultsThe authors successfully performed 22 MSLPNs and 10 cOPNs. Compared with cOPN, MSLPN was associated with significantly lower PT (median, 9.2 vs 13.0 min; p = 0.026), IT (median, 5.9 vs 9.0 min; p < 0.001), BL (median, 14.4 vs 38.3 mL; p = 0.043), and NNL (median, 7.6 vs 9.4 mm; p = 0.004). However, the extravasation rate was higher in the MSLPN group than in the cOPN group (54.5 % [n = 12] vs 30.0 % [n = 3]), albeit without a significant difference (p = 0.265). Pelvic stenosis occurred in one MSLPN procedure that involved deep lower pole resection near the kidney hilum.ConclusionsThe study data show that MSLPN can improve intraoperative outcomes while reducing technical demands for selected patients with non-hilar-localized renal tumors. However, renal calyces, if violated, should be additionally sutured to prevent urine leakage.

Comparison of Oncological and Functional Outcomes of Radical Versus Partial Nephrectomy for cT1b Renal Cell Carcinoma: A Two-Centre, Matched Analysis

BACKGROUND: It remains unclear which patients with cT1b renal cell carcinoma (RCC) benefit most from partial nephrectomy (PN) versus radical nephrectomy (RN) considering oncological outcomes and renal function. OBJECTIVE: To compare oncological and functional outcomes of RN with PN for cT1b RCC. METHODS: This is a retrospective analysis of patients who underwent RN or PN for cT1b between 2010 and 2022 (n = 241). Patients were grouped by RN or PN and matched by age, sex, Charlson Comorbidity Index, BMI, PADUA score, RENAL score, ASA score, and preoperative kidney function (eGFR) using propensity score matching. The 10-year overall survival (OS), 10-year cancer-specific survival (CSS), and 10-year recurrence-free survival (RFS) were compared. Change in eGFR from baseline to 5-year follow-up was assessed. RESULTS: After matching, 100 patients remained in each group for analysis. The 10-year OS, CSS, and RFS rates were similar between groups. For patients classified as low risk, the PN group displayed a higher recurrence rate compared to RN (7 vs. 0, p = 0.01). Patients who underwent RN had worse 1-year postoperative eGFR than PN (RN: 57 [44–65], PN: 73 [60–87], p &lt; 0.001). RN was more likely to induce new-onset chronic kidney disease (CKD) stage ≥3b compared to PN (p &lt; 0.001). Complication rate after PN was significantly higher (p = 0.003). CONCLUSION: 10-year survival rates were similar, despite more recurrences in the PN group. Our data shows that post-surgical renal function is superior for PN. Nevertheless, RN is a reliable treatment option when preservation of renal function is not a priority.

ASO Author Reflections: Thermal Ablation Versus Partial Nephrectomy for cT1 Renal Mass in a Solitary Kidney: A Matched Cohort Comparative Analysis.

ASO Author Reflections: Thermal Ablation Versus Partial Nephrectomy for cT1 Renal Mass in a Solitary Kidney: A Matched Cohort Comparative Analysis.

Thermal Ablation Versus Partial Nephrectomy for cT1 Renal Mass in a Solitary Kidney: A Matched Cohort Comparative Analysis.

Nephron-sparing approaches are preferred for renal mass in a solitary kidney (RMSK), with partial nephrectomy (PN) generally prioritized. Thermal ablation (TA) also is an option for small renal masses in this setting; however, comparative functional/survival outcomes are not well-defined. A retrospective study of 504 patients (1975-2022) with cT1 RMSK managed with PN (n = 409)/TA (n = 95) with necessary data for analysis was performed. Propensity score was used for matching patients, including age, preoperative glomerular filtration rate (GFR), tumor diameter, R.E.N.A.L. ((R)adius (tumor size as maximal diameter), (E)xophytic/endophytic properties of tumor, (N)earness of tumor deepest portion to collecting system or sinus, (A)nterior (a)/posterior (p) descriptor, and (L)ocation relative to polar lines), and comorbidities. Functional outcomes were compared, and Kaplan-Meier was used to analyze survival. The matched cohort included 132 patients (TA = 66/PN = 66), with median tumor diameter of 2.4 cm, R.E.N.A.L. of 6, and preoperative GFR of 52ml/min/1.73m2. Acute kidney injury occurred in 11%/61% in the TA/PN cohorts, respectively (p < 0.01). After recovery, median GFR preserved was 89%/83% for TA/PN, respectively (p = 0.02), and 5-year dialysis-free survival was 96% in both cohorts. Median follow-up was 53 months. Five-year recurrence-free survival (RFS) was 62%/86% in the TA/PN cohorts, respectively (p < 0.01). Five-year local recurrence (LR)-free survival was 74%/95% in the TA/PN cohorts, respectively (p < 0.01). Five-year cancer-specific survival (CSS) was 96%/98% in the TA/PN cohorts, respectively (p = 0.7). Local recurrence was observed in nine of 36 (25%) and five of 30 (17%) patients managed with laparoscopic versus percutaneous TA, respectively. For TA with LR (n = 14), nine patients presented with multifocality and/or cT1b tumors. Twelve LR were managed with salvage TA, and seven remained cancer-free, while five developed systemic recurrence, three with concomitant LR. Functional outcomes for TA for RMSK were improved compared with PN. Local recurrence was more common after TA and often was associated with the laparoscopic approach, multifocality, and large tumor size. Improved patient selection and greater experience with TA should improve outcomes. Salvage of LR was not always possible. Partial nephrectomy remains the reference standard for RMSK.

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

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

Cancer-specific Mortality in T1a Renal Cell Carcinoma Treated with Local Tumor Destruction Versus Partial Nephrectomy

BackgroundLarge-scale analyses addressing cancer-specific mortality (CSM) in T1a renal cell carcinoma (RCC) patients treated with local tumor destruction (LTD), relative to partial nephrectomy (PN), are scarce. ObjectiveTo compare CSM after LTD versus PN. Design, setting, and participantsWithin the Surveillance, Epidemiology, and End Results (SEER) database (2004–2018), we identified patients with clinical T1a stage RCC treated with LTD or PN. Outcome measurements and statistical analysesAfter 1:1 ratio propensity score matching (PSM) between patients treated with LTD versus PN, competing risks regression (CRR) models addressed CSM, after adjustment for other-cause mortality (OCM) and other covariates (age, tumor size, tumor grade, and histological subtype). Results and limitationsRelative to the 35 984 PN patients, 5936 LTD patients were older and more frequently harbored unknown RCC histological subtype or unknown grade. After 1:1 PSM that resulted in 5352 LTD versus 5352 PN patients, the 10-yr CSM rate was 8.7% versus 5.5%. In multivariable CRR models, LTD was associated with higher CSM, relative to PN (hazard ratio [HR]: 1.58, p < 0.001). Subgroup analyses revealed invariably higher CSM after LTD versus PN in patients with tumor size ≤3 cm (10-yr CSM 7.2% vs 5.3%, multivariable HR: 1.47, p < 0.001) and in patients with tumor size 3.1–4 cm (10-yr CSM 11.4% vs 6.1%, multivariable HR: 1.72, p < 0.001). Lack of information regarding earlier cancer controls, retreatment, tumor location within the kidney, and type of surgery represented limitations. ConclusionsIn T1a RCC patients, LTD is invariably associated with higher CSM relative to PN, even after adjustment for OCM and all available patient and tumor characteristics, and regardless of tumor size considerations. However, the magnitude of CSM disadvantage was more pronounced in LTD patients with tumor size 3.1–4 cm than in those with tumor size ≤3 cm. Patient summaryIn patients with small renal masses, we observed higher cancer-specific death rates for local tumor destruction (LTD) than for partial nephrectomy. The LTD disadvantage was more pronounced for patients with tumor size 3.1–4 cm, but was also present in those with tumor size ≤3 cm.

Partial Nephrectomy Versus Radical Nephrectomy for Endophytic Renal Tumors: Comparison of Operative, Functional, and Oncological Outcomes by Propensity Score Matching Analysis

PurposeThe study aimed to compare operative, functional, and oncological outcomes between partial nephrectomy (PN) and radical nephrectomy (RN) for entophytic renal tumors (ERTs) by propensity score matching (PSM) analysis.MethodsA total of 228 patients with ERTs who underwent PN or RN between August 2014 and December 2021 were assessed. A PSM in a 1:1 ratio was conducted to balance the differences between groups. Perioperative characteristics, renal functional, and oncological outcomes were compared between groups. Univariate and multivariate logistic and Cox proportional hazard regression analyses were used to determine the predictors of functional and survival outcomes.ResultsAfter PSM, 136 cases were matched to the PN group (n = 68) and the RN group (n = 68). Patients who underwent RN had shorter OT, less EBL, and lower high-grade complications (all p <0.05) relative to those who underwent PN. However, better perseveration of renal function was observed in the PN group, which was reflected in 48-h postoperative AKI (44.1% vs. 70.6%, p = 0.002), 1-year postoperative 90% eGFR preservation (45.6% vs. 22.1%, p = 0.004), and new-onset CKD Stage ≥III at last follow-up (2.9% vs. 29.4%, p <0.001). RN was the independent factor of short-term (OR, 2.812; 95% CI, 1.369–5.778; p = 0.005) and long-term renal function decline (OR, 10.242; 95% CI, 2.175–48.240; p = 0.003). Furthermore, PN resulted in a better OS and similar PFS and CSS as compared to RN (p = 0.042, 0.15, and 0.21, respectively). RN (OR, 7.361; 95% CI, 1.143–47.423; p = 0.036) and pT3 stage (OR, 4.241; 95% CI, 1.079–16.664; p = 0.039) were independent predictors of overall mortality.ConclusionAmong patients with ERTs, although the PN group showed a higher incidence of high-grade complications than RN, when technically feasible and with experienced surgeons, PN is recommended for better preservation of renal function, longer OS, and similar oncological outcomes.

1637 Ablative Therapies Versus Partial Nephrectomy for Small Renal Masses: A Systematic Review and Meta-Analysis

Abstract Introduction The optimal management of small renal masses is unclear. Ablative therapies (AT) have been advocated as a potential alternative due to lower complication rates and non-inferior oncological outcomes. We performed a systematic review to compare AT and partial nephrectomy (PN) in patients with T1aN0M0 renal masses. Method This review is registered on PROSPERO (CRD42020199099). A search was performed on Medline, EMBASE, and Cochrane CENTRAL to identify studies comparing AT and PN. Different modalities and approaches were analysed as subgroups. Outcomes include cancer-specific survival (CSS), overall survival (OS), recurrence-free survival (RFS), metastatic-free survival (MFS), postoperative complications, and change in renal function. Results From 1,351 identified records, 30 studies incorporating 85,837 patients were included for meta-analysis. Patients receiving AT were found to have significantly worse CSS, OS, RFS when compared to patients receiving PN (p &amp;lt; 0.05). Patients undergoing AT have a non-inferior MFS and significantly fewer overall complications (HR: 0.79, 95% CI 0.41-1.51, p = 0.48; RR: 0.71, 95% CI 0.53-0.96, p = 0.03). Patients undergoing AT have a smaller decline in renal function post-operatively (SMD: 0.30, 95% CI 0.11-0.50). When limited to studies with propensity score matching, CSS and RFS are no longer significantly different between the two groups (HR: 1.54, 95% CI 0.67-3.52, p = 0.31, HR: 1.72, 95% CI 0.90-3.28, p = 0.10). Subgroup analyses did not show significant differences between different modalities and approaches of AT in all outcomes. Conclusions AT is potentially non-inferior to PN when managing small renal masses, and more high-quality propensity score-matched studies with long follow-up time are needed to confirm the non-inferiority.

Partial Nephrectomy Versus Radical Nephrectomy for Localized Renal Masses: Critical Analysis of Oncological Outcome and Impact on the Renal Function

Background: Management of renal tumors remains a controversial issue especially in small size tumors or special situations as bilateral disease, single kidney, or compromised renal function, nephron-sparing surgery is the case in such situations. Objective: Comparing oncological outcome and impact on renal function of open radical nephrectomy and open partial nephrectomy for management of renal tumors. Patients and methods: Our study was conducted as a non-randomized prospective observational study at the Urology Department, Menoufia University Hospital between December 2018 and June 2020. Forty-eight patients with organ-confined renal masses were included in the study. They were divided into two equal groups; (group 1) 24 patients and was treated by PN, and (group 2) 24 patients and was treated by RN. Results: The mean age of our study is 56.6±13.2. Thirty-two patients were males (66.7%), while females represented 16 (33.3%). Hot ischemia was done for all partial nephrectomy cases with a mean time of ischemia 13.2±4.1. We used different techniques included simple enucleation in 17 patients (70.8%), polar nephrectomy in 4 patients (16.7%), and wedge resection in 3 patients (12.5%). Regarding surgical margin, it was free in 21 patients (87.5%) of PN and positive in 3 patients (12.5%) 2 of them missed follow up and 1 showed no recurrence till now. Our patients showed a smooth postoperative course. Conclusion: Both techniques (RN&PN) were comparable in terms of oncological outcomes. Patients tolerated both techniques with no major complications, however partial nephrectomy is advised in the localized renal tumors when technically feasible with less probability of complications and good follow-up data regarding the renal function, the oncological outcome is the same as radical surgery.

PP256 Cost-Utility Analysis of Robot-Assisted Partial Nephrectomy Versus Open Or Laparoscopic Radical Nephrectomy In Korean Patients With Renal Cancer

IntroductionPartial nephrectomy is recommended over radical nephrectomy for the surgical treatment of patients with stage cT1 renal cancer in multiple guidelines. The objective of this study is to examine the cost effectiveness of robot-assisted partial nephrectomy (RAPN), compared with open radical nephrectomy (ORN) or laparoscopic radical nephrectomy (LRN), for treating stage cT1 renal cancer in Korea.MethodsA Markov model was applied in patients with cT1 renal cancer that consisted of the following six health states: post-surgery, normal, chronic kidney disease (CKD), dialysis, death from renal failure, and natural death. Utilities and transition probabilities were obtained from systematic literature reviews. Costs were obtained from the current Korean National Health Insurance fee schedule, the Korean medical literature, and 2016 Health Insurance Review and Assessment Service inpatient claims data. Univariate and probabilistic sensitivity analyses were performed to check for uncertainty.ResultsRAPN was the dominant treatment, costing KRW 2.1 to 3.6 million (USD 1,700 to 2,900) less than the comparators while providing 0.45 to 0.61 more utility. Univariate sensitivity analysis showed that the most sensitive parameter was the relative risk reduction of CKD after partial nephrectomy. The sensitivity analysis also showed that the acceptability of RAPN at a cost-effectiveness threshold of KRW 30.5 million was high relative to both comparators (85.9% against LRN and 78.9% against ORN).ConclusionsThough there might be uncertainties in non-Korean utility data and some transition probabilities derived from Japanese data, the current study suggested that partial nephrectomy is a more cost-effective option than ORN or LRN in Korea for patients with stage cT1 renal cancer.

Re: Partial Nephrectomy Versus Radical Nephrectomy for cT2 or Greater Renal Tumors: A Systematic Review and Meta-analysis

Re: Partial Nephrectomy Versus Radical Nephrectomy for cT2 or Greater Renal Tumors: A Systematic Review and Meta-analysis

Radiofrequency Ablation Versus Partial Nephrectomy for cT1 Small Renal Lesions; a Comparison of Clinical and Oncological Outcomes

Radiofrequency Ablation Versus Partial Nephrectomy for cT1 Small Renal Lesions; a Comparison of Clinical and Oncological Outcomes

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

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

Renal Tumor Invasion Depth and Diameter are the Two Most Accurate Anatomical Features Regarding the Choice of Radical Versus Partial Nephrectomy

To evaluate simple tumor characteristics (renal tumor diameter and parenchymal invasion depth) compared with more complex classifications, that is, Renal Tumor Invasion Index (RTII) and Preoperative Aspects and Dimensions Used for an Anatomical classification, in predicting the type of nephrectomy (radical vs partial) performed. A total of 915 patients who had undergone either partial nephrectomy ( n = 388, 42%) or radical nephrectomy ( n = 527, 58%) were identified from the Helsinki University Hospital kidney tumor database between 1 January 2006 and 31 December 2014. Tumor maximum diameter and depth of invasion into the parenchyma were estimated from computed tomography or magnetic resonance imaging images and compared with Preoperative Aspects and Dimensions Used for an Anatomical and Renal Tumor Invasion Index. Logistic regression and receiver operating curves were used to compare the parameters at predicting the type of nephrectomy. All the anatomical variables of receiver operating curve/area under the curve analyses were significant predictors for the type of nephrectomy. Parenchymal invasion (area under the curve 0.91; 95% confidence interval, 0.89-0.93), RTII (area under the curve 0.91; 95% confidence interval, 0.89-0.93), and diameter (area under the curve 0.91; 95% confidence interval, 0.89-0.93) performed significantly better than Preoperative Aspects and Dimensions Used for an Anatomical classification (area under the curve 0.88; 95% confidence interval, 0.85-0.89). In multivariable analysis, invasion depth was the best predictor of nephrectomy type (percentage correct, 85.6%). Addition of one anatomic parameter into the model of non-anatomical cofactors improved the accuracy of the model significantly, but the addition of more parameters did not. Parenchymal invasion depth and tumor diameter are the most accurate anatomical features for predicting the nephrectomy type. All potential anatomical classification systems should be tested against these two simple characteristics.

MP100-01 PARTIAL NEPHRECTOMY VERSUS CRYOABLATION OR RADIOFREQUENCY ABLATION FOR CLINICAL STAGE T1 RENAL MASSES: SYSTEMATIC REVIEW AND META-ANALYSIS OF MORE THAN 3900 PATIENTS

You have accessJournal of UrologyKidney Cancer: Ablative Therapy1 Apr 2017MP100-01 PARTIAL NEPHRECTOMY VERSUS CRYOABLATION OR RADIOFREQUENCY ABLATION FOR CLINICAL STAGE T1 RENAL MASSES: SYSTEMATIC REVIEW AND META-ANALYSIS OF MORE THAN 3900 PATIENTS J. Ricardo Rivero, Jose De La Cerda, Hanzhang Wang, Ann M. Farrell, Michael A. Liss, Ronald Rodriguez, and Dharam Kaushik J. Ricardo RiveroJ. Ricardo Rivero More articles by this author , Jose De La CerdaJose De La Cerda More articles by this author , Hanzhang WangHanzhang Wang More articles by this author , Ann M. FarrellAnn M. Farrell More articles by this author , Michael A. LissMichael A. Liss More articles by this author , Ronald RodriguezRonald Rodriguez More articles by this author , and Dharam KaushikDharam Kaushik More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3108AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Conflicting data exist with regard to the outcomes of ablation procedures when compared with partial nephrectomy (PN) for cT1 renal masses. We compared all-cause mortality (ACM), cancer-specific mortality (CSM), local recurrence (LR), distant metastases (DM), treatment-related complication rates, and post-procedure changes in estimated glomerular filtration rate (eGFR) between PN and ablation therapies. METHODS We performed systematic review of original articles published upto July 2016. We conducted a meta-analysis to evaluate ACM, CSM, LR, DM rates, treatment-related complications and changes in eGFR. Publication bias was assessed using Begg and Egger tests. RESULTS We identified 961 papers, of which 15 fulfilled our inclusion criteria. These 15 studies represented 3974 patients who had undergone an ablative procedure (CA or RFA; n = 1455, 37%) or PN (n = 2519, 63%). ACM and CSM rates were higher for ablation than for PN (HR 2.11 [95% CI 1.54-2.87], p < 0.05; HR 3.84 [95% CI 1.66-8.88], p < 0.05 respectively). No statistically significant difference in LR rate or risk of DM was seen between ablation and PN (HR 1.32 [95% CI 0.79-2.22], p = 0.22 and HR 1.83 [95% CI 0.67-5.01], p = 0.23, respectively). Complication rates were lower for ablation than for PN (13% versus 17.6%, respectively; OR 0.49 [95% CI 0.25-0.94], p < 0.05). The overall difference in reduction of eGFR between the ablation and PN groups was -7.42 mL/min/1.73 m2 (95% CI -12.48, -2.36; p = 0.04). CONCLUSIONS In this up-to-date meta-analysis, ablation, when compared to PN was associated with higher ACM and CSM, but no differences were seen in rates of LR or DM. Ablation was associated with fewer complications and a smaller reduction in eGFR when compared with PN. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1329 Advertisement Copyright & Permissions© 2017MetricsAuthor Information J. Ricardo Rivero More articles by this author Jose De La Cerda More articles by this author Hanzhang Wang More articles by this author Ann M. Farrell More articles by this author Michael A. Liss More articles by this author Ronald Rodriguez More articles by this author Dharam Kaushik More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Systematic Review and Meta-Analysis of Comparative Studies Reporting Perioperative Outcomes of Robot-Assisted Partial Nephrectomy Versus Open Partial Nephrectomy.

Robot-assisted partial nephrectomy (RAPN) is increasingly being used for the surgical management of renal masses. The comparison of RAPN with open partial nephrectomy (OPN) has not yet led to a unified conclusion with regard to perioperative outcomes. To conduct a systematic review and meta-analysis of the literature on the perioperative outcomes of RAPN compared with OPN. We searched PubMed and EMBASE through January 31, 2016, to identify randomized controlled trials (RCTs) and observational comparative studies assessing the comparison of the two approaches (RAPN vs OPN). Primary outcomes were intraoperative complication rate and postoperative complication rate (including minor and major). Secondary outcomes were perioperative transfusion rate, positive surgical margin (PSM) rate, operative time (OT), warm ischemia time (WIT), estimated blood loss (EBL), length of hospital stay (LOS), and estimated glomerular filtration rate (eGFR) change. A total of 19 cohort studies with at least 3551 patients (RAPN, 1216; OPN, 2335) were included. Compared with OPN, RAPN had the advantages of (a) lower rates of postoperative complication (risk ratio [RR] = 0.60, 95% confidence interval [CI] = 0.46, 0.78, p = 0.0002), postoperative minor complication (RR = 0.73, 95% CI = 0.56, 0.96, p = 0.02), and postoperative major complication (RR = 0.50, 95% CI = 0.30, 0.84, p = 0.01); (b) lower need for transfusion (RR = 0.64, 95% CI = 0.41, 0.98, p = 0.04); (c) less EBL (weighted mean difference [WMD] = -98.82, 95% CI = -125.64, -72.01, p < 0.00001); and (d) shorter LOS (WMD = -2.64, 95% CI = -3.27, -2.00, p < 0.00001). Sensitivity analyses excluding studies with obvious selection bias based on tumor complexity confirmed all these advantages. RAPN had longer OT (WMD = 18.56, 95% CI = 2.13, 35.00, p = 0.03) and WIT (WMD = 3.65, 95% CI = 0.75, 6.56, p = 0.01) in the primary analyses. Sensitivity analyses, however, showed no differences between RAPN and OPN regarding OT and WIT. Intraoperative complication rate (RR = 0.61, 95% CI = 0.29, 1.27, p = 0.19), PSM rate (RR = 0.87, 95% CI = 0.56, 1.34, p = 0.52), and short-term eGFR change, including absolute eGFR change (WMD = -1.56, 95% CI = -3.41, 0.28, p = 0.10) and percentage eGFR change (WMD = 0.99, 95% CI = -0.52, 2.50), did not differ between the two approaches. Compared with OPN, RAPN appears to have lower morbidity and achieves similar short-term functional outcomes. However, evidence is limited regarding the long-term oncologic outcomes even though the PSM rate is similar between the two groups. Well-designed RCTs with large sample sizes and long-term follow-up are needed to confirm and update the findings of our study.

Comparative Analysis of Robotic-Assisted Partial Nephrectomy Versus Open Partial Nephrectomy During the Initial Robotic Learning Curve: Does the End Justify the Means?

Background: Several studies have alluded to a detrimental impact of the surgeon’s “learning curve” on outcomes of minimally invasive surgery. In this study, we evaluated the outcomes of robotic-assisted partial nephrectomy (RAPN) versus open partial nephrectomy (OPN) for kidney tumors, during the introduction of Robotic Urologic Oncology at our institution. Methods: A retrospective review of all consecutive partial nephrectomies (PN), RAPN and OPN, performed at the American University of Beirut Medical Center since the inception of the robotic program in July 2013 until July 2015. Thirty-four consecutive patients underwent PNs, 19 OPN and 15 RAPN. Preoperative variables (patient characteristics, tumor size, and RENAL score) and perioperative renal functional/patient outcomes (% change in glomerular filtration rate (GFR), ischemia time, blood loss, need for blood transfusions, total operating time, and length of hospital stay) were compared using SPSS. Results: Preoperative variables, including the size and RENAL score of the tumor were analyzed. The difference in the median size of the tumor between OPN and RAPN was not statistically significant (4.5 ± 2.7 cm vs. 3.6 ± 1.7 cm, respectively, P = 0.25). RENAL score was significantly higher for OPN compared to RAPN (7.3 ± 2.3 vs. 4.9 ± 1.5, respectively, P < 0.05). Mean operative time was significantly shorter for OPN vs. RAPN (178 ± 52 min vs. 296 ± 86 min, respectively, P < 0.05). Cold ischemia time was 24 ± 3 min in OPN, and warm ischemia time was 17.5 ± 2 min for RAPN; 10 out of the total 15 robotic cases were performed with a warm ischemia time of < 20 min. Intraoperative blood loss was comparable for both approaches (225 ± 132 mL in OPN vs. 243 ± 192 mL in RAPN), and there was no need for blood transfusions in either group. Hospital stay was significantly longer for OPN vs. RAPN (6 ± 1.6 days vs. 4 ± 0.9 days, respectively, P = 0.01). The change in GFR was comparable among both procedures (OPN = -9% vs. RAPN = -7%); pathological margin status was also comparable among both procedures, with 1/19 (5%) positive focal margins in OPN vs. 0/14 in RAPN. None of the robotic procedures required conversion to the laparoscopic or open approach. Conclusions: RAPN is currently an established approach for the treatment of kidney tumors with the advantages of decreased crude ischemia time and a shorter hospital stay, with comparable intraoperative blood loss and risk of GFR reduction. Our data show that tumor characteristics were not equivalent, with higher RENAL scores noted in patients allocated to OPN vs. RAPN, thus limiting a fair comparison of outcomes. However, the data confirm that with proper selection of patients for RAPN, outcomes were equivalent to OPN and were not jeopardized during the initial robotic learning curve. Larger prospective studies are needed to validate our results. World J Nephrol Urol. 2016;5(4):79-82 doi: https://doi.org/10.14740/wjnu286w

Oncologic and Functional Outcomes after Partial Nephrectomy Versus Radical Nephrectomy in T1b Renal Cell Carcinoma: A Multicenter, Matched Case-Control Study in Korean Patients

PurposeThe study was to compare the oncologic and functional outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for pathologically proven T1b renal cell carcinoma using pair-matched groups.Materials and MethodsWe reviewed our prospectively maintained database for RN and PN in T1b renal tumors surgically treated between 1999 and 2011 at five institutions in Korea. Of 611 patients treated with PN or RN for a solitary and NX/N0 M0 renal mass (4-7 cm), 577 (PN, 100; RN, 477) patients with pathologically confirmed pT1b remained for analysis. Study subjects were grouped by PN or RN, then matched by age, sex, comorbidities, body mass index, tumor size and depth, histologic type, and preoperative estimated glomerular filtration rate (eGFR) using propensities score. To evaluate oncologic outcomes, overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) rates were analyzed. The functional outcomes were evaluated by postoperative eGFR.ResultsThe median follow-up in the RN group was 48.1 and 42.6 months in the PN group. The estimated 10-year CSS rate (PN 85.7% vs. RN 84.4%, p=0.52) and 5- and estimated 10-year PFS rates (PN: 86.4% and 79.2% vs. RN: 86.0% and 66.1%, p=0.66) did not differ significantly between groups. The estimated 10-year OS rate was significantly higher in the PN group (85.7%) compared to the RN group (73.3%) (p=0.003). PN was less likely to induce new-onset chronic kidney disease (CKD) and end-stage CKD compared with RN.ConclusionOur study suggests that patients treated with PN demonstrate a superior OS rate and postoperative renal function with analogous CSS and PFS rates compared with pair-matched patients treated with RN.

Minimally Invasive Partial Nephrectomy Versus Laparoscopic Cryoablation for Patients Newly Diagnosed with a Single Small Renal Mass

BackgroundMinimally invasive partial nephrectomy (MIPN) and laparoscopic renal cryoablation (LRC) are two treatment options increasingly used for small renal masses. ObjectiveTo compare perioperative, oncologic, and functional outcomes after MIPN and LRC. Design, setting, and participantsWe included 372 consecutive patients newly diagnosed with a single small renal mass and treated with either MIPN or LRC at a single institution. InterventionMIPN and LRC. Outcome measurements and statistical analysisRegression models were used to evaluate the impact of surgical treatment (MIPN vs LRC) on perioperative, oncologic, and functional outcomes. Results and limitationsOverall, 206 patients (55%) underwent MIPN and 166 (45%) were treated with LRC. In multivariate analysis, the rate of postoperative complications was significantly lower in the MIPN compared to the LRC group (20% vs 28%; adjusted difference –11%; p=0.02) after adjusting for age at surgery, American Society of Anesthesiologists score (1 vs 2 vs 3), and tumor size. The median follow-up was similar in the two groups (43 and 39 mo for MIPN and LRC, respectively). In univariate Cox regression analysis, treatment type was not significantly associated with disease-free survival (hazard ratio 1.06, 95% confidence interval [CI] 0.45–2.52; p=0.9). The disease-free survival rate at 5 yr was 92% in MIPN and 93% in LRC patients. In multivariate linear regression analysis, LRC was significantly associated with a higher estimated glomerular filtration rate (eGFR) at 6 mo compared to MIPN (coefficient 4.68, 95% CI 0.06–9.30; p=0.047) after adjusting for age at surgery, tumor size, and preoperative eGFR. There was no significant association between surgical treatment and postoperative eGFR at 3 yr after surgery (coefficient –2.36, 95% CI –7.55 to 2.83; p=0.4). Limitations include the retrospective study design and selection bias. ConclusionsMIPN and LRC provided similar cancer control and comparable renal function at intermediate-term follow-up. Both surgical techniques emerged as viable treatment options for patient newly diagnosed with a single small renal mass. Further multi-institutional studies with longer follow-up and nephrometry scores are needed to corroborate our findings. Patient summaryIn patients newly diagnosed with a single small renal mass, minimally invasive partial nephrectomy and laparoscopic renal cryoablation provided similar cancer control and comparable renal function at intermediate-term follow-up.

Radical Versus Partial Nephrectomy

Radical Versus Partial Nephrectomy