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Cheaib JG, Talwar R, Roberson DS, Alam R, Lee DJ, Gupta M, Patel SH, Singla N, Pavlovich CP, Patel HD, Pierorazio PM. Urologist-level variation in the management of T1a renal cell carcinoma: A population-based cohort study. Urol Oncol 2024; 42:71.e9-71.e18. [PMID: 38278631 DOI: 10.1016/j.urolonc.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/30/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVES Lack of strict indications in current guidelines have led to significant variation in management patterns of small renal masses. The impact of the urologist on the management approach for patients with small renal masses has not been explored previously. MATERIALS AND METHODS Using the linked Surveillance, Epidemiology, and End Results-Medicare database, patients aged ≥66 years diagnosed with small renal masses from January 1, 2004 to December 31, 2013 were identified and assigned to primary urologists. Mixed-effects logistic models were used to evaluate factors associated with different management approaches, estimate urologist-level probabilities of each approach, assess management variation, and determine urologist impact on choice of approach. RESULTS A total of 12,402 patients with 2,794 corresponding primary urologists were included in the study. At the individual urologist level, the estimated case-adjusted probability of different approaches varied markedly: nonsurgical management (mean, 12.8%; range, 4.9%-36.1%); thermal ablation (mean, 10.8%; range, 2.4%-66.3%); partial nephrectomy (mean, 30.1%; range, 10.1%-66.6%); and radical nephrectomy (mean, 40.4%; range, 17.7%-71.6%). Compared to patient and tumor characteristics, the primary urologist was a more influential measured factor, accounting for 13.6% (vs. 12.9%), 33.8% (vs. 2.1%), 15.1% (vs. 8.4%), and 13.5% (vs. 4.0%) of the variation in management choice for nonsurgical management, thermal ablation, partial nephrectomy, and radical nephrectomy, respectively. CONCLUSIONS Significant variation exists in the management of small renal masses and appears to be driven primarily by urologist preference and practice patterns. Our findings emphasize the need for unified guidance regarding management of these masses to reduce unwarranted variation in care.
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Affiliation(s)
- Joseph G Cheaib
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Ruchika Talwar
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel S Roberson
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ridwan Alam
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel J Lee
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Mohit Gupta
- Department of Urology, MedStar Health-Georgetown University Hospital, Washington, DC
| | - Sunil H Patel
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nirmish Singla
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christian P Pavlovich
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hiten D Patel
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Phillip M Pierorazio
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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2
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Chartier S, Arif-Tiwari H. MR Virtual Biopsy of Solid Renal Masses: An Algorithmic Approach. Cancers (Basel) 2023; 15:2799. [PMID: 37345136 DOI: 10.3390/cancers15102799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 06/23/2023] Open
Abstract
Between 1983 and 2002, the incidence of solid renal tumors increased from 7.1 to 10.8 cases per 100,000. This is in large part due to the increase in the volume of ultrasound and cross-sectional imaging, although a majority of solid renal tumors are still found incidentally. Ultrasound and computed tomography (CT) have been the mainstay of renal mass screening and diagnosis but recent advances in magnetic resonance (MR) technology have made this the optimal choice when diagnosing and staging renal tumors. Our purpose in writing this review is to survey the modern MR imaging approach to benign and malignant solid renal tumors, consolidate the various imaging findings into an easy-to-read reference, and provide an imaging-based, algorithmic approach to renal mass characterization for clinicians. MR is at the forefront of renal mass characterization, surpassing ultrasound and CT in its ability to describe multiple tissue parameters and predict tumor biology. Cutting-edge MR protocols and the integration of diagnostic algorithms can improve patient outcomes, allowing the imager to narrow the differential and better guide oncologic and surgical management.
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Affiliation(s)
- Stephane Chartier
- Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson, AZ 85724, USA
| | - Hina Arif-Tiwari
- Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson, AZ 85724, USA
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3
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Herr H, Sogani P, Eastham J. Genitourinary tumors. J Surg Oncol 2022; 126:926-932. [PMID: 36087085 PMCID: PMC10671100 DOI: 10.1002/jso.27031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/03/2022] [Indexed: 11/09/2022]
Abstract
Memorial Sloan Kettering Cancer Center (MSK) has made many notable contributions to the scientific understanding and care of patients with common urologic cancers. Many of the advances represented paradigm shifts in management and established new standards of care. This review highlights the surgical procedures and treatment strategies originated and pioneered by urologic surgeons and colleagues at MSK during the past 50 years.
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Affiliation(s)
- Harry Herr
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Pramod Sogani
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - James Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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4
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Charbonneau G, Hudon C, Lavallée LT, Kassouf W, Gaboury I, Toren P, Couture F, Couture F, Foley V, Tétu A, Richard PO. Patients’ perceptions on active surveillance for the treatment of small renal masses. Urol Oncol 2022; 40:493.e17-493.e23. [DOI: 10.1016/j.urolonc.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/30/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022]
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5
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Richard PO, Violette PD, Bhindi B, Breau RH, Kassouf W, Lavallée LT, Jewett M, Kachura JR, Kapoor A, Noel-Lamy M, Ordon M, Pautler SE, Pouliot F, So AI, Rendon RA, Tanguay S, Collins C, Kandi M, Shayegan B, Weller A, Finelli A, Kokorovic A, Nayak J. Canadian Urological Association guideline: Management of small renal masses - Full-text. Can Urol Assoc J 2022; 16:E61-E75. [PMID: 35133268 PMCID: PMC8932428 DOI: 10.5489/cuaj.7763] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Patrick O. Richard
- Department of Surgery, Division of Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Philippe D. Violette
- Departments of Health Research Methods Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, ON, Canada
| | - Bimal Bhindi
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada
| | - Rodney H. Breau
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Wassim Kassouf
- Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - Luke T. Lavallée
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Michael Jewett
- Department of Surgical Oncology, Division of Urology, Princess Margaret Hospital, Toronto, ON, Canada
| | - John R. Kachura
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anil Kapoor
- McMaster Institute of Urology, St. Joseph Healthcare, Hamilton, ON, Canada
| | - Maxime Noel-Lamy
- Department of Medical Imaging, Division of Interventional Radiology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Michael Ordon
- Department of Surgery, Division of Urology, St. Michael’s Hospital, Toronto, ON, Canada
| | - Stephen E. Pautler
- Department of Surgery, Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Frédéric Pouliot
- Department of Surgery, Division of Urology, Centre Hospitalier Universitaire de Québec, Quebec, QC, Canada
| | - Alan I. So
- Division of Urology, British Columbia Cancer Care, Vancouver, BC, Canada
| | - Ricardo A. Rendon
- Department of Surgery, Division of Urology, Capital Health - QEII, Halifax, NS, Canada
| | - Simon Tanguay
- Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Maryam Kandi
- Departments of Health Research Methods Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, ON, Canada
| | - Bobby Shayegan
- McMaster Institute of Urology, St. Joseph Healthcare, Hamilton, ON, Canada
| | | | - Antonio Finelli
- Department of Surgical Oncology, Division of Urology, Princess Margaret Hospital, Toronto, ON, Canada
| | - Andrea Kokorovic
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Jay Nayak
- Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Patel AK, Rogers CG, Johnson A, Noyes SL, Qi J, Miller D, Shervish E, Stockton B, Lane BR. Initial Observation of a Large Proportion of Patients Presenting with Clinical Stage T1 Renal Masses: Results from the MUSIC-KIDNEY Statewide Collaborative. EUR UROL SUPPL 2021; 23:13-19. [PMID: 34337485 PMCID: PMC8317780 DOI: 10.1016/j.euros.2020.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND While surgical excision remains the principal management strategy for clinical T1 renal masses (cT1RMs), the rates of noninterventional approaches are not well known. Most single-institution and population-based series suggest rates below 10%. OBJECTIVE To evaluate the use of observation for newly diagnosed cT1RM patients in academic and community-based practices across a statewide collaborative. DESIGN SETTING AND PARTICIPANTS The Michigan Urological Surgery Improvement Collaborative-Kidney mass: Identifying and Defining Necessary Evaluation and therapY (MUSIC-KIDNEY) commenced data collection in September 2017 by recording clinical, radiographic, pathologic, and short-term follow-up data for cT1RM patients at 13 diverse practices. Patients with complete data were assessed at >90 d after initial evaluation as to whether observation or treatment was performed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Relationships with outcomes were analyzed using multivariable logistic regression, chi-square test, and Wilcoxon rank-sum test. RESULTS AND LIMITATIONS Out of 965 patients, observation was employed in 48% (n = 459), with practice-level rates ranging from 0% to 68%. Patients managed with observation (vs treatment) were significantly older (71.2 vs 62.8 yr, p < 0.0001) and had smaller tumors (2.3 vs 3.4 cm, p < 0.0001). Observation was used for 53.5% of cT1a renal masses, for 29.9% of cT1b renal masses, and for 42.5%, 53.7%, and 63.9% of radiographically solid, Bosniak III-IV cystic, and indeterminate cT1RMs, respectively. Factors significantly associated with observation in multivariable analysis included lesion type (Bosniak III-IV vs solid, p = 0.017), tumor stage (cT1a vs cT1b, p < 0.001), and higher age (p < 0.001). A short duration of follow-up limits the assessment of longer-term patient management. CONCLUSIONS Noninterventional management of cT1RMs is common across the MUSIC-KIDNEY collaborative, with wide variability across practices. Factors associated with observation were advanced age, smaller tumor size, and cystic tumor type. Durability of the initial decision for observation (delayed intervention vs active surveillance vs less active surveillance) will be a focus of subsequent study. PATIENT SUMMARY The Michigan Urological Surgery Improvement Collaborative: Kidney mass: Identifying and Defining Necessary Evaluation and therapY (MUSIC-KIDNEY) quality improvement collaborative assessed the current utilization of initial observation of a renal mass ≤7 cm across a diverse group of urology practices and found it to be used in 48% of patients. We found that the factors predicting observation were advanced age, smaller tumor size, and cystic tumor type.
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Affiliation(s)
| | | | - Anna Johnson
- Department of Urology, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Ji Qi
- Department of Urology, Michigan Medicine, Ann Arbor, MI, USA
| | - David Miller
- Department of Urology, Michigan Medicine, Ann Arbor, MI, USA
| | | | | | - Brian R. Lane
- Spectrum Health Hospital System, Grand Rapids, MI, USA
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
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7
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Russo P. Historical Perspective on Partial Nephrectomy and Renal Functional Preservation. Urology 2020; 145:314-315. [DOI: 10.1016/j.urology.2020.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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8
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Forbes MK, Owens EP, Wood ST, Gobe GC, Ellis RJ. Variability in surgical management of kidney cancer between urban and rural hospitals in Queensland, Australia: a population-based analysis. Transl Androl Urol 2020; 9:1210-1221. [PMID: 32676404 PMCID: PMC7354325 DOI: 10.21037/tau-19-775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background International guidelines recommend partial over radical nephrectomy for management of kidney tumours, due to perceived advantages of kidney function preservation. In Queensland, oncological nephrectomy is performed in both metropolitan and rural hospitals. Previous studies have shown that patients from rural areas with kidney tumours are less likely to undergo partial nephrectomy compared with those in major cities. The aim of this study was to investigate patterns of partial nephrectomy according to geographical area, and to identify patient- and health-service-level characteristics associated with partial nephrectomy. Methods All 3,799 incident kidney cancer cases in Queensland (Jan 2009 to Dec 2014) were ascertained. Patients aged <18 yrs (n=47), who did not receive surgery (n=988), or had end-stage kidney disease (ESKD) before surgery (n=17) were excluded. The final sample included 2,747 patients. Data were analysed using multivariable logistic regression in order to identify associations with partial nephrectomy. Results Of 2,747 patients, 637 (25%) underwent partial nephrectomy. The likelihood of undergoing partial nephrectomy increased with more recent year of surgery (P<0.001) and higher socioeconomic status (P<0.001). The likelihood of undergoing partial nephrectomy decreased for patients managed in lower-volume centres (P=0.004), with increasing age (P<0.001), and hospital location outside of a major city (P<0.001). Overall, the number of nephrectomies, and proportion/number of partial nephrectomies, performed in rural hospitals has increased over the study period. Conclusions Our results suggest that, although patients who are managed in major cities are more likely to undergo partial nephrectomy, likelihood of undergoing partial nephrectomy in rural centres is increasing, consistent with international best practice.
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Affiliation(s)
- Megan K Forbes
- Centre for Kidney Disease Research, University of Queensland, Translational Research Institute, Brisbane, Australia
| | - Evan P Owens
- Centre for Kidney Disease Research, University of Queensland, Translational Research Institute, Brisbane, Australia.,NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia
| | - Simon T Wood
- Centre for Kidney Disease Research, University of Queensland, Translational Research Institute, Brisbane, Australia.,Department of Urology, Princess Alexandra Hospital, Brisbane, Australia
| | - Glenda C Gobe
- Centre for Kidney Disease Research, University of Queensland, Translational Research Institute, Brisbane, Australia.,NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia.,School of Biomedical Sciences, University of Queensland, Brisbane, Australia
| | - Robert J Ellis
- Centre for Kidney Disease Research, University of Queensland, Translational Research Institute, Brisbane, Australia.,Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,School of Biomedical Sciences, University of Queensland, Brisbane, Australia
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9
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Cazzato RL, Garnon J, De Marini P, Auloge P, Koch G, Dalili D, Buy X, Palussiere J, Rao PP, Tricard T, Lang H, Gangi A. Is percutaneous image-guided renal tumour ablation ready for prime time? Br J Radiol 2020; 93:20200284. [PMID: 32543890 DOI: 10.1259/bjr.20200284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
In the last few decades, thermal ablation (TA) techniques have been increasingly applied to treat small localised renal cell carcinomas. Despite this trend, there is still an underuse of TA compared to surgery and a substantial lack of high-quality evidence derived from large, prospective, randomised controlled trials comparing the long-term oncologic outcomes of TA and surgery. Therefore, in this narrative review, we assess published guidelines and recent literature concerning the diagnosis and management of kidney-confined renal cell carcinoma to understand whether percutaneous image-guided TA is ready to be proposed as a first-line treatment.
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Affiliation(s)
- Roberto Luigi Cazzato
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Pierre De Marini
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Pierre Auloge
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Guillaume Koch
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Danoob Dalili
- Department of Diagnostic and Interventional Radiology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, 0 St Thomas St, London SE1 9RS, United Kingdom
| | - Xavier Buy
- Interventional Radiology, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Jean Palussiere
- Interventional Radiology, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Pramod Prabhakar Rao
- Interventional Radiology, Civil Hospital of Colmar; 39 Avenue de la Liberté, 68024 Colmar, France
| | - Thibault Tricard
- Urology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Hervé Lang
- Urology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
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Martínez Rodríguez C, Tardáguila de la Fuente G, Villanueva Campos A. Current management of small renal masses. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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Siev M, Renson A, Tan HJ, Rose TL, Kang SK, Huang WC, Bjurlin MA. Prognostic Value of Histologic Subtype and Treatment Modality for T1a Kidney Cancers. KIDNEY CANCER 2020; 4:49-58. [PMID: 34084980 PMCID: PMC8171275 DOI: 10.3233/kca-190072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION To evaluate overall survival (OS) of T1a kidney cancers stratified by histologic subtype and curative treatment including partial nephrectomy (PN), percutaneous ablation (PA), and radical nephrectomy (RN). MATERIALS AND METHODS We queried the National Cancer Data Base (2004-2015) for patients with T1a kidney cancers who were treated surgically. OS was estimated by Kaplan-Meier curves based on histologic subtype and management. Cox proportional regression models were used to determine whether histologic subtypes and management procedure predicted OS. RESULTS 46,014 T1a kidney cancers met inclusion criteria. Kaplan Meier curves demonstrated differences in OS by treatment for clear cell, papillary, chromophobe, and cystic histologic subtypes (all p < 0.001), but no differences for sarcomatoid (p = 0.110) or collecting duct (p = 0.392) were observed. Adjusted Cox regression showed worse OS for PA than PN among patients with clear cell (HR 1.58, 95%CI [1.44-1.73], papillary RCC (1.53 [1.34-1.75]), and chromophobe RCC (2.19 [1.64-2.91]). OS was worse for RN than PN for clear cell (HR 1.38 [1.28-1.50]) papillary (1.34 [1.16-1.56]) and chromophobe RCC (1.92 [1.43-2.58]). Predictive models using Cox proportional hazards incorporating histology and surgical procedure alone were limited (c-index 0.63) while adding demographics demonstrated fair predictive power for OS (c-index 0.73). CONCLUSIONS In patients with pathologic T1a RCC, patterns of OS differed by surgery and histologic subtype. Patients receiving PN appears to have better prognosis than both PA and RN. However, the incorporation of histologic subtype and treatment modality into a risk stratification model to predict OS had limited utility compared with variables representing competing risks.
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Affiliation(s)
- Michael Siev
- Department of Urology, Division of Urologic Oncology, NYU Langone Health, New York, NY, USA
| | - Audrey Renson
- Department of Clinical Research, NYU Langone Hospital – Brooklyn, Brooklyn, NY, USA
| | - Hung-Jui Tan
- Department of Urology, Lineberger Comprehensive Cancer Center, Multidisciplinary Genitourinary Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Tracy L. Rose
- Department of Hematology/Oncology, Lineberger Comprehensive Cancer Center, Multidisciplinary Genitourinary Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Stella K. Kang
- Department of Radiology, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - William C. Huang
- Department of Urology, Division of Urologic Oncology, NYU Langone Health, New York, NY, USA
| | - Marc A. Bjurlin
- Department of Urology, Lineberger Comprehensive Cancer Center, Multidisciplinary Genitourinary Oncology, University of North Carolina, Chapel Hill, NC, USA
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Morris CS, Baerlocher MO, Dariushnia SR, McLoney ED, Abi-Jaoudeh N, Nelson K, Cura M, Abdel Aal AK, Mitchell JW, Madassery S, Partovi S, McClure TD, Tam AL, Patel S. Society of Interventional Radiology Position Statement on the Role of Percutaneous Ablation in Renal Cell Carcinoma: Endorsed by the Canadian Association for Interventional Radiology and the Society of Interventional Oncology. J Vasc Interv Radiol 2020; 31:189-194.e3. [PMID: 31917025 DOI: 10.1016/j.jvir.2019.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/02/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Christopher S Morris
- Department of Radiology, Larner College of Medicine at the University of Vermont, Division of Interventional Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401.
| | | | - Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Eric D McLoney
- Department of Radiology, University Hospitals of Cleveland, Cleveland, Ohio
| | - Nadine Abi-Jaoudeh
- Department of Radiological Sciences, University of California Irvine, Orange, California
| | - Kari Nelson
- Department of Radiological Sciences, UC Irvine Medical Center, Orange, California
| | - Marco Cura
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
| | | | - Jason W Mitchell
- Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida
| | - Sreekumar Madassery
- Division of Vascular and Interventional Radiology, Rush University Medical Center, Chicago, Illinois
| | - Sasan Partovi
- Imaging Institute, Section of Interventional Radiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Timothy D McClure
- Departments of Urology and Radiology, Weill Cornell Medicine, Lefrak Center for Robotic Surgery, New York, New York
| | - Alda L Tam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sheena Patel
- Society of Interventional Radiology, Fairfax, Virgina
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13
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Martínez Rodríguez C, Tardáguila de la Fuente G, Villanueva Campos AM. Current management of small renal masses. RADIOLOGIA 2019; 62:167-179. [PMID: 31882171 DOI: 10.1016/j.rx.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 12/12/2022]
Abstract
One of the consequences of the growing use of diagnostic imaging techniques is the notable growth in the detection of small renal masses presumably corresponding to localized tumors that are potentially curable with surgical treatment. When faced with the finding of a small renal mass, radiologists must determine whether it is benign or malignant, and if it is malignant, what subtype it belong to, and whether it should be managed with surgical treatment, with ablative techniques, or with watchful waiting with active surveillance. Small renal masses are now a clinical entity that require management different from the approaches used for classical renal cell carcinomas. In this scenario, radiologists are key because they are involved in all aspects of the management of these tumors, including in their diagnosis, treatment, and follow-up.
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14
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Mano R, Hakimi AA. Are the long-term outcomes of percutaneous ablation for clinical stage T1 renal tumors similar to those of partial nephrectomy? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S370. [PMID: 32016088 PMCID: PMC6976441 DOI: 10.21037/atm.2019.08.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/28/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Roy Mano
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A. Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Chung DY, Lee JS, Ahmad A, Chang KD, Ham WS, Han WK, Hong CH, Choi YD, Rha KH. Lessons learned from clinical outcome and tumor features of patients underwent selective artery embolization due to postoperative bleeding following 2076 partial nephrectomies: propensity scoring matched study. World J Urol 2019; 38:1235-1242. [PMID: 31346763 DOI: 10.1007/s00345-019-02883-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the clinical and tumor characteristics in patients undergoing selective artery embolization (SAE) for bleeding after partial nephrectomy (PN). METHODS We retrospectively evaluated patients who underwent SAE from 2076 patients who underwent PN. The clinical and tumor characteristics of these patients were analyzed using entire data and propensity score matching (PSM). 76 patients who underwent PN (control, n = 38 patients; SAE, n = 38) were enrolled in PSM. RESULTS SAE was performed in 41 patients who underwent open (19/1171), laparoscopic (4/60), and robot-assisted PN (18/845). The median period from PN to SAE was 12 days (interquartile range 8-24 day). The most common symptom of 31 (75.61%) patients was gross hematuria, followed by flank pain (3/41). Follow-up imaging revealed large pseudoaneurysm in 7 asymptomatic patients. The main reason for SAE on angiography was pseudoaneurysm (32/41), followed by arteriovenous fistula (5/41). Technical and clinical success was achieved in all patients. There was no statistical difference in the estimated glomerular filtration rate after 1 year, surgical methods, or baseline characteristics between the two groups. Conversely, there was statistically significant difference in ischemic time in the entire data and PSM. In the embolization group, renal masses showed statistically significant endophytic (p = 0.006) and posterior (p = 0.028) characteristics. CONCLUSIONS SAE is an effective method for controlling postoperative bleeding while preserving renal function after PN. And, we suggest more attentive postoperative surveillance about vascular complications in patients with longer ischemia time or renal masses with endophytic and posterior locations.
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Affiliation(s)
- Doo Yong Chung
- Department of Urology, Inha University School of Medicine, Incheon, South Korea.,Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Jong Soo Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Almujalhem Ahmad
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Ki Don Chang
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Won Sik Ham
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Chang Hee Hong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Autorino R, Veccia A. Editorial Comment. Urology 2019; 130:41-42. [PMID: 31345295 DOI: 10.1016/j.urology.2019.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/18/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Riccardo Autorino
- Division of Urology, VCU Health System, Richmond, VA; Division of Urology, McGuire VA Medical Center, Richmond, VA
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Vigneswaran HT, Dobbs RW, Huang J, Sofer LA, Halgrimson WR, Crivellaro S. Use of a Novel Articulating Laparoscopic Needle Driver for Partial nephrectomy: An Initial Experience. Urology 2019; 132:123-129. [PMID: 31310768 DOI: 10.1016/j.urology.2019.05.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To demonstrate the clinical feasibility of an articulated laparoscopic needle driver to assist in the performance of laparoscopic partial nephrectomy (LPN). Previous studies have demonstrated under-utilization of minimally invasive techniques for patients undergoing partial nephrectomy (PN). METHODS Consecutive patients with renal masses amenable to PN underwent LPN with an articulating laparoscopic needle driver. A consecutive cohort of patients who previously underwent robot assisted laparoscopic PN (RALPN) was selected as a comparison cohort. Preoperative, perioperative, and postoperative variables were retrospectively collected. RESULTS A total of 20 patients underwent PN with 10 patients assigned to each of the LPN and RALPN cohorts. Median R.E.N.A.L. nephrometry scores assigned to the LPN and RALPN cohorts were 7 and 6 respectively (P= .31). Median warm ischemia time for patients in the LPN and RALPN groups was 25.5 and 18.5 minutes respectively (P= .36). Median estimated blood loss for LPN and RALPN was 200 and 50 mL (P= .03). Median operative time for LPN and RALPN was 203 and 194 minutes respectively (P= .76). Median Length of stay after LPN and RALPN was similar (3.0 vs 2.5 nights, P= .26). Following LPN, 3 patients required blood transfusion as compared to 2 patients in the RALPN cohort (P= .61). CONCLUSION Our initial results demonstrated the clinical safety and feasibility of a new surgical device for performing LPN. Patients who underwent LPN with a novel articulating needle driver demonstrated equivalent results to RALPN across several key outcomes.
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Affiliation(s)
| | - Ryan W Dobbs
- Department of Urology, University of Illinois at Chicago, Chicago, IL
| | - Jason Huang
- Department of Urology, University of Illinois at Chicago, Chicago, IL
| | - Laurel A Sofer
- Department of Urology, University of Illinois at Chicago, Chicago, IL
| | | | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL
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18
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Tuppin P, Paita M, Gastaldi-Menager C, Le Bihan-Benjamin C, Jean Bousquet P, Fagot Campagna A. Patient characteristics and treatments one year after diagnosis of renal cancer in 2015 according to the presence or absence of metastasis and a history of another tumour: A national observational study. Bull Cancer 2019; 106:538-549. [PMID: 31072597 DOI: 10.1016/j.bulcan.2019.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION This study describes the characteristics, management and outcome of patients one year after a diagnosis of renal cancer, according to the presence of a history of another tumour and metastases at diagnosis or during the first year. METHODS Based on information from the national health data system (SNDS), 10,989 general scheme beneficiaries (>15 years) with a first hospital stay in 2015 for renal cancer were divided into groups according to the presence of a history of another tumour or metastases. RESULTS In this cohort of 10,989 people (75 years and older: 30%, men: 65%), 12% had a history of another tumour diagnosed during the two years before and 22% presented one or more metastases at the time of the index hospitalisation or during the following year. Overall, nephrectomy was performed in 56% of cases (partial nephrectomy in 29% of cases), in 63% and 36% of cases without metastases and in 68% and 40% of cases without metastases and with no history of another tumour. Overall, 2% of patients received at least one monoclonal antibody and 15% received a protein kinase inhibitor. These drugs were used in 6% and 53% of cases, respectively, in the presence of metastases and in 7% and 31% of cases, respectively, in the presence of metastases and a history of another tumour. CONCLUSION This study highlights the high rate of a history of another tumour and adaptation of treatment according to a history of cancer and the presence of metastases.
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Affiliation(s)
- Philippe Tuppin
- Caisse nationale d'assurance maladie (CNAM), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France.
| | - Michel Paita
- Caisse nationale d'assurance maladie (CNAM), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
| | - Christelle Gastaldi-Menager
- Caisse nationale d'assurance maladie (CNAM), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
| | | | - Philippe Jean Bousquet
- Institut national du cancer, 52, avenue André-Morizet, 92100 Boulogne-Billancourt, France
| | - Anne Fagot Campagna
- Caisse nationale d'assurance maladie (CNAM), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
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Kang SK, Huang WC, Elkin EB, Pandharipande PV, Braithwaite RS. Personalized Treatment for Small Renal Tumors: Decision Analysis of Competing Causes of Mortality. Radiology 2019; 290:732-743. [PMID: 30644815 PMCID: PMC6394736 DOI: 10.1148/radiol.2018181114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 12/29/2022]
Abstract
Purpose To compare the effectiveness of personalized treatment for small (≤4 cm) renal tumors versus routine partial nephrectomy (PN), accounting for various competing causes of mortality. Materials and Methods A state-transition microsimulation model was constructed to compare life expectancy of management strategies for small renal tumors by using 1 000 000 simulations in the following ways: routine PN or personalized treatment involving percutaneous ablation for risk factors for worsening chronic kidney disease (CKD), and otherwise PN; biopsy, with triage of renal cell carcinoma (RCC) to PN or ablation depending on risk factors for worsening CKD; active surveillance for growth; and active surveillance when MRI findings are indicative of papillary RCC. Transition probabilities were incorporated from the literature. Effects of parameter variability were assessed in sensitivity analysis. Results In patients of all ages with normal renal function, routine PN yielded the longest life expectancy (eg, 0.67 years in 65-year-old men with nephrometry score [NS] of 4). Otherwise, personalized strategies extended life expectancy versus routine PN: in CKD stages 2 or 3a, moderate or high NS, and no comorbidities, MRI guidance for active surveillance extended life expectancy (eg, 2.60 years for MRI vs PN in CKD 3a, NS 10); and with Charlson comorbidity index of 1 or more, biopsy or active surveillance for growth extended life expectancy (eg, 2.70 years for surveillance for growth in CKD 3a, NS 10). CKD 3b was most effectively managed by using MRI to help predict papillary RCC for surveillance. Conclusion For patients with chronic kidney disease and small renal tumors, personalized treatment selection likely extends life expectancy. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Stella K. Kang
- From the Departments of Radiology (S.K.K.), Population Health (S.K.K., R.S.B.), Urology (W.C.H.), and Medicine (R.S.B.), NYU School of Medicine, 550 First Ave, New York, NY 10016; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (E.B.E.); and Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.V.P.)
| | - William C. Huang
- From the Departments of Radiology (S.K.K.), Population Health (S.K.K., R.S.B.), Urology (W.C.H.), and Medicine (R.S.B.), NYU School of Medicine, 550 First Ave, New York, NY 10016; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (E.B.E.); and Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.V.P.)
| | - Elena B. Elkin
- From the Departments of Radiology (S.K.K.), Population Health (S.K.K., R.S.B.), Urology (W.C.H.), and Medicine (R.S.B.), NYU School of Medicine, 550 First Ave, New York, NY 10016; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (E.B.E.); and Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.V.P.)
| | - Pari V. Pandharipande
- From the Departments of Radiology (S.K.K.), Population Health (S.K.K., R.S.B.), Urology (W.C.H.), and Medicine (R.S.B.), NYU School of Medicine, 550 First Ave, New York, NY 10016; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (E.B.E.); and Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.V.P.)
| | - R. Scott Braithwaite
- From the Departments of Radiology (S.K.K.), Population Health (S.K.K., R.S.B.), Urology (W.C.H.), and Medicine (R.S.B.), NYU School of Medicine, 550 First Ave, New York, NY 10016; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (E.B.E.); and Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.V.P.)
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20
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Dagenais J, Bertolo R, Garisto J, Chavali J, Kaouk J. "At-risk" kidney: How surgical factors influence renal functional preservation after partial nephrectomy. Int J Urol 2019; 26:565-570. [PMID: 30803075 DOI: 10.1111/iju.13930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/27/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the influence of surgical modifiable factors on chronic kidney disease upstaging in a contemporary cohort of patients with normal and "at-risk" kidneys undergoing partial nephrectomy. METHODS We reviewed 778 consecutive patients with (n = 634)/without (n = 144) chronic kidney disease or risk factors for chronic kidney disease in our institutional partial nephrectomy database. Chronic kidney disease upstaging was assessed using glomerular filtration rate measurements preoperatively and at 3-12 months postoperatively. Using a multivariate logistic regression, baseline clinicodemographic factors, and the operative measurements of excisional volume loss and warm and cold ischemia time on rates of chronic kidney disease upstaging were determined. Marginal effects were used to analyze the impact of ischemia time and generate interaction curves. RESULTS Chronic kidney disease/risk factors for chronic kidney disease had equivalent rates of chronic kidney disease upstaging as the healthy kidney cohort (31.5% vs 38.2%, P = 0.15). Of the entire cohort, 2.8% were upstaged to stage IV-V chronic kidney disease. Multivariate analysis found a significant association between chronic kidney disease upstaging and excisional volume loss in both cohorts (no chronic kidney disease/risk factors for chronic kidney disease: odds ratio 1.63, P = 0.04; chronic kidney disease/risk factors for chronic kidney disease: odds ratio 1.42, P = 0.001). Only in the chronic kidney disease/risk factors for chronic kidney disease cohort, there was an association between ischemia type/duration and chronic kidney disease upstaging (odds ratio 1.04, P = 0.04). Warm ischemia began to predict an increased risk of chronic kidney disease upstaging at 17.6 min, which became statistically significant at 49 min. CONCLUSIONS Chronic kidney disease upstaging is common after partial nephrectomy. Although volume loss unequivocally affects rates of upstaging irrespective of baseline renal function, warm ischemia time disproportionately influences "at-risk" kidneys. Therefore, strong consideration should be given to minimizing volume loss and using cold ischemia when extended clamp times are anticipated in "at-risk" kidneys.
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Affiliation(s)
- Julien Dagenais
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Riccardo Bertolo
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Juan Garisto
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jaya Chavali
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jihad Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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21
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Minervini A, Mari A, Borghesi M, Antonelli A, Bertolo R, Bianchi G, Brunocilla E, Ficarra V, Fiori C, Longo N, Mirone V, Morgia G, Porpiglia F, Rocco B, Serni S, Simeone C, Tellini R, Volpe A, Carini M, Schiavina R. The occurrence of intraoperative complications during partial nephrectomy and their impact on postoperative outcome: results from the RECORd1 project. MINERVA UROL NEFROL 2019; 71:47-54. [DOI: 10.23736/s0393-2249.18.03202-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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22
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Russo P. Editorial Comment. Urology 2019; 123:179. [PMID: 30598207 DOI: 10.1016/j.urology.2018.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Paul Russo
- Memorial Sloan Kettering Cancer Center, Weill Cornell School of Medicine, New York, NY
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23
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Determinants of Active Surveillance in Patients With Small Renal Masses. Urology 2019; 123:167-173. [DOI: 10.1016/j.urology.2018.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 01/20/2023]
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Abstract
Renal cell cancer (RCC) (epithelial carcinoma of the kidney) represents 2%-4% of newly diagnosed adult tumors. Over the past 2 decades, RCC has been better characterized clinically and molecularly. It is a heterogeneous disease, with multiple subtypes, each with characteristic histology, genetics, molecular profiles, and biologic behavior. Tremendous heterogeneity has been identified with many distinct subtypes characterized. There are clinical questions to be addressed at every stage of this disease, and new targets being identified for therapeutic development. The unique characteristics of the clinical presentations of RCC have led to both questions and opportunities for improvement in management. Advances in targeted drug development and understanding of immunologic control of RCC are leading to a number of new clinical trials and regimens for advanced disease, with the goal of achieving long-term disease-free survival, as has been achieved in a proportion of such patients historically. RCC management is a promising area of ongoing clinical investigation.
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25
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Bertolo R, Garisto J, Sagalovich D, Dagenais J, Agudelo J, Kaouk J. Achieving tumour control when suspecting sinus fat involvement during robot-assisted partial nephrectomy: step-by-step. BJU Int 2018; 123:548-556. [PMID: 30257064 DOI: 10.1111/bju.14552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To report a single expert robotic surgeon's step-by-step surgical technique for achieving local cancer control during robot-assisted PN (RAPN) for T3 tumours. PATIENTS AND METHODS Since January 2010 to December 2016, the institutional RAPN database was queried for patients who underwent transperitoneal RAPN performed by a single surgeon for tumours ≤4 mm from the collecting system at preoperative computed tomography (three points on the 'N [Nearness]' R.E.N.A.L. nephrometry-score item) that were pT3a involving sinus fat at final pathology. Baseline characteristics, perioperative and oncological outcomes (particularly positive surgical margins, PSMs), were identified. RESULTS Of 1497 masses that underwent RAPN, 512 scored 3 points on the 'N' item of the R.E.N.A.L. nephrometry score assessment. In all, 24 patients had pT3a tumours involving sinus fat at final pathology and represented the analysed cohort. RAPN were performed according to the here described technique. No PSMs were reported. Trifecta achievement was 54.2%. Within a median follow-up of 30 months, two and one patients had recurrence or metastasis, respectively. Two patients died unrelated to renal cancer. Retrospective analysis and limited follow-up represent study limitations. CONCLUSION In a selected cohort of patients with renal tumours near the sinus fat at baseline R.E.N.A.L. nephrometry score assessment and confirmed pT3a at final pathology, the described RAPN technique was able to achieve optimal local cancer control.
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Affiliation(s)
- Riccardo Bertolo
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Juan Garisto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel Sagalovich
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Julien Dagenais
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jose Agudelo
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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White VM, Marco DJT, Bolton D, Papa N, Neale RE, Coory M, Davis ID, Wood S, Giles GG, Jordan SJ. Age at diagnosis and the surgical management of small renal carcinomas: findings from a cross-sectional population-based study. BJU Int 2018; 122 Suppl 5:50-61. [PMID: 30307688 DOI: 10.1111/bju.14585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To describe the use of partial nephrectomy (PN) for patients with stage T1a renal cell carcinoma (RCC) by age group (<65 and ≥65 years) in two Australian states. MATERIALS AND METHODS All adults diagnosed with RCC in 2012 and 2013 were identified through population-based cancer registries in the Australian states of Queensland and Victoria. For each patient, research assistants extracted patient, tumour and treatment data from medical records. Percentages of patients treated by PN were determined for the two age groups. Multivariable logistic regression analyses examined factors associated with PN. Clinicians treating RCC were sent surveys to assess attitudes towards PN. RESULTS Data were collected on 956 patients (Victoria: n = 548; Queensland: n = 404) with stage T1a RCC. Of those undergoing surgery (n = 865), PN was more common for those aged <65 years (61%) than for those aged ≥65 years (44%), with this difference significant after adjusting for patient, tumour (odds ratio 0.50, 95% confidence interval 0.36-0.70). There were significant interactions between age and treatment centre volume (P < 0.05) and residential state (P < 0.05). PN was less likely for younger patients treated at lower-volume hospitals (<24 patients a year) but hospital volume was not associated with PN for older patients. PN was less likely for older patients in Queensland than Victoria. In multivariable analyses, age was not related to laparoscopic surgery. Queensland clinicians were less likely than those from Victoria to agree that PN was the treatment of choice for most T1aN0M0 tumours (P < 0.001). CONCLUSIONS In Australia, patients aged > 65 years with small renal cancers were less likely to be treated by PN than younger patients. The variation in the surgical procedure used to treat older T1a RCC patients by state and hospital volume indicates that better evidence is needed to direct practice in this area.
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Affiliation(s)
- Victoria M White
- Deakin University, Burwood, Vic., Australia.,Cancer Council Victoria, Melbourne, Vic., Australia
| | - David J T Marco
- Centre for Palliative Care, St Vincent's Hospital, Fitzroy, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia
| | | | | | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia.,School of Public Health, The University of Queensland, Brisbane, Qld, Australia
| | | | - Ian D Davis
- Eastern Health Clinical School, Monash University, Box Hill, Vic, Australia.,Eastern Health, Box Hill, Vic, Australia
| | - Simon Wood
- Centre for Kidney Disease Research, Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia.,Department of Urology, Princess Alexandra Hospital, Brisbane, Qld, Australia.,Translational Research Institute, Brisbane, Qld, Australia
| | - Graham G Giles
- Cancer Council Victoria, Melbourne, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia
| | - Susan J Jordan
- QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia.,School of Public Health, The University of Queensland, Brisbane, Qld, Australia
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27
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Chavali JSS, Bertolo R, Kara O, Garisto J, Mouracade P, Nelson RJ, Dagenais J, Kaouk JH. Renal Arterial Pseudoaneurysm After Partial Nephrectomy: Literature Review and Single-Center Analysis of Predictive Factors and Renal Functional Outcomes. J Laparoendosc Adv Surg Tech A 2018; 29:45-50. [PMID: 30300074 DOI: 10.1089/lap.2018.0364] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Partial nephrectomy (PN) represents the current surgical standard for T1 tumors. Renal arterial pseudoaneurysm is a rare but potentially life-threatening complication reported after PN. The aim of this study was to identify the factors associated with the occurrence of pseudoaneurysm after PN, specifically focusing on those requiring management with selective embolization. A literature review of the topic was performed. METHODS A retrospective review of the institutional PN database was performed from January 2011 to December 2016. Patients who underwent embolization for pseudoaneurysm represented a separated cohort to be compared with other patients (controls). Patients' and tumors' characteristics were considered. Univariable and multivariable analyses were used to test their eventual association with the occurrence of pseudoaneurysm. RESULTS A total of 1417 cases were evaluated. At a median of 21 days (interquartile range = 10-34), 20 patients (1.4%) developed postoperative pseudoaneurysm. The majority of patients (70%) presented with gross hematuria. The clinical suspicion was confirmed by contrast-enhanced computed tomography scan with angiography. Selective embolization was performed using endovascular coils. Technical success and clinical success rates were 100% and 95%, respectively. No difference was found in percentage estimated glomerular filtration rate (eGFR) preserved between patients who underwent embolization versus controls (median 82.6% versus 86.3%, P = .35). No differences in age, baseline renal function (as assessed by glomerular filtration rate [GFR]), tumor size, and R.E.N.A.L. were found between patients who reported and did not report pseudoaneurysm. In patients who developed pseudoaneurysm, longer operative time (225.6 minutes versus 193 minutes, P = .04), and cold ischemia time (48 minutes versus 29 minutes, P = .03) were reported. CONCLUSION In our series, the occurrence of pseudoaneurysm was associated with longer operative and cold ischemia times. In patients who underwent selective embolization, renal function remained comparable with that of controls.
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Affiliation(s)
- Jaya Sai S Chavali
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Riccardo Bertolo
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Onder Kara
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Juan Garisto
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Pascal Mouracade
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ryan J Nelson
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Julien Dagenais
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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28
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Richard PO, Lavallée LT, Pouliot F, Komisarenko M, Martin L, Lattouf JB, Finelli A. Is Routine Renal Tumor Biopsy Associated with Lower Rates of Benign Histology following Nephrectomy for Small Renal Masses? J Urol 2018; 200:731-736. [DOI: 10.1016/j.juro.2018.04.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Patrick O. Richard
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Centre de recherche du CHUS and University of Sherbrooke, Quebec, Canada
| | - Luke T. Lavallée
- Division of Urology, Department of Surgery, Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Frederic Pouliot
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Québec, Centre Hospitalier Universitaire de Québec Research Center, Université de Laval, Quebec, Canada
| | - Maria Komisarenko
- Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Lisa Martin
- Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Jean-Baptiste Lattouf
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montreal, University of Montreal, Montreal, Quebec, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Capogrosso P, Boeri L, Ventimiglia E, Camozzi I, Cazzaniga W, Chierigo F, Scano R, Briganti A, Montorsi F, Salonia A. Attitude towards active surveillance: a cross-sectional survey among patients with uroandrological disorders. BMJ Open 2018; 8:e022495. [PMID: 30158231 PMCID: PMC6119427 DOI: 10.1136/bmjopen-2018-022495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES We looked at subjective attitude towards active surveillance (AS) as the first option for cancer management in a cohort of patients seeking first medical help for uroandrological disorders prior to a formal discussion with a caregiver. DESIGN Cross-sectional observational study. SETTING Uroandrological outpatient clinic of a European academic centre. PARTICIPANTS Data of 1059 patients at their first access for uroandrological purposes from January 2014 to December 2016 were analysed. INTERVENTION Patients were invited to complete a survey with closed questions investigating their attitude towards AS, prior to any clinical evaluation. Likewise, patients were invited to score the importance given to different aspects of personal life in the case of a cancer diagnosis, using a 10-point Likert scale. PRIMARY AND SECONDARY OUTCOMES MEASURES The reported opinion towards AS management for cancer was assessed. Logistic regression analyses tested participants' sociodemographic characteristics associated with a positive opinion on AS. RESULTS Positive, negative and doubtful attitudes towards AS were observed in 347 (33%), 331 (31%) and 381 (36%) patients, respectively. Female patients were more likely to report a negative attitude towards AS (38.7% vs 29.6%, p=0.04) while patients with previous parenthood more frequently reported a positive opinion on AS (37.2% vs 29.9%, p=0.005). Patient age emerged as the only predictor of a positive attitude towards AS (OR 1.03; 95% CI 1.01 to 1.04, p<0.001), with a 46% and 33% probability of being pro-AS for a patient aged 65 and 45 years, respectively. CONCLUSIONS One out of three patients would express positive feedbacks on AS in the unfortunate case of tumour diagnosis, only according to his/her baseline personal opinion and prior to any discussion with a cancer caregiver. The older the patient, the higher the probability of being compliant with a conservative management for cancer.
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Affiliation(s)
- Paolo Capogrosso
- Urology, Università Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Luca Boeri
- Urology, Università Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Eugenio Ventimiglia
- Urology, Università Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Ilenya Camozzi
- Department of Sociology and Social Research, University of Milano-Bicocca, Milan, Italy
| | - Walter Cazzaniga
- Urology, Università Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Francesco Chierigo
- Urology, Università Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Roberta Scano
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Alberto Briganti
- Urology, Università Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Francesco Montorsi
- Urology, Università Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Andrea Salonia
- Urology, Università Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milano, Italy
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Herlemann A, Odisho AY, Porten SP. Partial Nephrectomy is the Surgical Treatment of Choice for (Most) Complex Localized Renal Tumors. KIDNEY CANCER 2018. [DOI: 10.3233/kca-180039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Annika Herlemann
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Anobel Y. Odisho
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Sima P. Porten
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
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Talenfeld AD, Gennarelli RL, Elkin EB, Atoria CL, Durack JC, Huang WC, Kwan SW. Percutaneous Ablation Versus Partial and Radical Nephrectomy for T1a Renal Cancer: A Population-Based Analysis. Ann Intern Med 2018; 169:69-77. [PMID: 29946703 PMCID: PMC8243237 DOI: 10.7326/m17-0585] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background Stage T1a renal cell carcinoma (RCC) (tumors <4 cm) is usually curable. Nephron-sparing partial nephrectomy (PN) has replaced radical nephrectomy (RN) as the standard of care for these tumors. Radical nephrectomy remains the first alternative treatment option, whereas percutaneous ablation (PA), a newer, nonsurgical treatment, is recommended less strongly because of the relative paucity of comparative PA data. Objective To compare PA, PN, and RN outcomes. Design Observational cohort analysis using inverse probability of treatment-weighted propensity scores. Setting Population-based SEER (Surveillance, Epidemiology, and End Results) cancer registry data linked to Medicare claims. Patients Persons aged 66 years or older who received treatment for T1a RCC between 2006 and 2011. Interventions PA versus PN and RN. Measurements RCC-specific and overall survival, 30- and 365-day postintervention complications. Results 4310 patients were followed for a median of 52 months for overall survival and 42 months for RCC-specific survival. After PA versus PN, the 5-year RCC-specific survival rate was 95% (95% CI, 93% to 98%) versus 98% (CI, 96% to 99%); after PA versus RN, 96% (CI, 94% to 98%) versus 95% (CI, 93% to 96%). After PA versus PN, the 5-year overall survival rate was 77% (CI, 74% to 81%) versus 86% (CI, 84% to 88%); after PA versus RN, 74% (CI, 71% to 78%) versus 75% (CI, 73% to 77%). Cumulative rates of renal insufficiency 31 to 365 days after PA, PN, and RN were 11% (CI, 8% to 14%), 9% (CI, 8% to 10%), and 18% (CI, 17% to 20%), respectively. Rates of nonurologic complications within 30 days after PA, PN, and RN were 6% (CI, 4% to 9%), 29% (CI, 27% to 30%), and 30% (CI, 28% to 32%), respectively. Ten percent of patients in the PN group had intraoperative conversion to RN. Seven percent of patients in the PA group received additional PA within 1 year of treatment. Limitations Analysis of observational data may have been affected by residual confounding by provider or from selection bias toward younger, healthier patients in the PN group. Findings from this older study population are probably less applicable to younger patients. Use of SEER-Medicare linked files prevented analysis of patients who received treatment after 2011, possibly reducing generalizability to the newest PA, PN, and RN techniques. Conclusion For well-selected older adults with T1a RCC, PA may result in oncologic outcomes similar to those of RN, but with less long-term renal insufficiency and markedly fewer periprocedural complications. Compared with PN, PA may be associated with slightly shorter RCC-specific survival but fewer periprocedural complications. Primary Funding Source Association of University Radiologists GE Radiology Research Academic Fellowship and Society of Interventional Radiology Foundation.
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Affiliation(s)
| | - Renee L Gennarelli
- Memorial Sloan Kettering Cancer Center, New York, New York (R.L.G., E.B.E., C.L.A., J.C.D.)
| | - Elena B Elkin
- Memorial Sloan Kettering Cancer Center, New York, New York (R.L.G., E.B.E., C.L.A., J.C.D.)
| | - Coral L Atoria
- Memorial Sloan Kettering Cancer Center, New York, New York (R.L.G., E.B.E., C.L.A., J.C.D.)
| | - Jeremy C Durack
- Memorial Sloan Kettering Cancer Center, New York, New York (R.L.G., E.B.E., C.L.A., J.C.D.)
| | - William C Huang
- New York University Langone Medical Center, New York, New York (W.C.H.)
| | - Sharon W Kwan
- University of Washington, Seattle, Washington (S.W.K.)
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Özcan MF, Altınova S, Atan A. Treatment approaches to small renal masses in patients of advanced age (≥75 years). Turk J Urol 2018; 44:281-286. [PMID: 29932396 DOI: 10.5152/tud.2018.04829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 02/28/2018] [Indexed: 02/06/2023]
Abstract
The elderly population is increasing in Turkey and across the world. With the frequent use of imaging modalities, the detection rate of coincidental small renal mass has also increased. Since small renal masses are generally not malignant, most of them can be followed up by active surveillance. In the current study, we examined the treatment options that can be offered to elderly patients with small renal masses. The optimum treatment method for patients of advanced age presenting with renal masses should be determined based on the presence of comorbidities such as age, renal function, and tumor characteristics.
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Affiliation(s)
- Muhammet Fuat Özcan
- Department of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | | | - Ali Atan
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey
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33
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Richard PO, Martin L, Lavallée LT, Violette PD, Komisarenko M, Evans AJ, Jain K, Jewett MAS, Finelli A. Identifying the use and barriers to the adoption of renal tumour biopsy in the management of small renal masses. Can Urol Assoc J 2018; 12:260-266. [PMID: 29629862 DOI: 10.5489/cuaj.5065] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Renal tumour biopsies (RTBs) can provide the histology of small renal masses (SRMs) prior to treatment decision-making. However, many urologists are reluctant to use RTB as a standard of care. This study characterizes the current use of RTB in the management of SRMs and identifies barriers to a more widespread adoption. METHODS A web-based survey was sent to members of the Canadian and Quebec Urological Associations who had registered email address (n=767) in June 2016. The survey examined physicians' practice patterns, RTB use, and potential barriers to RTB. Chi-squared tests were used to assess for differences between respondents. RESULTS The response rate was 29% (n=223), of which 188 respondents were eligible. A minority of respondents (12%) perform RTB in >75% of cases, while 53% never perform or perform RTB in <25% of cases. Respondents with urological oncology fellowship training were more likely to request a biopsy than their colleagues without such training. The most frequent management-related reason for not using routine RTB was a belief that biopsy won't alter management, while the most frequent pathology-related reason was the risk of obtaining a false-negative or a non-diagnostic biopsy. CONCLUSIONS Adoption of RTBs remains low in Canada. Concerns about the accuracy of RTB and its ability to change clinical practice are the largest barriers to adoption. A knowledge translation strategy is needed to address these concerns. Future studies are also required in order to define where RTB is most valuable and how to best to implement it.
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Affiliation(s)
- Patrick O Richard
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Centre de Recherche du CHUS and the University of Sherbrooke, Sherbrooke, QC, Canada
| | - Lisa Martin
- Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON, Canada
| | - Philippe D Violette
- Division of Urology, Department of Surgery, Woodstock General Hospital and Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Maria Komisarenko
- Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Andrew J Evans
- Department of Laboratory Medicine and Pathobiology, Toronto General Hospital, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Kunal Jain
- Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Michael A S Jewett
- Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
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Lee H, Hong H, Kim J, Jung DC. Deep feature classification of angiomyolipoma without visible fat and renal cell carcinoma in abdominal contrast-enhanced CT images with texture image patches and hand-crafted feature concatenation. Med Phys 2018; 45:1550-1561. [DOI: 10.1002/mp.12828] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/20/2017] [Accepted: 02/07/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Hansang Lee
- School of Electrical Engineering; Korea Advanced Institute of Science and Technology; 291 Daehak-ro, Yuseong-gu Daejeon 34141 Korea
| | - Helen Hong
- Department of Software Convergence; College of Interdisciplinary Studies for Emerging Industries; Seoul Women's University; 621 Hwarang-ro Nowon-gu, Seoul 01797 Korea
| | - Junmo Kim
- School of Electrical Engineering; Korea Advanced Institute of Science and Technology; 291 Daehak-ro, Yuseong-gu Daejeon 34141 Korea
| | - Dae Chul Jung
- Department of Radiology; Severance Hospital; Research Institute of Radiological Science; Yonsei University College of Medicine; 50-1 Yonsei-ro, Seodaemun-gu Seoul 03722 Korea
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35
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Abstract
With the ubiquitous use of cross-sectional abdominal imaging in recent years, the incidence of small renal masses (SRMs) has increased, and the evaluation and management of SRMs have become important clinical issues. Diagnosing a mass in the early stages theoretically allows for high rates of cure but simultaneously risks overtreatment. In the past 20 years, surgical treatment of SRMs has transitioned from radical nephrectomy for all renal tumors, regardless of size, to elective partial nephrectomy whenever technically feasible. Additionally, newer approaches, including renal mass biopsy, active surveillance for select patients, and renal mass ablation, have been increasingly used. In this chapter, we review the current evidence-based papers covering aspects of the diagnosis and management of SRMs.
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Affiliation(s)
- Avinash Chenam
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, 1500 E. Duarte Rd, MOB L002H, Duarte, CA, 91010, USA
| | - Clayton Lau
- Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, 1500 E. Duarte Rd, MOB L002H, Duarte, CA, 91010, USA.
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36
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Incidence of T3a up-staging and survival after partial nephrectomy: Size-stratified rates and implications for prognosis. Urol Oncol 2018; 36:12.e7-12.e13. [DOI: 10.1016/j.urolonc.2017.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/09/2017] [Accepted: 09/05/2017] [Indexed: 12/21/2022]
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37
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Tang DH, Nawlo J, Chipollini J, Gilbert SM, Poch M, Pow-Sang JM, Sexton WJ, Spiess PE. Management of Renal Masses in an Octogenarian Cohort: Is There a Right Approach? Clin Genitourin Cancer 2017; 15:696-703. [DOI: 10.1016/j.clgc.2017.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/26/2017] [Accepted: 05/01/2017] [Indexed: 11/29/2022]
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38
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Influence of renal biopsy results on the management of small kidney cancers in older patients: Results from a population-based cohort. Urol Oncol 2017; 35:604.e1-604.e9. [DOI: 10.1016/j.urolonc.2017.05.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/22/2017] [Accepted: 05/30/2017] [Indexed: 11/23/2022]
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39
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Holding Strength of a Hem-o-lok/Lapra-Ty Clip Combination on Sutures Used During Partial Nephrectomy. Urology 2017; 107:138-143. [DOI: 10.1016/j.urology.2017.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 11/20/2022]
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40
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Lee HS, Hong H, Jung DC, Park S, Kim J. Differentiation of fat-poor angiomyolipoma from clear cell renal cell carcinoma in contrast-enhanced MDCT images using quantitative feature classification. Med Phys 2017; 44:3604-3614. [DOI: 10.1002/mp.12258] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Han Sang Lee
- School of Electrical Engineering; Korea Advanced Institute of Science and Technology; 291 Daehak-ro, Yuseong-gu Daejeon 34141 Korea
| | - Helen Hong
- Department of Software Convergence; College of Interdisciplinary Studies for Emerging Industries; Seoul Women's University; 621 Hwarang-ro, Nowon-gu Seoul 01797 Korea
| | - Dae Chul Jung
- Department of Radiology; Severance Hospital; Research Institute of Radiological Science; Yonsei University College of Medicine; 50-1 Yonsei-ro, Seodaemun-gu Seoul 03722 Korea
| | - Seunghyun Park
- Department of Radiology; Severance Hospital; Research Institute of Radiological Science; Yonsei University College of Medicine; 50-1 Yonsei-ro, Seodaemun-gu Seoul 03722 Korea
| | - Junmo Kim
- School of Electrical Engineering; Korea Advanced Institute of Science and Technology; 291 Daehak-ro, Yuseong-gu Daejeon 34141 Korea
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41
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Katsnelson J, Barnes RJ, Patel HA, Monie D, Kaufman T, Hellenthal NJ. Effect of median household income on surgical approach and survival in renal cell carcinoma. Urol Oncol 2017; 35:541.e1-541.e6. [PMID: 28549821 DOI: 10.1016/j.urolonc.2017.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/28/2017] [Accepted: 05/05/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE We sought to determine whether median household income (MHI) independently predicts surgical approach (partial vs. radical nephrectomy) and survival in patients with renal cell carcinoma. METHODS The U.S. Surveillance Epidemiology and End Results Database (1988-2011) was queried to examine kidney cancer cases and linked to the Area Health Resources File. We correlated surgical approach and survival, both overall and cancer-specific, with tumor stage, age, race, sex, and income data. RESULTS Of 152,589 patients diagnosed with renal cell carcinoma, 24,221 (16%) patients underwent partial nephrectomy, 102,771 (67%) patients underwent radical nephrectomy, and 25,597 (17%) patients had no surgery. There was no significant difference in stage of presentation between the wealthiest and poorest MHI quartiles, with approximately 35% of patients in each quartile presenting with T1aN0M0 disease and 17% of patients presenting with metastatic disease. Despite this, 18% of patients in the wealthiest quartile underwent partial nephrectomy compared to 14% of patients in the poorest quartile. Although the percentage of patients undergoing partial nephrectomy rose over the timeframe studied in both the wealthiest and poorest quartiles, the rate of rise was highest in the wealthier group. Those in the poorest quartile were 0.10 times more likely to die of all causes (95% CI: 1.09-1.11, P<0.001) and 0.09 times more likely to die of kidney cancer (95% CI: 1.05-1.10, P<0.001) than those in the wealthiest quartile over the timeframe studied. CONCLUSIONS Despite presenting with similar stage, patients with lower MHI less commonly undergo partial nephrectomy and are more likely to die of kidney cancer than those in the highest MHIs.
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Affiliation(s)
| | | | - Hunaiz A Patel
- Department of Surgery, Bassett Healthcare, Cooperstown, NY
| | - Daphne Monie
- Department of Surgery, Bassett Healthcare, Cooperstown, NY
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Dey S, Hamilton Z, Noyes SL, Tobert CM, Keeley J, Derweesh IH, Lane BR. Chronic Kidney Disease Is More Common in Locally Advanced Renal Cell Carcinoma. Urology 2017; 105:101-107. [PMID: 28365357 DOI: 10.1016/j.urology.2017.03.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/20/2017] [Accepted: 03/23/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To retrospectively evaluate clinical predictors of chronic kidney disease (CKD) in renal cell carcinoma (RCC) patients to identify associations between patient- and tumor-specific factors with poorer renal function. CKD and RCC are interrelated, with 26%-44% of RCC patients having concomitant CKD at diagnosis. PATIENTS AND METHODS Institutional registries from Spectrum Health and University of California, San Diego, were queried for preoperative glomerular filtration rate and proteinuria status before radical or partial nephrectomy. Preoperative clinical and tumor factors were recorded; proteinuria was classified as A1 (<30 mg), A2 (30-300 mg), and A3 (>300 mg). CKD was grouped by Kidney Disease Improving Global Outcomes classification (low, moderately increased, high, very high). RESULTS We evaluated 1569 patients undergoing surgery for renal cortical tumors. CKD status was low risk in 860 (55%), moderately increased in 381 (24%), high in 194 (12%), and very high in 134 (9%) patients. Increased radius, exophytic or endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior or posterior, location relative to polar lines score, tumor size, and clinical tumor stage were strongly associated with increased CKD risk at baseline. Clinical stage T3/T4 disease had more at-risk patients than stages T2 and T1 disease (39.5% vs 22% and 19%, P = .0001). Clinical tumor stage and gender were the only predictors of proteinuria, lower glomerular filtration rate, and higher CKD risk group in both univariate and multivariate analyses. CONCLUSION Forty-five percent of patients with RCC had moderate or higher CKD before treatment. A positive correlation between pretreatment CKD and locally advanced RCC (cT3/T4) was present. This likely relates to increased loss of functional parenchyma with increasing tumor size or stage, with important implications in patient management.
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Affiliation(s)
- Sumi Dey
- Spectrum Health, Grand Rapids, MI
| | | | | | | | | | | | - Brian R Lane
- Spectrum Health, Grand Rapids, MI; Michigan State University College of Human Medicine, Grand Rapids, MI.
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Yang CS, Choi E, Idrees MT, Chen S, Wu HH. Percutaneous biopsy of the renal mass: FNA or core needle biopsy? Cancer Cytopathol 2017; 125:407-415. [PMID: 28334518 DOI: 10.1002/cncy.21852] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/06/2017] [Accepted: 02/21/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND In recent years, there have been increasing indications for percutaneous renal biopsy. Fine-needle aspiration (FNA), with or without core needle biopsy (CB), has been used increasingly in the management of renal tumors at the study institution. METHODS A computerized search of laboratory records was conducted to retrieve FNA cases of renal masses as well as the correlating CB and/or nephrectomy specimens. The cases spanned a period of 10 years (2006-2015). The diagnoses were classified into 5 categories: malignant, suspicious for malignancy, neoplastic, atypical, and negative/nondiagnostic. Based on the results of the nephrectomy specimens, the diagnostic rate, sensitivity, and diagnostic accuracy were calculated among 3 groups of specimens: FNA only, CB only, and combined FNA and CB. RESULTS A total of 247 cases of FNA with 123 correlating CB and 101 follow-up nephrectomy specimens were identified. The diagnostic rate, sensitivity, and diagnostic accuracy were 72%, 78%, and 96%, respectively, for FNA; 87%, 92%, and 94%, respectively, for CB; and 92%, 92%, and 94%, respectively, for the combined FNA and CB group. Renal cell carcinoma and its variants were the most common histologic diagnoses (112 of 174 cases; 64%). Significant diagnostic discrepancy was noted in one case: a malignant melanoma that was misdiagnosed as renal cell carcinoma in both the preoperative FNA specimen and in the CB specimen. CONCLUSIONS In the current study, both FNA and CB demonstrated excellent diagnostic accuracy (96% and 94%, respectively). The combination of FNA and CB was found to significantly improve the diagnostic rate when compared with either FNA alone (92% vs 72%; P<.05) or CB alone (92% vs 87%). Cancer Cytopathol 2017;125:407-15. © 2017 American Cancer Society.
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Affiliation(s)
- Chi-Shun Yang
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Euna Choi
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Muhammad T Idrees
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Shaoxiong Chen
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Howard H Wu
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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44
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Drangsholt S, Huang WC. Current Trends in Renal Surgery and Observation for Small Renal Masses. Urol Clin North Am 2017; 44:169-178. [PMID: 28411909 DOI: 10.1016/j.ucl.2016.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
There has been a rising incidence of small renal masses and concomitant downward stage migration. This has led to an evolution in the management of kidney cancer from radical nephrectomy to nephron-sparing treatment options including observation. The adoption of partial nephrectomy continues to increase but is still incomplete leading to significant disparities in the delivery of care throughout the country. Surgical excision remains the treatment of choice for small kidney cancers; however, ablative therapies and active surveillance are emerging as reasonable options for select patients. With continued refinements in treatment options and improvements in ability to risk stratify SRMs, the current treatment trends will likely continue to evolve.
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Affiliation(s)
- Siri Drangsholt
- Department of Urology, NYU Langone Medical Center, 150 East 32nd Street, New York, NY 10016, USA
| | - William C Huang
- Department of Urology, Perlmutter Cancer Center, NYU Langone Medical Center, 150 East 32nd Street, New York, NY 10016, USA.
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Magnetic Resonance Imaging and the Use in Small Renal Masses. Indian J Surg Oncol 2017; 8:19-23. [PMID: 28127178 DOI: 10.1007/s13193-016-0575-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/21/2016] [Indexed: 01/06/2023] Open
Abstract
The incidence of small renal masses (SRM) has been increasing, and this is mainly attributed to the incidental finding of such masses on imaging performed in asymptomatic patients. Consequently, this calls for careful evaluation and management of these masses to determine their nature and need for treatment. This article reviews current literature regarding the evaluation and management of SRM. It focuses on the specific use of MRI in the diagnosis and management of SRM. A Medline review of the literature was performed from 1996 to the present time. Computed tomography (CT) imaging has been the investigation of choice for evaluating SRM. However, some remain difficult to determine their malignant or benign nature and remain indeterminate. In such cases, further imaging with magnetic resonance imaging (MRI) can be performed to evaluate the mass in more detail. It can also be used where CT is contraindicated and where active surveillance is the treatment of choice and radiation exposure is a concern. MRI is a useful tool in evaluating an indeterminate small renal mass. Accurate diagnosis and management of SRM require close collaboration between a urologist and radiologist to identify potentially malignant tumours to subsequently reduce mortality from renal cell cancer.
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Finelli A, Ismaila N, Bro B, Durack J, Eggener S, Evans A, Gill I, Graham D, Huang W, Jewett MAS, Latcha S, Lowrance W, Rosner M, Shayegan B, Thompson RH, Uzzo R, Russo P. Management of Small Renal Masses: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2017; 35:668-680. [PMID: 28095147 DOI: 10.1200/jco.2016.69.9645] [Citation(s) in RCA: 228] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose To provide recommendations for the management options for patients with small renal masses (SRMs). Methods By using a literature search and prospectively defined study selection, we sought systematic reviews, meta-analyses, randomized clinical trials, prospective comparative observational studies, and retrospective studies published from 2000 through 2015. Outcomes included recurrence-free survival, disease-specific survival, and overall survival. Results Eighty-three studies, including 20 systematic reviews and 63 primary studies, met the eligibility criteria and form the evidentiary basis for the guideline recommendations. Recommendations On the basis of tumor-specific findings and competing risks of mortality, all patients with an SRM should be considered for a biopsy when the results may alter management. Active surveillance should be an initial management option for patients who have significant comorbidities and limited life expectancy. Partial nephrectomy (PN) for SRMs is the standard treatment that should be offered to all patients for whom an intervention is indicated and who possess a tumor that is amenable to this approach. Percutaneous thermal ablation should be considered an option if complete ablation can reliably be achieved. Radical nephrectomy for SRMs should only be reserved for patients who possess a tumor of significant complexity that is not amenable to PN or for whom PN may result in unacceptable morbidity even when performed at centers with expertise. Referral to a nephrologist should be considered if chronic kidney disease (estimated glomerular filtration rate < 45 mL/min/1.73 m2) or progressive chronic kidney disease occurs after treatment, especially if associated with proteinuria.
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Affiliation(s)
- Antonio Finelli
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Nofisat Ismaila
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Bill Bro
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Jeremy Durack
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Scott Eggener
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Andrew Evans
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Inderbir Gill
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - David Graham
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - William Huang
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Michael A S Jewett
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Sheron Latcha
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - William Lowrance
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Mitchell Rosner
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Bobby Shayegan
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - R Houston Thompson
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Robert Uzzo
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
| | - Paul Russo
- Antonio Finelli and Michael A.S. Jewett, Princess Margaret Cancer Center; Andrew Evans, University Health Network, Toronto; Bobby Shayegan, St Joseph Hospital, Hamilton, Ontario, Canada; Nofisat Ismaila, American Society of Clinical Oncology, Alexandria; Mitchell Rosner, University of Virginia School of Medicine, Charlottesville, VA; Bill Bro, Kidney Cancer Association; Scott Eggener, University of Chicago, Chicago, IL; Jeremy Durack, Sheron Latcha, and Paul Russo, Memorial Sloan Kettering Cancer Center; William Huang, New York University Langone Medical Center, New York, NY; Inderbir Gill, University of Southern California, Los Angeles, CA; David Graham, Levine Cancer Institute, Charlotte, NC; William Lowrance, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT; R. Houston Thompson, Mayo Clinic, Rochester, MN; and Robert Uzzo, Fox Chase Cancer Center, Philadelphia, PA
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Active surveillance for incidental renal mass in the octogenarian. World J Urol 2016; 35:1089-1094. [DOI: 10.1007/s00345-016-1961-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022] Open
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Davila HH, Storey RE, Rose MC. Robotic-assisted laparoscopic radical nephrectomy using the Da Vinci Si system: how to improve surgeon autonomy. Our step-by-step technique. J Robot Surg 2016; 10:285-8. [PMID: 27272759 DOI: 10.1007/s11701-016-0608-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/24/2016] [Indexed: 11/25/2022]
Abstract
Herein, we describe several steps to improve surgeon autonomy during a Left Robotic-Assisted Laparoscopic Radical Nephrectomy (RALRN), using the Da Vinci Si system. Our kidney cancer program is based on 2 community hospitals. We use the Da Vinci Si system. Access is obtained with the following trocars: Two 8 mm robotic, one 8 mm robotic, bariatric length (arm 3), 15 mm for the assistant and 12 mm for the camera. We use curved monopolar scissors in robotic arm 1, Bipolar Maryland in arm 2, Prograsp Forceps in arm 3, and we alternate throughout the surgery with EndoWrist clip appliers and the vessel sealer. Here, we described three steps and the use of 3 robotic instruments to improve surgeon autonomy. Step 1: the lower pole of the kidney was dissected and this was retracted upwards and laterally. This maneuver was performed using the 3rd robotic arm with the Prograsp Forceps. Step 2: the monopolar scissors was replaced (robotic arm 1) with the robotic EndoWrist clip applier, 10 mm Hem-o-Lok. The renal artery and vein were controlled and transected by the main surgeon. Step 3: the superior, posterolateral dissection and all bleeders were carefully coagulated by the surgeon with the EndoWrist one vessel sealer. We have now performed 15 RALRN following these steps. Our results were: blood loss 300 cc, console time 140 min, operating room time 200 min, anesthesia time 180 min, hospital stay 2.5 days, 1 incisional hernia, pathology: (13) RCC clear cell, (1) chromophobe and (1) papillary type 1. Tumor Stage: (5) T1b, (8) T2a, (2) T2b. We provide a concise, step-by-step technique for radical nephrectomy (RN) using the Da Vinci Si robotic system that may provide more autonomy to the surgeon, while maintaining surgical outcome equivalent to standard laparoscopic RN.
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Affiliation(s)
- Hugo H Davila
- Florida Healthcare Specialist, Urology and Minimally Invasive Surgery, 3730 7th Terrance, Vero Beach, FL, 32960, USA.
- Florida Cancer Specialist at Vero Beach, Vero Beach, FL, USA.
- Scully-Welsh Cancer Center, Indian River Urology Associates, Florida State University College of Medicine, 787 37th Street, Suite E-200, Vero Beach, FL, 32960, USA.
| | - Raul E Storey
- Florida Healthcare Specialist, Urology and Minimally Invasive Surgery, 3730 7th Terrance, Vero Beach, FL, 32960, USA
- Florida Cancer Specialist at Vero Beach, Vero Beach, FL, USA
- Scully-Welsh Cancer Center, Indian River Urology Associates, Florida State University College of Medicine, 787 37th Street, Suite E-200, Vero Beach, FL, 32960, USA
| | - Marc C Rose
- Scully-Welsh Cancer Center, Indian River Urology Associates, Florida State University College of Medicine, 787 37th Street, Suite E-200, Vero Beach, FL, 32960, USA
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Abstract
PURPOSE OF REVIEW The purpose is to discuss current data on the utilization and outcomes of active surveillance for T1a renal masses. Specifically, to address which patients are optimal for active surveillance and how their outcomes differ from those undergoing immediate treatment. RECENT FINDINGS Although nephron sparing surgery is the standard of care for small renal masses (SRMs), active surveillance is becoming a more popular intervention given the results of prospective studies revealing active surveillance to be safe and have excellent cancer-specific survival with intermediate follow-up. Older and sicker patients have competing risk of death from other causes when diagnosed with a SRM. SUMMARY Active surveillance is becoming a more popular treatment modality for SRMs given the increasing number of incidental diagnoses and better understanding of their often indolent course. Active surveillance with delayed intervention is a well-tolerated treatment modality and appears to have the most benefit for those patients that are older with more comorbidities.
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