Kidney cancer focal cryoablation trend: does location or approach matter?

PURPOSE

We evaluated the current indications and surgical and survival outcomes for cryoablation (CA) using either a percutaneous (PCA) or a laparoscopic approach (LCA). We also investigated the ability of the PADUA score to predict the risk of complications and local recurrence.

METHODS

A retrospective analysis was performed at two European tertiary referral centers. Parameters analyzed included size, location, approach, operative time, hospital stay, complications, and functional and oncologic outcomes. Univariate and multivariate analyses were performed. An ROC analysis was conducted to evaluate the accuracy of the PADUA score.

RESULTS

Eighty patients were included. Mean tumor size was 2.6 cm. PCA was more often performed in posterior (95 vs. 60 %), inferior (72 vs. 32 %), and lateral (87 vs. 55 %) tumors. The global complication rate was 8.75 %, although proximity to the renal sinus resulted in a higher rate (30 vs. 4 %). Mean follow-up was 34 and 23 months for LCA and PCA, respectively. The 5-year recurrence-free survival was 76 and 90 % for LCA and PCA, respectively. Multivariate analysis showed that tumor involvement of the collecting system was predictive of recurrence. Under ROC analysis, PADUA score was a mild predictor for complications (AUC = 0.601) and a good predictor for recurrence (AUC = 0.723); PADUA ≥8 was identified as a cutoff for patients to a higher risk of recurrence.

CONCLUSIONS

The percutaneous approach is confirmed to be the preferred CA technique for posterior and lateral tumors. CA in deeper renal lesions and tumors with PADUA score ≥8 might entail a higher risk of recurrence, and closer follow-up should be considered in these patients.

Salivary markers in renal cell carcinoma

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Background: Kidney cancer ranks number 8 among cancer diagnoses in the UK with around 9,600 new diagnoses made each year (Cancer Research UK. Risks and causes of kidney cancer. http://www.cancerresearchuk.org/cancer-help/type/kidney-cancer/about/risks-and-causes-of-kidney-cancer). This study aimed to identify overexpressed proteins in human saliva that could serve as markers for renal cell carcinoma. Methods: Saliva was collected from 144 participants (95 male and 28 female).; 123 RCC patients (85%) and 21 healthy controls (15%), Total salivary protein levels were determined by BCA protein assay. Then 10ug of total saliva protein were evaluated via Western blotting on 4-12% Bis-Tris SDS-PAGE gels. Blots were probed for albumin as well as for three proteins associated with RCC; profilin1, 14-3-3 zeta, and endogenous avidin binding protein (EABP). Additionally, 6 saliva samples were evaluated via quantitative proteomics in a Tandem mass tag (TMT) labelling experiment comparing 4 RCC patients vs. 2 renal cyst patients. Results: Profilin1 levels were determined visually on a scale of 0 to 3 depending on band intensities on Western blots. Cancer patients had a higher percentage of levels 2 and 3 with 62 patients (50.4%). The control group only had 2 patients at level 2 (9.5%) and none at level 3. No difference in profilin1 levels was seen between metastatic vs. non-metastatic disease. Differences were seen in gender and histology, with female and non-CC patients having higher profilin levels. There is a potential link between profilin1 levels and surgical or drug treatment. 14-3-3 zeta could not be detected in saliva with these analyses. Albumin was present across all samples. EABP was found in 40.6% of cancer patients vs. 0% of controls; however no clear trend was seen with respect to disease burden, histology, or gender. Proteomic analysis gave a total of 33 hits showing raised protein levels of up to 20x higher in cancer patients vs. controls. Profilin1 was 2x and 14-3-3 zeta 5x more prevalent. Conclusions: This study has successfully identified profilin1 as a detectable salivary marker for renal cell carcinoma. [Table: see text]

Current status of robot-assisted partial nephrectomy

What's known on the subject? and What does the study add? The use of robotic assistance for the partial nephrectomy procedure has emerged as an alternative that may help some of the technical challenges of laparoscopic partial nephrectomy. The main concerns in laparoscopic partial nephrectomy relates to a steeper 'learning curve', prolonged warm ischaemia times and the potential for postoperative haemorrhage. The article delineates the dynamics of patient preparation, the surgical team, surgical technique & post-operative care to conclude that robotic-assisted partial nephrectomy is a viable alternative to both open and laparoscopic techniques. Partial nephrectomy has shown both improved overall patient survival and more effective preservation of renal function, when compared with radical nephrectomy. Robot-assisted partial nephrectomy has several potential advantages over the laparoscopic approach. Robotic assistance allows urologists to perform this complex reconstructive procedure more quickly, with improved precision and dexterity, tremor elimination and improved visualization. The present article aims to delineate the dynamics of patient preparation and surgical team, surgical technique and postoperative care. The oncological outcomes and disease-free survival of partial nephrectomy have been found to be equivalent to open partial nephrectomy [1-4].

Scarless single-port laparoscopic pelvic kidney nephrectomy

INTRODUCTION

We report the first pelvic kidney removal through the umbilicus using a scarless pure single-port technique in a young woman.

PATIENTS AND METHODS

A 27-year-old woman presented with uro-sepsis and acute renal failure secondary to a dilated, chronically infected, nonfunctioning left-sided pelvic kidney with ureteropelvic obstruction causing an obstruction to the right kidney. The acute episode was managed with bilateral ureteric stents and antibiotics. Definitive treatment involved removal of the diseased pelvic kidney through the umbilicus via a single-port access device (TriPor™; Olympus). A curved tissue grasper and extralong bariatric suction device were used along with standard straight laparoscopic instruments. In addition, a 10-mm flexible-tip video laparoendoscope (HD EndoEYE LTF-VH™; Olympus) and a robotic camera holder (FreeHand™; Prosurgics) were used to reduce external instrument clash.

RESULTS

The procedure was technically successful leaving the patient with a scarless abdomen. The operative time was 185 minutes, blood loss 100 mL, and length of stay 48 hours. There were no complications.

CONCLUSION

Scarless transumbilical pelvic nephrectomy is technically feasible. The first reported clinical experience is discussed.

The surgical risk of suprapubic catheter insertion and long-term sequelae

INTRODUCTION

Suprapubic catheter (SPC) insertion is a common urological procedure, which is often referred to as safe and simple even in inexperienced hands. There is, however, very little published evidence on the safety of this procedure. Our study aimed to provide evidence on the associated morbidity and mortality and provide guidance for practising clinicians.

PATIENTS AND METHODS

A total of 219 patients who underwent SPC insertion under cystoscopic guidance at two urology institutions between 1994 and 2002 were identified and their case notes reviewed.

RESULTS

The intra-operative complication rate was 10% and the 30-day complications rate was 19%. Mortality rate was 1.8%. Long-term complications included recurrent UTIs (21%), catheter blockage (25%) resulting in multiple accident and emergency attendance (43%). Despite this, the satisfaction rate was high (72%) and most patients (89%) prefer the SPC over the urethral catheter.

CONCLUSIONS

SPC bladder drainage results in a high patient satisfaction rate. Patients and clinicians should be aware of the potential complications associated with SPC insertion.