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Crocerossa F, Autorino R, Derweesh I, Carbonara U, Cantiello F, Damiano R, Rubio-Briones J, Roupret M, Breda A, Volpe A, Mir MC. Management of renal cell carcinoma in transplant kidney: a systematic review and meta-analysis. Minerva Urol Nephrol 2023; 75:1-16. [PMID: 36094386 DOI: 10.23736/s2724-6051.22.04881-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION After transplantation, approximately 10% of renal cell carcinomas are detected in graft kidneys. These tumors (gRCC) present surgeons with the difficulty of finding a treatment that guarantees both oncological clearance and maintenance of function. We conducted a systematic review and an individual patient data meta-analysis on the oncology, safety and functional outcomes of the available treatments for gRCC. EVIDENCE ACQUISITION A systematic search was performed across MEDLINE, EMBASE, and Web of Science including any study reporting perioperative, functional and survival outcomes for patients undergoing graft nephrectomy (GN), partial nephrectomy (PN) or thermal ablation (TA) for gRCC. Quade's ANCOVA, Spearman Rho and Pearson χ2, Kaplan-Meier, Log-rank and Standard Cox regression and other tests were used to compare treatments. Studies' quality was evaluated using a modified version of Newcastle Ottawa Scale. EVIDENCE SYNTHESIS A number of 29 studies (357 patients) were included. No differences between TA and PN were found in terms of safety, functional and oncological outcomes for T1a gRCCs. When applied to pT1b gRCC, PN showed no difference in complications, progression or cancer-specific deaths compared to smaller lesions; PN validity for pT2 gRCCs should be considered unverified due to lack of sufficient evidence. The efficacy and safety of PN or TA for multiple gRCC remain controversial. In case of non-functioning, large (T≥2), complicated or metastatic gRCCs, GN appears to be the most reasonable choice. Quality of evidence ranged from very low to moderate. Studies with large cohorts and longer follow-up are still needed to clarify oncological and functional differences. CONCLUSIONS PN and TA might be offered as a nephron-sparing treatment in patients with T1a gRCC. There is no significant difference between these options and GN in terms of oncological outcomes and complications. PN and TA offer similar functional outcomes and graft preservation. PN for T1b gRCC seems feasible and safe, but its validity should be considered unverified.
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Affiliation(s)
- Fabio Crocerossa
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA.,Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | | | - Umberto Carbonara
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA.,Unit of Andrology and Kidney Transplantation, Department of Urology, University of Bari, Bari, Italy
| | - Francesco Cantiello
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Jose Rubio-Briones
- Department of Urology, Instituto Valenciano Oncologia (IVO) Foundation, Valencia, Spain
| | - Morgan Roupret
- Department of Urology, GRC5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Alberto Breda
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Alessandro Volpe
- Division of Urology, Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - M Carmen Mir
- Urology Department, IMED Hospitals, Valencia, Spain -
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2
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Tillou X, Doerfler A, Szabla N, Verhoest G, Defortescu G, Bessede T, Prudhomme T, Culty T, Bigot P, Bensalah K, Méjean A, Timsit MO. [Renal cell carcinoma of the kidney transplant: The French guidelines from CTAFU]. Prog Urol 2021; 31:24-30. [PMID: 33423743 DOI: 10.1016/j.purol.2020.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To propose recommendations for the management of renal cell carcinomas (RCC) of the renal transplant. METHOD Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU to evaluate prevalence, diagnosis and management of RCC arousing in the renal transplant. References were assessed according to a predefined process to propose recommendations with levels of evidence. RESULTS Renal cell carcinomas of the renal transplant affect approximately 0.2% of recipients. Mostly asymptomatic, these tumors are mainly diagnosed on a routine imaging of the renal transplant. Predominant pathology is clear cell carcinomas but papillary carcinomas are more frequent than in general population (up to 40-50%). RCC of the renal transplant is often localized, of low stage and low grade. According to tumor characteristics and renal function, preferred treatment is radical (transplantectomy) or nephron sparing through partial nephrectomy (open or minimally invasive approach) or thermoablation after percutaneous biopsy. Although no robust data support a switch of immunosuppressive regimen, some authors suggest to favor the use of mTOR inhibitors. CTAFU does not recommend a mandatory waiting time after transplantectomy for RCC in candidates for a subsequent renal tranplantation when tumor stage<T3 and low ISUP grade. CONCLUSION These French recommendations should contribute to improving the oncological and functional prognosis of renal transplant recipients by improving the management of RCC of the renal transplant.
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Affiliation(s)
- X Tillou
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - A Doerfler
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Brugmann, place A. Van Gehuchten 4, 1020 Bruxelles, Belgique
| | - N Szabla
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - G Verhoest
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - G Defortescu
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - T Bessede
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, université de Paris-Saclay, hôpital de Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - T Prudhomme
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, 9, place Lange, 31300 Toulouse, France
| | - T Culty
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - P Bigot
- Service d'urologie et transplantation rénale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France; Comité de cancérologie de l'association française d'urologie (CCAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - K Bensalah
- Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; Comité de cancérologie de l'association française d'urologie (CCAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - A Méjean
- Comité de cancérologie de l'association française d'urologie (CCAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Inserm, équipe labellisée par la ligue contre le cancer, université de Paris, PARCC, 56, rue Leblanc, 75015 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - M-O Timsit
- Comité de transplantation et d'insuffisance rénale chronique de l'association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Inserm, équipe labellisée par la ligue contre le cancer, université de Paris, PARCC, 56, rue Leblanc, 75015 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.
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3
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Robotic-assisted laparoscopic partial nephrectomy in a renal transplant. UROLOGY VIDEO JOURNAL 2021. [DOI: 10.1016/j.urolvj.2021.100082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Watanabe S, Takagi T, Yoshida K, Unagami K, Kanzawa T, Iizuka J, Ishida H, Tanabe K. Robot-Assisted Laparoscopic Partial Nephrectomy for Allograft Renal Cell Carcinoma: A Case Report. Transplant Proc 2021; 53:1445-1449. [PMID: 33962772 DOI: 10.1016/j.transproceed.2021.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/27/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nephron-sparing surgery is required for patients with kidney transplant with organ-confined renal cell carcinoma (RCC) in the allograft kidney to preserve renal function. Robot-assisted laparoscopic partial nephrectomy (RAPN) is expected to be the optimal surgical approach for these patients, as in the general population. However, RAPN for RCC arising in the allograft kidney is rarely reported. Here, we report 2 cases of patients who underwent RAPN for allograft RCC. CASE PRESENTATION Two patients were diagnosed with RCC in the renal allograft based on enhanced computed tomography findings. Case 1 was a 69-year-old man with a 32-mm mass in the middle portion of the right iliac fossa renal allograft, and case 2 was a 55-year-old man with a 24-mm mass in the lower pole of the right iliac fossa renal allograft. In each patient, RAPN was performed for the renal mass through a transperitoneal approach, with clamping of the renal artery. No major perioperative complications occurred in either patient, negative surgical margins were achieved, and no significant changes in kidney function were observed during either surgery. Pathologic findings showed clear cell RCC in case 1 and papillary RCC in case 2. CONCLUSION RAPN can be a feasible and effective treatment option for allograft RCC.
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Affiliation(s)
- Shun Watanabe
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kohei Unagami
- Department of Organ Transplant Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Taichi Kanzawa
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hideki Ishida
- Department of Organ Transplant Medicine, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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5
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Ramachandran R, Bharati J, Gupta P, Gorsi U, Mavuduru R, Kumar V, Rathi M, Kohli H. Immunosuppression after the diagnosis of renal allograft renal cell carcinoma in two transplant recipients: Case reports and review of the literature. INDIAN JOURNAL OF TRANSPLANTATION 2021. [DOI: 10.4103/ijot.ijot_70_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Abdul-Muhsin HM, McAdams SB, Syal A, Nuñez-Nateras R, Navaratnam A, Moss AA, Hewitt WR, Singer AL, Jadlowiec CC, Harbell JW, Mathur AK, Reddy KS, Castle EP. Robot Assisted Renal Allograft Nephrectomy: Initial Case Series and Description of Technique. Urology 2020; 146:118-124. [PMID: 33091385 DOI: 10.1016/j.urology.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/27/2020] [Accepted: 10/06/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the outcomes and perioperative complication rates following robot- assisted transplant nephrectomy ((RATN). METHODS All patients who underwent RATN at our institution were included. No exclusion criteria were applied. Clinical records were retrospectively reviewed and reported. This included preoperative, intraoperative, and postoperative outcomes. Complications were reported utilizing the Clavien-Dindo classification system. Descriptive statistics were reported using frequencies and percentages for categorical variables, means and standard deviation for continuous variables. RESULTS Between July 2014 and April 2018, 15 patients underwent RATN. Most patients had the transplant in the right iliac fossa (13/15). Ten patients underwent a concomitant procedure. The total operative time for the entire cohort was 336 (±102) minutes (including cases who had concomitant procedures) and 259 (±46 minutes) when cases with concomitant procedures were excluded. Mean estimated blood loss was 383 (±444) mL. Postoperatively, 3 patients required blood transfusion. Average hospital stay was 4 (±2.7) days. Most patients had finding consistent with graft rejection on final pathology. There were 5 complications; 3 of which were minor (grade 2 = 2 and grade 3 = 1); one patient had a wound infection requiring dressing (3A) and one patient died due to pulmonary embolism following discharge. Limitations include small series and retrospective nature of the study. CONCLUSION This case series demonstrate that RATN is technically feasible. With continued experience and larger case series, the robotic approach may provide a minimally invasive alternative to open allograft nephrectomy.
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Affiliation(s)
| | | | - Amit Syal
- Mayo Clinic Arizona, Department of Urology, Phoenix, AZ
| | | | | | - Adyr A Moss
- Mayo Clinic Arizona, Department of Transplantation, Phoenix, AZ
| | | | - Andrew L Singer
- Mayo Clinic Arizona, Department of Transplantation, Phoenix, AZ
| | | | - Jack W Harbell
- Mayo Clinic Arizona, Department of Transplantation, Phoenix, AZ
| | - Amit K Mathur
- Mayo Clinic Arizona, Department of Transplantation, Phoenix, AZ
| | - Kunam S Reddy
- Mayo Clinic Arizona, Department of Transplantation, Phoenix, AZ
| | - Erik P Castle
- Mayo Clinic Arizona, Department of Urology, Phoenix, AZ
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7
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Hubatsch M, Peters R, Maxeiner A, El-Bandar N, Weinberger S, Friedersdorff F. Nephron Sparing Surgery in Renal Allograft in Recipients with de novo Renal Cell Carcinoma: Two Case Reports and Review of the Literature. Urol Int 2020; 104:997-999. [PMID: 32966984 DOI: 10.1159/000509292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/16/2020] [Indexed: 12/11/2022]
Abstract
We report 2 cases of de novo renal cell carcinoma (RCC) in renal grafts after transplantation. Both patients underwent nephron sparing surgery (NSS) 211 and 167 months after transplantation, revealing papillary RCC with a tumour size >4 cm (pT1a). Within a follow-up of 25 and 32 months after NSS, a stable renal function without indication for dialysis was present. No recurrence of RCC in both cases was reported within the yearly routine examinations. NSS in kidney allografts is a safe procedure with preservation of renal function.
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Affiliation(s)
- Mandy Hubatsch
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Robert Peters
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Maxeiner
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nasrin El-Bandar
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sarah Weinberger
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,
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8
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Ozden E, Gulsen M, Mercimek MN, Bostanci Y, Sarikaya S, Yakupoglu YK. Laparoscopic Partial Nephrectomy in Allograft Kidney. Urology 2020; 146:e5-e7. [PMID: 32882302 DOI: 10.1016/j.urology.2020.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 11/29/2022]
Abstract
The incidence of renal tumor on the allograft kidney is relatively rare. There is no standard treatment available for the management of such cases. However, if technically feasible nephron-sparing surgical approaches, whether open or minimally invasive, should be preferred for the management of these challenging cases. To our knowledge, there is no pure laparoscopic technique reported in the literature but only 3 cases of robot-assisted partial nephrectomy. In this article, we aimed to present the application of pure transperitoneal laparoscopic partial nephrectomy for the management of a renal mass on the allograft kidney.
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Affiliation(s)
- Ender Ozden
- Department of Urology, Ondokuz Mayıs University, Atakum, Samsun, Turkey.
| | - Murat Gulsen
- Department of Urology, Ondokuz Mayıs University, Atakum, Samsun, Turkey
| | | | - Yakup Bostanci
- Department of Urology, Ondokuz Mayıs University, Atakum, Samsun, Turkey
| | - Saban Sarikaya
- Department of Urology, Ondokuz Mayıs University, Atakum, Samsun, Turkey
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9
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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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Laclergerie F, Delchier MC, Covin B, Sallusto F, Soulie M, Gamé X, Beauval JB, Kamar N, Roumiguié M, Doumerc N. Robot-assisted laparoscopic partial nephrectomy with renal artery clamping using an endovascular balloon catheter for an allograft kidney tumor: A new perspective to manage renal vascular control? Am J Transplant 2019; 19:1239-1240. [PMID: 30372583 DOI: 10.1111/ajt.15151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Florian Laclergerie
- Urology and Renal Transplantation Department, University Hospital of Rangueil, Toulouse, France
| | | | - Bertrand Covin
- Urology and Renal Transplantation Department, University Hospital of Rangueil, Toulouse, France
| | - Fédérico Sallusto
- Urology and Renal Transplantation Department, University Hospital of Rangueil, Toulouse, France
| | - Michel Soulie
- Urology and Renal Transplantation Department, University Hospital of Rangueil, Toulouse, France
| | - Xavier Gamé
- Urology and Renal Transplantation Department, University Hospital of Rangueil, Toulouse, France
| | - Jean-Baptiste Beauval
- Urology and Renal Transplantation Department, University Hospital of Rangueil, Toulouse, France
| | - Nassim Kamar
- Nephrology Department, University Hospital of Rangueil, Toulouse, France
| | - Mathieu Roumiguié
- Urology and Renal Transplantation Department, University Hospital of Rangueil, Toulouse, France
| | - Nicolas Doumerc
- Urology and Renal Transplantation Department, University Hospital of Rangueil, Toulouse, France
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Elec FI, Zaharie A, Iacob G, Moisoiu T, Burghelea D, Socaciu MA, Badea RI, Ghervan L. Successful partial nephrectomy of a T1b multilocular clear cell renal cell carcinoma arising in a renal graft. Urol Case Rep 2018; 22:19-20. [PMID: 30345224 PMCID: PMC6189605 DOI: 10.1016/j.eucr.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/17/2018] [Accepted: 10/04/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Florin Ioan Elec
- Clinical Institute of Urology and Renal Transplantation, Transplantation Department, 4-6 Clinicilor Street, 400006, Cluj-Napoca, Romania.,"Iuliu Hatieganu" University of Medicine and Pharmacy, Urology Department, 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
| | - Andreea Zaharie
- "Leon Daniello" Pulmonology and Tuberculosis Hospital, Cluj-Napoca, Romania
| | - Gheorghiţă Iacob
- Clinical Institute of Urology and Renal Transplantation, Transplantation Department, 4-6 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Tudor Moisoiu
- Clinical Institute of Urology and Renal Transplantation, Transplantation Department, 4-6 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Dan Burghelea
- Clinical Institute of Urology and Renal Transplantation, Transplantation Department, 4-6 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Mihai Adrian Socaciu
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Medical Imaging Department, 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
| | - Radu Ion Badea
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Medical Imaging Department, 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
| | - Liviu Ghervan
- Clinical Institute of Urology and Renal Transplantation, Transplantation Department, 4-6 Clinicilor Street, 400006, Cluj-Napoca, Romania.,"Iuliu Hatieganu" University of Medicine and Pharmacy, Urology Department, 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
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12
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Stiegler P, Schemmer P. Robot-Assisted Transplant Surgery - Vision or Reality? A Comprehensive Review. Visc Med 2018; 34:24-30. [PMID: 29594166 DOI: 10.1159/000485686] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Minimally invasive surgery is standard procedure for many operations. Further refinements include the introduction of robotic surgery which is still an emerging field especially in laparoscopic surgery. Since the successful introduction of the da Vinci Robotic Surgical System, the robotic approach in organ transplantation has become of great interest in both the live donor organ retrieval and the recipient operation. Robotic surgery for kidney, liver, and pancreas transplantation is feasible. Over 700 donor nephrectomies and 100 kidney transplantations have been performed already, and robotic surgery is standard in a small number of pioneer centers; however, larger series and most importantly randomized controlled trials for the highest evidence are needed. Longer warm ischemia time and higher costs limit these procedures at the moment.
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Affiliation(s)
- Philipp Stiegler
- Division of Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Transplant Center Graz, Medical University of Graz, Graz, Austria
| | - Peter Schemmer
- Division of Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.,Transplant Center Graz, Medical University of Graz, Graz, Austria
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13
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Griffith JJ, Amin KA, Waingankar N, Lerner SM, Delaney V, Ames SA, Badani K, Palese MA, Mehrazin R. Solid Renal Masses in Transplanted Allograft Kidneys: A Closer Look at the Epidemiology and Management. Am J Transplant 2017; 17:2775-2781. [PMID: 28544435 DOI: 10.1111/ajt.14366] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/05/2017] [Accepted: 05/06/2017] [Indexed: 01/25/2023]
Abstract
The objective of this review is to explore the available literature on solid renal masses (SRMs) in transplant allograft kidneys to better understand the epidemiology and management of these tumors. A literature review using PubMed was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Fifty-six relevant studies were identified from 1988 to 2015. A total of 174 SRMs in 163 patients were identified, with a mean tumor size of 2.75 cm (range 0.5-9.0 cm). Tumor histology was available for 164 (94.3%) tumors: clear cell renal cell carcinoma (RCC; 45.7%), papillary RCC (42.1%), chromophobe RCC (3%), and others (9.1%). Tumors were managed by partial nephrectomy (67.5%), radical nephrectomy (19.4%), percutaneous radiofrequency ablation (10.4%), and percutaneous cryoablation (2.4%). Of the 131 patients (80.3%) who underwent nephron-sparing interventions, 10 (7.6%) returned to dialysis and eight (6.1%) developed tumor recurrence over a mean follow-up of 2.85 years. Of the 110 patients (67.5%) who underwent partial nephrectomy, 3.6% developed a local recurrence during a mean follow-up of 3.12 years. The current management of SRMs in allograft kidneys mirrors management in the nontransplant population, with notable findings including an increased rate of papillary RCC and similar recurrence rates after partial nephrectomy in the transplant population despite complex surgical anatomy.
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Affiliation(s)
- J J Griffith
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - K A Amin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - N Waingankar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - S M Lerner
- Transplant Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - V Delaney
- Transplant Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - S A Ames
- Transplant Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - M A Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - R Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
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14
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Levi Sandri GB, de Werra E, Mascianà G, Guerra F, Spoletini G, Lai Q. The use of robotic surgery in abdominal organ transplantation: A literature review. Clin Transplant 2016; 31. [PMID: 27726195 DOI: 10.1111/ctr.12856] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Giovanni B. Levi Sandri
- Division of General Surgery and Liver Transplantation; San Camillo Hospital; Rome Italy
- Department of Surgical Sciences; Sapienza University of Rome; Rome Italy
| | - Edoardo de Werra
- Division of General Surgery and Liver Transplantation; San Camillo Hospital; Rome Italy
| | - Gianluca Mascianà
- Division of General Surgery and Liver Transplantation; San Camillo Hospital; Rome Italy
| | - Francesco Guerra
- Division of Oncological and Robotic General Surgery; Careggi University Hospital; Florence Italy
| | - Gabriele Spoletini
- Department of HPB and Liver Transplant Surgery; Royal Free Hospital; London UK
| | - Quirino Lai
- Transplant Unit; Department of Surgery; University of L'Aquila; San Salvatore Hospital; L'Aquila Italy
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15
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Kleinclauss F, Thuret R, Murez T, Timsit M. Transplantation rénale et cancers urologiques. Prog Urol 2016; 26:1094-1113. [DOI: 10.1016/j.purol.2016.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 08/22/2016] [Indexed: 12/18/2022]
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16
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Tillou X, Guleryuz K, Collon S, Doerfler A. Renal cell carcinoma in functional renal graft: Toward ablative treatments. Transplant Rev (Orlando) 2015; 30:20-6. [PMID: 26318289 DOI: 10.1016/j.trre.2015.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/28/2015] [Indexed: 12/21/2022]
Abstract
The occurrence of a kidney transplant tumor is a rare but serious issue with a double risk: the return to dialysis and the development of metastatic cancer. Publications on this topic are mainly case reports. The purpose of this review was to report an exhaustive literature review of functional graft renal cell carcinomas to highlight the impact of tumors on the renal graft outcomes. 201 de novo renal carcinomas in functional renal grafts from 69 publications were included. Incidence was estimated at 0.18%. Graft tumors were mostly asymptomatic (85.9%). Whatever the discovery circumstances of graft tumors, they were mostly documented by graft ultrasounds supplemented by CT-scanning or MR imaging. Nephron sparing surgery (95 patients) was the first treatment performed followed by radiofrequency ablation (38 patients) and cryotherapy (10 patients). The most common tumor graft histology was clear cell carcinoma (46.4%), followed by papillary carcinoma (43.7%). Specific mortality was 2.9% with 6 deaths. Renal graft cell carcinoma is a rare pathology with a low specific death. When possible, conservative treatment should be the first choice.
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Affiliation(s)
- Xavier Tillou
- Urology and Transplantation Department, Caen University Hospital, Avenue Cote de Nacre, 14000 Caen, France; Medical University of Caen, Unicaen, Claude Bloch Street, 14000 Caen, France.
| | - Kerem Guleryuz
- Urology and Transplantation Department, Caen University Hospital, Avenue Cote de Nacre, 14000 Caen, France
| | - Sylvie Collon
- Orthopaedic Department, Caen University Hospital, Avenue Cote de Nacre, 14000 Caen, France
| | - Arnaud Doerfler
- Urology and Transplantation Department, Caen University Hospital, Avenue Cote de Nacre, 14000 Caen, France
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17
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Abstract
Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90% of cases and the graft in 10 %. In addition to general risk factors, malignancy susceptibility may be influenced by immunosuppressive therapy, the use of calcineurin inhibitors (CNI) as compared with mammalian target of rapamycin inhibitors, and the length of dialysis treatment. Acquired cystic kidney disease may increase the risk for renal cancer after transplantation, while autosomal dominant polycystic kidney disease does not seem to predispose to cancer development. Annual ultrasound evaluation seems appropriate in patients with congenital or acquired cystic disease or even a single cyst in native kidneys, and every 2 years in patients older than 60 years if they were on dialysis for more than 5 years before transplantation. Immunosuppression should be lowered in patients who develop renal cancer, by reduction or withdrawal of CNI. Although more evidence is still needed, it seems reasonable to shift patients from CNI to everolimus or sirolimus if not already treated with one of these drugs, with due caution in subjects with chronic allograft nephropathy.
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18
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Zargar H, Bhayani S, Allaf ME, Stifelman M, Rogers C, Larson J, Ball MW, Marshall S, Kumar R, Fergany A, Campbell S, Kaouk J. Comparison of Perioperative Outcomes of Robot-Assisted Partial Nephrectomy and Open Partial Nephrectomy in Patients with a Solitary Kidney. J Endourol 2014; 28:1224-30. [DOI: 10.1089/end.2014.0297] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Homayoun Zargar
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sam Bhayani
- Washington University School of Medicine, Department of Urology, St. Louis, Missouri
| | - Mohamad E. Allaf
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Michael Stifelman
- New York University School of Medicine, Department of Urology, New York, New York
| | - Craig Rogers
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Jeffrey Larson
- Washington University School of Medicine, Department of Urology, St. Louis, Missouri
| | - Mark W. Ball
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Susan Marshall
- New York University School of Medicine, Department of Urology, New York, New York
| | - Ramesh Kumar
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Amr Fergany
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Steven Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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19
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Tillou X, Guleryuz K, Doerfler A, Bensadoun H, Chambade D, Codas R, Devonec M, Dugardin F, Erauso A, Hubert J, Karam G, Salomon L, Sénéchal C, Salusto F, Terrier N, Timsit MO, Thuret R, Verhoest G, Kleinclauss F. Nephron sparing surgery for De Novo kidney graft tumor: results from a multicenter national study. Am J Transplant 2014; 14:2120-5. [PMID: 24984974 DOI: 10.1111/ajt.12788] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 01/25/2023]
Abstract
Nephron sparing surgery (NSS) results in the transplanted population remain unknown because they are only presented in small series or case reports. Our objective was to study renal sparing surgery for kidney graft renal cell carcinomas (RCC) in a multicenter cohort. Data were collected from 32 French transplantation centers. Cases of renal graft de novo tumors treated as RCC since the beginning of their transplantation activity were included. Seventy-nine allograft kidney de novo tumors were diagnosed. Forty-three patients (54.4%) underwent renal sparing surgery. Mean age of grafted kidneys at the time of diagnosis was 47.5 years old (26.1-72.6). The mean time between transplantation and tumor diagnosis was 142.6 months (12.2-300). Fifteen tumors were clear cell carcinomas (34.9%), and 25 (58.1%) were papillary carcinomas. Respectively, 10 (24.4%), 24 (58.3%) and 8 (19.5%) tumors were Fuhrman grade 1, 2 and 3. Nine patients had postoperative complications (20.9%) including four requiring surgery (Clavien IIIb). At the last follow-up, 41 patients had a functional kidney graft, without dialysis and no long-term complications. NSS is safe and appropriate for all small tumors of transplanted kidneys with good long-term functional and oncological outcomes, which prevent patients from returning to dialysis.
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Affiliation(s)
- X Tillou
- Department of Urology, CHU de Caen, France
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20
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21
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Hillyer SP, Yakoubi R, Autorino R, Isac W, Miocinovic R, Laydner H, Khalifeh A, Stein RJ, Haber GP, Kaouk JH. Utility of Intraoperative Frozen Section During Robot-Assisted Partial Nephrectomy: A Single Institution Experience. J Endourol 2013; 27:324-7. [DOI: 10.1089/end.2012.0206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shahab P. Hillyer
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rachid Yakoubi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Riccardo Autorino
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wahib Isac
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ranko Miocinovic
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Humberto Laydner
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ali Khalifeh
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert J. Stein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Jihad H. Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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22
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Hillyer SP, Bhayani SB, Allaf ME, Rogers CG, Stifelman MD, Tanagho Y, Mullins JK, Chiu Y, Kaczmarek BF, Kaouk JH. Robotic Partial Nephrectomy for Solitary Kidney: A Multi-institutional Analysis. Urology 2013; 81:93-7. [DOI: 10.1016/j.urology.2012.08.055] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 08/21/2012] [Accepted: 08/27/2012] [Indexed: 11/17/2022]
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23
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Current world literature. Curr Opin Urol 2012. [PMID: 23202289 DOI: 10.1097/mou.0b013e32835bb149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Detection and management of renal cell carcinoma in the renal allograft. Int Urol Nephrol 2012; 45:93-8. [DOI: 10.1007/s11255-012-0274-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 08/20/2012] [Indexed: 12/20/2022]
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25
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Breda A, Villamizar JM, Faba OR, Caliolo C, de Gracia A, Gausa L, de Leon JP, Villavicencio H. Laparoscopic live donor nephrectomy with the use of 3-mm instruments and laparoscope: initial experience at a tertiary center. Eur Urol 2011; 61:840-4. [PMID: 22176782 DOI: 10.1016/j.eururo.2011.11.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 11/22/2011] [Indexed: 11/29/2022]
Abstract
Laparoscopy has become the standard of care for kidney recovery during live donor nephrectomy (LDN) because of the well-documented better outcomes of minimally invasive surgery compared with the open approach. Especially in the donor population, the cosmetic results are of great importance; therefore, an effort to reduce the incision size should be attempted while maintaining the safe general principles of surgery. We present our initial experience with the use of 3-mm instruments for laparoscopic LDN.
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Affiliation(s)
- Alberto Breda
- Department of Urology, Universidad Autonoma de Barcelona, Fundaciò Puigvert, Barcelona, Spain.
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