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Bosnalı E, Baynal EA, Çınar NB, Akdas EM, Telli E, Yaprak Bayrak B, Teke K, Yılmaz H, Dillioğlugil Ö, Kara Ö. Oncological and functional outcomes of patients who underwent open partial nephrectomy for kidney tumor. Arch Ital Urol Androl 2023; 95:12130. [PMID: 38193219 DOI: 10.4081/aiua.2023.12130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 12/02/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE To report long-term functional and oncological outcomes of OPN Methods: We enrolled 182 patients who underwent consecutive OPN with a diagnosis of kidney tumor in our clinic between April 2002 and February 2020 and were selected from our prospective OPN database. Preoperative demographic and clinical characteristics, intraoperative and pathological results, and patients' postoperative functional and oncological follow-up data were retrospectively analyzed. Overall survival (OS) and disease- free survival (DFS) were evaluated using Kaplan-Meier survival analysis. The time-dependent variation between preoperative and postoperative functional results was statistically analyzed and presented in a graph. RESULTS AND LIMITATIONS The mean age was 54.4 ± 10.8 yr, and the median age-adjusted Charlson comorbidity index (ACCI) was 1 (interquartile range [IQR] 0-1). The mean tumor size was 3.1 ± 1.2 cm, and the median RENAL score was 6 (IQR 5-8). The most common malign histopathological subtype was clear cell carcinoma with 76.6%, and five cases (3.4%) had positive surgical margins (PSMs). The most common surgical techniques were the retroperitoneal approach (98.9%) and cold ischemia (88.5%). Estimated glomerular filtration rate (eGFR) preservation was 92% (80.8-99.3, IQR), which translates to 32% chronic kidney disease (CKD) upstaging. Acute kidney injury (AKI) was detected in 27 (14.8%) patients according to RIFLE criteria. The intraoperative complication rate was 5.5%, and the postoperative overall complication rate (Clavien-Dindo 1-5) was 30.2%. Major complications (Clavien-Dindo 3-5) were observed in 13 (7.1%) patients. The median oncological follow-up was 42 mo (21.3- 84.6, IQR), and the 5- and 10-yr OS were 90.1% and 78.6%, 5 and 10-yr DFS were 99.4% and 92.1%, respectively. No local recurrence was observed in 5 (3.4%) patients with PSMs; only one had distant metastasis in the 8th postoperative month. The retrospective design, the small number of patients who underwent PN based on mandatory indication, and one type of surgical approach may limit the generalizability of our findings. CONCLUSIONS This study confirms excellent long-term oncologic and functional outcomes after OPN in a cohort of patients selected from a single institution. In light of the information provided by the literature and our study, our recommendation is to push the limits of PN under every technically feasible condition in the treatment of kidney tumors to protect the kidney reserve and achieve near-perfect oncological results.
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Affiliation(s)
- Efe Bosnalı
- University of Health Sciences, Derince Training and Research Hospital, Department of Urology, Kocaeli.
| | | | - Naci Burak Çınar
- Kocaeli University, School of Medicine, Department of Urology, Kocaeli.
| | - Enes Malik Akdas
- Kocaeli University, School of Medicine, Department of Urology, Kocaeli.
| | - Engin Telli
- Kocaeli University, School of Medicine, Department of Urology, Kocaeli.
| | | | - Kerem Teke
- Kocaeli University, School of Medicine, Department of Urology, Kocaeli.
| | - Hasan Yılmaz
- Kocaeli University, School of Medicine, Department of Urology, Kocaeli.
| | | | - Önder Kara
- Kocaeli University, School of Medicine, Department of Urology, Kocaeli.
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Cignoli D, Salonia A, Bertini R, Montorsi F, Capitanio U, Larcher A. To clamp or not to clamp? A step back to go forward. BJU Int 2023; 132:716-717. [PMID: 37696650 DOI: 10.1111/bju.16177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Affiliation(s)
- Daniele Cignoli
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Bertini
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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3
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Cignoli D, Basile G, Fallara G, Rosiello G, Belladelli F, Cei F, Musso G, Re C, Bertini R, Karakiewicz P, Mottrie A, Dehò F, Gallina A, Montorsi F, Salonia A, Capitanio U, Larcher A. Risks and benefits of partial nephrectomy performed with limited or with zero ischaemia time. BJU Int 2023; 132:283-290. [PMID: 36932928 DOI: 10.1111/bju.16009] [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] [Indexed: 03/19/2023]
Abstract
OBJECTIVE To test the hypothesis that longer warm ischaemia time (WIT) might have a marginal impact on renal functional outcomes and might, in fact, reduce haemorrhagic risk intra-operatively. PATIENTS AND METHODS Data from 1140 patients treated with elective partial nephrectomy (PN) for a cT1-2 cN0 cM0 renal mass were prospectively collected. WIT was defined as the duration of clamping of the main renal artery with no refrigeration and was tested as a continuous variable. The primary outcome of the study was evaluation of the effect of WIT on renal function (estimated glomerular filtration rate [eGFR]) postoperatively, at 6 months and in the long term (measured between 1 and 5 years after surgery). The secondary outcome of the study was haemorrhagic risk, defined as estimated blood loss (EBL) or peri-operative transfusions. Multivariable linear, logistic and Cox regression analyses, accounting for age, Charlson comorbidity index, clinical size, preoperative eGFR and year of surgery, were used and the potential nonlinear relationship between WIT and the study outcomes was modelled using restricted cubic splines. RESULTS A total of 863 patients (76%) underwent PN with WIT and 277 (24%) without. The baseline median eGFR was 87.3 (68.8-99.2) mL/min/1.73m2 for the on-clamp population and 80.6 (63.2-95.2) mL/min/1.73m2 for the off-clamp population. The median duration of WIT was 17 (13-21) min. At multivariable analyses predicting renal function, longer WIT was associated with decreased postoperative eGFR (estimate: -0.21, 95% confidence interval [CI] -0.31; -0.11 [P < 0.001]). Conversely, no association between WIT and eGFR was recorded at 6-month or long-term follow-up (all P > 0.8). At multivariable analyses predicting haemorrhagic risk, clampless resection with no ischaemia time and PN with short WIT was associated with an increased EBL (estimate: -21.56, 95% CI -28.33; -14.79 [P < 0.001]) and peri-operative transfusion rate (estimate: -0.009, 95% CI -0.01; -0.003 [P = 0.002]). No association between WIT and positive surgical margin status was recorded (all P = 0.1). CONCLUSION Patients and clinicians should be aware that performing PN with very limited or even with zero WIT might increase bleeding and the need for peri-operative transfusion while not improving long-term renal function outcomes.
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Affiliation(s)
- Daniele Cignoli
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Basile
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Fallara
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Rosiello
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Federico Belladelli
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Cei
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giacomo Musso
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Re
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Bertini
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pierre Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Alexandre Mottrie
- Department of Urology, OLV Ziekenhuis Aalst, Aalst, Belgium
- ORSI Academy, Melle, Belgium
| | - Federico Dehò
- Department of Urology, Ospedale di Circolo e Fondazione Macchi-ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Andrea Gallina
- Department of Urology, Ospedale Regionale di Lugano, Civico USI-Università della Svizzera Italiana, Lugano, Switzerland
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Liu X, Jin D, Zhang Y, Zhang S. Limited non-linear impact of warm ischemia time on renal functional decline after partial nephrectomy: a propensity score-matched study. Int Urol Nephrol 2023:10.1007/s11255-023-03630-0. [PMID: 37191733 DOI: 10.1007/s11255-023-03630-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/08/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To quantificationally illustrate the impact of ischemia time (IT) on renal function decline after partial nephrectomy (PN), especially for patients with compromised baseline renal function (estimated glomerular filtration rate [eGFR] < 90 mL/min/1.73 m2). METHODS Patients undergoing PN during 2014-2021 from a prospectively maintained database were reviewed. Propensity score matching (PSM) was employed to balance the possible covariates between patients with or without baseline compromised renal function. Specifically, the relationship of IT with postoperative renal function was illustrated. Two machine learning methods (logistic least absolute shrinkage and selection operator [LASSO] logistic regression and random forest) were applied to quantify the relative impact of each covariables. RESULTS The average drop percent of eGFR was -10.9% (- 12.2%, - 9.0%). Multivariable Cox proportional regression and linear regression analyses identified five risk factors for renal function decline, namely RENAL Nephrometry Score (RNS), age, baseline eGFR, diabetes and IT (all p < 0.05). Specifically, the relationship of IT with postoperative functional decline emerged as non-linear, with an increase from 10-30 min and a plateau afterwards among patients with normal function (eGFR ≥ 90 mL/min/1.73 m2), whereas with an increase from 10 to 20 min and a plateau afterwards among patients with compromised function (eGFR < 90 mL/min/1.73 m2). Furthermore, the coefficient's path and random forest analysis revealed that the top two most important features were RNS and age. CONCLUSION IT exhibits the secondarily non-linear relationship with postoperative renal function decline. Patients with compromised baseline renal function are less tolerant to ischemia damage. The use of a single cut-off interval of IT in the setting of PN is flawed.
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Affiliation(s)
- Xudong Liu
- Department of Urology, Chongqing Bishan Hospital of Traditional Chinese Medicine, Chongqing, People's Republic of China
| | - Dachun Jin
- Department of Urology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
- Department of Urology, Daping Hospital/Army Medical Center, Army Medical University, Chongqing, People's Republic of China
| | - Yuanfeng Zhang
- Department of Urology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Sizhou Zhang
- Department of Urology, People's Hospital of Chongqing Hechuan, Chongqing, 401520, People's Republic of China.
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5
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Yu M, Zhou J, Shangguan X, Qian S, Ding J, Qi J. Nephron sparing surgery for a patient with a complicated solitary functioning kidney and a giant pT3 renal cell carcinoma: A case report. Front Surg 2023; 10:1094472. [PMID: 37009598 PMCID: PMC10063810 DOI: 10.3389/fsurg.2023.1094472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/20/2023] [Indexed: 03/19/2023] Open
Abstract
A solitary functioning kidney (SFK) with renal cell carcinoma (RCC) is an imperative indication for nephron-sparing surgery (NSS). Nevertheless, a giant pT3 RCC mass (maximum diameter >20 cm) on the functioning side of a patient with SFK is extremely rare. However, whether NSS is more beneficial than radical nephrectomy (RN) in such patients is controversial. Here, we present the case of a 71-year-old female patient with a 20 cm*16 cm RCC mass in the SFK, who initially presented with hematuria and acute urinary tract obstructive anuria caused by renal calculi. The patient underwent NSS treatment after our evaluation, and the 26-month follow-up revealed that her renal function recovered to the state before the tumor formation. In addition, no relapse or metastasis was detected.
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Bravi CA, Rosiello G, Mazzone E, Minervini A, Mari A, Di Maida F, Bensalah K, Peyronnet B, Khene ZE, Schiavina R, Bianchi L, Mottrie A, De Naeyer G, Antonelli A, Furlan M, Rha KH, Almujalhem A, Derweesh I, Bradshaw A, Kaouk J, Sawczyn G, Bertolo R, Breda A, Montorsi F, Capitanio U, Larcher A. The IRON Study: Investigation of Robot-assisted Versus Open Nephron-sparing Surgery. EUR UROL SUPPL 2023; 49:71-77. [PMID: 36874602 PMCID: PMC9974968 DOI: 10.1016/j.euros.2022.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 02/03/2023] Open
Abstract
Background Current literature does not provide large-scale data regarding clinical outcomes of robot-assisted (RAPN) versus open (OPN) partial nephrectomy. Moreover, data assessing predictors of long-term oncologic outcomes after RAPN are scarce. Objective To compare perioperative, functional, and oncologic outcomes of RAPN versus OPN, and to investigate the predictors of oncologic outcomes after RAPN. Design setting and participants This study included 3467 patients treated with OPN (n = 1063) or RAPN (n = 2404) for a single cT1-2N0M0 renal mass from 2004 to 2018 at nine high-volume European, North American, and Asian institutions. Outcome measurements and statistical analysis The study outcomes were short-term postoperative, functional, and oncologic outcomes. Regression models investigated the effect of surgical approach (open vs Robot assisted) on study outcomes, and interaction tests were used for subgroup analyses. Propensity score matching for demographic and tumor characteristics was used in sensitivity analyses. Multivariable Cox-regression analyses identified predictors of oncologic outcomes after RAPN. Results and limitations Baseline characteristics were similar between patients receiving RAPN and OPN, with only few differences. After adjusting for confounding, RAPN was associated with lower odds of intraoperative (odds ratio [OR]: 0.39, 95% confidence interval [CI]: 0.22, 0.68) and Clavien-Dindo ≥2 postoperative (OR: 0.29, 95% CI: 0.16, 0.50) complications (both p < 0.05). This association was not affected by comorbidities, tumor dimension, PADUA score, or preoperative renal function (all p > 0.05 on interaction tests). On multivariable analyses, we found no differences between the two techniques with respect to functional and oncologic outcomes (all p > 0.05). Overall, there were 63 and 92 local recurrences and systemic progressions, respectively, with a median follow-up after surgery of 32 mo (interquartile range: 18, 60). Among patients receiving RAPN, we assessed predictors of local recurrence and systemic progression with discrimination accuracy (ie, C-index) that ranged from 0.73 to 0.81. Conclusions While cancer control and long-term renal function did not differ between RAPN and OPN, we found that the intra- and postoperative morbidity-especially in terms of complications-was lower after RAPN than after OPN. Our predictive models allow surgeons to estimate the risk of adverse oncologic outcomes after RAPN, with relevant implications for preoperative counseling and follow-up after surgery. Patient summary In this comparative study on robotic versus open partial nephrectomy, functional and oncologic outcomes were similar between the two techniques, with lower morbidity-especially in terms of complications-for robot-assisted surgery. The assessment of prognosticators for patients receiving robot-assisted partial nephrectomy may help in preoperative counseling and provides relevant data to tailor postoperative follow-up.
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Affiliation(s)
- Carlo Andrea Bravi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Giuseppe Rosiello
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elio Mazzone
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Minervini
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Mari
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Fabrizio Di Maida
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | | | | | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Geert De Naeyer
- Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Maria Furlan
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Koon Ho Rha
- Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ahmad Almujalhem
- Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ithaar Derweesh
- Department of Urology, Moores UCSD Cancer Center, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Aaronw Bradshaw
- Department of Urology, Moores UCSD Cancer Center, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Jihak Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Guilherme Sawczyn
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Riccardo Bertolo
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Larcher
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Corresponding author. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy. Tel. +39 02.2643.7286.
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Peraire Lores M, Domínguez J, Bravi CA, Mottaran A, Sarchi L, Paciotti M, Piro A, Nocera L, Balestrazzi E, Farinha R, Pauwaert K, Van Herwaarden M, Vinckier MH, De Backer P, De Groote R, D'Hondt F, De Naeyer G, Mottrie A. Robot-assisted sutureless partial nephrectomy for the treatment of fifteen bilateral renal masses in a patient with Von Hippel-Lindau syndrome: a case report from a high-volume robotic center. CEN Case Rep 2023:10.1007/s13730-022-00770-7. [PMID: 36611089 PMCID: PMC10393926 DOI: 10.1007/s13730-022-00770-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/13/2022] [Indexed: 01/09/2023] Open
Abstract
Renal cell carcinoma is among major causes of death in patients with Von Hippel-Lindau (VHL) syndrome, and it usually presents with multiple and bilateral lesions that may require multiple renal surgeries. This, in turn, may compromise renal function, resulting in end-stage renal disease. To minimize renal function impairment in these patients, great importance is given to the preservation of functional parenchyma with the use of nephron-sparing techniques. Furthermore, new techniques such as off-clamp surgery, selective suturing or sutureless techniques may improve long-term functional outcomes. We described the case of a 27-year-old male patient with a family history of VHL disease affected by multiple, bilateral renal masses. He received bilateral, metachronous robot-assisted partial nephrectomies (RAPN) for a total of 15 renal lesions. No intra- or post-operative complications occurred, and the patient was discharged on the second postoperative day after both procedures. Serum creatinine after the second RAPN was 0.99 mg/dl (baseline value was 1.11 mg/dl). In patients with VHL syndrome and multiple renal lesions, robot-assisted partial nephrectomy, especially with the use of clampless and sutureless techniques, helps minimizing renal function impairment and should be performed when anatomically and technically feasible.
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Affiliation(s)
- Maria Peraire Lores
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium. .,ORSI Academy, Ghent, Belgium.
| | - Jesús Domínguez
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium
| | - Carlo A Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium.,Division of Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Angelo Mottaran
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium.,Division of Urology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Luca Sarchi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium
| | - Marco Paciotti
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium.,Department of Urology, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - Adele Piro
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium.,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Nocera
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium.,Division of Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Eleonora Balestrazzi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium.,Division of Urology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Rui Farinha
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium
| | - Kim Pauwaert
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | | | | | | | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium
| | - Frederiek D'Hondt
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium
| | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium
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8
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Martini A, Bravi CA. Acute kidney injury and functional outcomes after partial nephrectomy. Int J Urol 2022; 29:1243-1244. [PMID: 35596560 DOI: 10.1111/iju.14939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alberto Martini
- Department of Urology, La Croix du Sud Hospital.,Department of Urology, Institut Universitaire du Cancer Toulouse - Oncopôle, Toulouse, France
| | - Carlo Andrea Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst.,ORSI Academy, Melle, Belgium
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Campi R, Grosso AA, Lane BR, DE Cobelli O, Sanguedolce F, Hatzichristodoulou G, Antonelli A, Noyes S, DI Maida F, Mari A, Rodriguez-Faba O, Keeley FX, Langenhuijsen J, Musi G, Klatte T, Roscigno M, Akdogan B, Furlan M, Karakoyunlu N, Marszalek M, Capitanio U, Volpe A, Brookman-May S, Gschwend JE, Smaldone MC, Uzzo RG, Kutikov A, Minervini A. Impact of Trifecta definition on rates and predictors of "successful" robotic partial nephrectomy for localized renal masses: results from the Surface-Intermediate-Base Margin Score International Consortium. Minerva Urol Nephrol 2022; 74:186-193. [PMID: 35345387 DOI: 10.23736/s2724-6051.21.04601-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Over the years, five different Trifecta score definitions have been proposed to optimize the framing of "success" in partial nephrectomy (PN) field. However, such classifications rely on different metrics. The aim of the present study was to explore how the success rate of robotic PN, as well as its drivers, vary according to the currently available definitions of Trifecta. METHODS Data from consecutive patients with cT1-2N0M0 renal masses treated with robotic PN at 16 referral centers from September 2014 to March 2015 were prospectively collected. Trifecta rate was defined for each of the currently available definitions. Multivariable logistic regression analysis was used to evaluate possible predictors of "Trifecta failure" according to the different adopted formulation. RESULTS Overall, 289 patients met the inclusion criteria. Among the definitions, Trifecta rates ranged between 66.4% and 85.9%. Multivariable analysis showed that predictors for "Trifecta failure" were mainly tumor-related (i.e. tumor's nephrometry) for those Trifecta scores relying on WIT as a surrogate metric for postoperative renal function deterioration (definitions 1,2), while mainly surgery-related (i.e. ischemia time and excision strategy) for those including the percentage change in postoperative eGFR as the functional cornerstone of Trifecta (definitions 3-5). CONCLUSIONS There was large variability in rates and predictors of "unsuccessful PN" when using different Trifecta scores. Further research is needed to improve the value of the Trifecta metrics, integrating them into routine patient counseling and standardized assessment of surgical quality across institutions.
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Affiliation(s)
- Riccardo Campi
- Department of Urology, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Antonio A Grosso
- Department of Urology, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Brian R Lane
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Ottavio DE Cobelli
- Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy
| | - Francesco Sanguedolce
- Bristol Urological Institute, Southmead Hospital, Bristol, UK.,Unit of Uro-Oncology, Puigvert Foundation, Barcelona, Spain
| | - Georgios Hatzichristodoulou
- Department of Urology, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany.,Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany
| | | | - Sabrina Noyes
- Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Fabrizio DI Maida
- Department of Urology, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Mari
- Department of Urology, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Frank X Keeley
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Johan Langenhuijsen
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK.,Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Marco Roscigno
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Bulent Akdogan
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Maria Furlan
- Department of Urology, University of Brescia, Brescia, Italy
| | - Nihat Karakoyunlu
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Martin Marszalek
- Department of Urology and Andrology, Donauspital, Austria.,Department of Urology, Graz Medical University, Graz, Austria
| | - Umberto Capitanio
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Sabine Brookman-May
- Department of Urology, Campus Grosshadern, Ludwig-Maximilians University (LMU) Munich, Germany.,Janssen Pharma Research and Development, Los Angeles, CA, USA
| | - Jürgen E Gschwend
- Department of Urology, Technical University of Munich, University Hospital Klinikum Rechts Der Isar, Munich, Germany
| | - Marc C Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Robert G Uzzo
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Andrea Minervini
- Department of Urology, University of Florence, Florence, Italy - .,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Robotic-Assisted Partial Nephrectomy: Techniques to Improve Clinical Outcomes. Curr Urol Rep 2021; 22:51. [PMID: 34622373 DOI: 10.1007/s11934-021-01068-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW To summarize current options available for robot-assisted partial nephrectomy RECENT FINDINGS: Partial nephrectomy (PN) is a standard treatment option for management of cT1 renal masses. It may be carried out by multiple approaches. Robot-assisted (RA) PN is one such option. The goal of treatment is both correct oncological (negative surgical margins) and functional (preservation of sufficient amount of renal parenchyma of the operated kidney) outcome. Appropriate outcomes depend on multiple factors. There are many, but among others tumor characteristics (size, location, i.e., tumor complexity), patient baseline renal function, patient comorbidities, and performance status etc. Based on all these, the surgeon adapts the intervention for each mass/patient by preoperative planning, absence/use/duration of warm or cold ischemia, perioperative imaging, resection technique adapted to tumor location and depth of invasion, use of hemostatics, type and degree of renal parenchymal closure and others details. Nephroprotective agents have not shown efficacy so far. It should not be forgotten that surgeon's experience plays a key role in the achievement of good results. Although multiple factors have a role in the RA partial nephrectomy, surgeon experience and adaptation of technique of intervention have the crucial role in the achievement of both functional and oncological results.
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Mari A, Tellini R, Antonelli A, Porpiglia F, Schiavina R, Amparore D, Bertini R, Brunocilla E, Capitanio U, Checcucci E, Da Pozzo L, Di Maida F, Fiori C, Furlan M, Gontero P, Longo N, Roscigno M, Simeone C, Siracusano S, Ficarra V, Carini M, Minervini A. A Nomogram for the Prediction of Intermediate Significant Renal Function Loss After Robot-assisted Partial Nephrectomy for Localized Renal Tumors: A Prospective Multicenter Observational Study (RECORd2 Project). Eur Urol Focus 2021; 8:980-987. [PMID: 34561199 DOI: 10.1016/j.euf.2021.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/28/2021] [Accepted: 09/13/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Robot-assisted partial nephrectomy (RAPN) is increasingly adopted for the treatment of localized renal tumors; however, rates and predictors of significant renal function (RF) loss after RAPN are still poorly investigated, especially at a long-term evaluation. OBJECTIVE To analyze the predictive factors and develop a clinical nomogram for predicting the likelihood of ultimate RF loss after RAPN. DESIGN, SETTING, AND PARTICIPANTS We prospectively evaluated all patients treated with RAPN in a multicenter series (RECORd2 project). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Significant RF loss was defined as >25% reduction in estimated glomerular filtration rate (eGFR) from preoperative assessment at 48th month follow-up after surgery. Uni- and multivariable logistic regression analyses for RF loss were performed. The area under the receiving operator characteristic curve (AUC) was used to quantify predictive discrimination. A nomogram was created from the multivariable model. RESULTS AND LIMITATIONS A total of 981 patients were included. The median age at surgery was 64.2 (interquartile range [IQR] 54.3-71.4) yr, and 62.4% of patients were male. The median Charlson Comorbidity Index (CCI) was 1 (IQR 0-2), 12.9% of patients suffered from diabetes mellitus, and 18.6% of patients showed peripheral vascular disease (PVD). The median Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score was 7 (IQR 7-9). Imperative indications to partial nephrectomy were present in 3.6% of patients. Significant RF loss at 48th month postoperative evaluation was registered in 108 (11%) patients. At multivariable analysis, age (p = 0.04), female gender (p < 0.0001), CCI (p < 0.0001), CCI (p < 0.0001), diabetes (p < 0.0001), PVD (p < 0.0001), eGFR (p = 0.02), imperative (p = 0.001) surgical indication, and PADUA score (p < 0.0001) were found to be predictors of RF loss. The developed nomogram including these variables showed an AUC of 0.816. CONCLUSIONS We developed a clinical nomogram for the prediction of late RF loss after RAPN using preoperative and surgical variables from a large multicenter dataset. PATIENT SUMMARY We developed a nomogram that could represent a clinical tool for early detection of patients at the highest risk of significant renal function impairment after robotic conservative surgery for renal tumors.
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Affiliation(s)
- Andrea Mari
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Tellini
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Roberto Bertini
- Unit of Urology, Division of Experimental Oncology, URI-Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, URI-Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Luigi Da Pozzo
- Department of Urology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fabrizio Di Maida
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy
| | - Maria Furlan
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Nicola Longo
- Department of Urology, University Federico II of Naples, Naples, Italy
| | - Marco Roscigno
- Department of Urology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Claudio Simeone
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Salvatore Siracusano
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Vincenzo Ficarra
- Department of Human and Paediatric Pathology, Gaetano Barresi, Urologic Section, University of Messina, Messina, Italy
| | - Marco Carini
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Urology, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.
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