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Benichou Y, Audenet F, Bensalah K, Roupret M, Paparel P, Lebacle C, Bruyère F, Beauval JB, Villers A, Lang H, Durand X, Bigot P, Long JA, Champy C, Lavolle A, Bernhard JC, Alezra E. Partial nephrectomy in solitary kidneys: comparison between open surgery and robotic-assisted laparoscopy on perioperative and functional outcomes (UroCCR-54 study). World J Urol 2023; 41:315-324. [PMID: 35723688 DOI: 10.1007/s00345-022-04026-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 04/22/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The management of solitary kidney tumors is a surgical challenge, requiring irreproachable results on both oncological and functional outcomes. The goal of our study was to compare the perioperative results of robotic-assisted partial nephrectomy (RAPN) to open surgery in this indication. METHODS We led a multicentric study based on the prospectively maintained French national database UroCCR. Patients who underwent partial nephrectomy on a solitary kidney between 1988 and 2020 were included. Clinical and pathological data were retrospectively analyzed. The main outcome of the study was the analysis of the variation of the estimated glomerular filtration rate (eGFR) calculated according to MDRD at 3, 6, 12, and 24 months depending on the chosen surgical approach. The secondary outcomes were the comparison of Trifecta success, perioperative complications, and length of hospital stay. RESULTS In total, 150 patients were included; 68 (45%) in the RAPN group and 82 (55%) in the open surgery group. The two groups were comparable for all data. The variation of eGFR at 3, 6, 12, or 24 months was comparable without any significant difference between the 2 groups (p = 0.45). Trifecta was achieved in 40% of the patients in the RAPN group and 33% in the open group (p = 0.42). A significant difference was observed for the length of stay, 5 days for the robot group versus 9 days for the open surgery group (p < 0.0001). CONCLUSION In our study, the surgical approach did not modify functional results and we noted a significant decrease in hospital stay and complications in the RAPN group. RAPN is a safe and efficient method for management of kidney tumors in solitary kidneys.
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Affiliation(s)
- Ygal Benichou
- Urology Department of Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France.
| | - François Audenet
- Urology Department of Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015, Paris, France
| | | | - Morgan Roupret
- Urology Department of La Pitié-Salpétrière, Paris, France
| | | | - Cedric Lebacle
- Urology Department of Le Kremlin-Bicètre, Le Kremlin Bicetre, France
| | | | | | | | - Hervé Lang
- Urology Department of Strasbourg, Strasbourg, France
| | | | - Pierre Bigot
- Urology Department of Angers, Angers Cedex 9, France
| | | | | | | | | | - Eric Alezra
- Urology Department of Bordeaux, Bordeaux, France
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2
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El Gdaouni A, Ziouziou I. Pseudo-tumor renal tuberculosis: a case report. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00285-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Renal lesion is a very frequent location of tuberculosis disease, the diagnosis of which is often difficult and delayed due to its atypical clinical presentations, especially in its pseudo-tumoral form.
Case presentation
Patient of 54 year old was referred after a kidney mass was found on an abdominal ultrasound. In addition, the patient reported the notion of minimal intermittent low back pain with weight loss. On computed tomography, it was a nodular lesion of the superior pole of the right kidney, and it has a heterogeneous density and a suspicious appearance. A total nephrectomy was performed by subcostal incision. Pathological examination of the specimen revealed the presence of diffuse gigantocellular granulomas with caseous necrosis suggestive of renal tuberculosis.
Conclusion
Despite the rarity of this form, renal tuberculosis should always be thought in order to avoid radical treatment.
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Laquet P, Pradère B, Francois M, Ravel A, Lambert C, Guy L. Résultats périopératoires de la radiofréquence sur les petites tumeurs du rein : complications, impact sur la fonction rénale et résultats oncologiques. Prog Urol 2022; 32:551-557. [DOI: 10.1016/j.purol.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/14/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
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Magnier A, Nedelcu C, Chelly S, Rousselet-Chapeau MC, Azzouzi AR, Lebdai S. Prostate cancer detection by targeted prostate biopsy using the 3D Navigo system: a prospective study. Abdom Radiol (NY) 2021; 46:4381-4387. [PMID: 33856508 DOI: 10.1007/s00261-021-03078-9] [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: 12/08/2020] [Revised: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The 3D Navigo™ system is a magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) fusion device for prostate targeted biopsies (TB). Our aim was to evaluate the clinically significant prostate cancer (CSC) detection rate of TB using the 3D Navigo™ system. METHODS Patients who underwent TB with the 3D Navigo™ system in our center between June 2014 and May 2018 were prospectively included, excluding those who have previously received treatment for prostate cancer. A 3-Tesla MRI imaging was performed before biopsies; findings were reported according to the Prostate Imaging Reporting and Data System version 2 (PIRADS). CSC was defined by an ISUP score ≥ 2. RESULTS 304 patients underwent TB. Median age was 66 years (51-84). Median PSA was 7.75 ng/ml (0.6-70.0). Median prostate volume was 45.0 ml (15.9-221.7). PCa and CSC were found in 70.4% (214/304) and 47.7% (145/304) of the patients, respectively. The proportion of patients diagnosed with CSC among those with PCa was 67.8% (145/214). There was a significant risk of having a CSC in case of PIRADS score ≥ 4 and 5 (OR 5.0, 95% CI [2.7-9.2], P < 0.001; OR 3.2, 95% CI [1.8-5.5], P < 0.001). PIRADS score was an independent risk factor of having a CSC (OR 4.19, 95% CI [2.49-7.05], P < 0.001). There was no significant difference between pathological outcomes of TB and RP in paired analysis (P = 0.892). There was a correlation between TB and RP specimens for PCa detection (r = 0.60, P < 0.001). CONCLUSION Detecting CSC with MRI-TRUS fusion targeted biopsies using the 3D Navigo™ system is feasible and safe. We found a positive correlation between TB and RP for ISUP scores.
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Affiliation(s)
- Alexandre Magnier
- Urology Department, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France.
| | - Cosmina Nedelcu
- Radiology Department, University Hospital of Angers, Angers, France
| | - Samuel Chelly
- Urology Department, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
| | | | - Abdel Rahmene Azzouzi
- Urology Department, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - Souhil Lebdai
- Urology Department, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
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Are gastric metastases of renal cell carcinoma really rare? A case report and systematic review of the literature. Int J Surg Case Rep 2021; 82:105867. [PMID: 33839629 PMCID: PMC8055614 DOI: 10.1016/j.ijscr.2021.105867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/23/2022] Open
Abstract
Solitary gastric metastasis of RCC are scarce. When feasible, surgical or endoscopic treatment of gastric metastasis should be performed. Risk of metastatic recurrence is significant and must be taken into consideration in the therapeutic strategy.
Introduction Renal cell carcinoma (RCC) represents above 3 % of all cancers. At diagnosis, above 25 % of patients with RCC present an advanced disease. Gastric metastasis of RCC is associated with poor outcome. We report the case of a patient treated for a gastric metastasis of RCC and we conducted a systematic review of the literature to report all published cases of RCC patients with gastric metastasis. Case presentation In December 2010, a 61-year-old man was treated by open partial nephrectomy for a localized right clear cell RCC. In September 2018, a metachronous gastric metastasis was found on CT scan. The lesion was located on the lesser curvature of the stomach, measuring 4.5 cm long axis. No other secondary lesions were identified. A laparoscopic wedge resection, converted to laparotomy was performed. Two years later, in September 2020, a CT scan was performed, revealing a 17 mm adenopathy behind the hepatic hilum and a surgical management was performed, including a lymph node dissection of the hepatic hilum and the hepatic artery. Actually, he remains healthy. Clinical discussion and conclusion Our systematic review suggests that solitary gastric metastasis of RCC are scarce. In comparison of patients with multiple metastatic sites, the median survival of patients with solitary gastric metastasis is longer.
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[Long-term follow-up of renal cell carcinomas T1a treated by percutaneous radiofrequency]. Prog Urol 2021; 31:576-583. [PMID: 33593696 DOI: 10.1016/j.purol.2020.09.021] [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: 09/02/2019] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the long-term oncological and functional results of the ablative treatment of T1a kidney malignancies by percutaneous radiofrequency (RF). MATERIALS AND METHODS Monocentric retrospective study including all patients treated for renal cell carcinoma (RCC) T1a by radiofrequency, in our center, from 2005 to 2009. All patients had a tumor biopsy before treatment. The primary endpoint was local recurrence. A total of 44 RCCs in 41 consecutive patients were treated (1 patient had 3 synchronous tumors and 1 patient had 2 tumors). There were 26 clear cell RCCs, 13 papillary RCCs and 5 chromophobe RCCs. The median age at diagnosis was 70 years [48-82]. The median American Society of Anesthesiologists (ASA) score was 2 [1-3] and the median glomerular filtration rate (GFR) was 64mL/min [26-109]. Furhman grade was defined for 39 tumors (Clear cell RCC and papillary RCC), of which 82% were grade 1-2. The median tumor size was 20mm [11-40], and the median RENAL score was 4 [4-6]. Complications were assessed according to the Clavien-Dindo classification. Overall survival, recurrence-free survival and metastasis-free survival were calculated using the Kaplan-Meier method. RESULTS Median follow-up was 90.5 months [17.8-145.3]. Three (7%) local recurrences were reported within a median of 26 months [12-93]. All were treated by a 2nd RF. The overall 10-year survival was 70% (95% CI [56-85]). The 10-year recurrence-free survival was 72% (95% CI [57-88]). The 10-year metastasis-free survival was 87% (95% CI [74-97]). The median GFR on the date of the last news was 51mL/min [16-98] (P=0.05). Post-RFA complications consisted in 5 (11.3%) Clavien-Dindo 1-2 complications. No high grade (Clavien ≥3). CONCLUSION Percutaneous radiofrequency for RCC T1a is an alternative. It appears to be safe with low morbidity, satisfaying long-term oncological and functional results, but a risk of reprocessing of 7%. LEVEL OF EVIDENCE 3.
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Vuong NS, Ferriere JM, Michiels C, Calen L, Tesi L, Capon G, Bensadoun H, Alezra E, Estrade V, Robert G, Bladou F, Bernhard JC. Robot-assisted versus open surgery for radical nephrectomy with level 1-2 vena cava tumor thrombectomy: a French monocenter experience (UroCCR study #73). Minerva Urol Nephrol 2020; 73:498-508. [PMID: 33200900 DOI: 10.23736/s2724-6051.20.04052-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this paper was to assess the feasibility of robot-assisted radical nephrectomy (RN) with inferior vena cava thrombectomy (RRVCT) and compare perioperative and oncological outcomes of this approach to open surgery for renal tumors with level 1-2 inferior vena cava (IVC) thrombus. METHODS We performed a retrospective analysis of patients surgically treated for renal cancer with IVC level 1-2 thrombus in the Urology department of Bordeaux University Hospital between December 2015 and December 2019. Patients were stratified by surgical approach in two groups: open vs. robotic procedures. Pre-, per- and postoperative data were collected within the framework of the UroCCR project (NCT03293563). Univariate and multivariate analysis using regression models were performed. RESULTS A total of 40 patients underwent RN with IVC tumor thrombus. Open and robotic surgery represented respectively 30 and 10 cases. The two groups were comparable regarding pre-operative tumor and patient characteristics. Robotic procedures were associated with lower estimated blood loss (EBL) (500 vs. 1250 mL, P=0.02), shorter Intensive Care Unit stay (2 vs. 4 days, P=0.03) and decrease of global length of stay (LOS) (7 vs. 10 days, P<0.01). Operative Time (OT) was significantly longer in the robotic group (350.5 vs. 208 min, P<0.01). No difference were observed between the two approaches regarding complications and oncological outcomes. CONCLUSIONS Robotic approach induced lower bleeding and shorter LOS but required longer OT. This technique is feasible and safe for selected cases and experimented surgical teams. Complications rate and oncological outcomes are not different compared to standard open procedures.
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Affiliation(s)
- Nam-Son Vuong
- Department of Urology, Bordeaux University Hospital, Bordeaux, France -
| | | | - Clément Michiels
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Laura Calen
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Lorenso Tesi
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Grégoire Capon
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Henri Bensadoun
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Eric Alezra
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Vincent Estrade
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Grégoire Robert
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Franck Bladou
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
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Renal Carcinoma and Kartagener Syndrome: An Unusual Association. Case Rep Urol 2020; 2020:8260191. [PMID: 32509371 PMCID: PMC7246399 DOI: 10.1155/2020/8260191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/01/2020] [Indexed: 11/18/2022] Open
Abstract
Background The association of renal cell carcinoma and Kartagener's syndrome is unusual, and only eleven cases have been reported in the literature. The purpose of this work is to analyze this unusual association of Kartagener's syndrome and renal cell tumor and to study the main diagnostic and therapeutic aspects through our observation and review of the literature. Case Presentation. We report the case of a 50-year-old patient, with a history of recurrent respiratory infections, in whom a renal tumor was simultaneously diagnosed with Kartagener's syndrome, represented by situs inversus, bronchiectasia, and chronic sinusitis. The patient was treated by partial nephrectomy, and the histological examination showed a clear cell carcinoma. Through this observation and a review of the literature, we try to analyze this association as well as the main diagnostic and therapeutic aspects. Conclusion The association of situs inversus and renal cell carcinoma is very rare—preoperative assessment and anatomy knowledge are crucial for a better adaptation of the surgical technique.
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Nientiedt M, Bertolo R, Campi R, Capitanio U, Erdem S, Kara Ö, Klatte T, Larcher A, Mir MC, Ouzaid I, Roussel E, Salagierski M, Waldbillig F, Kriegmair MC. Chronic Kidney Disease After Partial Nephrectomy in Patients With Preoperative Inconspicuous Renal Function - Curiosity or Relevant Issue? Clin Genitourin Cancer 2020; 18:e754-e761. [PMID: 32660879 DOI: 10.1016/j.clgc.2020.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/04/2020] [Accepted: 05/12/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a severe long-term complication after partial nephrectomy (PN). Clinical and scientific focus lies on patients with impaired renal function at the time of surgery. Little data is available on patients with normal preoperative renal function (NPRF). PATIENTS AND METHODS Patients who underwent PN with a preoperative estimated glomular filtration rate > 60 mL/min/1.73m2 were retrospectively examined at 8 European urologic centers. The occurrence of new onset CKD ≥ stage III after surgery (sCKD) was defined as the primary endpoint. Group comparisons and risk correlations were determined. Based on this data, a risk stratification model for sCKD was developed. RESULTS Of the 1315 patients with NPRF included, 249 (18.9%) developed sCKD after a median follow-up of 44 months (range, 6-255 months). Pair analysis and univariable regression revealed age, arterial hypertension, American Society of Anesthesiologists score, tumor stage, surgical approach, intraoperative blood loss, perioperative blood transfusions and preoperative CKD stage as predictors for sCKD development. Multivariate analysis confirmed perioperative blood transfusion (hazard ratio [HR], 2.96; P ≤ .0001), age (≥ 55 years; HR, 2.60; P = .0002), tumor stage (> pT1; HR, 2.15; P = .025), and preoperative CKD stage (stage II vs. I; HR, 3.85; P ≤ .0001) as independent risk factors. A model that stratified patient risk for new onset CKD was highly significant (P < .0001). CONCLUSION Every fifth patient with NPRF developed sCKD following PN. Elderly patients with higher tumor stage and who require blood transfusion appear to be at increased risk. Based on our risk stratification, patients with ≥ 2 risk factors are candidates for an early, nephrologic follow-up.
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Affiliation(s)
- Malin Nientiedt
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Riccardo Bertolo
- Department of Urology, "San Carlo di Nancy Hospital", Rome, Italy
| | - Riccardo Campi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Umberto Capitanio
- Division of Experimental Oncology, Department of Urology, Urological Research Institute, Vita-Salute San Raffaele University, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - Selcuk Erdem
- Department of Urology, Istanbul University, Istanbul School of Medicine, Istanbul, Turkey
| | - Önder Kara
- Urology Department, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth and Christchurch Hospitals, Bournemouth, UK; Department of Surgery, University of Cambridge, Cambridge, UK
| | - Alessandro Larcher
- Division of Experimental Oncology, Department of Urology, Urological Research Institute, Vita-Salute San Raffaele University, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - Maria Carmen Mir
- Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Idir Ouzaid
- Department of Urology, Bichat Hospital, APHP, Paris Diderot University, Paris, France
| | - Eduard Roussel
- Unit of Urogenital, Abdominal and Plastic Surgery, Biomedical Science Group, KU Leuven University, Leuven, Belgium
| | - Maciej Salagierski
- Department of Urology, Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland
| | - Frank Waldbillig
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
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Neuzillet Y, Albrand G, Caillet P, Paillaud E, Mongiat-Artus P. [Specificity of the management of metastatic renal cancer in the older patient]. Prog Urol 2020; 29:874-895. [PMID: 31771770 DOI: 10.1016/j.purol.2019.08.272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 08/19/2019] [Indexed: 01/27/2023]
Abstract
AIM To define the necessary arrangements of medical treatment with anti-angiogenics, mTOR inhibitor or systemic immunotherapies in the management of metastatic renal cell carcinoma in elderly patients. METHOD Bibliographical search was performed from the Medline bibliographic database (NLM Pubmed tool) and Embase focused on: metastatic renal cell carcinoma, elderly, treatment. RESULTS The selection criteria for the medical treatment of metastatic renal cell carcinoma in elderly patients are the IMDC score, necessarily complemented by performance status, the tolerability profile of treatments, more frequent drug interactions, treatment adherence, management capacity of side effects, and patient preference. Each of these criteria is detailed in critical ways. CONCLUSION The efficacy and tolerability of medical treatments for metastatic renal cancer have not been reported as different depending on age. No dosage adjustment is recommended in principle. However, prevention and early treatment of side effects of treatment should be strengthened in elderly patients.
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Affiliation(s)
- Y Neuzillet
- Service d'urologie et de transplantation rénale, hôpital Foch, université de Versailles - Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France.
| | - G Albrand
- Service UCOG-IR, pavillon 1C Louis-Lortet, hospices civils de Lyon, centre hôpitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - P Caillet
- Service de gériatrie, unité d'oncogériatrie, hôpital européen Georges-Pompidou, université de Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - E Paillaud
- Service de gériatrie, unité d'oncogériatrie, hôpital européen Georges-Pompidou, université de Paris-Descartes, 20, rue Leblanc, 75908 Paris cedex 15, France
| | - P Mongiat-Artus
- Inserm UMR, S1165, service d'urologie, unité de chirurgie et d'anesthésie ambulatoires, hôpital Saint-Louis, université de Paris-7-Denis-Diderot, 1, avenue Claude-Vellefaux, 75010 Paris, France
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Aubert C, Rolley C, Mauny M, Heuveline J, Silve E, Humeau M, Le Corre V, Lebdai S, Brassart E, Culty T, Baize N, Rousselet MC, Nedelcu C, Aubé C, Bouvier A, Bigot P. [Impact of partial nephrectomy in a hybrid operating room on the activity of kidney cancer surgery]. Prog Urol 2020; 30:288-295. [PMID: 32234422 DOI: 10.1016/j.purol.2020.02.003] [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: 10/05/2019] [Revised: 02/01/2020] [Accepted: 02/13/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Partial nephrectomy (NP) after embolization of tumor vessels (NPESH) in a hybrid room combines embolization of tumor vessels and enucleation of the tumor under laparoscopy in the same operative time. The purpose of this study was to assess the impact of the use of NPESH in the management of patients treated with surgery for a localized kidney tumor. MATERIAL AND METHODS Using the uroCCR database, we included all consecutive patients operated in a university hospital for localized kidney tumor. From 2011 to May 2015, patients were treated by Standard Partial Nephrectomy (NPS) Laparoscopic or Open and from May 2015 to May 2019 by NPESH. We evaluated characteristics of patients, tumors, perioperative data and complications. These data were compared by Student and Khi2 tests. RESULTS 87 NPS were performed during Period 1 and 137 NPS were performed during period 2. The ASA score of patients undergoing NPESH was higher than NPS (P<0.0001). The tumor complexity and median tumor size were similar in the two groups (P=0.852 and P=0.48). The complication rate for NPS and NPESH was 55.2% and 33.6% (P=0.002). There were less severe complications in the NEPSH group (P=0.012). The median length of stay was 8 and 4 days for the NPS and NPESH groups (P<0.0001). Positive surgical margins were 2 (2.3%) and 6 (4.6%) for the NPS and NPESH group (P=0.713). DISCUSSION NPESH is an efficient technique compared to NPS. It seems to be an interesting alternative to limit renal ischemia, complication rate and length of stay for the management of localized kidney tumors.
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Affiliation(s)
- C Aubert
- Service d'urologie, CHU de Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - C Rolley
- UTTIOM, unité transversale de thérapeutiques innovantes en oncologie médicale, CHU de Angers, 4, rue Larrey, 49933 Angers, France
| | - M Mauny
- Faculté de médecine d'Angers, 49000 Angers, France
| | - J Heuveline
- Faculté de médecine d'Angers, 49000 Angers, France
| | - E Silve
- Faculté de médecine d'Angers, 49000 Angers, France
| | - M Humeau
- Faculté de médecine d'Angers, 49000 Angers, France
| | - V Le Corre
- Service d'urologie, CHU de Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - S Lebdai
- Service d'urologie, CHU de Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - E Brassart
- Service d'urologie, CHU de Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - T Culty
- Service d'urologie, CHU de Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - N Baize
- UTTIOM, unité transversale de thérapeutiques innovantes en oncologie médicale, CHU de Angers, 4, rue Larrey, 49933 Angers, France
| | - M C Rousselet
- Département d'anatomopathologie, CHU de Angers, 4, rue Larrey, 49933 Angers, France
| | - C Nedelcu
- Service de radiologie, CHU de Angers, 4, rue Larrey, 49933 Angers, France
| | - C Aubé
- Service de radiologie, CHU de Angers, 4, rue Larrey, 49933 Angers, France
| | - A Bouvier
- Service de radiologie, CHU de Angers, 4, rue Larrey, 49933 Angers, France
| | - P Bigot
- Service d'urologie, CHU de Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
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Richard V, Detrée P, Frontczak A, Balssa L, Bernardini S, Chabannes E, Guichard G, David A, Manzoni P, Bittard H, Kleinclauss F. [Concordances and predictors of biopsies in renal tumors]. Prog Urol 2019; 29:955-961. [PMID: 31629660 DOI: 10.1016/j.purol.2019.08.275] [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: 06/04/2018] [Revised: 08/07/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
Abstract
AIM Evaluate the concordance between the renal lesions biopsy's histology and the final histology of the surgical specimen according to histological subtype, and search for predictive factors of non-concordance. MATERIAL We performed a monocentric retrospective study that included 156 patients suffering from a renal tumor that benefited a lesion biopsy before surgical treatment. Sensibility and specificity of the renal lesion's biopsy for histological diagnostic of the different renal tumors where calculated. RESULTS One hundred and fifty-eight renal tumor biopsies were realized between 2001 and 2016. One hundred and forty-three renal cell carcinoma were found on the surgical piece, 135 were diagnosed on prior biopsy. Global concordance rate was 88%. For the establishment of the nuclear Fuhrmann grade, the concordance rate (low vs. high grade) was 72.9%. The cohort was divided into 2 groups according to the existence (group 1, n=139) or the absence (group 2, n=19) of concordance. Group 1 and 2 differed by the predominance of men in group 1 (66% vs. 37%, P=0.013), distance between the sinus and the tumor above 4mm (65% vs. 42%, P=0.05). CONCLUSION In renal tumor care, renal biopsy is a reliable testing. However, some factors most likely linked to the tumor anatomy (intra-sinusal tumor) and their histological composition were involved in the lack of non-contribution to the diagnosis. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- V Richard
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France; UFR sciences médicales et pharmaceutique, université de Franche-Comté, 25000 Besançon, France.
| | - P Detrée
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France; UFR sciences médicales et pharmaceutique, université de Franche-Comté, 25000 Besançon, France
| | - A Frontczak
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France; UFR sciences médicales et pharmaceutique, université de Franche-Comté, 25000 Besançon, France
| | - L Balssa
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France
| | - S Bernardini
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France
| | - E Chabannes
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France
| | - G Guichard
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France
| | - A David
- Service de radiologie, CHRU de Besançon, 25000 Besançon, France
| | - P Manzoni
- Service de radiologie, CHRU de Besançon, 25000 Besançon, France
| | - H Bittard
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France; UFR sciences médicales et pharmaceutique, université de Franche-Comté, 25000 Besançon, France
| | - F Kleinclauss
- Service d'urologie, andrologie et transplantation rénale, CHRU de Besançon, 25000 Besançon, France; UFR sciences médicales et pharmaceutique, université de Franche-Comté, 25000 Besançon, France; Inserm URM 1098, 25000 Besançon, France
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Borchiellini D. Cancer du rein métastatique : quels critères de choix en 2e ligne ? Bull Cancer 2019; 105 Suppl 3:S242-S254. [PMID: 30595153 DOI: 10.1016/s0007-4551(18)30379-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
METASTATIC RENAL CELL CARCINOMA HOW TO CHOOSE THE APPROPRIATE SECOND-LINE TREATMENT?: The treatment of advanced or metastatic renal cell cancer (RCC) has dramatically improved in the past ten years. In the second-line setting, for patients who progressed on prior antiangiogenic therapy (mainly the VEGFR tyrosine kinase inhibitors (TKI) sunitinib or pazopanib), axitinib and everolimus have been recommended. Since 2015, other drugs have proven their efficacy and are currently considered the standard of care: cabozantinib (TKI that targets VEGFR, MET and AXL) and nivolumab (first anti-PD-1 check point inhibitor). Lenvatinib has also demonstrated promising results in association with everolimus, but this combination is not available in France. The optimal treatment choice for a given patient is challenging for the clinician when facing multiple options. In this article, we review the efficacy, safety and quality of life results of the main pivotal clinical studies involving advanced or metastatic RCC in the second-line setting, to help clinicians in selecting the most appropriate treatment. Beyond that, it is important to define all the sequencing strategy for patients to successively receive all the drugs that have demonstrated an increase in overall survival.
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Affiliation(s)
- Delphine Borchiellini
- Département d'oncologie médicale, centre Antoine-Lacassagne, université Côte d'Azur, Nice, France.
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