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Ali M, Kwon YS, Koo K, Bruynzeel A, Pryor D, Schep DG, Huo M, Stein M, Swaminath A, Hannan R, Siva S. Salvage stereotactic ablative body radiotherapy after thermal ablation of primary kidney cancer. BJU Int 2025; 135:110-116. [PMID: 39187428 DOI: 10.1111/bju.16520] [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] [Indexed: 08/28/2024]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of salvage stereotactic ablative body radiotherapy (SABR) for recurrent renal cell carcinoma (RCC) after thermal ablation (TA). MATERIALS AND METHODS This study was a multi-institutional retrospective analysis of patients with recurrent RCC following TA who received SABR between 2016 and 2020. The primary study outcome was freedom from local failure, evaluated radiographically based on Response Evaluation Criteria in Solid Tumours (RECIST) v1.1. Distant failure, cancer-specific survival (CSS), overall survival (OS), treatment-related toxicity and renal function changes following SABR were the secondary outcomes. The Kaplan-Meier method was used to estimate freedom from local and distant failure, CSS and OS. RESULTS Seventeen patients with 18 biopsy-confirmed RCCs were included, with a median (interquartile range [IQR]) age at time of SABR of 75.2 (72.6-68.7) years, a median (IQR) tumour size of 3.5 (1.9-4.1) cm and follow-up (reverse Kaplan-Meier method) of 3.36 (95% confidence interval [CI] 1.6-4.1) years. Six of the 17 patients had a solitary kidney. Five patients had failed repeat TA prior to SABR. The median (IQR) time from TA procedure to SABR was 3.03 (1.5-5.1) years. No patient experienced local progression, with a local control rate of 100%. Four patients, two with baseline metastatic disease, experienced distant progression. The distant progression-free survival, CSS and OS at 3 years were 72.1% (95% CI 51.9%-100%), 92.3% (95% CI 78.9%-100%) and 82.1% (95% CI 62.1%-100%), respectively. The median (IQR) glomerular filtration rate before SABR was 58 (40-71) mL/min, and at last follow-up, it was 48 (33-57) mL/min. No patient experienced grade 3+ toxicity or went on to develop end-stage renal disease. CONCLUSION The results showed that SABR appears to be an effective and safe salvage strategy in patients with recurrent RCC following TA.
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Affiliation(s)
- Muhammad Ali
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Young Suk Kwon
- Department of Radiation Oncology, UT Southwestern Medical Centre, Dallas, TX, USA
| | - Kendrick Koo
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Anna Bruynzeel
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- University of Amsterdam, Amsterdam, The Netherlands
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Daniel G Schep
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Michael Huo
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Maggie Stein
- Department of Radiation Oncology, UT Southwestern Medical Centre, Dallas, TX, USA
| | - Anand Swaminath
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Raquibul Hannan
- Department of Radiation Oncology, UT Southwestern Medical Centre, Dallas, TX, USA
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
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Tan VS, Correa RJM, Warner A, Ali M, Muacevic A, Ponsky L, Ellis RJ, Lo SS, Onishi H, Swaminath A, Suk Kwon Y, Morgan SC, Cury FL, Teh BS, Mahadevan A, Kaplan ID, Chu W, Hannan R, Staehler M, Zaorsky NG, Louie AV, Siva S. Long-term Renal Function Outcomes After Stereotactic Ablative Body Radiotherapy for Primary Renal Cell Carcinoma Including Patients with a Solitary Kidney: A Report from the International Radiosurgery Oncology Consortium of the Kidney. Eur Urol Oncol 2024; 7:1527-1534. [PMID: 38987159 DOI: 10.1016/j.euo.2024.06.012] [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: 02/12/2024] [Revised: 05/29/2024] [Accepted: 06/24/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND AND OBJECTIVE Renal function preservation is particularly important following nonoperative treatment of localized renal cell carcinoma (RCC) since patients are often older with medical comorbidities. Our objective was to report long-term renal function outcomes after stereotactic ablative radiotherapy (SABR) including patients with a solitary kidney. METHODS Patients with primary RCC treated with SABR with ≥2 yr of follow-up at 12 International Radiosurgery Consortium for Kidney institutions were included. Renal function was measured by estimated glomerular filtration rate (eGFR). KEY FINDINGS AND LIMITATIONS In total, 190 patients (56 with a solitary kidney) underwent SABR and were followed for a median of 5.0 yr (interquartile range [IQR]: 3.4-6.8). In patients with a solitary kidney versus bilateral kidneys, pre-SABR eGFR (mean [standard deviation]) was 61.1 (23.2) versus 58.0 (22.3) ml/min (p = 0.32) and the median tumor size was 3.65 cm (IQR: 2.59-4.50 cm) versus 4.00 cm (IQR: 3.00-5.00 cm; p = 0.026). At 5 yr after SABR, eGFR decreased by -14.5 (7.6) and -13.3 (15.9) ml/min (p = 0.67), respectively, and there were similar rates of post-SABR dialysis (3.6% [n = 2/56] vs 3.7% [n = 5/134]). A multivariable analysis demonstrated that increasing tumor size (odds ratio [OR] per 1 cm: 1.57; 95% confidence interval [CI]: 1.14-2.16, p = 0.0055) and baseline eGFR (OR per 10 ml/min: 1.30; 95% CI: 1.02-1.66, p = 0.034) were associated with an eGFR decline of ≥15 ml/min at 1 yr. CONCLUSIONS AND CLINICAL IMPLICATIONS With long-term follow-up after SABR, kidney function decline remains moderate, with no observed difference between patients with a solitary kidney and bilateral kidneys. Tumor size and baseline eGFR are dominant factors predictive of long-term renal function decline. PATIENT SUMMARY With long-term follow-up, stereotactic ablative radiotherapy (SABR) yields moderate long-term renal function decline and low dialysis rates even in patients with a solitary kidney. SABR thus represents a promising noninvasive, nephron-sparing option for patients with localized renal cell carcinoma.
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Affiliation(s)
- Vivian S Tan
- London Health Sciences Centre, London, ON, Canada
| | | | | | - Muhammad Ali
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Lee Ponsky
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Rodney J Ellis
- GenesisCare USA, Fort Myers, FL, USA; Northeast Ohio Medical University Rootstown, OH, USA
| | - Simon S Lo
- University of Washington School of Medicine, Seattle, WA, USA
| | | | - Anand Swaminath
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Young Suk Kwon
- University of Texas - Southwestern Medical Center, Dallas, TX, USA
| | | | - Fabio L Cury
- McGill University Health Centre, Montreal, QC, Canada
| | - Bin S Teh
- Houston Methodist Hospital, Cancer Center and Research Institute, Houston, TX, USA
| | - Anand Mahadevan
- NYU Langone Health - Laura and Isaac Perlmutter Cancer Center, New York, NY, USA
| | | | - William Chu
- Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, ON, Canada
| | - Raquibul Hannan
- University of Texas - Southwestern Medical Center, Dallas, TX, USA
| | | | - Nicholas G Zaorsky
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Alexander V Louie
- London Health Sciences Centre, London, ON, Canada; Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, ON, Canada
| | - Shankar Siva
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.
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Bertolo R, Francolini G, Bukavina L. Functional Outcomes of Stereotactic Ablative Radiotherapy: There Is Room for Improvement. Eur Urol Oncol 2024; 7:1159-1161. [PMID: 39084966 DOI: 10.1016/j.euo.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Riccardo Bertolo
- Department of Urology, University of Verona, Borgo Trento Hospital, AOUI Verona, Verona, Italy.
| | - Giulio Francolini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Laura Bukavina
- Glickman Urological Institute, Cleveland Clinic, Cleveland, OH, USA
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Correa RJM, Louie AV, Siva S. Room for improvement when approaching RCC in the solitary kidney: surgery is not the only choice. Eur Urol Oncol 2024; 7:1164-1165. [PMID: 39343638 DOI: 10.1016/j.euo.2024.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Accepted: 09/17/2024] [Indexed: 10/01/2024]
Affiliation(s)
- Rohann J M Correa
- London Health Sciences Centre and Western University, London, Canada.
| | - Alexander V Louie
- London Health Sciences Centre and Western University, London, Canada; Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Shankar Siva
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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Terauchi M, Yamashiro T, Sawamura S, Koyama S, Nakaigawa N, Kondo K, Hasumi H, Makiyama K, Utsunomiya D. Combining Transarterial Embolization and Percutaneous Cryoablation for Early-Stage Renal Cell Carcinoma: Embolization Materials and Impacts of Tumor Size. Tomography 2024; 10:1767-1779. [PMID: 39590939 PMCID: PMC11598556 DOI: 10.3390/tomography10110130] [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: 09/19/2024] [Revised: 10/30/2024] [Accepted: 11/03/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND/OBJECTIVES Our aim was to compare the complication rates of different embolization materials (absolute ethanol and gelatin sponges) used for combined transarterial embolization (TAE) and to investigate the impact of tumor size on operative time and cryoneedle use during percutaneous cryoablation (PCA). METHODS We treated 27 patients (9 women and 18 men; mean age, 74 years) with 28 early-stage (T1a) renal cell carcinoma (RCC) lesions using combined TAE and PCA between September 2018 and January 2021. During TAE, 15 lesions in 14 patients were embolized using mixed absolute ethanol and iodized oil. The remaining 13 lesions (in 13 patients) were embolized using a gelatin sponge followed by iodized oil. The PCA was performed within 3 to 21 days of the TAE. We compared complications between the TAE subgroups (i.e., absolute ethanol and gelatin sponge) and assessed potential correlations between tumor size and the operative time of the PCA. RESULTS All patients were successfully treated by combined TAE-PCA. Local control was achieved for all patients (monitoring period, 1-48 months; median, 28 months). Although the effect of TAE did not differ between subgroups, a significantly higher number of patients in the absolute ethanol group experienced intraprocedural pain than in the gelatin sponge group (p < 0.05). The operative time of the PCA was significantly correlated with the size of the RCC lesion (p < 0.01). The number of cryoneedles used for the PCA was also correlated with the size of the RCC lesion (p < 0.0001). CONCLUSIONS For TAE prior to PCA for early-stage RCC, gelatin sponges can replace absolute ethanol to reduce intraprocedural pain. Tumor size correlates with operative time and the number of cryoneedles needed for PCA, which suggests the total medical cost for PCA therefore varies based on the tumor's size.
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Affiliation(s)
- Miki Terauchi
- Department of Interventional Radiology, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, 3211 Kozukuechou, Kohoku-ku, Yokohama 222-0036, Japan
| | - Tsuneo Yamashiro
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (T.Y.); (S.S.); (S.K.); (D.U.)
| | - Shungo Sawamura
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (T.Y.); (S.S.); (S.K.); (D.U.)
| | - Shingo Koyama
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (T.Y.); (S.S.); (S.K.); (D.U.)
| | - Noboru Nakaigawa
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (N.N.); (K.K.); (H.H.); (K.M.)
- Department of Urology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan
| | - Keiichi Kondo
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (N.N.); (K.K.); (H.H.); (K.M.)
- Kanazawa-Hakkei Kondo Urology Clinic, 19-14 Seto, Kanazawa-ku, Yokohama 236-0027, Japan
| | - Hisashi Hasumi
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (N.N.); (K.K.); (H.H.); (K.M.)
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (N.N.); (K.K.); (H.H.); (K.M.)
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (T.Y.); (S.S.); (S.K.); (D.U.)
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Gupta VF, Ronald J, Mastria EM, Benvenuti T, Cline BC, Johnson DY, Martin JG, Befera NT, Kim CY. Correlation of Ablation Volume with Renal Function Loss after Cryoablation in Solitary Functioning Kidneys. J Vasc Interv Radiol 2024; 35:1481-1490. [PMID: 38942284 DOI: 10.1016/j.jvir.2024.06.018] [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: 12/14/2023] [Revised: 06/08/2024] [Accepted: 06/16/2024] [Indexed: 06/30/2024] Open
Abstract
PURPOSE To determine the degree of renal function deterioration after renal cryoablation in patients with a solitary functioning kidney on the basis of ablation volume. MATERIALS AND METHODS Over a 15-year period, 81 percutaneous cryoablations were performed in solitary functioning kidneys. After exclusion of patients with baseline end-stage renal disease (ESRD) and insufficient follow-up, analysis was performed on 65 procedures in 52 patients (40 men; mean age, 63.5 years). The postcryoablation renal function was based on the lowest serum creatinine within 6 months after procedure. Renal function change was defined as percentage glomerular filtration rate (GFR) change. Volumetric analysis was performed on the target lesion, renal parenchyma, and ablation zone. RESULTS The median tumor diameter was 2.0 cm (range, 0.8-4.7 cm). The median baseline GFR decreased from 56.4 mL/min/1.73 m2 (range, 17.5-89.7 mL/min/1.73 m2) to 46.9 mL/min/1.73 m2 (range, 16.5-89.7 mL/min/1.73 m2) at median of 95 days (P < .001), equating to a -7.9% median renal function change (range, -45.0% to +30.7%). All patients had Stage 2 or worse chronic kidney disease, and baseline function did not correlate with renal function change. The median volume of ablated parenchyma was 19.7 mL (range, 2.4-87.3 mL), equating to 8.1% (range, 0.7%-37.2%) of total parenchyma. The volume of parenchymal volume ablated correlated significantly with renal function loss, whereas age, hypertension, and diabetes mellitus did not. No patient developed ESRD within 1 year after cryoablation. CONCLUSIONS Cryoablation in solitary functioning kidneys resulted in a modest reduction in renal function, even in patients with chronic kidney disease and ablations of up to 20% of renal parenchymal volume.
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Affiliation(s)
- Vikram F Gupta
- Division of Interventional Radiology, Duke University Health System, Durham, North Carolina
| | - James Ronald
- Division of Interventional Radiology, Duke University Health System, Durham, North Carolina
| | - Eric M Mastria
- Division of Interventional Radiology, Duke University Health System, Durham, North Carolina
| | - Teresa Benvenuti
- Division of Interventional Radiology, Duke University Health System, Durham, North Carolina
| | - Brendan C Cline
- Division of Interventional Radiology, Duke University Health System, Durham, North Carolina
| | - David Y Johnson
- Division of Interventional Radiology, Duke University Health System, Durham, North Carolina
| | - Jonathan G Martin
- Division of Interventional Radiology, Duke University Health System, Durham, North Carolina
| | - Nicholas T Befera
- Division of Interventional Radiology, Duke University Health System, Durham, North Carolina
| | - Charles Y Kim
- Division of Interventional Radiology, Duke University Health System, Durham, North Carolina.
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Kazama A, Attawettayanon W, Munoz-Lopez C, Rathi N, Lewis K, Maina E, Campbell RA, Lone Z, Boumitri M, Kaouk J, Haber GP, Haywood S, Almassi N, Weight C, Li J, Campbell SC. Parenchymal volume preservation during partial nephrectomy: improved methodology to assess impact and predictive factors. BJU Int 2024; 134:219-228. [PMID: 38355293 DOI: 10.1111/bju.16300] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To rigorously evaluate the impact of the percentage of parenchymal volume preserved (PPVP) and how well the preserved parenchyma recovers from ischaemia (Recischaemia) on functional outcomes after partial nephrectomy (PN) using an accurate and objective software-based methodology for estimating parenchymal volumes and split renal function (SRF). A secondary objective was to assess potential predictors of the PPVP. PATIENTS AND METHODS A total of 894 PN patients with available studies (2011-2014) were evaluated. The PPVP was measured from cross-sectional imaging at ≤3 months before and 3-12 months after PN using semi-automated software. Pearson correlation evaluated relationships between continuous variables. Multivariable linear regression evaluated predictors of ipsilateral glomerular filtration rate (GFR) preserved and the PPVP. Relative-importance analysis was used to evaluate the impact of the PPVP on ipsilateral GFR preserved. Recischaemia was defined as the percentage of ipsilateral GFR preserved normalised by the PPVP. RESULTS The median tumour size and R.E.N.A.L. nephrometry score were 3.4 cm and 7, respectively. In all, 49 patients (5.5%) had a solitary kidney. In all, 538 (60%)/251 (28%)/104 (12%) patients were managed with warm/cold/zero ischaemia, respectively. The median pre/post ipsilateral GFRs were 40/31 mL/min/1.73 m2, and the median (interquartile range [IQR]) percentage of ipsilateral GFR preserved was 80% (71-88%). The median pre/post ipsilateral parenchymal volumes were 181/149 mL, and the median (IQR) PPVP was 84% (76-92%). In all, 330 patients (37%) had a PPVP of <80%, while only 34 (4%) had a Recischaemia of <80%. The percentage of ipsilateral GFR preserved correlated strongly with the PPVP (r = 0.83, P < 0.01) and loss of parenchymal volume accounted for 80% of the loss of ipsilateral GFR. Multivariable analysis confirmed that the PPVP was the strongest predictor of ipsilateral GFR preserved. Greater tumour size and endophytic and nearness properties of the R.E.N.A.L. nephrometry score were associated with a reduced PPVP (all P ≤ 0.01). Solitary kidney and cold ischaemia were associated with an increased PPVP (all P < 0.05). CONCLUSIONS A reduced PPVP predominates regarding functional decline after PN, although a low Recischaemia can also contribute. Tumour-related factors strongly influence the PPVP, while surgical efforts can improve the PPVP as observed for patients with solitary kidneys.
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Affiliation(s)
- Akira Kazama
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Worapat Attawettayanon
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Carlos Munoz-Lopez
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nityam Rathi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kieran Lewis
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eran Maina
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca A Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zaeem Lone
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Melissa Boumitri
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Samuel Haywood
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nima Almassi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jianbo Li
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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Xhepa G, Carrafiello G, Ricoeur A. Commentary on Renal Function After CT-Guided Cryoablation of Small Renal Tumours in Patients with Solitary Kidney: An Analysis of European Multinational Prospective EuRECA Registry. Cardiovasc Intervent Radiol 2024; 47:590-591. [PMID: 38587533 DOI: 10.1007/s00270-024-03705-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Genti Xhepa
- Repubblica e Cantone Ticino Ente Ospedaliero Cantonale, IIMSI, Via Tesserete 46, 6900, Lugano, Switzerland.
- Radiology and Interventional Radiology Department, Hôpitaux Universitaires de Genève (HUG), Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Gianpaolo Carrafiello
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 28, 20122, Milan, Italy
- Università Degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, MI, Italy
| | - Alexis Ricoeur
- Radiology and Interventional Radiology Department, Hôpitaux Universitaires de Genève (HUG), Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
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9
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Attawettayanon W, Kazama A, Yasuda Y, Zhang JJH, Shah S, Rathi N, Munoz-Lopez C, Lewis K, Li J, Beksac AT, Campbell RA, Kaouk J, Haber GP, Weight C, Martin C, Campbell SC. Thermal Ablation Versus Partial Nephrectomy for cT1 Renal Mass in a Solitary Kidney: A Matched Cohort Comparative Analysis. Ann Surg Oncol 2024; 31:2133-2143. [PMID: 38071719 DOI: 10.1245/s10434-023-14646-2] [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: 08/07/2023] [Accepted: 11/09/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Nephron-sparing approaches are preferred for renal mass in a solitary kidney (RMSK), with partial nephrectomy (PN) generally prioritized. Thermal ablation (TA) also is an option for small renal masses in this setting; however, comparative functional/survival outcomes are not well-defined. METHODS A retrospective study of 504 patients (1975-2022) with cT1 RMSK managed with PN (n = 409)/TA (n = 95) with necessary data for analysis was performed. Propensity score was used for matching patients, including age, preoperative glomerular filtration rate (GFR), tumor diameter, R.E.N.A.L. ((R)adius (tumor size as maximal diameter), (E)xophytic/endophytic properties of tumor, (N)earness of tumor deepest portion to collecting system or sinus, (A)nterior (a)/posterior (p) descriptor, and (L)ocation relative to polar lines), and comorbidities. Functional outcomes were compared, and Kaplan-Meier was used to analyze survival. RESULTS The matched cohort included 132 patients (TA = 66/PN = 66), with median tumor diameter of 2.4 cm, R.E.N.A.L. of 6, and preoperative GFR of 52 ml/min/1.73 m2. Acute kidney injury occurred in 11%/61% in the TA/PN cohorts, respectively (p < 0.01). After recovery, median GFR preserved was 89%/83% for TA/PN, respectively (p = 0.02), and 5-year dialysis-free survival was 96% in both cohorts. Median follow-up was 53 months. Five-year recurrence-free survival (RFS) was 62%/86% in the TA/PN cohorts, respectively (p < 0.01). Five-year local recurrence (LR)-free survival was 74%/95% in the TA/PN cohorts, respectively (p < 0.01). Five-year cancer-specific survival (CSS) was 96%/98% in the TA/PN cohorts, respectively (p = 0.7). Local recurrence was observed in nine of 36 (25%) and five of 30 (17%) patients managed with laparoscopic versus percutaneous TA, respectively. For TA with LR (n = 14), nine patients presented with multifocality and/or cT1b tumors. Twelve LR were managed with salvage TA, and seven remained cancer-free, while five developed systemic recurrence, three with concomitant LR. CONCLUSIONS Functional outcomes for TA for RMSK were improved compared with PN. Local recurrence was more common after TA and often was associated with the laparoscopic approach, multifocality, and large tumor size. Improved patient selection and greater experience with TA should improve outcomes. Salvage of LR was not always possible. Partial nephrectomy remains the reference standard for RMSK.
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Affiliation(s)
- Worapat Attawettayanon
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Akira Kazama
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yosuke Yasuda
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - J J H Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Snehi Shah
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nityam Rathi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Carlos Munoz-Lopez
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kieran Lewis
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jianbo Li
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, OH, USA
| | - Alp T Beksac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca A Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Christopher Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Charles Martin
- Department of Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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10
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Fan B, Yokoyama M, Kobayashi M, Nakamura Y, Fujiwara M, Ishikawa Y, Fukuda S, Waseda Y, Tanaka H, Yoshida S, Fujii Y. Incidence, risk factors, and significance of 20% decrease from new baseline estimated glomerular filtration rate after radical and partial nephrectomy within 2 years. Int J Urol 2024; 31:119-124. [PMID: 37828800 DOI: 10.1111/iju.15322] [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: 05/31/2023] [Accepted: 09/24/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES To evaluate the incidence and risk factors of a 20% decrease from new baseline (NB)-estimated glomerular filtration rate (eGFR) within 2 years after radical nephrectomy (RN) and partial nephrectomy (PN) and to examine the difference in the incidence of end-stage renal disease (ESRD) with or without the 20% decrease. METHODS This retrospective study included 238 patients undergoing RN and 369 undergoing PN for cT1a-cT3a renal cancer. The incidence of a 20% decrease from NB-eGFR within 2 years after RN/PN was examined and its potential risk factors including surgery type were assessed by multivariate logistic regression analysis. The development of ESRD was analyzed as an endpoint and its incidence was compared according to the presence or absence of the 20% decrease from NB-eGFR within 2 years. RESULTS Overall, the 20% decrease from NB-eGFR within 2 years was observed in 37 patients (6.1%), including 10 (4.2%) and 27 (7.3%) after RN and PN, respectively (p = 0.117). Diabetes mellitus, proteinuria, and perioperative complications were shown to be independent risk factors for the 20% decrease from NB-eGFR, while surgery type was not. During the median follow-up of 65 months, the ESRD-free survival rate at 6 years was 75.5% and 99.6% in patients with and without the 20% decrease from NB-eGFR, respectively (p < 0.001), while no significant difference was observed between patients undergoing RN and PN (98.1% and 98.7%, p = 0.561). CONCLUSIONS Because the incidence of ESRD after the 20% decrease from NB-eGFR within 2 years was as high as 24.5% at 6 years, these patients should be followed with utmost care.
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Affiliation(s)
- Bo Fan
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Kobayashi
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Nakamura
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motohiro Fujiwara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yudai Ishikawa
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shohei Fukuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
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11
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Attawettayanon W, Yasuda Y, Zhang JH, Rathi N, Munoz-Lopez C, Kazama A, Lewis K, Ponvilawan B, Shah S, Wood A, Li J, Accioly JPE, Campbell RA, Zabell J, Kaouk J, Haber GP, Eltemamy M, Krishnamurthi V, Abouassaly R, Weight C, Campbell SC. Functional recovery after partial nephrectomy in a solitary kidney. Urol Oncol 2024; 42:32.e17-32.e27. [PMID: 38142208 DOI: 10.1016/j.urolonc.2023.12.004] [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: 08/29/2023] [Revised: 11/13/2023] [Accepted: 12/02/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES Partial nephrectomy (PN) is the reference standard for renal mass in a solitary kidney (RMSK), although factors determining functional recovery in this setting remain poorly defined. PATIENTS/METHODS Single center, retrospective analysis of 841 RMSK patients (1975-2022) managed with PN with functional data, including 361/435/45 with cold/warm/zero ischemia, respectively. A total of 155 of these patients also had necessary studies for detailed analysis of parenchymal volume preserved. Acute kidney injury (AKI) was classified by RIFLE (Risk/Injury/Failure/Loss/Endstage). Recovery-from-ischemia (Rec-Ischemia) was defined as glomerular filtration rate (GFR) saved normalized by parenchymal volume saved. Logistic regression identified predictive factors for AKI and predictors of Rec-Ischemia were analyzed by multivariable linear regression. RESULTS Overall, median preoperative GFR was 56.7 ml/min/1.73m2 and new-baseline and 5-year GFRs were 43.1 and 44.5 ml/min/1.73m2, respectively. Median follow-up was 55 months; 5-year dialysis-free survival was 97%. In the detailed analysis cohort, a primary focus of this study, median warm (n = 70)/cold (n = 85) ischemia times were 25/34 minutes, respectively; and median preoperative, new-baseline and 5-year GFRs were 57.8, 45.0, and 41.7 ml/min/1.73m2, respectively. Functional recovery correlated strongly with parenchymal volume preserved (r = 0.84, p < 0.001). Parenchymal volume loss accounted for 69% of the total median GFR decline associated with PN, leaving only 3 to 4 ml/min/1.73m2 attributed to ischemia and other factors. AKI occurred in 52% of patients and the only independent predictor of AKI was ischemia time. Independent predictors of reduced Rec-Ischemia were increased age, warm ischemia, and AKI. CONCLUSION The main determinant of functional recovery after PN in RMSK is parenchymal volume preservation. Type/duration of ischemia, AKI, and age also correlated, although altogether their contributions were less impactful. Our findings suggest multiple opportunities for optimizing functional outcomes although preservation of parenchymal volume remains predominant. Long-term function generally remains stable with dialysis only occasionally required.
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Affiliation(s)
- Worapat Attawettayanon
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Yosuke Yasuda
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Tokyo Medical and Dental University, Graduate School, Tokyo, Japan
| | - Jj H Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, University of California Los Angeles (UCLA), Los Angeles, CA
| | - Nityam Rathi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Carlos Munoz-Lopez
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Akira Kazama
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kieran Lewis
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ben Ponvilawan
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Snehi Shah
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Andrew Wood
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jianbo Li
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, OH
| | | | - Rebecca A Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Joseph Zabell
- Department of Urology, University of Minnesota, Minneapolis, MN
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Mohamad Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Robert Abouassaly
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Christopher Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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12
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Liu Y, Wang L, Bao EH, Wang L, Wang JH, Yang L, Zhu PY. Perioperative, functional, and oncological outcomes after cryoablation or partial nephrectomy for small renal masses in solitary kidneys: a systematic review and meta-analysis. BMC Urol 2024; 24:19. [PMID: 38268005 PMCID: PMC10809601 DOI: 10.1186/s12894-024-01406-x] [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: 06/29/2023] [Accepted: 01/12/2024] [Indexed: 01/26/2024] Open
Abstract
AIM This study aims to compare the perioperative, functional, and oncological outcomes of cryoablation (CA) and partial nephrectomy (PN) for managing small renal masses in patients with solitary kidneys. The study seeks to assess the efficacy and safety of both interventions, evaluating their impact on kidney function and their ability to mitigate cancer recurrence. METHODS Searches were systematically conducted on PubMed, Scopus, EMBASE, SinoMed, and Google Scholar, identifying seven observational studies. Statistical analysis was performed using Stata v.12.0 and Review Manager version 5.2. Results for dichotomous variables are expressed using odds ratios, and weighted mean differences are used for continuous variables. RESULTS Our findings revealed that patients undergoing CA experienced significantly shorter operative time (p < 0.0001), reduced estimated blood loss (p < 0.00001), a shorter length of stay (p = 0.0001), and fewer postoperative complications (p = 0.02) compared to those undergoing PN. Although the CA group exhibited a lower transfusion rate (p = 0.69) compared with the PN group, the difference was not statistically significant. The combined data analysis demonstrated a significantly lower increase in serum creatinine levels after surgery in the CA group compared with the PN group (p = 0.003). Similarly, there was a noteworthy decrease in the estimated glomerular filtration rate after surgery in the PN group compared with the CA group (p < 0.0001). While not statistically significant, the CA group showed a lower postoperative dialysis rate (p = 0.11). Regarding oncological outcomes, the analysis revealed no significant differences between CA and PN concerning local recurrence (p = 0.2) and distant metastasis (p = 0.12), respectively. CONCLUSIONS Our analysis indicates comparable efficacy between PN and CA in controlling tumour recurrence and metastasis. However, CA is associated with superior preservation of renal function, significantly enhanced perioperative outcomes, and fewer postoperative complications. Based on our data, it can be inferred that the scope for applying CA might be expanded to encompass more patients seeking a less invasive treatment option.
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Affiliation(s)
- Ying Liu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Li Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Er-Hao Bao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Lei Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jia-Hao Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Lin Yang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ping-Yu Zhu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
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13
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Yasuda Y, Attawettayanon W, Nguyen JK, Kattar J, Lachowski M, Voros G, Kazama A, Campbell RA, Krishnamurthi V, Eltemamy M, Campbell SC. Neocapsular reconstruction for challenging partial nephrectomy: A feasibility study in a porcine model and recent clinical experience. Int J Urol 2023; 30:1165-1174. [PMID: 37665182 DOI: 10.1111/iju.15293] [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: 03/28/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES Multifocal renal masses and large central-endophytic tumors can be challenging for partial nephrectomy (PN) due to the paucity of capsule remaining after tumor removal. Our objective was to develop a neocapsule to provide tamponade and test its feasibility/safety in a porcine model. METHODS Eight live pigs (50-70 kg) underwent unclamped open right flank PN. Renal defects were 1 cm deep and had moderate ongoing venous bleeding. A 6 × 9 inch sheet of Nu-knit® was used for neocapsular reconstruction with Fibrillar™ packing to provide modest tamponade and preclude ongoing bleeding. Blood chemistry and hemoglobin (Hb) levels were drawn preoperatively and postoperative Days 3/5/8. On postoperative Day 8, euthanasia was performed, and both kidneys were inspected and analyzed for histologic changes. RESULTS PN defects ranged from 1 × 1 × 1 cm to 4 × 2 × 1 cm; four pigs had PN performed in both poles and four in one pole. Neocapsular reconstruction was successful (n = 8), with no perioperative complications. Median baseline Hb was 10.4 g/dL, and median Hb postoperative Days 3/5/8 were 10.0/10.8/10.6 g/dL, respectively. Median baseline serum creatinine (SCr) was 1.9 mg/dL, and median SCr postoperative Days 3/5/8 were 1.5/1.4/1.5 mg/dL, respectively. At sacrifice, no significant hematomas were observed. Other than adjacent to the PN site, there were no significant histologic changes in the parenchyma for operative kidneys versus controls. Based on our experience, we recently performed neocapsular reconstruction safely/effectively after extensive PN for multifocal tumors and for an allograft with difficult-to-manage subcapsular hematoma. CONCLUSIONS Neocapsular reconstruction after PN or capsular trauma appears feasible and safe and may be considered to reduce the risk of perioperative bleeding. However, further study will be needed to confirm the utility/efficacy of this approach.
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Affiliation(s)
- Yosuke Yasuda
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Tokyo Medical and Dental University, Graduate School, Tokyo, Japan
| | - Worapat Attawettayanon
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Jane K Nguyen
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jackie Kattar
- Department of Innovations, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mary Lachowski
- Department of Innovations, Cleveland Clinic, Cleveland, Ohio, USA
| | - George Voros
- Department of Innovations, Cleveland Clinic, Cleveland, Ohio, USA
- Biological Resources Unit, Cleveland Clinic, Cleveland, Ohio, USA
| | - Akira Kazama
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Urology, Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Rebecca A Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Mohamad Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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14
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Munoz-Lopez C, Lewis K, Attawettayanon W, Yasuda Y, Accioly JPE, Rathi N, Lone Z, Boumitri M, Campbell RA, Wood A, Kaouk J, Haber GP, Eltemamy M, Krishnamurthi V, Abouassaly R, Haywood S, Weight C, Campbell SC. Parenchymal volume analysis to assess longitudinal functional decline following partial nephrectomy. BJU Int 2023; 132:435-443. [PMID: 37409822 DOI: 10.1111/bju.16110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To identify factors associated with longitudinal ipsilateral functional decline after partial nephrectomy (PN). PATIENTS AND METHODS Of 1140 patients managed with PN (2012-2014), 349 (31%) had imaging/serum creatinine levels pre-PN, 1-12 months post-PN (new baseline), and >3 years later necessary for inclusion. Parenchymal-volume analysis was used to determine split renal function. Patients were grouped as having significant renal comorbidity (CohortSRC : diabetes mellitus with insulin-dependence or end-organ damage, refractory hypertension, or severe pre-existing chronic kidney disease) vs not having significant renal comorbidity (CohortNoSRC ) preoperatively. Multivariable regression was used to identify predictors of annual ipsilateral parenchymal atrophy and functional decline relative to new baseline values post-PN, after the kidney had healed. RESULTS The median follow-up was 6.3 years with 87/226/36 patients having cold/warm/zero ischaemia. The median cold/warm ischaemia times were 32/22 min. Overall, the median tumour size was 3.0 cm. The preoperative glomerular filtration rate (GFR) and new baseline GFR (NBGFR) were 81 and 71 mL/min/1.73 m2 , respectively. After establishment of the NBGFR, the median loss of global and ipsilateral function was 0.7 and 0.4 mL/min/1.73 m2 /year, respectively, consistent with the natural ageing process. Overall, the median ipsilateral parenchymal atrophy was 1.2 cm3 /year and accounted for a median of 53% of the annual functional decline. Significant renal comorbidity, age, and warm ischaemia were independently associated with ipsilateral parenchymal atrophy (all P < 0.01). Significant renal comorbidity and ipsilateral parenchymal atrophy were independently associated with annual ipsilateral functional decline (both P < 0.01). Annual median ipsilateral parenchymal atrophy and functional decline were both significantly increased for CohortSRC compared to CohortNoSRC (2.8 vs 0.9 cm3 , P < 0.01 and 0.90 vs 0.30 mL/min/1.73 m2 /year, P < 0.01, respectively). CONCLUSIONS Longitudinal renal function following PN generally follows the normal ageing process. Significant renal comorbidities, age, warm ischaemia, and ipsilateral parenchymal atrophy were the most important predictors of ipsilateral functional decline following establishment of NBGFR.
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Affiliation(s)
- Carlos Munoz-Lopez
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kieran Lewis
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Worapat Attawettayanon
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Yosuke Yasuda
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Tokyo Medical and Dental University, Graduate School, Tokyo, Japan
| | | | - Nityam Rathi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zaeem Lone
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Melissa Boumitri
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca A Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew Wood
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Mohamad Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Robert Abouassaly
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samuel Haywood
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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15
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Munoz-Lopez C, Lewis K, Attawettayanon W, Yasuda Y, Emrich Accioly JP, Rathi N, Lone Z, Boumitri M, Campbell RA, Wood A, Kaouk JH, Haber GP, Eltemamy M, Krishnamurthi V, Abouassaly R, Haywood SC, Weight CJ, Campbell SC. Functional recovery after partial nephrectomy: next generation analysis. BJU Int 2023; 132:202-209. [PMID: 37017637 DOI: 10.1111/bju.16023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVES To provide a more rigorous assessment of factors affecting functional recovery after partial nephrectomy (PN) using novel tools that allow for analysis of more patients and improved accuracy for assessment of parenchymal volume loss, thereby revealing the potential impact of secondary factors such as ischaemia. PATIENTS AND METHODS Of 1140 patients managed with PN (2012-2014), 670 (59%) had imaging and serum creatinine levels measured before and after PN necessary for inclusion. Recovery from ischaemia was defined as the ipsilateral glomerular filtration rate (GFR) saved normalised by parenchymal volume saved. Acute kidney injury was assessed through Spectrum Score, which quantifies the degree of acute ipsilateral renal dysfunction due to exposure to ischaemia that would otherwise be masked by the contralateral kidney. Multivariable regression was used to identify predictors of Spectrum Score and Recovery from Ischaemia. RESULTS In all, 409/189/72 patients had warm/cold/zero ischaemia, respectively, with median (interquartile range [IQR]) ischaemia times for cold and warm ischaemia of 30 (25-42) and 22 (18-28) min, respectively. The median (IQR) global preoperative GFR and new baseline GFR (NBGFR) were 78 (63-92) and 69 (54-81) mL/min/1.73 m2 , respectively. The median (IQR) ipsilateral preoperative GFR and NBGFR were 40 (33-47) and 31 (24-38) mL/min/1.73 m2 , respectively. Functional recovery correlated strongly with parenchymal volume preserved (r = 0.83, P < 0.01). The median (IQR) decline in ipsilateral GFR associated with PN was 7.8 (4.5-12) mL/min/1.73 m2 with loss of parenchyma accounting for 81% of this loss. The median (IQR) recovery from ischaemia was similar across the cold/warm/zero ischaemia groups at 96% (90%-102%), 95% (89%-101%), and 97% (91%-102%), respectively. Independent predictors of Spectrum Score were ischaemia time, tumour complexity, and preoperative global GFR. Independent predictors of recovery from ischaemia were insulin-dependent diabetes mellitus, refractory hypertension, warm ischaemia, and Spectrum Score. CONCLUSIONS The main determinant of functional recovery after PN is parenchymal volume preservation. A more robust and rigorous evaluation allowed us to identify secondary factors including comorbidities, increased tumour complexity, and ischaemia-related factors that are also independently associated with impaired recovery, although altogether these were much less impactful.
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Affiliation(s)
- Carlos Munoz-Lopez
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kieran Lewis
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Worapat Attawettayanon
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Yosuke Yasuda
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Tokyo Medical and Dental University, Graduate School, Tokyo, Japan
| | | | - Nityam Rathi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zaeem Lone
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Melissa Boumitri
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca A Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew Wood
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Mohamad Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Robert Abouassaly
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samuel C Haywood
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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16
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Attawettayanon W, Yasuda Y, Zhang JJH, Kazama A, Rathi N, Munoz-Lopez C, Lewis K, Shah S, Li J, Emrich Accioly JP, Campbell RA, Shah S, Wood A, Kaouk J, Haber GP, Eltemamy M, Krishnamurthi V, Abouassaly R, Weight C, Derweesh I, Campbell SC. Selective Use of Neoadjuvant Targeted Therapy Is Associated with Greater Achievement of Partial Nephrectomy for High-complexity Renal Masses in a Solitary Kidney. EUR UROL SUPPL 2023; 54:1-9. [PMID: 37545849 PMCID: PMC10403684 DOI: 10.1016/j.euros.2023.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 08/08/2023] Open
Abstract
Background Partial nephrectomy (PN) is preferred for a renal mass in a solitary kidney (RMSK), although tumors with high complexity can be challenging. Objective To evaluate the evolution of RMSK management with a focus on achievement of PN. Design setting and participants Patients with nonmetastatic RMSK (n = 499) were retrospectively reviewed; 133 had high tumor complexity, including 80 in the pre-tyrosine kinase inhibitor (TKI) era (1999-2008) and 53 in the TKI era (2009-2022). After 2009, 23/53 patients received neoadjuvant TKI and 30/53 had immediate-surgery. Outcome measurements and statistical analysis Functional outcomes, adverse events and complications, dialysis-free survival, and recurrence-free survival (RFS) were the measures evaluated. Mann-Whitney and χ2 tests were used to compare cohorts, and the log-rank test was applied for survival analyses. Results and limitations Overall, the median RENAL score was 10 and the median tumor diameter was 5.2 cm. Demographic characteristics, tumor diameter, and RENAL scores were similar between the pre-TKI-era and TKI-era groups. In the TKI era, 23/53 patients (43%) with clear-cell histology were selected for neoadjuvant TKI. These 23 patients had a greater median tumor diameter (7.1 vs 4.4 cm; p = 0.02) and RENAL score (11 vs 10; p = 0.07). After TKI treatment, the median tumor diameter decreased to 5.6 cm and the RENAL score to 9, and tumor volume was reduced by 59% (all p < 0.05). PN was accomplished in 21/23 (91%) the TKI-treated cases and in 27/30 (90%) of the immediate-surgery cases (2009-2022). PN was only accomplished in 52/80 (65%) of the patients from the pre-TKI era (p < 0.01). The 5-yr dialysis-free survival rate was 59% in the pre-TKI-era group and 91% in the TKI-era group. The 5-yr RFS rate was lower in the TKI-era group (59% vs 74%; p = 0.21), which was mostly related to more aggressive tumor biology, as reflected by a predominance of systemic rather than local recurrences. Conclusions Management of RMSK with high tumor complexity is challenging. Selective use of TKI therapy was associated with greater use of PN, although a randomized study is needed. RFS mostly reflected aggressive tumor biology rather than failure of local management. Patient summary For complex kidney tumors in patients with a single kidney, management is challenging. Use of drugs called tyrosine kinase inhibitors before surgery was associated with reductions in tumor size and greater ability to achieve partial kidney removal for cancer control. Most recurrences were metastatic, which reflects aggressive tumor biology rather than failure of surgery.
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Affiliation(s)
- Worapat Attawettayanon
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Division of Urology, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | - Yosuke Yasuda
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Tokyo Medical and Dental University, Graduate School, Tokyo, Japan
| | - JJ H. Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, University of California-Los Angeles, Los Angeles, CA, USA
| | - Akira Kazama
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Division of Urology and Molecular Oncology. Niigata University, Niigata, Japan
| | - Nityam Rathi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Carlos Munoz-Lopez
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kieran Lewis
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Snehi Shah
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jianbo Li
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, OH, USA
| | | | - Rebecca A. Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shetal Shah
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew Wood
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Mohamad Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Robert Abouassaly
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher Weight
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ithaar Derweesh
- Department of Urology, School of Medicine, University of California-San Diego, La Jolla, CA, USA
| | - Steven C. Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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17
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Wen Z, Wang L, Huang J, Liu Y, Chen CX, Wang CJ, Chen LL, Yang XS. Perioperative, functional, and oncologic outcomes after ablation or partial nephrectomy for solitary renal tumors: a systematic review and meta-analysis of comparative trials. Front Oncol 2023; 13:1202587. [PMID: 37434978 PMCID: PMC10331136 DOI: 10.3389/fonc.2023.1202587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Abstract
Objectives The perioperative, functional, and oncological outcomes of patients with solitary small renal tumors (SRMs) treated with ablation (AT) or partial nephrectomy (PN) remain controversial. The aim of this study was to compare the outcomes of these two surgical techniques. Methods In April 2023, we conducted a literature search in several widely used databases worldwide, including PubMed, Embase, and Google Scholar. Review Manager was used to compare various parameters. The study was registered with PROSPERO (CRD42022377157). Results Our final meta-analysis included 13 cohort studies with a total of 2,107 patients. Compared to partial nephrectomy (PN), ablation (AT) had shorter hospital stays (WMD -2.37 days, 95% CI -3.05 to -1.69; p < 0.00001), shorter operating times (WMD -57.06 min, 95% CI -88.92 to -25.19; p = 0.0004), less postoperative creatinine increases (WMD -0.17 mg/dL, 95% CI -0.29 to -0.05; p = 0.006), less postoperative glomerular filtration rate decreases (WMD -9.84 mL/min/1.73 m2, 95% CI -14.25 to -5.44; p < 0.0001), less postoperative new-onset chronic kidney disease (OR 0.33, 95% CI 0.16 to 0.71; p = 0.005), and less intraoperative blood loss (WMD -285.92 ml, 95% CI -428.44 to -143.40; p < 0.0001). The transfusion rate was lower in the ablation group (OR 0.17, 95% CI 0.06 to 0.51; p = 0.001). The risk of local recurrence was higher in the ablation group (OR 2.96, 95% CI 1.27 to 6.89; p = 0.01), while the risk of distant metastasis was higher in the partial nephrectomy group (OR 2.81, 95% CI 1.28 to 6.18; p = 0.01). The intraoperative and postoperative complication rates were lower in the ablation group (OR 0.23, 95% CI 0.08 to 0.62; p = 0.004 and OR 0.21, 95% CI 0.11 to 0.38; p < 0.00001, respectively). However, overall survival, postoperative dialysis rate, and tumor-specific survival were not different between the two groups. Conclusions Our data suggest that ablation and partial nephrectomy are equally safe and effective in the treatment of small solitary kidney tumors and are better options for patients with poor preoperative physical condition or poor renal function.
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Affiliation(s)
- Zhi Wen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Li Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jing Huang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yang Liu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Cai-xia Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Chong-jian Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Lin-lin Chen
- Department of Hemodialysis, Sixth People’s Hospital of Nanchong, Nanchong, Sichuan, China
| | - Xue-song Yang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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18
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Chen KY, Chen SL, Sung WW. Re: Yosuke Yasuda, J.J.H. Zhang, Worapat Attawettayanon, et al. Comprehensive Management of Renal Masses in Solitary Kidneys. Eur Urol Oncol. 2023;6:84-94. Eur Urol Oncol 2023; 6:233. [PMID: 36804736 DOI: 10.1016/j.euo.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 01/23/2023] [Accepted: 02/01/2023] [Indexed: 02/18/2023]
Affiliation(s)
- Kuan-Yu Chen
- Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Sung-Lang Chen
- Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wen-Wei Sung
- Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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