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Applications of Focused Ultrasound in the Treatment of Genitourinary Cancers. Cancers (Basel) 2022; 14:cancers14061536. [PMID: 35326687 PMCID: PMC8945954 DOI: 10.3390/cancers14061536] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Cancer is a prevalent disease globally, and conventional treatment options have been associated with substantial morbidity for patients. The unique acoustic properties and biological effects of focused ultrasound have been investigated for use as an alternative treatment option for various forms of cancer with lower associated morbidity than standard treatments. The objective of our review was to assess the current state and various applications of focused ultrasound for the treatment of genitourinary cancers, including prostate, kidney, bladder, penile, and testicular malignancies. Current research demonstrates that focused ultrasound-based focal therapy shows promise for the treatment of localized prostate and kidney cancer, and the effect of ultrasound on cell membranes may increase the efficacy of chemotherapeutics and radiotherapy. Focused ultrasound-based treatment modalities should continue to be investigated as an alternative or complementary treatment option for cancer patients. Abstract Traditional cancer treatments have been associated with substantial morbidity for patients. Focused ultrasound offers a novel modality for the treatment of various forms of cancer which may offer effective oncological control and low morbidity. We performed a review of PubMed articles assessing the current applications of focused ultrasound in the treatment of genitourinary cancers, including prostate, kidney, bladder, penile, and testicular cancer. Current research indicates that high-intensity focused ultrasound (HIFU) focal therapy offers effective short-term oncologic control of localized prostate and kidney cancer with lower associated morbidity than radical surgery. In addition, studies in mice have demonstrated that focused ultrasound treatment increases the accuracy of chemotherapeutic drug delivery, the efficacy of drug uptake, and cytotoxic effects within targeted cancer cells. Ultrasound-based therapy shows promise for the treatment of genitourinary cancers. Further research should continue to investigate focused ultrasound as an alternative cancer treatment option or as a complement to increase the efficacy of conventional treatments such as chemotherapy and radiotherapy.
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Motta G, Ferraresso M, Lamperti L, Di Paolo D, Raison N, Perego M, Favi E. Treatment options for localised renal cell carcinoma of the transplanted kidney. World J Transplant 2020; 10:147-161. [PMID: 32742948 PMCID: PMC7360528 DOI: 10.5500/wjt.v10.i6.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/07/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023] Open
Abstract
Currently, there is no consensus among the transplant community about the treatment of renal cell carcinoma (RCC) of the transplanted kidney. Until recently, graftectomy was universally considered the golden standard, regardless of the characteristics of the neoplasm. Due to the encouraging results observed in native kidneys, conservative options such as nephron-sparing surgery (NSS) (enucleation and partial nephrectomy) and ablative therapy (radiofrequency ablation, cryoablation, microwave ablation, high-intensity focused ultrasound, and irreversible electroporation) have been progressively used in carefully selected recipients with early-stage allograft RCC. Available reports show excellent patient survival, optimal oncological outcome, and preserved renal function with acceptable complication rates. Nevertheless, the rarity and the heterogeneity of the disease, the number of options available, and the lack of long-term follow-up data do not allow to adequately define treatment-specific advantages and limitations. The role of active surveillance and immunosuppression management remain also debated. In order to offer a better insight into this difficult topic and to help clinicians choose the best therapy for their patients, we performed and extensive review of the literature. We focused on epidemiology, clinical presentation, diagnostic work up, staging strategies, tumour characteristics, treatment modalities, and follow-up protocols. Our research confirms that both NSS and focal ablation represent a valuable alternative to graftectomy for kidney transplant recipients with American Joint Committee on Cancer stage T1aN0M0 RCC. Data on T1bN0M0 lesions are scarce but suggest extra caution. Properly designed multi-centre prospective clinical trials are warranted.
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Affiliation(s)
- Gloria Motta
- Urology, IRCCS Policlinico San Donato, San Donato Milanese 27288, Italy
| | - Mariano Ferraresso
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Luca Lamperti
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Dhanai Di Paolo
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Nicholas Raison
- MRC Centre for Transplantation, King’s College London, London WC2R 2LS, United Kingdom
| | - Marta Perego
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Evaldo Favi
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
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Factors influencing harmonized health data collection, sharing and linkage in Denmark and Switzerland: A systematic review. PLoS One 2019; 14:e0226015. [PMID: 31830124 PMCID: PMC6907832 DOI: 10.1371/journal.pone.0226015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction The digitalization of medicine has led to a considerable growth of heterogeneous health datasets, which could improve healthcare research if integrated into the clinical life cycle. This process requires, amongst other things, the harmonization of these datasets, which is a prerequisite to improve their quality, re-usability and interoperability. However, there is a wide range of factors that either hinder or favor the harmonized collection, sharing and linkage of health data. Objective This systematic review aims to identify barriers and facilitators to health data harmonization—including data sharing and linkage—by a comparative analysis of studies from Denmark and Switzerland. Methods Publications from PubMed, Web of Science, EMBASE and CINAHL involving cross-institutional or cross-border collection, sharing or linkage of health data from Denmark or Switzerland were searched to identify the reported barriers and facilitators to data harmonization. Results Of the 345 projects included, 240 were single-country and 105 were multinational studies. Regarding national projects, a Swiss study reported on average more barriers and facilitators than a Danish study. Barriers and facilitators of a technical nature were most frequently reported. Conclusion This systematic review gathered evidence from Denmark and Switzerland on barriers and facilitators concerning data harmonization, sharing and linkage. Barriers and facilitators were strictly interrelated with the national context where projects were carried out. Structural changes, such as legislation implemented at the national level, were mirrored in the projects. This underlines the impact of national strategies in the field of health data. Our findings also suggest that more openness and clarity in the reporting of both barriers and facilitators to data harmonization constitute a key element to promote the successful management of new projects using health data and the implementation of proper policies in this field. Our study findings are thus meaningful beyond these two countries.
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Hu X, Shao YX, Wang Y, Yang ZQ, Yang WX, Li X. Partial nephrectomy versus ablative therapies for cT1a renal masses: A Systematic Review and meta-analysis. Eur J Surg Oncol 2019; 45:1527-1535. [DOI: 10.1016/j.ejso.2019.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/18/2019] [Accepted: 05/08/2019] [Indexed: 01/20/2023] Open
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Liao X, Qiu S, Wang W, Zheng X, Jin K, Zhang S, Bao Y, Yang L, Wei Q. Partial nephrectomy vs cryoablation for T1a renal cell carcinoma: A comparison of survival benefit stratified by tumour size. Cancer Epidemiol 2019; 59:221-226. [PMID: 30836219 DOI: 10.1016/j.canep.2019.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We compared the impact on survival outcomes of partial nephrectomy (PN) and cryoablation (CA) for patients diagnosed with T1a renal cell carcinoma (RCC). PATIENTS AND METHODS Among patients diagnosed between 2004 and 2014 in the Surveillance, Epidemiology and End Results program, we identified histologically confirmed T1aN0M0 RCC treated with PN (n = 17644) or CA (n = 868). Propensity score matching (PSM) was performed. Kaplan-Meier method, Cox proportional hazards model were used to calculate cancer specific mortality (CSM) and overall mortality (OM) in the unmatched and matched cohort, and in subgroups based on tumour size (< 2 cm, 2-3 cm, 3-4 cm). Sensitivity analyses were performed. RESULTS A total of 18512 patients were identified: PN (93.88%) and CA (6.12%). In the propensity-score matched cohort, for tumours ≤ 2 cm, the CA and PN groups had similar CSM (HR: 1.41, 95% CI: 0.32-6.31, p = 0.65) and OM (HR 0.97, 95%CI: 0.47-2.01, p = 0.93). For tumours 2-3 cm, CA was associated with similar CSM (HR 1.64, 95%CI: 0.67-4.03, p = 0.28) but higher OM (HR 2.05, 95%CI: 1.35-3.11, p < 0.001), compared with PN. For tumours 3-4 cm, CA was associated with increased CSM (HR: 3.76, 95% CI: 1.62-8.69, p = 0.002) and OM (HR 2.17, 95%CI: 1.48-3.18, p < 0.001). CONCLUSION For RCC ≤ 2 cm, PN and CA are equal in survival outcomes. For RCC 2-4 cm, PN may have a possible advantage over CA.
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Affiliation(s)
- Xinyang Liao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Shi Qiu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China; Center of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Wanyu Wang
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Xiaonan Zheng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Kun Jin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Shiyu Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Yige Bao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
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Pessoa RR, Autorino R, Laguna MP, Molina WR, Gustafson D, Nogueira L, da Silva RD, Werahera PN, Kim FJ. Laparoscopic Versus Percutaneous Cryoablation of Small Renal Mass: Systematic Review and Cumulative Analysis of Comparative Studies. Clin Genitourin Cancer 2017; 15:513-519.e5. [DOI: 10.1016/j.clgc.2017.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/01/2017] [Accepted: 02/19/2017] [Indexed: 01/24/2023]
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Non-Surgical Ablative Therapy for Management of Small Renal Masses-Current Status and Future Trends. Indian J Surg Oncol 2017; 8:39-45. [PMID: 28127181 DOI: 10.1007/s13193-016-0598-x] [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: 09/09/2016] [Accepted: 09/16/2016] [Indexed: 10/20/2022] Open
Abstract
A large number of small renal masses (SRMs) with size less than 4 cm are being identified due to advances in diagnostic imaging. As the natural history of these tumours remains unknown, there is no reliable way to predict their behaviour or future growth. Although, partial nephrectomy is the gold standard for treatment of these tumours, ablative non-surgical therapies such as cryoablation and radiofrequency ablation provide a less invasive option of treatment with comparable oncological outcomes. In this systematic review, the principle, indications, methods of treatment, oncological control, complication and renal function of ablative therapies are critically reviewed. Cryotherapy utilizes the principle of inducing tissue destruction by freezing and thawing using argon and helium gasses, respectively. Radiofrequency ablation (RFA) works on the principle of tissue heating. Ablative treatments are particularly useful in the elderly patients, those with comorbidities or in patients with SRMs in solitary kidneys or renal impairment. Ablative therapies have less procedure-related complications and have promising medium-term oncological outcome. Longer-term results are accumulating. Cryotherapy may be a better modality for oncological control than RFA. Ablative therapy has emerged as a viable treatment options for SRMs with recurrence free survival rates approaching that of extirpative surgery. However, there is no consensus in the literature on the best selection criteria and this needs further refinement. Prospective long-term data with regards to oncological control is still needed.
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Zondervan PJ, Buijs M, de la Rosette JJ, van Delden O, van Lienden K, Laguna MP. Cryoablation of small kidney tumors. Int J Surg 2016; 36:533-540. [PMID: 27500963 DOI: 10.1016/j.ijsu.2016.06.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/04/2016] [Accepted: 06/19/2016] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Cryoablation (CA) has been broadly used mostly in the treatment of small renal masses (SRMs). The present review aims to define the current role of CA in the treatment of SRMs by assessing clinical indications and outcomes. METHOD A comprehensive review on patient selection, procedural details, perioperative complications, and short/long-term oncological and functional outcomes was conducted. For each section, a take-home message was formulated with level of evidence (LoE) according to Cochrane collaboration. RESULTS Age and comorbidity drive the choice of ablation in SRMs, although hospital setting also influences the decision. Technically in adequate CA or first post-CA control occurs in 3-5% of laparoscopic cryoablation (LCA) or percutaneous cryoablation (PCA) series. Meta-analysis does not evidence differences in the rate of residual tumor per person-year between the approaches (0.033 LCA vs. 0.046 PCA, p = 0.25). Perioperative complications (8-25%) are erratically reported. LCA has significantly lower likelihood of complications than minimally invasive partial nephrectomy (MIPN). Systematic reviews indicate 30-month local tumor progression rate of 8.5% for LCA in renal cell carcinoma but low metastatic progression (1-4.4%). Few LCA long-term follow-up series (mean/media 48-98 months) report recurrence-free survival (RFS) and cancer-specific survival (CSS) ranges of 80-100%. For PCA, Kaplan-Meier local disease-free survival (DFS) of 95.6% at 3-5 years [32] and 5-year overall survival and local RFS of 86.3% were reported. The decrease in renal function after CA is minimal, and the only risk factor associated is the basal estimated glomerular filtration rate (eGFR). CONCLUSION LoE 3a/b confirms lower CA perioperative complication rate and higher local progression rate than those for MIPN. CA preserves postoperative renal functional, without any evidence of differences in mid-/long-term follow-up compared to nephron sparing surgery.
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Affiliation(s)
- P J Zondervan
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M Buijs
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J J de la Rosette
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - O van Delden
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - K van Lienden
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M P Laguna
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Gkentzis A, Oades G. Thermal ablative therapies for treatment of localised renal cell carcinoma: a systematic review of the literature. Scott Med J 2016; 61:185-191. [PMID: 27247133 DOI: 10.1177/0036933016638630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Small renal masses are commonly diagnosed incidentally. The majority are malignant and require intervention. The gold standard treatment is partial nephrectomy unless the patient has significant co-morbidities when surveillance or ablative therapies are utilised. The latter are relatively novel and their long-term efficacy and safety remain generally poorly understood. We performed a literature review to establish the current evidence on the oncological outcome of thermal ablative techniques in small renal masses treatment. METHODS AND RESULTS A systematic literature search was performed using PubMed, supplemented with additional references. Articles were reviewed for data on indications, tumour characteristics, ablative techniques, oncological outcome, impact on renal function and complications. The vast majority of articles identified were observational studies. There has not been any direct comparison against partial nephrectomy. Radiofrequency ablation and cryoablation are the techniques that are more commonly used. They have favourable oncological results on intermediate follow-up and indications that successful outcome is sustained long term. The morbidity and impact on renal function appear to be minimal. CONCLUSION Thermal ablative therapies are valid alternatives to partial nephrectomy for the treatment of small renal masses in patients unfit for surgery. Prospective long-term data will be needed before the indications for their use expand further.
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Affiliation(s)
- Agapios Gkentzis
- Urology Specialty Trainee Year 7. St James' University Hospital, Leeds, UK
| | - Grenville Oades
- Urology Consultant. Queen Elizabeth University Hospital, Glasgow, UK
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Zargar H, Atwell TD, Cadeddu JA, de la Rosette JJ, Janetschek G, Kaouk JH, Matin SF, Polascik TJ, Zargar-Shoshtari K, Thompson RH. Cryoablation for Small Renal Masses: Selection Criteria, Complications, and Functional and Oncologic Results. Eur Urol 2016; 69:116-28. [DOI: 10.1016/j.eururo.2015.03.027] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/11/2015] [Indexed: 12/27/2022]
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Domínguez A, Bellido JA, Muñoz-Rodríguez J, Abascal-Junquera JM, Hannaoui N, Banús JM. Retroperitoneal and transperitoneal laparoscopic cryotherapy for small renal masses. Actas Urol Esp 2015; 39:582-7. [PMID: 26255076 DOI: 10.1016/j.acuro.2015.04.005] [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: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Cryotherapy is a minimally invasive ablative technique that is considered an alternative to conventional surgery for preserving renal function in small renal tumors and in selected cases. We present our results from laparoscopic renal cryotherapy. MATERIAL AND METHOD We retrospectively analyzed 17 renal tumors diagnosed in 16 patients treated with cryotherapy. The patients' mean age was 66 years (43-80). The mean tumor size was 1.8cm (0.7-3.7cm). Cryotherapy with double-freeze cycle was performed laparoscopically in all cases (10 by transperitoneal approach and 7 by retroperitoneal approach). RESULTS Perioperative biopsies were performed on all patients and were positive for malignancy in 10 cases (59%). The mean stay was 2.8 days. The mean operative time was 162 minutes. Only 1 case reverted to open surgery due to bleeding. One patient required a blood transfusion in the immediate postoperative period. The majority of complications were Clavien-Dindo grades I and II. Some 76.5% of the patients had no complications. After a mean follow-up of 31 months (6-102), 1 patient died from nontumor-related causes, and 12 patients (75%) still show no evidence of local recurrence or progression. One patient had tumor persistence and therefore underwent partial nephrectomy at 6 months. One patient had a metachronous recurrence in the same kidney at 36 months, and another patient had a recurrence at 23 months. CONCLUSIONS Laparoscopic renal cryotherapy is a safe and feasible technique and is a good alternative to surgery for selected renal tumors.
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Affiliation(s)
- A Domínguez
- Departamento de Urología, Institut Català d'Urologia i Nefrologia, Barcelona, España.
| | - J A Bellido
- Departamento de Urología, Institut Català d'Urologia i Nefrologia, Barcelona, España
| | - J Muñoz-Rodríguez
- Departamento de Urología, Institut Català d'Urologia i Nefrologia, Barcelona, España
| | - J M Abascal-Junquera
- Departamento de Urología, Institut Català d'Urologia i Nefrologia, Barcelona, España
| | - N Hannaoui
- Departamento de Urología, Institut Català d'Urologia i Nefrologia, Barcelona, España
| | - J M Banús
- Departamento de Urología, Institut Català d'Urologia i Nefrologia, Barcelona, España
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Staehler M, Bader M, Schlenker B, Casuscelli J, Karl A, Roosen A, Stief CG, Bex A, Wowra B, Muacevic A. Single Fraction Radiosurgery for the Treatment of Renal Tumors. J Urol 2015; 193:771-5. [DOI: 10.1016/j.juro.2014.08.044] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 01/20/2023]
Affiliation(s)
- Michael Staehler
- Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany
| | - Markus Bader
- Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany
| | - Boris Schlenker
- Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany
| | - Jozefina Casuscelli
- Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany
| | - Alexander Karl
- Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany
| | - Alexander Roosen
- Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany
| | - Christian G. Stief
- Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany
| | - Axel Bex
- Division of Surgical Oncology, Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Berndt Wowra
- European Cyberknife Center Munich, Munich, Germany
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Kim HK, Pyun JH, Kim JY, Kim SB, Cho S, Kang SG, Lee JG, Kim JJ, Cheon J, Kang SH. Renal cryoablation of small renal masses: a Korea University experience. Korean J Urol 2015; 56:117-24. [PMID: 25685298 PMCID: PMC4325115 DOI: 10.4111/kju.2015.56.2.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/29/2014] [Indexed: 11/28/2022] Open
Abstract
Purpose To evaluate the perioperative, functional, and oncological outcomes of renal cryoablation (RC) of small renal masses (SRMs) performed in Korea University Hospital. Materials and Methods We reviewed an Institutional Review Board-approved database of 70 patients who underwent RC and were followed up for a minimum of 3 months by a single surgeon in Korea University Hospital from August 2007 to May 2014. Among these patients, 68 patients (79 renal masses) were enrolled in our research. We evaluated perioperative, functional, and oncologic outcomes of RC. Results A total of 68 patients (79 renal masses) underwent RC in our institution. The mean age of the patients was 62.0 years. The mean tumor size was 2.25 cm. Among the 59 patients who underwent laparoscopic surgery, only 1 patient (1.47%) was converted to open surgery. No other perioperative complications occurred. The mean preoperative and 1-month postoperative estimated glomerular filtration ratio (eGFR) were 71.8 and 68.3 mL/min/1.73 m2, respectively (p=0.19). The mean 1-year postoperative eGFR was 65.0 mL/min/1.73 m2 (p=0.25). The mean follow-up period was 59.76 months (range, 3-119 months). Local tumor recurrence occurred in eight tumors (15.4%; a total of 52 renal cell carcinomas). Concerning treatment in the patients with recurrence, five patients underwent re-treatment and three patients are under active surveillance. None of the eight patients who experienced local recurrence had additional recurrence or tumor progression during the follow-up period. In our study, the recurrence-free rate was 83.0% and the cancer-specific survival rate was 100%. Moreover, the 5- and 10-year overall survival rates were both 100%. Conclusions Long-term experience with RC in our institution demonstrates that RC is a safe and effective treatment for patients with SRMs.
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Affiliation(s)
- Hyung Keun Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jong Hyun Pyun
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jae Yoon Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Seung Bin Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Seok Cho
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jeong Gu Lee
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Je Jong Kim
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jun Cheon
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
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Kim SH, Lee ES, Kim HH, Kwak C, Ku JH, Lee SE, Hong SK, Jeong CW, Kim SH, Cho JY, Hwang SI, Lee HJ, Byun SS. A propensity-matched comparison of perioperative complications and of chronic kidney disease between robot-assisted laparoscopic partial nephrectomy and radiofrequency ablative therapy. Asian J Surg 2014; 38:126-33. [PMID: 25458737 DOI: 10.1016/j.asjsur.2014.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 09/19/2014] [Accepted: 09/29/2014] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The study presents a matched-pair analysis of robot-assisted laparoscopic partial nephrectomy (RALPN) versus radiofrequency ablation (RFA) to compare the perioperative incidence of complications and chronic kidney disease (CKD). METHODS All 46 RFA and 206 RALPN cases from June 2005 to December 2011 were retrospectively reviewed from the medical records and were matched 1:1 based on propensity scores by sex, tumor size, tumor laterality of kidney, tumor location within the kidney, and clinical T stage. Hilar vessel clamping was performed in all RALPN patients. The estimated glomerular filtration rate was used to define the CKD of < 60 mL/minute/1.73 m(2) by the Modification of Diet in Renal Disease equation. All patients with baseline CKD or solitary kidney were excluded prior to the matching analysis. The complication was noted with modified Clavien grades ≥ 3. Statistical analysis was performed to compare the perioperative incidence of complications and CKD. RESULTS A total of 27 matched pairs of RFA and RALPN patients were enrolled for analyzing CKD and perioperative complications. The better general conditions, higher estimated blood loss and transfusion rates, and longer operative time and hospital stay were observed significantly in RALPN patients (p < 0.05). Matched analysis demonstrated that the incidences of both perioperative complications (p = 0.434) and of CKD (p = 0.500) were not significantly different. No complication higher than Grade 4 was detected in either group. CONCLUSION Despite the intraoperative renal ischemia and invasiveness of the procedure associated with RALPN, the incidence of perioperative complication and of CKD developing rates were statistically similar.
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Affiliation(s)
- Sung Han Kim
- Department of Urology, National Cancer Center, Goyang, Gyeonggi, South Korea
| | - Eun-Sik Lee
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bun-Dang Hospital, Seoul, South Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bun-Dang Hospital, Seoul, South Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Bun-Dang Hospital, Seoul, South Korea
| | - Seung Hyup Kim
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong Yeon Cho
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung Il Hwang
- Department of Urology, Seoul National University Bun-Dang Hospital, Seoul, South Korea
| | - Hak Jong Lee
- Department of Urology, Seoul National University Bun-Dang Hospital, Seoul, South Korea
| | - Seok Soo Byun
- Department of Urology, Seoul National University Bun-Dang Hospital, Seoul, South Korea.
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Klatte T, Kroeger N, Zimmermann U, Burchardt M, Belldegrun AS, Pantuck AJ. The contemporary role of ablative treatment approaches in the management of renal cell carcinoma (RCC): focus on radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation. World J Urol 2014; 32:597-605. [PMID: 24700308 DOI: 10.1007/s00345-014-1284-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/17/2014] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Currently, most of renal tumors are small, low grade, with a slow growth rate, a low metastatic potential, and with up to 30 % of these tumors being benign on the final pathology. Moreover, they are often diagnosed in elderly patients with preexisting medical comorbidities in whom the underlying medical conditions may pose a greater risk of death than the small renal mass. Concerns regarding overdiagnosis and overtreatment of patients with indolent small renal tumors have led to an increasing interest in minimally invasive, ablative as an alternative to extirpative interventions for selected patients. OBJECTIVE To provide an overview about the state of the art in radiofrequency ablation (RFA), high-intensity focused ultrasound, and cryoablation in the clinical management of renal cell carcinoma. METHODS A PubMed wide the literature search of was conducted. RESULTS International consensus panels recommend ablative techniques in patients who are unfit for surgery, who are not considered candidates for or elect against elective surveillance, and who have small renal masses. The most often used techniques are cryoablation and RFA. These ablative techniques offer potentially curative outcomes while conferring several advantages over extirpative surgery, including improved patient procedural tolerance, faster recovery, preservation of renal function, and reduction in the risk of intraoperative and postsurgical complications. While it is likely that outcomes associated with ablative modalities will improve with further advances in technology, their application will expand to more elective indications as longer-term efficacy data become available. CONCLUSION Ablative techniques pose a valid treatment option in selected patients.
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Affiliation(s)
- Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Percutaneous Renal Cryoablation: Prospective Experience Treating 120 Consecutive Tumors. AJR Am J Roentgenol 2013; 201:1353-61. [DOI: 10.2214/ajr.13.11084] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Chalasani V, Martinez CH, Lim D, Abdelhady M, Chin JL. Surgical cryoablation as an option for small renal masses in patients who are not ideal partial nephrectomy candidates: intermediate-term outcomes. Can Urol Assoc J 2013; 4:399-402. [PMID: 21191499 DOI: 10.5489/cuaj.954] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE There has been increasing interest in surveillance and ablative techniques for small renal masses (SRM), given the increasing number being diagnosed at smaller sizes. Of the currently available ablative techniques, radiofrequency ablation and cryoablation have been the popular ones. We describe our intermediate-term outcomes with using cryoablation for SRM in patients who were not ideal candidates for partial nephrectomy. MATERIALS AND METHODS Nineteen patients treated with cryoablation were included. Patients with renal lesions <4 cm were considered for cryoablation, and all patients were treated between 2002 and 2007. Access was either laparoscopic (transperitoneal) or via open surgical techniques. From 2002 to 2004, the CryoCare System (Endocare, Inc., Irvine, CA) was used, with probe sizes ranging from 3 to 5 mm. Before 2004, the SeedNet system (Galil Medical, Arden Hills, MN) was used, with 17-gauge (1.47 mm) IceRod cryoneedles. Recurrence-free survival (RFS) and overall survival (OS) were calculated using Kaplan Meier methodology. RESULTS The mean age was 56.7 years. The mean tumour size was 2.6 cm (range 1.2-4.0 cm). There were no intraoperative or postoperative complications in the 19 patients. One patient has been lost to follow-up; mean follow up was 41.6 months (range 7-84 months) in the cohort. Recurrence, defined as either increase in size of lesion or enhancement on follow-up imaging, was seen in 4 patients. There was 1 non-cancer specific death, and 1 cancer specific death. CONCLUSIONS The 4-year RFS rate and OS rate were 83.6% and 94.1%, respectively, in patients with SRM who were unsuitable for partial nephrectomy.
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Affiliation(s)
- Venu Chalasani
- Division of Urology, University of Western Ontario, London, ON
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Sisul DM, Liss MA, Palazzi KL, Briles K, Mehrazin R, Gold RE, Masterson JH, Mirheydar HS, Jabaji R, Stroup SP, L'Esperance JO, Wake RW, Rivera-Sanfeliz G, Derweesh IH. RENAL Nephrometry Score Is Associated With Complications After Renal Cryoablation: A Multicenter Analysis. Urology 2013; 81:775-80. [DOI: 10.1016/j.urology.2012.11.037] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/19/2012] [Accepted: 11/27/2012] [Indexed: 10/27/2022]
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Probability of downsizing primary tumors of renal cell carcinoma by targeted therapies is related to size at presentation. Urology 2012; 81:111-5. [PMID: 23153934 DOI: 10.1016/j.urology.2012.09.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 09/04/2012] [Accepted: 09/12/2012] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the probability of downsizing primary renal tumors by targeted therapy in correlation to size. METHODS A literature search was conducted and our own data were pooled with data of retrospective series and prospective trials in which patients were treated with tyrosine kinase inhibitors (TKIs) and in which tumor sizes before and after treatment were reported. Included were 89 primary clear cell renal tumors, including 34 from our institutes. The longest diameter of the primary tumors before and after treatment was obtained. Primary tumor size at presentation was divided in 4 categories: <5 cm (n=10), 5 to 7 cm (n=21), 7 to 10 cm (n=31), and >10 cm (n=27). Pearson correlation and t test were used for statistical analysis. RESULTS The TKI was sorafenib in 21 tumors and sunitinib in the remaining 68. Smaller tumor size was related to more effective downsizing (P=0.01). Median downsizing was 32% (-46% to 11%) in the first group (<5 cm) and 11% (-55% to 16%) in the second group (5-7 cm); however, 8 of 21 (38%) in this group reduced to a range of 2.3 to 4.7 cm in which ablative techniques are feasible and nephron-sparing surgery may benefit from the reduced size. Median downsizing was 18% (-39% to 2%) in tumors of 7 to 10 cm and 10% (-31% to 0%) in those>10 cm. CONCLUSION The smaller the primary tumor, the greater the likelihood and the more effective the downsizing. A potential benefit of neoadjuvant treatment to downsize the primary tumor for ablative techniques or nephron-sparing surgery may exist, particularly in tumors sized 5 to 7 cm.
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Okhunov Z, Shapiro EY, Moreira DM, Lipsky MJ, Hillelsohn J, Badani K, Landman J, Kavoussi LR. R.E.N.A.L. Nephrometry Score Accurately Predicts Complications Following Laparoscopic Renal Cryoablation. J Urol 2012; 188:1796-800. [DOI: 10.1016/j.juro.2012.07.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Indexed: 01/20/2023]
Affiliation(s)
- Zhamshid Okhunov
- Arthur Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine, Hempstead, New York
| | - Edan Y. Shapiro
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Daniel M. Moreira
- Arthur Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine, Hempstead, New York
| | - Michael J. Lipsky
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Joel Hillelsohn
- Arthur Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine, Hempstead, New York
| | - Ketan Badani
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Irvine, California
| | - Louis R. Kavoussi
- Arthur Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine, Hempstead, New York
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Tanagho YS, Roytman TM, Bhayani SB, Kim EH, Benway BM, Gardner MW, Figenshau RS. Laparoscopic cryoablation of renal masses: single-center long-term experience. Urology 2012; 80:307-14. [PMID: 22857748 DOI: 10.1016/j.urology.2012.03.044] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 02/06/2012] [Accepted: 03/05/2012] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate perioperative and long-term functional and oncological outcomes of laparoscopic cryoablation (LCA) performed at Washington University. METHODS A retrospective chart review was performed evaluating 62 consecutive patients who underwent LCA at our institution between 2000 and 2005. RESULTS Mean age-adjusted Charlson Comorbidity Index (CCI) was 6.1 (SD, 2.1; 95% confidence interval [CI], 5.6-6.6). Mean tumor size was 2.52 cm (SD, 0.99; CI, 2.3-2.8). Mean operative time was 162.0 minutes (SD, 66.6; CI, 142.0-182.1). Mean estimated blood loss was 84.9 mL (SD, 102; CI, 58.6-111.2). Mean hospital stay was 2.6 days (SD, 1.90; CI, 2.1-3.1). The perioperative complication rate was 9.7% (Clavien 1-2). Among patients with biopsy proven, localized renal cell carcinoma, the 6-year Kaplan-Meier estimated disease-free survival (DFS) was 80%; cancer-specific survival (CSS) was 100%; and overall survival (OS) was 76.2%. Mean follow-up in this subset was 76.0 months (SD, 39.3; CI, 62.7-89.4; n = 35), whereas mean time to cancer recurrence was 27.6 months (SD, 11.2; CI, 15.9-39.3; n = 6). Tumor size ≥2.6 cm was the only predictor of cancer recurrence in a multivariate Cox proportional hazards model (hazard ratio [HR] = 28.9; P = .046; n = 35). Mean preoperative estimated glomerular filtration rate (eGFR) was 68.3 (SD, 22.3; CI, 62.1-74.5), compared to 64.5 mL/min/1.73 m(2) (SD, 28.9; CI, 56.5-72.6) at last follow-up (P = .12; n = 52). Excluding patients requiring secondary ablative or extirpative treatments for recurrent renal cell carcinoma, preoperative eGFR <60 mL/min/1.73 m(2) (odds ratio [OR] = 88.3; P = .036) and age-adjusted CCI ≥6 (OR = 32.4; P = .046) were the only factors predicting renal disease progression on multiple logistic regression (n = 47). CONCLUSION We report what is by far the longest follow-up to date of postlaparoscopic cryoablation changes in eGFR and note excellent long-term renal functional outcomes. For those willing to accept the potential need for retreatment for recurrent disease, LCA offers excellent long-term CSS.
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Affiliation(s)
- Youssef S Tanagho
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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Mues AC, Mucksavage P, Graversen JA, Landman J. BioGlue surgical adhesive as a thermal reflector during laparoscopic cryoablation: effect on iceball size and ablation zone diameter. JSLS 2012; 16:23-6. [PMID: 22906325 PMCID: PMC3407451 DOI: 10.4293/108680812x13291597715781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In a porcine model, the application of BioGlue did not appear to increase the size of the iceball generated, nor did it change the amount of subjective bleeding noted. Background and Objectives: Cryoablation represents an alternative for treating small renal cortical neoplasms (RCN). Previously, we demonstrated that applying BioGlue during cryoablation diminished bleeding and incidentally noted that the iceballs seemed larger than those in controls. We examined the effects of BioGlue as a thermal insulator of cryoablated tissue to determine its effect on iceball size. Methods: Laparoscopic cryoablation (LCA) was performed in 6 female pigs (24 ablations) by using a single 1.47-mm cryoablation probe. One pole of each kidney was randomly treated with BioGlue prior to ablation, while the contralateral pole was the untreated control. The size of the iceball was measured using laparoscopic ultrasound. The tissue ablation zone was measured grossly after the specimens were harvested. We also documented the amount of bleeding on a subjective scale. Results: There were no differences in the diameters of the iceballs between the BioGlue and control groups when measured with laparoscopic ultrasound (P=.85). Similarly, the ablation zones on gross measurement were not significantly different (P=.47). No difference occurred in the amount of subjective bleeding. Conclusions: In a porcine model, the application of BioGlue prior to LCA does not appear to increase the size of the iceball generated. No change was observed in the amount of subjective bleeding as a result of using BioGlue.
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Affiliation(s)
- Adam C Mues
- New York University School of Medicine, Department of Urology, New York, NY, USA
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Critchfield J, Harb J. Percutaneous renal cryoablation complicated by hemorrhage. Semin Intervent Radiol 2012; 28:137-41. [PMID: 22654249 DOI: 10.1055/s-0031-1280651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The authors describe a case in which a patient underwent percutaneous cryoablation of a suspected right renal cell carcinoma complicated by bleeding. Urgent angiography revealed a lower renal pole arteriovenous (AV) fistula, correlating with the recent treatment site. This AV fistula was successfully treated with coil and Gelfoam embolization. Three days later, the patient's hemoglobin dropped following dialysis. Computed tomography (CT) imaging revealed an increase in the size of the pararenal hematoma. There were multiple pseudoaneurysms as well as a small AV fistula on repeat angiography. The right main renal artery was coil embolized.
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Affiliation(s)
- Jeffrey Critchfield
- Detroit Medical Center, Wayne State University, Karmanos Cancer Institute, Detroit, Michigan
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Autorino R, Kaouk JH. Cryoablation for small renal tumors: Current status and future perspectives. Urol Oncol 2012; 30:S20-7. [DOI: 10.1016/j.urolonc.2011.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 10/24/2011] [Accepted: 10/28/2011] [Indexed: 10/28/2022]
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Guillotreau J, Haber GP, Autorino R, Miocinovic R, Hillyer S, Hernandez A, Laydner H, Yakoubi R, Isac W, Long JA, Stein RJ, Kaouk JH. Robotic Partial Nephrectomy Versus Laparoscopic Cryoablation for the Small Renal Mass. Eur Urol 2012; 61:899-904. [DOI: 10.1016/j.eururo.2012.01.007] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 01/05/2012] [Indexed: 01/20/2023]
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Haramis G, Graversen JA, Mues AC, Korets R, Rosales JC, Okhunov Z, Badani KK, Gupta M, Landman J. Retrospective Comparison of Laparoscopic Partial Nephrectomy Versus Laparoscopic Renal Cryoablation for Small (<3.5 cm) Cortical Renal Masses. J Laparoendosc Adv Surg Tech A 2012; 22:152-7. [DOI: 10.1089/lap.2011.0246] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Georgios Haramis
- Department of Urology, Columbia University Medical Center, New York, New York
| | | | - Adam C. Mues
- Department of Urology, New York University School of Medicine, New York, New York
| | - Ruslan Korets
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Juan Carlos Rosales
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Zhamshid Okhunov
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Ketan K. Badani
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Mantu Gupta
- Department of Urology, Columbia University Medical Center, New York, New York
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Irvine, California
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Duffey B, Nguyen V, Lund E, Koopmeiners JS, Hulbert J, Anderson JK. Third Prize: Intermediate-Term Outcomes After Renal Cryoablation: Results of a Multi-Institutional Study. J Endourol 2012; 26:15-20. [DOI: 10.1089/end.2011.0179] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Branden Duffey
- Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Vannhu Nguyen
- Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Erik Lund
- Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota
| | | | | | - James Kyle Anderson
- Department of Urologic Surgery, University of Minnesota, Minneapolis, Minnesota
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CT-guided percutaneous cryoablation of renal masses in selected patients. Radiol Med 2011; 117:593-605. [PMID: 22020435 DOI: 10.1007/s11547-011-0742-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 03/02/2011] [Indexed: 10/16/2022]
Abstract
PURPOSE We analysed our experience with computed tomography (CT)-guided percutaneous cryoablation (PCA) in patients who were not surgical candidates or refused surgery for small to medium-sized renal masses. MATERIALS AND METHODS Two freezing cycles were applied and separated by a passive warming cycle using 1.7- and 2.4-mm cryoprobes under either general anaesthesia or sedation based on patient positioning and respiratory status. Postoperative monitoring included haematological and biochemistry evaluation and CT scan 24 h after PCA. Follow-up consisted of a multislice CT scan at 1 month and every 3 months in the first year then every 6 months thereafter. RESULTS Thirty-seven patients (38 lesions) underwent 40 PCA procedures; 5/37 (13.5%) had a solitary kidney. Median mass size was 35 (range 12-70) mm. No complications occurred during the procedure. Clavien grade ≥2 anaemia occurred in two patients (5.4 %): one patient required 1 U of packed red blood cells; the other required an arterial embolisation. Serum creatinine did not increase in any case. Two patients showed persisting or recurrent disease at 1 and 9 months, respectively, and both could be re-treated with PCA. All other patients showed a hypodense mass 3 months after PCA, with no contrast enhancement. Subsequent examinations showed that lesion sizes decreased and CT densitometry remained stable or increased minimally, also with no contrast enhancement. CONCLUSIONS PCA proved relatively easy and safe and could be considered an effective alternative for patients who are not surgical candidates or refuse surgery, as well as in patients with medium-sized lesions.
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Klatte T, Grubmüller B, Waldert M, Weibl P, Remzi M. Laparoscopic Cryoablation Versus Partial Nephrectomy for the Treatment of Small Renal Masses: Systematic Review and Cumulative Analysis of Observational Studies. Eur Urol 2011; 60:435-43. [DOI: 10.1016/j.eururo.2011.05.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 05/02/2011] [Indexed: 02/07/2023]
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Barwari K, Beemster PW, Hew MN, Wijkstra H, de la Rosette J, Laguna MP. Are There Parameters that Predict a Nondiagnostic Biopsy Outcome Taken During Laparoscopic-Assisted Cryoablation of Small Renal Tumors? J Endourol 2011; 25:1463-8. [DOI: 10.1089/end.2010.0693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kurdo Barwari
- Department of Urology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Patricia W.T. Beemster
- Department of Urology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Miki N. Hew
- Department of Urology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Hessel Wijkstra
- Department of Urology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Jean de la Rosette
- Department of Urology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - M. Pilar Laguna
- Department of Urology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, the Netherlands
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Contemporary Management of Small Renal Masses. Eur Urol 2011; 60:501-15. [DOI: 10.1016/j.eururo.2011.05.044] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 05/23/2011] [Indexed: 02/07/2023]
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Small renal mass: what the urologist needs to know for treatment planning and assessment of treatment results. AJR Am J Roentgenol 2011; 196:1267-73. [PMID: 21606288 DOI: 10.2214/ajr.10.6336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Small renal mass is a new distinct clinical entity. Detection of these tumors has increased with increased use of imaging. CONCLUSION We know that a proportion of these tumors are not renal cell carcinoma, and imaging-guided biopsy is being increasingly used for treatment planning. The objectives of this review are to provide an update on our current understanding of the biology of small renal masses and to review approaches to the diagnosis and treatment of these lesions.
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Tsivian M, Caso J, Kimura M, Polascik TJ. Renal Function Outcomes After Laparoscopic Renal Cryoablation. J Endourol 2011; 25:1287-91. [DOI: 10.1089/end.2011.0017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Jorge Caso
- Duke University Medical Center, Durham, North Carolina
| | - Masaki Kimura
- Duke University Medical Center, Durham, North Carolina
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Mues AC, Graversen JA, Truesdale MD, Casazza C, Landman J. BioGlue Iceball Stabilization to Minimize the Risk of Hemorrhage During Laparoscopic Renal Cryoablation. Urology 2011; 78:353-6. [DOI: 10.1016/j.urology.2011.01.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 01/07/2011] [Accepted: 01/13/2011] [Indexed: 10/17/2022]
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Van Poppel H, Becker F, Cadeddu JA, Gill IS, Janetschek G, Jewett MAS, Laguna MP, Marberger M, Montorsi F, Polascik TJ, Ukimura O, Zhu G. Treatment of localised renal cell carcinoma. Eur Urol 2011; 60:662-72. [PMID: 21726933 DOI: 10.1016/j.eururo.2011.06.040] [Citation(s) in RCA: 170] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 06/20/2011] [Indexed: 02/08/2023]
Abstract
CONTEXT The increasing incidence of localised renal cell carcinoma (RCC) over the last 3 decades and controversy over mortality rates have prompted reassessment of current treatment. OBJECTIVE To critically review the recent data on the management of localised RCC to arrive at a general consensus. EVIDENCE ACQUISITION A Medline search was performed from January 1, 2004, to May 3, 2011, using renal cell carcinoma, nephrectomy (Medical Subject Heading [MeSH] major topic), surgical procedures, minimally invasive (MeSH major topic), nephron-sparing surgery, cryoablation, radiofrequency ablation, surveillance, and watchful waiting. EVIDENCE SYNTHESIS Initial active surveillance (AS) should be a first treatment option for small renal masses (SRMs) <4 cm in unfit patients or those with limited life expectancy. SRMs that show fast growth or reach 4 cm in diameter while on AS should be considered for treatment. Partial nephrectomy (PN) is the established treatment for T1a tumours (<4 cm) and an emerging standard treatment for T1b tumours (4-7 cm) provided that the operation is technically feasible and the tumour can be completely removed. Radical nephrectomy (RN) should be limited to those cases where the tumour is not amenable to nephron-sparing surgery (NSS). Laparoscopic radical nephrectomy (LRN) has benefits over open RN in terms of morbidity and should be the standard of care for T1 and T2 tumours, provided that it is performed in an advanced laparoscopic centre and NSS is not applicable. Open PN, not LRN, should be performed if minimally invasive expertise is not available. At this time, there is insufficient long-term data available to adequately compare ablative techniques with surgical options. Therefore ablative therapies should be reserved for carefully selected high surgical risk patients with SRMs <4 cm. CONCLUSIONS The choice of treatment for the patient with localised RCC needs to be individualised. Preservation of renal function without compromising the oncologic outcome should be the most important goal in the decision-making process.
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Affiliation(s)
- Hein Van Poppel
- Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium
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Klatte T, Mauermann J, Heinz-Peer G, Waldert M, Weibl P, Klingler HC, Remzi M. Perioperative, oncologic, and functional outcomes of laparoscopic renal cryoablation and open partial nephrectomy: a matched pair analysis. J Endourol 2011; 25:991-7. [PMID: 21568698 DOI: 10.1089/end.2010.0615] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To directly compare perioperative, oncologic, and functional outcomes of laparoscopic renal cryoablation and open partial nephrectomy using a matched pair analysis. PATIENTS AND METHODS A total of 41 patients who underwent laparoscopic cryoablation for an incidental, solid clinical T(1a)N(0)M(0) renal tumor were matched with 82 patients who received partial nephrectomy in cold ischemia, using optimal matching based on propensity scores, which were created on the basis of preoperative aspects and dimensions used for an anatomic classification of renal tumors (PADUA) score, preoperative glomerular filtration rate, age-adjusted Charlson comorbidity index, and sex. Median follow-up was 33.6 months. RESULTS No differences in the overall incidence of complications (cryoablation, 20%; partial nephrectomy, 17%; P=0.739) and grade of complications (P=0.424) were observed. After cryoablation, local recurrence developed in four patients with renal-cell carcinoma (n=35) after a median duration of 14 months (range 6-18 mos), but none after partial nephrectomy. The 3-year recurrence-free survival probabilities after laparoscopic renal cryoablation vs open partial nephrectomy were 83% vs 100%, respectively (P=0.015). The average decrease of estimated glomerular filtration rate during follow-up was 7.8±3.1 mL/min/1.73 m(2) after laparoscopic cryoablation and 9.8±2.3 mL/min/1.73 m(2) after open partial nephrectomy, which was not statistically significant (P=0.602). CONCLUSIONS Perioperative complications and renal functional outcomes of laparoscopic cryoablation and open partial nephrectomy are similar; however, laparoscopic cryoablation confers a substantially higher local recurrence risk of about 17% after 3 years. Therefore, laparoscopic renal cryoablation should be reserved for high-risk patients with decreased life expectancy. Careful patient counseling is advocated. Study limitations include the small sample size, the lack of randomization, and the short follow-up.
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Affiliation(s)
- Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna, Austria.
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Barwari K, de la Rosette JJ, Laguna MP. Focal Therapy in Renal Cell Carcinoma: Which Modality Is Best? ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.eursup.2011.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Vricella GJ, Haaga JR, Adler BL, Dean Nakamoto, Cherullo EE, Flick S, Ponsky LE. Percutaneous Cryoablation of Renal Masses: Impact of Patient Selection and Treatment Parameters on Outcomes. Urology 2011; 77:649-54. [DOI: 10.1016/j.urology.2010.08.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 07/31/2010] [Accepted: 08/14/2010] [Indexed: 11/26/2022]
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Beemster PWT, Barwari K, Mamoulakis C, Wijkstra H, de la Rosette JJMCH, Laguna MP. Laparoscopic renal cryoablation using ultrathin 17-gauge cryoprobes: mid-term oncological and functional results. BJU Int 2010; 108:577-82. [PMID: 21044249 DOI: 10.1111/j.1464-410x.2010.09807.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
UNLABELLED Study Type - Therapy (case series). LEVEL OF EVIDENCE 4. What's known on the subject? and What does the study add? Laparoscopic Cryoablation of renal masses has a low persistence and recurrence rates at short term follow-up albeit higher than Partial Nephrectomy. Long term results are scarcely reported. It is however a NSS technique suitable for high-risk that preserves renal function. The study provides (1) mid-term oncological outcomes of laparoscopic cryoablation of renal masses stratified by primary pathology (RCC, benign mass or undetermined biopsy) and (2) data on renal function evolution up to one year of follow-up supporting the fact that the only predictor of (moderate)renal insufficiency development after Laparoscopic cryoablation is the eGFR at baseline. OBJECTIVE To present the functional and oncological mid-term results of laparoscopic cryoablation of renal masses using third generation ultrathin (17-gauge[G]) cryoprobes. PATIENTS AND METHODS • Consecutive patients with small renal masses treated by cryoablation from September 2003 to September 2008 were prospectively evaluated. The cryoablation was performed using multiple third generation 17-G cryoprobes after intraoperative mass biopsy. • Data on serum creatinine measurements and cross sectional imaging (computed tomography/magnetic resonance imaging) were regularly collected according to a previously determined protocol. Follow-up was censored in October 2009. • Renal function analysis was based on estimated glomerular filtration rate (eGFR) at 1 year compared with baseline. Residual (or persistent tumour) and recurrence were defined as the presence of residual enhancement at first follow-up and 'de novo' enhancement of a non-enhancing cryolesion at any time during follow-up. • Survival data were analysed using the Kaplan-Meier method. Best estimates for the overall survival (OS), recurrence-free survival (RFS), cancer-specific survival (CSS) and metastatic-free survival (MFS) were made for patients with renal cell carcinoma (RCC) and for patients with RCC or non-diagnostic biopsy. RESULTS • A total of 92 patients (100 tumours; mean size 2.5 ± 0.8 cm) were treated in 95 sessions. The mean follow-up was 30.2 ± 16.6 months (Mean values are ±SD). • Intraoperative biopsy showed RCC in 51 patients (53.7%), benign lesion in 23 patients (24.2%) and was non-diagnostic in 21 patients (22.1%). Three tumour persistences and four radiological recurrences were detected. • The estimated mean RFS time and 3-year OS and RFS in patients with RCC exclusively were 47.8 (95% confidence interval [CI]: 44.1-51.1) months, 86.1% (95% CI: 71.2-93.6) and 91.8% (95% CI: 76.3-97.3), respectively. The figures were slightly higher in the group of patients with RCC or unknown pathology. The actual CSS and MFS rates were 100%. • Renal function was preserved in 84.5% of patients with normal preoperative eGFR. • Baseline eGFR was the only predictor of renal insufficiency development at 1-year follow-up. CONCLUSION Laparoscopic cryoablation with multiple ultrathin cryoprobes is oncologically and functionally effective at mid-term follow-up.
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Affiliation(s)
- Patricia W T Beemster
- Department of Urology, Academic Medical Center University of Amsterdam, Amsterdam, The Netherlands
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Crow P, Keeley FX. Prevention and handling of complications of renal focal therapies. J Endourol 2010; 24:765-7. [PMID: 20377430 DOI: 10.1089/end.2009.0542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Small renal lesions often confer relatively low oncologic risk and, as such, dictate for treatment strategies with low morbidity. Minimally invasive ablative techniques have been developed and can deliver good outcomes where used judiciously. The potential risks of treatment relate to the method of ablation, the route by which it is delivered, together with patient and tumor factors. The complications associated with radiofrequency ablation and cryoablation, delivered via percutaneous and laparoscopic approaches, are considered in this review. Percutaneous ablation appears to be associated with lower rates of morbidity but higher rates of recurrence when compared with laparoscopic ablation. The ability to dissect the lesion away from surrounding structures is limited with the percutaneous approach, which can lead to poor outcomes when treating lesions close to the ureter or hilum. Hemorrhagic complications that are seen with laparoscopic cryoablation are most often associated with tumor fracture during the freeze-thaw cycle. This is encountered most frequently in larger, peripheral lesions but may be mitigated by slowing the freeze rate. Postablation inpatient stays are often short, and early signs of complication are often nonspecific. This combination can lead to significant delay in the recognition of postablative problems with a resultant increase in morbidity. A high index of suspicion together with appropriate use of imaging allows for earlier detection and management of complications.
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Affiliation(s)
- Paul Crow
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
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Current world literature. Curr Opin Urol 2010; 20:443-51. [PMID: 20679773 DOI: 10.1097/mou.0b013e32833dde0d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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de la Rosette J, Gill I, Polascik T. Focal therapy for prostate and renal cancer--are we ready for it? J Endourol 2010; 24:663. [PMID: 20477539 DOI: 10.1089/end.2010.1504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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The modified Clavien classification system: a standardized platform for reporting complications in transurethral resection of the prostate. World J Urol 2010; 29:205-10. [PMID: 20461386 PMCID: PMC3062770 DOI: 10.1007/s00345-010-0566-y] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 04/22/2010] [Indexed: 11/06/2022] Open
Abstract
Purpose The aim of the study was to evaluate the applicability of the modified Clavien classification system (CCS) in grading perioperative complications of transurethral resection of the prostate (TURP). Methods All patients with benign prostatic hyperplasia submitted to monopolar TURP from January 2006 to February 2008 at a non-academic center were evaluated for complications occurring up to the end of the first postoperative month. All complications were classified according to the modified CCS independently by two urologists, and the final decision was based on consensus. If multiple complications per patient occurred, categorization was done in more than one grade. Results were presented as complication rates per grade. Results Forty-four complications were recorded in 31 out of 198 patients (overall perioperative morbidity rate: 15.7%), and their grading was generally easy, non-time-consuming and straightforward. Most of them were classified as grade I (59.1%) and II (29.5%). Higher grade complications were scarce (grade III: 2.3% and grade IV: 6.8%, respectively) There was one death (grade V: 2.3%) due to acute myocardial infarction (overall mortality rate: 0.5%). Negative outcomes such as mild dysuria during this early postoperative period or retrograde ejaculation were considered sequelae and were not recorded. Nobody was complicated with severe dysuria. There was one re-operation due to residual adenoma (0.5%). Conclusions The modified CCS represents a straightforward and easily applicable tool that may help urologists to classify the complications of TURP in a more objective and detailed way. It may serve as a standardized platform of communication among clinicians allowing for sound comparisons.
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Autorino R, Haber GP, White MA, Stein RJ, Kaouk JH. New Developments in Renal Focal Therapy. J Endourol 2010; 24:665-72. [DOI: 10.1089/end.2009.0643] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Riccardo Autorino
- Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Georges-Pascal Haber
- Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael A. White
- Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert J. Stein
- Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad H. Kaouk
- Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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Klingler HC, Susani M. Focal Therapy and Imaging in Prostate and Kidney Cancer: Renal Biopsy Protocols Before and After Focal Therapy. J Endourol 2010; 24:701-5. [DOI: 10.1089/end.2009.0526] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Martin Susani
- Department of Pathology, Medical University of Vienna, Vienna, Austria
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Rioja J, Tzortzis V, Mamoulakis C, Laguna M. Crioterapia de tumores renales: estado actual y desarrollos contemporáneos. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2009.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Complications of laparoscopic and percutaneous renal cryoablation in a single tertiary referral center. Eur Urol 2010; 58:142-7. [PMID: 20363550 DOI: 10.1016/j.eururo.2010.03.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 03/19/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Laparoscopic cryoablation (LCA) and percutaneous cryoablation (PCA) of small renal masses have gained popularity, but only limited data exist on the complication rates. OBJECTIVES In this study, we report on postoperative complications associated with LCA and PCA in a single tertiary center experience. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective review of electronic medical records for patients undergoing LCA or PCA between 2001 and 2008 at our institution. INTERVENTIONS All patients underwent LCA or PCA. MEASUREMENTS Demographics, radiographic variables, and complication rates were compared between the two groups. Complications were classified according to the modified Clavien system. RESULTS AND LIMITATIONS Of a total of 195 patients included in this study, 72 underwent LCA and 123 underwent PCA. There were no differences in demographics between the groups. We observed complications in 10 LCA procedures (13.9%) and 26 PCA procedures (21.1%) (p=0.253). The distribution of the complications differed significantly between the groups with mild complications (grades 1 and 2) more common in the PCA group (20.3% vs 5.6%, respectively; p=0.001), whereas severe events (grades 3 and 4) were more frequent in the LCA group (8.3% vs 0.8%, respectively; p=0.011). On multivariate analysis, age and body mass index were inversely associated with complications, whereas female gender, multiple tumors, and preexisting comorbidities showed a trend toward increased risk. CONCLUSIONS LCA and PCA, although minimally invasive, are not void of complications. Most of the complications encountered are mild; however, severe (grade 3 or 4) events may occur in up to 3.6% of patients. PCA may be associated with a higher rate of complications, although most of these are mild and transient. However, on multivariate analysis, the chosen ablative approach (laparoscopic or percutaneous) is not associated with the risk of complications.
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