The laparoscopic management of symptomatic renal cysts: A single-centre experience

Aspiration-sclerotherapy versus laparoscopic de-roofing in the treatment of renal cysts: which is better?

BACKGROUND

To compare the clinical efficiency between aspiration-sclerotherapy (AS) and laparoscopic de-roofing (LD) in the management of renal cysts through meta-analysis of comparative studies.

METHOD

A comprehensive literature search was performed by PubMed, MEDLINE, Ovid and Web of Science for relevant studies published up to January 2020. The statistical analyses were conducted with Review Manager 5.3.0 and Stata 15.1. The sensitivity analysis was also carried out to confirm the reliability of this Meta-analysis.

RESULTS

Our searches of literature generated 6 studies (1547 patients incorporated) comparing AS with LD in the impacts of renal cyst therapy. Of these, 6 studies contained 1106 and 441 patients who were treated with AS and LD, respectively. The outcome of this meta-analysis indicated that LD group was superior in symptomatic successful rate [Odds Ratio (OR): 0.28; 95%Confidence Interval (CI): 0.09 to 0.86; P = 0.03), radiological successful rate (OR: 0.06; 95%CI: 0.02 to 0.15; P < 0.01) and recurrence rate (OR: 6.08; 95%CI: 2.81 to 13.15; p < 0.01). Nevertheless, AS group had shorter treatment time [Mean Difference (MD):-51.10; 95% CI:-73.01 to - 29.20; p < 0.01]. No statistically significant difference was showed in the rate of complications (OR: 3.19; 95% CI: 0.39 to 25.88; P = 0.28).

CONCLUSIONS

In our meta-analysis, LD had higher symptomatic successful rate, radiological successful rate as well as lower recurrence rate than AS, while the treatment time was longer.

Surgical fenestration combined with omentalization for the treatment of renal cysts in 2 dogs

Two cases of surgical fenestration combined with omentalization for canine renal cysts using laparotomy and laparoscopy are described. After surgery, the cystic lesions gradually diminished in size, and a complete regression was confirmed in Case 2 by ultrasonography. The dogs maintained good condition without clinical signs of renal compromise for 14 months (Case 1) and 24 months (Case 2). Omentalization is a simple and effective procedure for canine renal cysts that conserves the remaining parenchyma and can be performed by a laparoscopic approach.

Limitations of CT scanning in Bosniak staging of renal cystic carcinoma

The Bosniak Classification is used to quantify the risk of malignancy and need for observation or radical treatment based on the findings of computed tomography (CT). The case described is that of a 65-year-old man with renal cystic disease who was initially given a Bosniak stage IIF classification and was subsequently managed with CT surveillance. CT surveillance showed increased cyst size in the left kidney with cystic changes, however, the Bosniak classification remained the same. It was not until the patient deteriorated further that an MRI was indicated. The MRI findings upgraded the lesion from Bosniak IIF to Bosniak III. As a result, the patient underwent a radical left nephrectomy and a biopsy, which revealed clear cell carcinoma. This case argues the limitations of the Bosniak classification and the value of using MRI at an earlier stage, especially with unusual circumstances such as a chronic history of enlarging cysts.

Robot-assisted partial nephrectomy confers excellent long-term outcomes for the treatment of complex cystic renal tumors: Median follow up of 58 months

OBJECTIVES

To analyze long-term outcomes of robot-assisted partial nephrectomy for treatment of complex cystic renal tumors.

METHODS

We retrospectively analyzed the data of patients who underwent robot-assisted partial nephrectomy for cystic (n = 32) and solid (n = 263) renal masses at Severance Hospital, Seoul, Korea. The primary outcome was assessment of perioperative safety for cystic tumor. Secondary outcomes were evaluation of long-term oncological and functional results.

RESULTS

Patients' clinical and demographic characteristics were similar among both groups. The median follow up of cystic and solid masses were 58 and 46 months, respectively. Cystic masses were more likely to have low Fuhrman grade 1 and 2 (P = 0.03), and shorter operative time (P = 0.04) compared with solid masses. There was no statistically significant difference regarding warm ischemia time, estimated blood loss, trifecta achievement, length of hospital stay, complication rates and renal function preservation (P > 0.05) between groups. In the solid group, 12 patients (4.1%) recurred, and six patients (2%) died from metastatic renal cell carcinoma, whereas the patients in the cystic group did not have any local or distance recurrence, and the survival rates were 100%. The 5-year cancer-free survival (P = 0.77), cancer-specific survival (P = 0.65) and overall survival (P = 0.83) rates were similar between the groups.

CONCLUSION

Robot-assisted partial nephrectomy appears to be safe and feasible treatment for complex cystic renal masses. It confers excellent long-term oncological outcomes. Robot-assisted partial nephrectomy should be the treatment of choice for complex cysts whenever feasible.