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Xu L, Li C, Zhao L, Zhou B, Luo C, Man X, Luan H, Che L, Wang Y, Xu Y. Acute kidney injury after nephrectomy: a new nomogram to predict postoperative renal function. BMC Nephrol 2020; 21:181. [PMID: 32410656 DOI: 10.1186/s12882-020-01839-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 05/04/2020] [Indexed: 12/15/2022] Open
Abstract
Background We aimed to develop a nomogram based on preprocedural features for early prediction of acute kidney injury (AKI) and to assess the prognosis in patients after radical and partial nephrectomy. Methods The study included a development cohort of 1111 patients who were treated between June 2012 and June 2017 and an additional validation cohort of 356 patients who were treated between July 2017 and June 2018. Stepwise regression and logistic regression analyses were used to evaluate the association between predictors and AKI. Incorporating all independent predictors, a nomogram for postoperative AKI was developed and externally validated. Patients were followed up for 5 years to assess renal function, acute kidney disease (AKD), chronic kidney disease (CKD), hospital readmission and mortality were key prognosis we focused on. Results After multivariate logistic regression, radical nephrectomy (odds ratio (OR) = 3.57, p < 0.001), aspirin (OR = 1.79, p = 0.008), systolic blood pressure (OR = 1.41, p = 0.004), triglyceride (OR = 1.26, p = 0.024), and alkaline phosphatase (OR = 1.75, p = 0.034) were independent risk factors for postoperative AKI, while albumin (OR = 0.72, p = 0.031) was a protective factor for postoperative AKI. Patients with a higher estimated glomerular filtration rate (eGFR) (60–90 ml/min/1.73 m2, OR = 0.41, p = 0.004; ≥ 90 ml/min/1.73 m2, OR = 0.37, p < 0.001) were less prone to AKI than those with a lower eGFR (< 15 ml/min/1.73 m2). These predictors were all included in the final nomogram. The area under the receiver operating characteristics curve for the model were 0.77 (p < 0.001) in the development cohort and 0.72 (p < 0.001) in the validation cohort. The incidence of AKD and CKD were 27.12 and 18.64% in AKI group, which were much higher than those in no AKI group (p < 0.001). Conclusions The nomogram had excellent predictive ability and might have significant clinical implications for the early detection of AKI in patients undergoing nephrectomy.
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Abstract
The use of partial nephrectomy for renal cell carcinoma has continuously changed in the clinical practice. Previously it was mostly used in imperative cases, in patients with a solitary kidney or in patients with a risk of renal failure. An increased number of incidentally detected renal cell carcinomas are diagnosed due to the advances of the radiological methods. These tumours tend to be smaller and generally with a lower stage. The reported excellent results of partial nephrectomy have promoted the use of nephron-sparing surgery also in patients with a normal contralateral kidney and tumours smaller than 4-5 cm. The technical outcome is excellent with a low operative morbidity and a good oncologic control. Therefore partial nephrectomy has become a standard technique in the treatment of properly selected patients. Laparoscopy with its reduced postoperative pain and shorter rehabilitation time, has encouraged the interest in minimally invasive nephron sparing surgical techniques. Although low, the risk of local tumour recurrence and surgical complications are higher after nephron-sparing surgery compared with radical nephrectomy. Furthermore, long-term renal function remains adequate in most patients with a normally functioning contralateral kidney also after radical nephrectomy. Albeit these facts, there is convincing evidence justifying nephron-sparing surgery to be used routinely for patients with a small renal cell carcinoma and a normal functioning contralateral kidney.
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Affiliation(s)
- B Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
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Kirkali Z, Van Poppel H, Tüzel E, Mungan U, Newling DW, Jacqmin D. A Prospective Survey of Surgical Approaches in Clinically Localized Renal Cell Carcinoma--A Preliminary Attempt at Surgical Quality Control. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/1561095021000092306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stang A, Büchel C. Renal surgery for kidney cancer in Germany 2005-2006: length of stay, risk of postoperative complications and in-hospital death. BMC Urol 2014; 14:74. [PMID: 25217295 PMCID: PMC4169703 DOI: 10.1186/1471-2490-14-74] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 09/10/2014] [Indexed: 01/07/2023] Open
Abstract
Background Representative statistics of surgical care among patients with kidney cancer are scant. With the introduction of the diagnosis related group system in Germany, it is now possible to provide nationwide statistics on surgical care. We studied in-hospital mortality risk in relation to comorbidity and complications, length of hospital stay in relation to surgical approach and comorbidity, and risk of complications in relation to surgical approach among kidney cancer patients undergoing nephrectomy. Methods We analyzed the nationwide hospitalization file of the years 2005 and 2006 including 23,753 hospitalizations with a diagnosis of renal cancer and partial or complete nephrectomy and classified comorbidity (Charlson comorbidity index) and complications. Length of stay, risk of in-hospital complications and in-hospital death were analyzed by linear regression and log-linear regression (relative risks (RR) and 95% confidence intervals (95% CI)). Results The overall in-hospital mortality was 1.4%. Per one unit increase of the Charlson comorbidity index, the adjusted risk of in-hospital mortality increased by 53% (95% CI 47-59%). The risks of bleeding or acute posthaemorrhagic anemia, respiratory, urological and gastrointestinal complications and infections ranged between 1.1% and 2.7% with the exception of bleeding or acute posthaemorrhagic anemia with 18.4%. Complications were associated with an increased adjusted in-hospital mortality risk. Highest adjusted mortality risk ratios were observed for gastrointestinal (RR = 3.61, 95% CI 2.32-5.63) and urological complications (RR = 3.62, 95% CI 2.62-5.00). The risk of haemorrhage or acute posthaemorrhagic anemia was lower for total laparoscopic nephrectomies than total open nephrectomies. The adjusted risk of gastrointestinal complications was lower for partial open compared to total open nephrectomy (adjusted RR = 0.66, 95% CI 0.45-0.97). Total laparoscopic nephrectomy was associated with shorter length of stay (−3.3 days; 95% CI 2.9-3.7 days) compared to total open nephrectomy. The estimated age-adjusted increase of length of stay per one unit increase of the Charlson comorbidity index was 1.3 days (95% CI 1.2-1.4 days). Conclusions In this representative population-based analysis, we found that the surgical approach is associated with the risk of complications and length of hospital stay. Furthermore, in the era of ageing populations, renal cancer patients with comorbidities should be counseled about their increased in-hospital mortality risk.
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Affiliation(s)
- Andreas Stang
- Institut für Medizinische Informatik, Biometrie, und Epidemiologie (IMIBE), Universitätsklinikum Halle, Halle, Essen 45147, Germany.
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Pflanz S, Brookman-Amissah S, Roigas J, Kendel F, Hoschke B, May M. Impact of macroscopic tumour necrosis to predict survival of patients with surgically resected renal cell carcinoma. ACTA ACUST UNITED AC 2009; 42:507-13. [PMID: 19031267 DOI: 10.1080/00365590802460633] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sandra Pflanz
- Department of Urology, Carl-Thiem Hospital, Cottbus, Germany
| | | | - Jan Roigas
- Department of Urology, Vivantes-Clinic Am Urban, Berlin, Germany
| | | | - Bernd Hoschke
- Department of Urology, Carl-Thiem Hospital, Cottbus, Germany
| | - Matthias May
- Department of Urology, Carl-Thiem Hospital, Cottbus, Germany
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Kwon YK, Kim BH, Park CH, Kim CI, Chang HS. Effectiveness of Computed Tomography for Predicting the Nuclear Grade of Renal Cell Carcinoma. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.10.942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Young Kee Kwon
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
| | - Byung Hoon Kim
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
| | - Choal Hee Park
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
| | - Chun Il Kim
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
| | - Hyuk Soo Chang
- Department of Urology, Keimyung University School of Medicine, Daegu, Korea
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Bae SR, Kim TH, Sung GT. Efficacy of Laparoscopic and Percutaneous Radiofrequency Ablation of Renal Tumor. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.4.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sang Rak Bae
- Department of Urology, Dong-A University School of Medicine, Busan, Korea
| | - Tae Hyo Kim
- Department of Urology, Dong-A University School of Medicine, Busan, Korea
| | - Gyung Tak Sung
- Department of Urology, Dong-A University School of Medicine, Busan, Korea
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Lee SK, Cheon SH, Moon KH, Ahn H, Kim CS. The Analysis of Prognostic Factors of Survival for Patients with Renal Cell Carcinoma according to Lymph Node Involvement or Metastasis. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.6.490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Seung Kyu Lee
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang Hyeon Cheon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyung Hyun Moon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Fornara P. Nephron-Sparing Surgery in Renal Cell Carcinoma: Did We Sacrifice Too Many Kidneys in the Past? Eur Urol 2007; 51:1475-6. [PMID: 17287074 DOI: 10.1016/j.eururo.2007.01.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Accepted: 01/24/2007] [Indexed: 10/23/2022]
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Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Marechal JM, Klotz L, Skinner E, Keane T, Claessens I, Sylvester R. A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 2006; 51:1606-15. [PMID: 17140723 DOI: 10.1016/j.eururo.2006.11.013] [Citation(s) in RCA: 283] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 11/03/2006] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study compared the complications and the cancer control of elective nephron-sparing surgery (NSS) and radical nephrectomy (RN) in patients with a small (<or=5 cm), solitary, low-stage N0 M0 tumour suspicious for renal cell carcinoma (RCC) and a normal contralateral kidney. METHODS 541 patients were randomised in a prospective, multicentre, phase 3 trial to undergo NSS (n=268) or RN (n=273) together with a limited lymph node dissection. RESULTS This publication reports only on the complications reported for both surgical methods. The rate of perioperative blood loss<0.5l was slightly higher after RN (96.0% vs. 87.2%) and the rate of severe haemorrhage was slightly higher after NSS (3.1% vs. 1.2%). Ten patients (4.4%), all of whom were treated with NSS, developed urinary fistulas. Pleural damage (11.5% for NSS vs. 9.3% for RN) and spleen damage (0.4% for NSS and 0.4% for RN) were observed with similar rates in both groups. Postoperative computed tomography scanning abnormalities were seen in 5.8% of NSS and 2.0% of RN patients. Reoperation for complications was necessary in 4.4% of NSS and 2.4% of RN patients. CONCLUSIONS NSS for small, easily resectable, incidentally discovered RCC in the presence of a normal contralateral kidney can be performed safely with slightly higher complication rates than after RN. The oncologic results are eagerly awaited to confirm that NSS is an acceptable approach for small asymptomatic RCC.
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Affiliation(s)
- Hendrik Van Poppel
- Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Lesage K, Joniau S, Fransis K, Van Poppel H. Comparison between open partial and radical nephrectomy for renal tumours: perioperative outcome and health-related quality of life. Eur Urol 2006; 51:614-20. [PMID: 17097216 DOI: 10.1016/j.eururo.2006.10.040] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 10/19/2006] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare perioperative outcome and health-related quality of life (HRQOL) after open partial and radical nephrectomy for renal tumours. METHODS Literature search of Medline and additional references from non-Medline-indexed journals for documents concerning treatment of renal tumours, perioperative outcome, and HRQOL after radical and partial nephrectomy. RESULTS A total of 39 references were used of which 7 discussed complications, 3 included hospital costs and length of stay, and 7 each discussed renal function and QOL. No statistical difference was found concerning perioperative complications although there seems to be a trend towards a slightly higher complication rate after partial nephrectomy. No statistical difference was reported between the two procedures concerning hospital costs and length of stay. For postoperative renal function, a higher incidence of chronic renal failure was noted after radical nephrectomy. When considering the HRQOL a benefit was found after elective partial nephrectomy. In case of mandatory partial nephrectomy the fear of recurrence and the worry about having fewer than two normal kidneys were significantly higher. CONCLUSIONS Partial nephrectomy achieves a better HRQOL due to better preservation of renal function and overall quality of life. Considering perioperative outcome no statistical difference was found for hospital costs and length of stay. A trend towards a higher perioperative complication rate was found after partial nephrectomy.
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Affiliation(s)
- Karl Lesage
- Department of Urology, University Hospital Gasthuisberg, Leuven, Belgium
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Heo J, Yun SK, Sung GT. Initial Experience of Radiofrequency Ablation of Renal Tumor. Korean J Urol 2006. [DOI: 10.4111/kju.2006.47.3.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- June Heo
- Department of Urology, Dong-A University School of Medicine, Busan, Korea
| | - Sung Kuk Yun
- Department of Diagnostic Radiology, Dong-A University School of Medicine, Busan, Korea
| | - Gyung Tak Sung
- Department of Urology, Dong-A University School of Medicine, Busan, Korea
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Abstract
PURPOSE Nephron sparing surgery has become accepted surgical practice for removing of renal tumors. The resection of central lesions has been thought to be more surgically challenging than that of peripheral tumors. We analyzed our experience with renal preservation surgery in patients with small hereditary central renal tumors. MATERIALS AND METHODS From 1992 to 2000 we performed 116 partial nephrectomies with 44 kidneys (38%) demonstrating central renal masses. Central renal tumors were defined radiologically as those completely encircled by parenchyma or transgressing the interpapillary line on computerized tomography. We compared this group to a similar series of 67 patients with hereditary renal cancer with only peripheral based tumors. RESULTS Mean tumor size was 3.2 cm (range 1.5 to 7.5). Mean operative time was 352 minutes (range 70 to 830). Renal hypothermia and vascular clamping were used in 19 of 44 procedures (41%). Mean ischemic time was 55 minutes (range 16 to 143). Mean blood loss was 4.6 l (range 0.1 to 23). The complication rate was 23% (10 of 44 cases) and with 18% (8 of 44) directly related to surgical technique. The mean transfusion requirement was 6.7 U (range 0 to 32) and 12 of 44 procedures (27%) required no blood products. Mean preoperative and postoperative serum creatinine was 1.05 (range 0.6 to 1.8) and 1.08 mg/dl (range 0.6 to 2.1), respectively. Mean followup was 33.7 months. No metastasis developed during followup. CONCLUSIONS Central renal tumors are a common manifestation of hereditary renal cell carcinoma. There was no statistical difference found between common operative parameters when central and peripheral nephron sparing surgeries were compared. However, mean operative blood loss and transfusion requirements were increased in the central tumor group.
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Affiliation(s)
- Darrel E Drachenberg
- Urologic Oncology Branch and Diagnostic Radiology Department, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892, USA
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Ito K, Nakashima J, Hanawa Y, Oya M, Ohigashi T, Marumo K, Murai M. The Prediction of Renal Function 6 Years After Unilateral Nephrectomy Using Preoperative Risk Factors. J Urol 2004; 171:120-5. [PMID: 14665858 DOI: 10.1097/01.ju.0000100981.11470.2f] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Since middle-aged and elderly patients seem to have risk factors affecting renal function, it is important to predict postoperative renal function prior to unilateral nephrectomy (UNx). We evaluated preoperative factors for predicting postoperative renal function in middle-aged and elderly patients with renal cell carcinoma (RCC) treated with radical nephrectomy (RNx). MATERIALS AND METHODS In 201 patients who underwent RNx preoperative records and postoperative serum creatinine (SCR) 6 years after nephrectomy were available. Postoperative renal insufficiency was defined as serum creatinine 1.4 mg/dl or greater. The relationship of each preoperative and postoperative factor was analyzed. Logistic regression analysis was performed to evaluate preoperative factors for predicting postoperative SCR 1.4 mg/dl or greater after 6 years. RESULTS There was a significant difference in postoperative SCR between female and male patients, and between those with and without hypertension, diabetes and proteinuria (p <0.05). Age, hemoglobin, preoperative SCR, blood urea nitrogen, uric acid and K significantly correlated with postoperative SCR (p <0.05). The increase in SCR during 6 years after UNx was significantly higher in patients with hypertension, diabetes and proteinuria than in their respective counterparts (p <0.05). Multivariate stepwise logistic regression analysis demonstrated that preoperative serum creatinine, hypertension and proteinuria were significant independent factors predicting postoperative renal function 6 years after UNx in patients with RCC (p <0.05). CONCLUSIONS Preoperative SCR, hypertension and proteinuria are useful factors for predicting postoperative renal function after RNx in patients with RCC.
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Affiliation(s)
- Keiicho Ito
- Department of Urology, School of Medicine, Keio University, Tokyo, Japan.
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Giménez Bachs J, Salinas Sánchez A, Hernández Millán I, Ruiz Mondéjar R, Lorenzo Romero J, Segura Martín M, Virseda Rodríguez J. Cirugía conservadora de parénquima en los tumores renales. Rev Clin Esp 2004; 204:191-197. [DOI: 10.1016/s0014-2565(04)71433-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Delakas D, Karyotis I, Daskalopoulos G, Terhorst B, Lymberopoulos S, Cranidis A. Nephron-sparing surgery for localized renal cell carcinoma with a normal contralateral kidney: a European three-center experience. Urology 2002; 60:998-1002. [PMID: 12475657 DOI: 10.1016/s0090-4295(02)01993-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the long-term effectiveness and safety of nephron-sparing surgery for the treatment of localized renal cell carcinoma with a normal contralateral kidney. METHODS Since 1973, 118 patients have undergone nephron-sparing surgery for renal cell carcinoma on an elective basis at our institutions. The vast majority of these tumors were incidental findings, with a mean tumor diameter of 3.35 cm (range 0.7 to 5.6). The median follow-up was 8.5 years (range 0.5 to 18), and of those patients alive, 27 (28%) were followed up for more than 10 years. RESULTS The pathologic stage was pT1N0M0 in 110 cases (93.2%) and pT3aN0M0 in 8 (6.7%); 59 were grade 1, 52 were grade 2, and 7 were grade 3. Complications occurred in 4 patients, including retroperitoneal bleeding in 1 treated by reoperation, urinomas in 2, and ureteral stricture in 1 treated conservatively. Renal function remained normal during the whole follow-up period, and slight proteinuria was observed in 13 patients. The 10-year distant and local recurrence rate was 4% and 3.9%, respectively. The cancer-specific 5, 10, and 15-year survival rate was 97.3%, 96.4%, and 96.4%, respectively. CONCLUSIONS Our experience, based on a long median follow-up, suggests that nephron-sparing surgery on an elective basis can achieve long-term survival for the treatment of incidental and low-stage renal cell carcinomas without compromising the efficacy of cancer treatment.
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Affiliation(s)
- Dimitrios Delakas
- Department of Urology, General University Hospital of Heraklion, Crete, Greece
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Mitsumori K, Kittleson JM, Itoh N, Delahunt B, Heathcott RW, Stewart JH, McCredie MRE, Reeve AE. Chromosome 14q LOH in localized clear cell renal cell carcinoma. J Pathol 2002; 198:110-4. [PMID: 12210070 DOI: 10.1002/path.1165] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The progression of a malignant tumour is understood to be the result of the accumulation of multiple genetic aberrations. As up to 14% of organ-confined renal cell carcinomas will recur after surgery, tumour clones with metastatic potential must already be present in some of these localized tumours. The association of 14q LOH with high-grade tumours and advanced tumour stage suggests an important role for the gene in tumour progression. Chromosome 14q LOH has been analysed in microdissected specimens from 130 organ-confined (UICC TNM stage 1 and 2) clear cell renal cell carcinomas using three microsatellite markers (D14S588, D14S617, GATA136B01). Tumours were classified as 14q LOH or not on the basis of LOH at one or more of the markers. The allelic imbalance ratio was used to determine both LOH and LOH proportion and the association between LOH and mortality, tumour size, histological grade and growth kinetics, measured by quantification of nucleolar organizer regions, was analysed. 14q LOH was present in 35.4% of informative cases at marker D14S588, 24.4% at D14S617, 36.4% at GATA136B01 and 39.5% for any one of the three markers. The mean 14q LOH proportion was 0.24 (range 0.009-0.80). LOH proportion correlated significantly with tumour size, AgNOR score and histological grade. It was also significantly associated with disease-specific mortality; (hazard ratio 1.22; 95% CI 1.02-1.45; p = 0.039). LOH proportion did not remain significant after adjusting for tumour size (hazard ratio 0.98; 95% CI 0.76-1.27; p = 0.90). These results indicate that the proportion of cells with 14q LOH in the tumour is associated with tumour aggressiveness; while this is not an independent predictor of survival, it may have some utility as a marker of latent metastatic potential.
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Affiliation(s)
- Kenji Mitsumori
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
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Ficarra V, Righetti R, Pilloni S, D'amico A, Maffei N, Novella G, Zanolla L, Malossini G, Mobilio G. Prognostic factors in patients with renal cell carcinoma: retrospective analysis of 675 cases. Eur Urol 2002; 41:190-8. [PMID: 12074408 DOI: 10.1016/s0302-2838(01)00027-6] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To identify independent predictors of cause-specific survival in patients affected by renal cell carcinoma (RCC). MATERIAL AND METHODS We evaluated retrospectively 675 patients who underwent in our department from 1976 to 1999 radical nephrectomy for RCC. Pathological stage of the primary tumor (TNM, 1997) was pT1 in 326 cases (48%), pT2 in 133 (20%), pT3a in 66 (10%), pT3b in 138 (20%) and pT4 in 12 (2%). According to TNM classification (Union International Contre le Cancer (UICC), 1997) the pathological stage was I in 303 cases (45%), II in 119 (18%), III in 150 (22%) and IV in 103 (15%). Histological grading was assigned according to Fuhrman's classification in only 333 cases: G1 in 25%, G2 in 35%, G3 in 33% and G4 in 7%. RESULTS Cause-specific survival was 77% at 5 years, 69% at 10 years, 64% at 15 years and 57% at 20 years. Five and 10 year cause-specific survival was, respectively 91.4 and 88.5% in pT1 tumors, 84.8 and 72.7% in pT2, 57.4 and 35.6% in pT3a, 47.2 and 33.6% in pT3b-c, and 29.6% in pT4 (P < 0.0001). In relation to the pathological stage according to TNM classification, 5 and 10 year cause-specific survival was, respectively 94 and 91.6% in stage I tumors, 89.7 and 78% in stage II, 63.4 and 46.4% in stage III and 28 and 16.3% in stage IV (P < 0.0001). In relation to the nuclear grade of the primary tumor 5 and 10 year cause-specific survival was, respectively 94 and 88% in G1 tumors, 86 and 75% in G2, 59 and 40% in G3 and 31% in G4 (P < 0.0001). At multivariate analysis pathological stage of the primary tumor, lymph nodes involvement, presence of distant metastases at diagnosis and nuclear grading resulted all independent predictors of cause-specific survival in patients with RCC. CONCLUSION Pathological stage of primary tumors, lymph nodes involvement, presence of distant metastases at diagnosis and nuclear grading according to Fuhrman resulted all independent predictors of cause-specific mortality in patients with RCC.
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Abstract
PURPOSE We evaluated the clinical efficacy of laparoscopic versus open radical nephrectomy in patients with clinically localized renal cell carcinoma. MATERIALS AND METHODS Between 1991 and 1999, 67 laparoscopic radical nephrectomies were performed for clinically localized, stages cT1/2 NXMX, pathologically confirmed renal cell carcinoma. During this period 54 patients who underwent open radical nephrectomy with pathologically confirmed stages pT1/2 NXMX disease were also identified. Medical and operative records were retrospectively reviewed and telephone followup was done to assess patient status. RESULTS In the laparoscopic and open groups average tumor size was 5.1 (range 1 to 13) and 5.4 cm. (range 0.2 to 18), respectively, which was not statistically significant. No patient had laparoscopic port site, wound or renal fossa tumor recurrence in either group. All patients were followed at least 12 months. In the laparoscopic group 2 cancer specific deaths occurred at a mean followup of 35.6 months. In the open group there were 2 cancer specific deaths and 3 cases of disease progression at a mean followup of 44 months. Kaplan-Meier disease-free survival and actuarial survival analysis revealed no significant differences in the laparoscopic and open radical nephrectomy groups. Also, no differences were noted in the complication rate. CONCLUSIONS Laparoscopic radical nephrectomy is an effective alternative for localized renal cell carcinoma when the principles of surgical oncology are maintained. Initial data show shorter patient hospitalization and effective cancer control with no significant difference in survival compared with open radical nephrectomy.
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Affiliation(s)
- D Y Chan
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institution, Baltimore, Maryland, USA
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23
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Filipas D, Fichtner J, Spix C, Black P, Carus W, Hohenfellner R, Thüroff JW. Nephron-sparing surgery of renal cell carcinoma with a normal opposite kidney: long-term outcome in 180 patients. Urology 2000; 56:387-92. [PMID: 10962300 DOI: 10.1016/s0090-4295(00)00656-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate the long-term outcome of an organ-saving approach for renal cell carcinoma (RCC) with a normal opposite kidney (elective indication). METHODS Since 1979, 180 patients have undergone nephron-sparing surgery at our institution for RCC in the presence of a normal contralateral kidney. The mean age was 56 years (range 23 to 83), and the mean follow-up was 4.7 years (maximum 14. 8). Most of these tumors were found incidentally, with a mean tumor diameter on ultrasound of 3.3 cm (range 1.0 to 8.6). RESULTS The postoperative course was unremarkable in 173 patients. Postoperative bleeding was encountered in 4 patients and urinary extravasation in an additional 3 patients. No surgical reintervention was necessary. One hundred seventy-five RCCs were pT1 and 5 were pT3a; 73 were grade 1, 100 grade 2, and 7 were grade 3. The mean tumor diameter (surgical specimen) was 3.2 cm (range 0.5 to 7). In 132 cases, the tumor was less than 4 cm and in 48 cases, greater than 4 cm. Three patients experienced local tumor recurrence (1.6%) during follow-up, and two others developed distant metastases. The 5-year tumor-specific survival rate was 98.0%. CONCLUSIONS Nephron-sparing surgery for RCC under an elective indication in selected patients offers excellent long-term survival and an acceptably low local tumor recurrence rate. These results support the concept of nephron-sparing surgery in the presence of a normal contralateral kidney.
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Affiliation(s)
- D Filipas
- Department of Urology, Johannes Gutenberg University School of Medicine, Mainz, Germany
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BLACK PETER, FILIPAS DRAGANA, FICHTNER JAN, HOHENFELLNER RUDOLF, THÜROFF JOACHIMW. NEPHRON SPARING SURGERY FOR CENTRAL RENAL TUMORS: EXPERIENCE WITH 33 CASES. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67794-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- PETER BLACK
- From the Department of Urology, School of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - DRAGANA FILIPAS
- From the Department of Urology, School of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - JAN FICHTNER
- From the Department of Urology, School of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - RUDOLF HOHENFELLNER
- From the Department of Urology, School of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - JOACHIM W. THÜROFF
- From the Department of Urology, School of Medicine, Johannes Gutenberg University, Mainz, Germany
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Abstract
In addition to the known risk factors for renal cell carcinoma, hypertension, obesity, and tobacco use, a diet high in consumption of fried or sautéed meat and the frequent consumption of poultry may increase the risk for renal cell carcinoma. A diet high in consumption of fruits and vegetables appears to have a protective effect. Molecular markers, in particular markers of cell proliferation, may have prognostic value and be of assistance in identifying patients who would benefit from more aggressive therapy. Surgery continues to the mainstay of treatment of localized disease, and may be the optimal treatment for patients with isolated solitary metastatic disease. Response rates to systemic therapy with cytokines vary from 5% to 20% with significant adverse effects.
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Affiliation(s)
- P A Godley
- University of North Carolina at Chapel Hill, Division of Hematology/Oncology, Lineberger Comprehensive Cancer Center, 27599-7305, USA
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