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Yamamoto R, Numakura K, Kobayashi M, Nara T, Saito M, Narita S, Habuchi T. Predictive factors of renal function after robot-assisted partial nephrectomy in clinical T1b tumors. J Robot Surg 2024; 18:154. [PMID: 38564051 PMCID: PMC10987366 DOI: 10.1007/s11701-024-01848-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/27/2024] [Indexed: 04/04/2024]
Abstract
Robot-assisted partial nephrectomy (RAPN) has been shown to be a safe and effective method for treatment of small renal tumors, including clinical T1b renal cell carcinoma (RCC); however, the impact of RAPN for cT1b renal tumors on renal function is not well understood. In this retrospective study, 50 patients who underwent RAPN for cT1b renal tumors were evaluated for pre- and post-operative renal function and perioperative clinical factors. Renal function was assessed using the estimated glomerular filtration rate (eGFR) at baseline and on postoperative days (POD) 1, 7, 30, and 180.A significant renal functional decline was defined as ≥ 15% reduction in eGFR at POD180 compared with eGFR at baseline. Logistic regression analyses were used to identify risk factors for renal function decline, including age, sex, RENAL nephrometry score, operative time, and estimated blood loss. The median patient age was 62 years, and the median tumor diameter and RENAL nephrometry score were 44 mm (IQR 43-50) and 8 (IQR 7-9), respectively. Of these patients, 16 (36%) showed a significant renal functional decline at POD 180. In the multivariate analysis, the L component of the RENAL nephrometry score and an estimated blood loss of 200 mL or more were identified as significant risk factors for renal functional decline. These findings suggest that the preoperatively definable L component of the RENAL nephrometry score and intraoperative blood loss, which may be modifiable factors, play significant roles in post-RAPN renal function decline.
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Affiliation(s)
- Ryohei Yamamoto
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Mizuki Kobayashi
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Taketoshi Nara
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Mitsuru Saito
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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Sun ZJ, Liu F, Wei HB, Zhang DH. Laparoscopic partial versus radical nephrectomy for localized renal cell carcinoma over 4 cm. J Cancer Res Clin Oncol 2023; 149:17837-17848. [PMID: 37943356 PMCID: PMC10725398 DOI: 10.1007/s00432-023-05487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE To compare the long-term clinical and oncologic outcomes of laparoscopic partial nephrectomy (LPN) and laparoscopic radical nephrectomy (LRN) in patients with renal cell carcinoma (RCC) > 4 cm. METHODS We retrospectively reviewed the records of all patients who underwent LPN or LRN in our department from January 2012 to December 2017. Of the 151 patients who met the study selection criteria, 54 received LPN, and 97 received LRN. After propensity-score matching, 51 matched pairs were further analyzed. Data on patients' surgical data, complications, histologic data, renal function, and survival outcomes were collected and analyzed. RESULTS Compared with the LRN group, the LPN group had a longer operative time (135 min vs. 102.5 min, p = 0.001), larger intraoperative bleeding (150 ml vs. 50 ml, p < 0.001), and required longer stays in hospital (8 days vs. 6 days, p < 0.001); however, the level of ECT-GFR was superior at 3, 6, and 12 months (all p < 0.001). Similarly, a greater number of LRN patients developed CKD compared with LPN until postoperative 12 months (58.8% vs. 19.6%, p < 0.001). In patients with preoperative CKD, LPN may delay the progression of the CKD stage and even improve it when compared to LRN treatment. There were no significant differences between the two groups for OS, CSS, MFS, and PFS (p = 0.06, p = 0.30, p = 0.90, p = 0.31, respectively). The surgical method may not be a risk factor for long-term survival prognosis. CONCLUSION LPN preserves renal function better than LRN and has the potential value of significantly reducing the risk of postoperative CKD, but the long-term survival prognosis of patients is comparable.
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Affiliation(s)
- Zi-Jun Sun
- Department of Urology, Zhejiang Provincial People's Hospital, Qingdao University, Qingdao, Shandong, China
| | - Feng Liu
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang, China
| | - Hai-Bin Wei
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang, China
| | - Da-Hong Zhang
- Department of Urology, Zhejiang Provincial People's Hospital, Qingdao University, Qingdao, Shandong, China.
- Urology and Nephrology Center, Department of Urology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang, China.
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Wang BR, Ou YC, Huang LH, Lu CH, Weng WC, Yang CK, Hsu CY, Lin YS, Chang YK, Tung MC. Robotic partial nephrectomy for renal tumor: The pentafecta outcomes of a single surgeon experience. Asian J Surg 2023; 46:3587-3592. [PMID: 37670437 DOI: 10.1016/j.asjsur.2023.05.140] [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: 12/02/2022] [Accepted: 05/26/2023] [Indexed: 09/07/2023] Open
Abstract
PURPOSE This study investigated the oncological and functional surgical outcomes for patients with renal tumor who underwent robot-assisted partial nephrectomy (PN) by a single surgeon in Taiwan from 2006 to 2019. METHODS This retrospective study assessed patients who underwent robot-assisted PN for renal tumor. Patient data were analyzed for age, sex, body mass index, operative time and total ischemic time, surgical margin (positive/negative), and surgical complications. To evaluate functional and oncological outcomes, achievement of trifecta, and pentafecta criteria was used. Trifecta criteria were defined as a negative surgical margin, no postoperative complications, warm ischemia time <25 min. Pentafecta criteria were the trifecta criteria, >90% preservation of estimated glomerular filtration rate (eGFR) preservation, and no stage progression of chronic kidney disease at 1-year follow-up. RESULTS Of 101 patients who received robot-assisted PN, the most common type of renal tumor was clear cell renal cell carcinoma (RCC) (38%), followed by angiomyolipoma (26%). Patient characteristics were mean age 54.59 ± 13.8 years; mean RENAL Nephrometry score 6.63 ± 2.16; mean operative time 102.34 ± 50.06 min; and warm ischemia time 20.01 ± 14.12 min. The mean eGFR was 104.43 ± 31.73 mL/min/1.73 m2 preoperatively and 89.39 ± 32.3 mL/min/1.73 m2 postoperatively. Pathologic evaluation showed malignant tumors in 57 patients, among whom achievement of trifecta criteria occurred for 39 (68.42%) and pentafecta criteria for 18 (31.57%). Operation time was the only predictor for pentafecta achievement. CONCLUSION Robotic PN is a safe and effective approach for patients with renal tumor that can preserve most renal function and achieve oncological control. Pentafecta criteria can be used to more clearly define the surgical outcome of RAPN.
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Affiliation(s)
- Bo-Ren Wang
- Division of Urology, Department of Surgery, Taichung Armed Forces General Hospital, No. 348, Sec. 2, Zhongshan Rd., Taiping Dist., Taichung City, 411, Taiwan; National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei City, 11490, Taiwan
| | - Yen-Chuan Ou
- Divisions of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Taichung City, 435, Taiwan.
| | - Li-Hua Huang
- Divisions of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Taichung City, 435, Taiwan
| | - Chin-Heng Lu
- Divisions of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Taichung City, 435, Taiwan
| | - Wei-Chun Weng
- Divisions of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Taichung City, 435, Taiwan
| | - Cheng-Kuang Yang
- Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Chao-Yu Hsu
- Divisions of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Taichung City, 435, Taiwan
| | - Yi-Sheng Lin
- Divisions of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Taichung City, 435, Taiwan
| | - Yu-Kang Chang
- Divisions of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Taichung City, 435, Taiwan
| | - Min-Che Tung
- Divisions of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Taichung City, 435, Taiwan
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Bai N, Qi M, Shan D, Liu S, Na T, Chen L. Trifecta achievement in patients undergoing partial nephrectomy: a systematic review and meta-analysis of predictive factors. Int Braz J Urol 2021; 48:625-636. [PMID: 34115456 PMCID: PMC9306373 DOI: 10.1590/s1677-5538.ibju.2021.0095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/23/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The predictors of trifecta achievement in partial nephrectomy (PN) were poorly inquired and remained a controversial area of discovery. To evaluate predictive factors of trifecta achievement in patients undergoing PN. MATERIALS AND METHODS A systematic literature search was performed to identify relevant articles. Only studies focusing on postoperative trifecta achievement and exploring its predictor with multivariable analyses were included. The trifecta achievement was defined as negative surgical margins, warm ischemia time <25 minutes, and no complications. Merged odds ratio (OR) and 95% confidence interval (CI) were used to evaluate the predictive effect. RESULTS Thirteen studies with 7066 patients meeting the inclusion criteria were included. The rate of trifecta achievement ranged from 43.3% to 78.6%. Merged results showed that preoperative eGFR (OR: 1.01, 95% CI: 1.00, 1.02, P=0.02), operative time (OR: 0.99, 95% CI: 0.99, 1.00, P=0.02), estimated blood loss (OR: 1.00, 95% CI: 1.00, 1.00, P <0.001), tumor size (OR: 0.70, 95% CI: 0.58, 0.84, P <0.001), medium (OR: 0.39, 95% CI: 0.18, 0.84, P=0.02) and high PADUA score (OR: 0.23, 95% CI: 0.08, 0.64, P=0.005) were independently associated with trifecta achievement. A publication bias was identified for tumor size. Sensitivity analysis confirmed the stability of result for tumor size. CONCLUSIONS Larger tumor size, medium and high PADUA score are associated with decreased probability of trifecta achievement. After verifying by further high-quality studies, these variables can be incorporated into tools to predict probability of trifecta achievement during clinical practice.
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Affiliation(s)
- Nigemutu Bai
- Department of Mongolian Medicine Urology, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao,China
| | - Muge Qi
- Department of Mongolian Medicine Gastroenterology, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao,China
| | - Dan Shan
- Department of Mongolian Medicine Cardiology, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao,China
| | - Suo Liu
- Department of Mongolian Medicine Urology, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao,China
| | - Ta Na
- Department of Mongolian Medicine Urology, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao,China
| | - Liang Chen
- Department of Mongolian Medicine Urology, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao,China
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