1
|
Papadopoulou A, Campain N, Abu-Ghanem Y, Shanmugathas N, Poullas M, Mumtaz F, Barod R, Tran M, Bex A, Patki P. Not-so-simple nephrectomy: Comparative analysis of radical and simple nephrectomy in a high-volume tertiary referral center. Int J Urol 2024; 31:160-168. [PMID: 37929800 DOI: 10.1111/iju.15330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/15/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES Simple nephrectomies can be challenging with significant morbidity. To prove the hypothesis of "not-so-simple" nephrectomy, we compared demographics, perioperative outcomes, and complications between simple and radical nephrectomy in a tertiary referral center. METHODS We analyzed 473 consecutive radical nephrectomies (January 2018-October 2020) and simple nephrectomies (January 2016-October 2020). Univariate and multivariate analysis of perioperative outcomes utilized the Mann-Whitney U test, Chi-squared test, Mantel-Haenszel test of trend, and multiple linear regression. Radical nephrectomies were classified in cT1, cT2a, and cT2b-T3 subgroups and compared to simple nephrectomies. Minimally invasive and open techniques were compared between the two groups. Infected versus non-infected simple nephrectomies were compared. RESULTS A total of 344 radical and 129 simple nephrectomies were included. Simple nephrectomy was an independent predictor of increased operative time (p = 0.001), length of stay (p = 0.049), and postoperative complications (p < 0.001). Simple nephrectomies had higher operative time (p < 0.001), length of stay (p = 0.014), and postoperative morbidity (p < 0.001) than cT1 radical nephrectomies and significantly more Clavien 1-2 complications than cT2a radical nephrectomies (p = 0.001). The trend was similar in minimally invasive operations. However, conversion to open rates was not significantly different. Infected simple nephrectomies had increased operative time (p < 0.001), length of stay (p = 0.005), blood loss (p = 0.016), and intensive care stay (p = 0.019). CONCLUSIONS Patients undergoing simple nephrectomy experienced increased operative time and morbidity. Simple nephrectomy carries higher morbidity than radical nephrectomy in tumors ≤10 cm. Robotic simple nephrectomies may reduce open conversion rates. Postoperative intensive care and enhanced recovery may be essential in simple nephrectomy planning with infected pathology.
Collapse
Affiliation(s)
- Ariadni Papadopoulou
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, UK
| | - Nicholas Campain
- The Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Yasmin Abu-Ghanem
- The Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Nimlan Shanmugathas
- Department of Urology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Marios Poullas
- Department of Cell and Developmental Biology, University College London, London, UK
- Department of Computer Science, Neapolis University Pafos, Pafos, Cyprus
| | - Faiz Mumtaz
- The Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Ravi Barod
- The Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Maxine Tran
- The Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Axel Bex
- The Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
| | - Prasad Patki
- The Specialist Centre for Kidney Cancer, Royal Free Hospital, London, UK
- Department of Urology, Royal London Hospital, Barts Health NHS Trust, London, UK
| |
Collapse
|
2
|
Spazzapan M, Javier P, Abu-Ghanem Y, Dryhurst D, Faure Walker N, Lunawat R, Nkwam N, Tasleem A. Reducing last-minute cancellations of elective urological surgery-effectiveness of specialist nurse preoperative assessment. Int J Qual Health Care 2023; 35:7061817. [PMID: 36857374 PMCID: PMC10019125 DOI: 10.1093/intqhc/mzad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/15/2022] [Accepted: 02/28/2023] [Indexed: 03/02/2023] Open
Abstract
Last-minute cancellations in urological surgery are a global issue, resulting in the wastage of resources and delays to patient care. In addition to non-cessation of anticoagulants and inadequately treated medical comorbidities, untreated urinary tract infections are a significant cause of last-minute cancellations. This study aimed to ascertain whether the introduction of a specialist nurse clinic resulted in a reduction of last-minute cancellations of elective urological surgery as part of our elective recovery plan following the Coronavirus disease 2019, the contagious disease caused by severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 pandemic. A specialist urology nurse-led clinic was introduced to review urine culture results preoperatively. Specialist nurses contacted patients with positive urine cultures and their general practitioners by telephone and email to ensure a minimum of 2 days of 'lead-in' antibiotics were given prior to surgery. Patients unfit for surgery were postponed and optimized, and vacant slots were backfilled. A new guideline was created to improve the timing and structure of the generic preassessment. Between 1 January 2021 and 30 June 2021, a mean of 40 cases was booked each month, with average cancellations rates of 9.57/40 (23.92%). After implementing changes on 1 July 2021, cancellations fell to 4/124 (3%) for the month. On re-audit, there was a sustained and statistically significant reduction in cancellation rates: between 1 July 2021 and 31 December 2021 cancellations averaged 4.2/97.5 (4.3%, P < .001). Two to nine (2%-16%) patients were started on antibiotics each month, while another zero to two (0%-2%) were contacted for other reasons. The implementation of a specialist urology nurse-led preassessment clinic resulted in a sustained reduction in cancellations of last-minute elective urological procedures.
Collapse
Affiliation(s)
- Martina Spazzapan
- Department of Urology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Farnborough Common, London BR6 8ND, United Kingdom
| | - Pinky Javier
- Department of Urology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Farnborough Common, London BR6 8ND, United Kingdom
| | - Yasmin Abu-Ghanem
- Department of Urology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Farnborough Common, London BR6 8ND, United Kingdom
| | - David Dryhurst
- Department of Urology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Farnborough Common, London BR6 8ND, United Kingdom
| | - Nicholas Faure Walker
- *Corresponding author. Department of Urology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Farnborough Common, London BR6 8ND, United Kingdom. E-mail:
| | - Rahul Lunawat
- Department of Urology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Farnborough Common, London BR6 8ND, United Kingdom
| | - Nkwam Nkwam
- Department of Urology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Farnborough Common, London BR6 8ND, United Kingdom
| | - Ali Tasleem
- Department of Urology, Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust, Farnborough Common, London BR6 8ND, United Kingdom
| |
Collapse
|
3
|
Capitanio U, Bedke J, Albiges L, Volpe A, Giles RH, Hora M, Marconi L, Klatte T, Abu-Ghanem Y, Dabestani S, Fernández Pello S, Hofmann F, Kuusk T, Campi R, Tahbaz R, Powles T, Ljungberg B, Bex A. Reply to Yaxiong Tang, Xu Hu, Kan Wu, Yanxiang Shao, and Xiang Li's Letter to the Editor re: Umberto Capitanio, Jens Bedke, Laurence Albiges, et al. A Renewal of the TNM Staging System for Patients with Renal Cancer To Comply with Current Decision-making: Proposal from the European Association of Urology Guidelines Panel. Eur Urol. 2022;83:3-5. Eur Urol 2023; 83:e74-e75. [PMID: 36526491 DOI: 10.1016/j.eururo.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Jens Bedke
- Department of Urology, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium and German Cancer Research Center, Heidelberg, Germany
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Rachel H Giles
- International Kidney Cancer Coalition, Duivendrecht, The Netherlands
| | - Milan Hora
- Department of Urology, University Hospital Pilsen and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Tobias Klatte
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Saeed Dabestani
- Department of Translational Medicine, Division of Urological Cancers, Lund University, Kristianstad Central Hospital, Lund, Sweden
| | | | - Fabian Hofmann
- Department of Urology, Sunderby Sjukhus, Umeå University, Luleå, Sweden
| | - Teele Kuusk
- Department of Urology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rana Tahbaz
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Powles
- The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Axel Bex
- The Royal Free London NHS Foundation Trust, London, UK; UCL Division of Surgery and Interventional Science, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Hora M, Albiges L, Bedke J, Campi R, Capitanio U, Giles RH, Ljungberg B, Marconi L, Klatte T, Volpe A, Abu-Ghanem Y, Dabestani S, Fernández-Pello S, Hofmann F, Kuusk T, Tahbaz R, Powles T, Bex A, Trpkov K. European Association of Urology Guidelines Panel on Renal Cell Carcinoma Update on the New World Health Organization Classification of Kidney Tumours 2022: The Urologist's Point of View. Eur Urol 2023; 83:97-100. [PMID: 36435661 DOI: 10.1016/j.eururo.2022.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022]
Abstract
The fifth edition of the World Health Organization (WHO) classification of urogenital tumours published in 2022 will be implemented in the European Association of Urology guidelines on renal cell carcinoma for 2023. Here we provide an update summarising changes in the new WHO classification of renal tumours from a clinician perspective.
Collapse
Affiliation(s)
- Milan Hora
- Department of Urology, University Hospital Pilsen and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia.
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Jens Bedke
- Department of Urology, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium and German Cancer Research Center, Heidelberg, Germany
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rachel H Giles
- International Kidney Cancer Coalition, Duivendrecht, The Netherlands
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Tobias Klatte
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Saeed Dabestani
- Department of Translational Medicine, Division of Urological Cancers, Lund University, Malmö, Sweden
| | | | - Fabian Hofmann
- Department of Urology, Sunderby Sjukhus, Umeå University, Luleå, Sweden
| | - Teele Kuusk
- Department of Urology, Homerton University Hospital, London, UK
| | - Rana Tahbaz
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Powles
- The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Axel Bex
- The Royal Free London NHS Foundation Trust, London, UK; UCL Division of Surgery and Interventional Science, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary and Alberta Precision Laboratories, Calgary, Canada
| |
Collapse
|
5
|
Vaggers S, Abu-Ghanem Y, Nair R, Fowler S, Bromage S. Management of the distal ureter in Nephroureterectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00964-8] [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: 02/12/2023]
|
6
|
Capitanio U, Bedke J, Albiges L, Volpe A, Giles RH, Hora M, Marconi L, Klatte T, Abu-Ghanem Y, Dabestani S, Fernández Pello S, Hofmann F, Kuusk T, Tahbaz R, Powles T, Ljungberg B, Bex A. A Renewal of the TNM Staging System for Patients with Renal Cancer To Comply with Current Decision-making: Proposal from the European Association of Urology Guidelines Panel. Eur Urol 2023; 83:3-5. [PMID: 36253306 DOI: 10.1016/j.eururo.2022.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/15/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022]
Abstract
Over the past decade, only minor changes have been introduced in the TNM staging system for renal cancer. Conversely, many milestones and modifications in management of the disease have been achieved, especially for patients with locally advanced and metastatic cancers. The European Association of Urology guidelines panel proposes a new TNM classification scheme for staging of renal cell carcinoma to reflect these breakthrough clinical improvements.
Collapse
Affiliation(s)
- Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Jens Bedke
- Department of Urology, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium and German Cancer Research Center, Heidelberg, Germany
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Rachel H Giles
- International Kidney Cancer Coalition, Duivendrecht, The Netherlands
| | - Milan Hora
- Department of Urology, University Hospital Pilsen, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Tobias Klatte
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Saeed Dabestani
- Department of Translational Medicine, Division of Urological Cancers, Lund University, Kristianstad Central Hospital, Lund, Sweden
| | | | - Fabian Hofmann
- Department of Urology, Sunderby Sjukhus, Umeå University, Luleå, Sweden
| | - Teele Kuusk
- Department of Urology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Rana Tahbaz
- Department of Urology, Elbe Kliniken, Stade, Germany
| | - Thomas Powles
- The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Axel Bex
- 17The Royal Free London NHS Foundation Trust, London, UK; UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| |
Collapse
|
7
|
Bedke J, Albiges L, Capitanio U, Giles RH, Hora M, Ljungberg B, Marconi L, Klatte T, Volpe A, Abu-Ghanem Y, Dabestani S, Fernández-Pello S, Hofmann F, Kuusk T, Tahbaz R, Powles T, Bex A. The 2022 Updated European Association of Urology Guidelines on the Use of Adjuvant Immune Checkpoint Inhibitor Therapy for Renal Cell Carcinoma. Eur Urol 2023; 83:10-14. [PMID: 36511268 DOI: 10.1016/j.eururo.2022.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 02/03/2023]
Abstract
In KEYNOTE-564, adjuvant pembrolizumab, a PD-1 antibody, significantly improved disease-free survival (DFS) in localised clear-cell renal cell carcinoma (ccRCC) with a high risk of relapse. In 2021, the European Association of Urology RCC Guidelines Panel issued a weak recommendation for adjuvant pembrolizumab for high-risk ccRCC as defined by the trial until final overall survival data and results from other trials were available. Meanwhile, the primary DFS endpoints were not met for adjuvant atezolizumab (PD-L1 inhibitor; IMmotion010), adjuvant nivolumab plus ipilimumab (CheckMate 914), or perioperative nivolumab (PROSPER). Owing to heterogeneity, a meta-analysis is not recommended. Pembrolizumab remains the only immune checkpoint inhibitor currently recommended in this setting. Overall survival data are immature and biomarkers to predict outcome are lacking. Uncertainty exists and overtreatment is occurring. Treatment decisions should be made with caution and with the involvement of each patient. PATIENT SUMMARY: New results from three trials of immunotherapy after surgery for kidney cancer to reduce the risk of recurrence showed no improvement with these treatments. These results are in contrast to an earlier study that showed that the antibody pembrolizumab did extend the time before kidney cancer recurrence, even though it is not yet clear if overall survival is longer. Thus, we cautiously recommend pembrolizumab as additional treatment in high-risk kidney cancer after surgery, but patient preference should be carefully considered and the risk of overtreatment should be discussed.
Collapse
Affiliation(s)
- Jens Bedke
- Department of Urology, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium and German Cancer Research Center, Heidelberg, Germany
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rachel H Giles
- International Kidney Cancer Coalition, Duivendrecht, The Netherlands
| | - Milan Hora
- Department of Urology, University Hospital Pilsen and Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Tobias Klatte
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Saeed Dabestani
- Department of Translational Medicine, Division of Urological Cancers, Lund University, Malmö, Sweden
| | | | - Fabian Hofmann
- Department of Urology, Sunderby Sjukhus, Umeå University, Luleå, Sweden
| | - Teele Kuusk
- Department of Urology, Homerton University Hospital, London, UK
| | - Rana Tahbaz
- Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Powles
- The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Axel Bex
- The Royal Free London NHS Foundation Trust, London, UK; UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| |
Collapse
|
8
|
Abu-Ghanem Y, Forster L, Khetrapal P, Ellis G, Singh P, Srinivasan R, Kucheria R, Goyal A, Allen D, Goode A, Yu D, Ajayi L. Factors Predicting Outcomes of Supine Percutaneous Nephrolithotomy: Large Single-Centre Experience. J Pers Med 2022; 12:jpm12121956. [PMID: 36556177 PMCID: PMC9784354 DOI: 10.3390/jpm12121956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022] Open
Abstract
Objective: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large renal calculi. The prone position has been considered the preferred position to obtain renal access. However, the supine position has recently gained popularity, which confers several potential advantages. The current study analyses the prognostic factors for successful supine PCNL procedures in a larger tertiary centre. Subjects: Prospective data were collected from all patients undergoing PCNL in the Galdako modified Valdivia position at our institution between February-2007 and September-2020. Surgical outcomes variables collected included: the rate of Endoscopic-combined intra-renal surgery (ECIRS), operative times, surgical effectiveness (no residuals <2 mm stone fragments) and complications. Results: A total of 592 patients underwent PCNL with a median age of 56 years (IQR: 42−67). The median stone size was 17 mm (IQR: 13−23). Of those, 79% of patients had an effective procedure. Stone size (p < 0.001), location (p < 0.001) and Guys-Stone Score (GSS) (p < 0.001) were associated with effectiveness. A Percutaneous nephrostomy tube was sited at the completion of the procedure in 97.3% of patients and a simultaneous double-J stent in 45.3%. Stent insertion was associated with larger stones (p < 0.001), the performance of ECIRS (p < 0.001) and higher GSS (p < 0.001). The overall complication rate was 21.7%. The main type of complication was an infection in 26.2 of the cases followed by the need for repeated nephrostogram in 12.7%. Conclusions: We demonstrate that PCNL in a high-volume centre is safe and efficacious in the Galdalko modified Valdivia position. Patients with smaller stones in the renal pelvis and a low GSS have the highest chance of a successful procedure.
Collapse
Affiliation(s)
- Yasmin Abu-Ghanem
- Department of Urology, Royal Free Hospital, London NW3 2PS, UK
- Correspondence:
| | - Luke Forster
- Department of Urology, Royal Free Hospital, London NW3 2PS, UK
| | | | - Gidon Ellis
- Department of Urology, Royal Free Hospital, London NW3 2PS, UK
| | - Paras Singh
- Department of Urology, Royal Free Hospital, London NW3 2PS, UK
| | | | - Rajesh Kucheria
- Department of Urology, Royal Free Hospital, London NW3 2PS, UK
| | - Anuj Goyal
- Department of Urology, Royal Free Hospital, London NW3 2PS, UK
| | - Darrell Allen
- Department of Urology, Royal Free Hospital, London NW3 2PS, UK
| | - Antony Goode
- Department of Radiology, Royal Free Hospital, London NW3 2PS, UK
| | - Dominic Yu
- Department of Radiology, Royal Free Hospital, London NW3 2PS, UK
| | - Leye Ajayi
- Department of Urology, Royal Free Hospital, London NW3 2PS, UK
| |
Collapse
|
9
|
Abu-Ghanem Y, Fontaine C, Sehgal R, Forster L, Verma N, Ellis G, Kucheria R, Allen D, Singh P, Goyal A, Ajayi L. Emergency Primary Ureteroscopy for Acute Ureteric Colic-From Guidelines to Practice. J Pers Med 2022; 12:jpm12111866. [PMID: 36579588 PMCID: PMC9695960 DOI: 10.3390/jpm12111866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/24/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To review the factors that may influence the ability to achieve the present guidelines' recommendations in a well-resourced tertiary centre. According to current National Institute for Health and Care Excellence (NICE) guidelines, definitive treatment (primary ureteroscopy (URS) or shock wave lithotripsy (ESWL)) should be offered to patients with symptomatic renal colic that are unlikely to pass the stone within 48 h of diagnosis. METHODS Retrospective review of all patients presenting to the emergency department between January and December 2019 with a ureteric or renal stone diagnosis. The rate of emergency intervention, risk factors for intervention and outcomes were compared between patients who were treated by primary definitive surgery vs. primary symptom relief by urethral stenting alone. RESULTS A total of 244 patients required surgical management for symptomatic ureteric colic without symptoms of urinary infection. Of those, 92 patients (37.7%) underwent definitive treatment by either primary URS (82 patients) or ESWL (9 patients). The mean time for the procedure was 25.5 h (range: 1-118). Patients who underwent primary definitive treatment were likelier to have smaller and distally located stones than the primary stenting group. Primary ureteroscopy was more likely to be performed in a supervised setting than emergency stenting. CONCLUSIONS Although definitive treatment carries high success rates, in a high-volume tertiary referral centre, it may not be feasible to offer it to all patients, with emergency stenting providing a safe and quick interim measure. Factors determining the ability to provide definitive treatment are stone location, stone size and resident supervision in theatre.
Collapse
|
10
|
Lloyd A, Reeves F, Abu-Ghanem Y, Challacombe B. Metastasectomy in renal cell carcinoma: where are we now? Curr Opin Urol 2022; 32:627-633. [PMID: 36111850 DOI: 10.1097/mou.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/26/2022]
Abstract
PURPOSE OF REVIEW Metastatic RCC has a variable natural history. Treatment choice depends on disease and patient factors, but most importantly disease burden and site of metastasis. This article highlights key variables to consider when contemplating metastasectomy for RCC and provide a narrative review on the evidence for metastasectomy in these patients. RECENT FINDINGS Tumour subtype is associated with differing patterns of recurrence. Patients with single or few metastatic sites have better outcomes, and those with greater time interval from initial nephrectomy. Local recurrence is particularly amenable to minimally invasive surgical resection and is oncologically sound. Very well selected cases of liver or brain metastases may benefit from metastectomy, although lung and endocrine metastases have more favourable outcomes. Although site and burden of disease is important, the key determinate of outcome in metastasectomy depends mostly on the ability to achieve a complete resection. Adjuvant treatment is not currently advocated. SUMMARY Metastasectomy should be generally reserved for cases where complete resection is achievable, unless the goal of treatment is to palliate symptoms. This field warrants ongoing research, particularly as systemic therapy and minimally invasive surgical techniques evolve. Elucidating tumour biology to inform patient selection will be important in future research.
Collapse
Affiliation(s)
- Alexander Lloyd
- Urology Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | | | | |
Collapse
|
11
|
Sehgal R, Abu-Ghanem Y, Fontaine C, Forster L, Goyal A, Allen D, Kucheria R, Singh P, Ellis G, Ajayi L. Primary Definitive Treatment versus Ureteric Stenting in the Management of Acute Ureteric Colic: A Cost-Effectiveness Analysis. J Pers Med 2022; 12:jpm12111773. [PMID: 36579512 PMCID: PMC9697827 DOI: 10.3390/jpm12111773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 01/01/2023] Open
Abstract
Objectives: To analyze the differences in cost-effectiveness between primary ureteroscopy and ureteric stenting in patients with ureteric calculi in the emergency setting. Patients and Methods: Patients requiring emergency intervention for a ureteric calculus at a tertiary centre were analysed between January and December 2019. The total secondary care cost included the cost of the procedure, inpatient hospital bed days, emergency department (A&E) reattendances, ancillary procedures and any secondary definitive procedure. Results: A total of 244 patients were included. Patients underwent ureteric stenting (62.3%) or primary treatment (37.7%), including primary ureteroscopy (URS) (34%) and shock wave lithotripsy (SWL) (3.6%). The total secondary care cost was more significant in the ureteric stenting group (GBP 4485.42 vs. GBP 3536.83; p = 0.65), though not statistically significant. While mean procedural costs for primary treatment were significantly higher (GBP 2605.27 vs. GBP 1729.00; p < 0.001), costs in addition to the procedure itself were significantly lower (GBP 931.57 vs. GBP 2742.35; p < 0.001) for primary treatment compared to ureteric stenting. Those undergoing ureteric stenting had a significantly higher A&E reattendance rate compared with primary treatment (25.7% vs. 10.9%, p = 0.02) and a significantly greater cost per patient related to revisits to A&E (GBP 61.05 vs. GBP 20.87; p < 0.001). Conclusion: Primary definitive treatment for patients with acute ureteric colic, although associated with higher procedural costs than ureteric stenting, infers a significant reduction in additional expenses, notably related to fewer A&E attendances. This is particularly relevant in the COVID-19 era, where it is crucial to avoid unnecessary attendances to A&E and reduce the backlog of delayed definitive procedures. Primary treatment should be considered concordance with clinical judgement and factors such as patient preference, equipment availability and operator experience.
Collapse
|
12
|
Bex A, Abu-Ghanem Y, Van Thienen JV, Graafland N, Lagerveld B, Zondervan P, Beerlage H, van Moorselaar J, Kockx M, Van Dam PJ, Szabados B, Blank CU, Powles T, Haanen JBAG. Efficacy, safety, and biomarker analysis of neoadjuvant avelumab/axitinib in patients (pts) with localized renal cell carcinoma (RCC) who are at high risk of relapse after nephrectomy (NeoAvAx). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.289] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
289 Background: Antibodies targeting PD-1/PD-L1 combined with vascular endothelial growth factor (VEGF) inhibitors are a first-line standard of care for metastatic RCC. Neoadjuvant use of these combinations may lead to downstaging and reduce the risk of recurrence. In addition, sequential tissue may allow identification of key immune biomarkers associated with outcome. Methods: Neoavax is a single arm phase II trial of 12 weeks neoadjuvant avelumab/axitinib prior to nephrectomy in 40 pts with high-risk non-metastatic clear-cell (cc) RCC (cT1b-4cN0-1M0, Grades 3-4). Primary endpoint is RECIST 1.1 partial response (PR) in the primary tumour (PT) in ≥25%. Secondary endpoints are disease-free survival (DFS), overall survival (OS) and safety. Biomarker analysis on sequential tissue is an exploratory endpoint. Expression of PD-L1 (SP263), CD8+, CD8-granzyme-B (CD8/GZMB)+, Foxp3+ cells, CD8/CD39+ and MHC-I were compared on pre-treatment biopsy and nephrectomy samples from 34 pts (NCT03341845). Results: Pts/tumour characteristics are shown in table. Twelve pts (30%) had a PR of the PT from a baseline mean diameter of 10.3 (range 5.6-16.4) cm. Median PT downsizing was 20 (0-43.5) % and median post-treatment vital tumour presence was 50 (1-100) %. At a median follow-up of 23.5 months, recurrence occurred in 13 (32%) pts at a median of 8 (2-23) months and 3 died of disease. Of the 12 pts with PT PR, 11 (92%) are disease-free. Median DFS and OS are not reached. Postoperative adverse events occurred in 8 pts (2 Clavien Dindo grade 3a). There were no treatment-related surgery delays and no PT progression. Post-treatment samples showed upregulation of PD-L1 expression (p <0.0001) and total CD8+ densities (p < 0.01) when compared to pre-treatment biopsies. Comparing samples of pts with PR vs no PR in the PT, no clear immune marker differences were observed. Post-treatment samples from pts that recurred were characterized by lower densities of total, intra-epithelial and stromal CD8+, intra-epithelial CD8+CD39+ (p<0.05) and total CD8+GZMB+ (p=0.1). Pre-treatment biopsies showed no clear differences. Conclusions: Neoadjuvant avelumab/axitinib for non-metastatic high-risk RCC leads to PR of the PT in 30% which is associated with DFS. Pts without recurrence had a significant increase in CD8+ densities compared to pts with recurrence suggesting expansion of a pre-existing immune response. Clinical trial information: NCT03341845. [Table: see text]
Collapse
Affiliation(s)
- Axel Bex
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | | | | | | | | | | | | | | | | | - Christian U. Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Thomas Powles
- Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, London, United Kingdom
| | | |
Collapse
|
13
|
Bedke J, Albiges L, Capitanio U, Giles RH, Hora M, Lam TB, Ljungberg B, Marconi L, Klatte T, Volpe A, Abu-Ghanem Y, Dabestani S, Fernández-Pello S, Hofmann F, Kuusk T, Tahbaz R, Powles T, Bex A. 2021 Updated European Association of Urology Guidelines on the Use of Adjuvant Pembrolizumab for Renal Cell Carcinoma. Eur Urol 2021; 81:134-137. [PMID: 34920897 DOI: 10.1016/j.eururo.2021.11.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 11/18/2021] [Indexed: 01/02/2023]
Abstract
Adjuvant treatment of nonmetastatic high-risk renal cell carcinoma is an unmet medical need. In the past, several tyrosine kinase inhibitor trials have failed to demonstrate an improvement of disease-free survival (DFS) in this setting. Only one trial (S-TRAC) provided evidence for improved DFS with sunitinib but without an overall survival (OS) signal. Keynote-564 is the first trial of an immune checkpoint inhibitor that significantly improved DFS with adjuvant pembrolizumab, a programmed death receptor-1 antibody, in clear cell renal cell carcinoma with a high risk of relapse. The intention-to-treat population, which included a group of patients after metastasectomy and no evidence of disease (M1 NED), had a significant DFS benefit. The OS data are not mature as yet. The Renal Cell Carcinoma Guideline Panel issues a weak recommendation for the adjuvant use of pembrolizumab for high-risk clear cell renal carcinoma, as defined by the trial until final OS data are available. However, the trial reilluminates the discussion on when and in whom metastasectomy should be performed. Here, caution is necessary not to perform metastasectomy in patients with poor prognostic features and rapid progressive disease, which must be excluded by a confirmatory scan of disease status prior to planned metastasectomy. PATIENT SUMMARY: New data from the adjuvant immune checkpoint inhibitor trial with pembrolizumab (a programmed death receptor-1 antibody) for the treatment of high-risk clear cell renal cell carcinoma (ccRCC) after surgery showed that the drug prolonged the period of being cancer free significantly, although whether it prolonged survival remained uncertain. Consequently, pembrolizumab is cautiously recommended as additional (ie, adjuvant) treatment in high-risk ccRCC after kidney cancer surgery.
Collapse
Affiliation(s)
- Jens Bedke
- Department of Urology, University Hospital Tuebingen, Tuebingen, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rachel H Giles
- International Kidney Cancer Coalition (IKCC), Duivendrecht, The Netherlands
| | - Milan Hora
- Department of Urology, University Hospital Pilsen and Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Tobias Klatte
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Saeed Dabestani
- Department of Translational Medicine, Division of Urological Cancers, Lund University, Malmö, Sweden
| | | | - Fabian Hofmann
- Department of Urology, Sunderby Sjukhus, Umeå University, Luleå, Sweden
| | - Teele Kuusk
- Department of Urology, Darent Valley Hospital, Dartford, UK; Gravesham NHS Trust, Dartford, UK
| | - Rana Tahbaz
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Powles
- The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Axel Bex
- The Royal Free London NHS Foundation Trust, London, UK; UCL Division of Surgery and Interventional Science, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| |
Collapse
|
14
|
Simson N, Mehan N, Abu-Ghanem Y, McDermott K, de Luyk N, Catterwell R, Namdarian B, O’Brien T, Fernando A, Nair R, Challacombe B. Robotic partial nephrectomy in solitary kidney: Feasibility and outcome. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02269-2] [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: 11/16/2022] Open
|
15
|
Abu-Ghanem Y, van Thienen JV, Blank C, Aarts MJB, Jewett M, de Jong IJ, Lattouf JB, van Melick HHE, Wood L, Mulders P, Rottey S, Wagstaff J, Zondervan P, Powles T, Neven A, Collette L, Tombal B, Haanen J, Bex A. Cytoreductive nephrectomy and exposure to sunitinib - a post hoc analysis of the Immediate Surgery or Surgery After Sunitinib Malate in Treating Patients With Metastatic Kidney Cancer (SURTIME) trial. BJU Int 2021; 130:68-75. [PMID: 34706141 DOI: 10.1111/bju.15625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/17/2021] [Accepted: 10/23/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To analyse if exposure to sunitinib in the Immediate Surgery or Surgery After Sunitinib Malate in Treating Patients With Metastatic Kidney Cancer (SURTIME) trial, which investigated opposite sequences of cytoreductive nephrectomy (CN) and systemic therapy, is associated with the overall survival (OS) benefit observed in the deferred CN arm. PATIENTS AND METHODS A post hoc analysis of SURTIME trial data. Variables analysed included number of patients receiving sunitinib, time from randomisation to start sunitinib, overall response rate by Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1, and duration of drug exposure and dose in the intention-to-treat population of the immediate and deferred arm. Descriptive methods and 95% confidence-intervals (CI) were used. RESULTS In the deferred arm, 97.7% (95% CI 89.3-99.6%; n = 48) received sunitinib vs 80% (95% CI 66.9-88.7%, n = 40) in the immediate arm. Following immediate CN, 19.6% progressed 4 weeks after CN and the median time to start sunitinib was 39.5 vs 4.5 days in the deferred arm. At week 16, 46.0% had progressed at metastatic sites in the immediate CN arm vs 32.7% in the deferred arm. Sunitinib dose reductions, escalations and interruptions were not statistically significantly different between arms. Among patients who received sunitinib in the immediate or deferred arm the median total sunitinib treatment duration was 172.5 vs 248 days. Reduction of target lesions was more profound in the deferred arm. CONCLUSIONS In comparison to the deferred CN approach, immediate CN impairs administration, onset, and duration of sunitinib. Starting with systemic therapy leads to early and more profound disease control and identification of progression prior to planned CN, which may have contributed to the observed OS benefit.
Collapse
Affiliation(s)
- Yasmin Abu-Ghanem
- Royal Free London NHS Foundation Trust and UCL Division of Surgery and Interventional Science, London, UK
| | | | | | | | | | - Igle Jan de Jong
- University of Groningen, University Medical Center Groningen, the Netherlands
| | | | | | - Lori Wood
- QEII Health Sciences Center, Halifax, NS, Canada
| | - Peter Mulders
- Radboud University Hospital, Nijmegen, the Netherlands
| | | | - John Wagstaff
- South West Wales Cancer Centre and Swansea University College of Medicine, Swansea, UK
| | | | - Tom Powles
- Barts and Queen Mary University London, London, UK
| | - Anouk Neven
- European Organisation of Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Laurence Collette
- European Organisation of Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Bertrand Tombal
- European Organisation of Research and Treatment of Cancer (EORTC), Brussels, Belgium.,Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - John Haanen
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Axel Bex
- Royal Free London NHS Foundation Trust and UCL Division of Surgery and Interventional Science, London, UK.,Netherlands Cancer Institute, Amsterdam, the Netherlands
| |
Collapse
|
16
|
Abu-Ghanem Y, Challacombe B. How to Deal with Renal Cell Carcinoma Tumours >7 cm: Referee. EUR UROL SUPPL 2021; 33:45-47. [PMID: 34632422 PMCID: PMC8488232 DOI: 10.1016/j.euros.2021.08.006] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Ben Challacombe
- Urology Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
17
|
Sehgal R, Wong S, Abu-Ghanem Y, Birks T, Kucheria R, Allen D, Goyal A, Singh P, Ajayi L, Ellis G. PD43-12 WHAT PART DOES URETEROSCOPY PLAY IN THE DIAGNOSTIC PATHWAY OF UPPER TRACT TRANSITIONAL CARCINOMA? A TWO-YEAR REVIEW IN A HIGH-VOLUME INSTITUTION. J Urol 2021. [DOI: 10.1097/ju.0000000000002057.12] [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: 11/25/2022]
|
18
|
Carmona O, Abu-Ghanem Y, Rosenzweig B, Zilberman DE, Dotan ZA. [CLINICAL OUTCOMES FOLLOWING ROBOT-ASSISTED PARTIAL NEPHRECTOMY (RAPN)]. Harefuah 2021; 160:598-602. [PMID: 34482673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Partial nephrectomy is the gold standard treatment for renal tumors less than 7 cm. OBJECTIVES To describe surgical techniques and trends of treating renal tumors less than 7 cm at our department and present the clinical outcomes of our experience with Robot-Assisted Partial Nephrectomy (RAPN). METHODS Out of an established prospective RAPN database, we retrieved demographic, clinical, surgical and pathological parameters. Operation length was defined as the time between the first surgical incision and the last suture (skin to skin). Warm ischemia time (WIT) was defined as the time between the renal artery clamping and clamp releasing. Data is presented as mean (range, standard deviation) or numeric value (%). RESULTS Overall, 250 RAPN cases were recorded between the years 2013-2020. Mean tumor size was 32 mm. Mean operation length was 153 minutes. Mean warm ischemia time was 17.5 minutes. Intra-operative complication rates, including converting the surgery to an open approach or to radical nephrectomy, was low. Mean estimated blood loss was 359 cc. An increase in the utilization of the robotic approach has been recorded throughout the years, with a concurrent decrease in the open and laparoscopic approaches. CONCLUSIONS RAPN is associated with lower complication rates and superior perioperative outcomes, therefore considered a good alternative to the open and laparoscopic approaches. Thus, RAPN is the gold standard treatment for renal tumors less than 7 cm at our institute.
Collapse
Affiliation(s)
- Orel Carmona
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Barak Rosenzweig
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
19
|
Yacobi Y, Abu-Ghanem Y, Dotan ZA, Kleinmann N, Mor Y, Zilberman DE. [ROBOT ASSISTED PYELOPLASTY IN ADULTS WITH URETERO-PELVIC JUNCTION OBSTRUCTION (UPJO)]. Harefuah 2021; 160:570-575. [PMID: 34482668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Robotic-pyeloplasty (RP) for uretero-pelvic-junction-obstruction (UPJO) has been performed in our institution since 2013. OBJECTIVES To summarize the outcomes of RP in adults over 18 years of age. METHODS Adult RP cases have been prospectively documented. Analysis included demographic data such as age, sex, American Association of Anesthesiology-ASA Score, surgical-side, pre-operative imaging. Operative time (OT), estimated blood loss (EBL), length of stay (LOS) and short-term complications were also recorded. In all cases a JJ-stent has been left in place and subsequently taken out. Complications were classified in accordance with the Clavien-Dindo classification criteria. Patients were seen periodically with repeat imaging. The renal scan was performed at least once during the post-operative follow-up. Results are given as median (inter-quartile range) or numeric values (%). RESULTS A total of 32 patients aged 33.5 years (21-45.2) had RP between the years 2013-2020, among which 53% were females and 59% right sided. An ASA score of 1-2 has been observed in 87.5% of all cases. Skin-to-skin OT was 163 min (136-185), and EBL was 5 ml (0-30). Short-term post-operative complications were hematuria (3.1%), urinary leak/urinoma (12.5%), body temperature>38.30C (12.5%). In 2 cases (6.2%) the JJ-stent had been re-positioned in the operating-theater (Clavien-Dindo 3b). LOS was 3 days (2-4) and JJ-stent had been taken out 39 days (31.7-45.2) post-operatively. Median length of follow-up was 19.5 months (9.5-26.7). In 92.3% of cases an improvement in hydronephrosis has been observed in post-operative imaging. The renal scan did not demonstrate renal function deterioration. CONCLUSIONS Adult robotic pyeloplasty for UPJO is safe and effective. Low complication rates and over 90% success rates have been observed. These findings are in line with those found in previous studies.
Collapse
Affiliation(s)
- Yonatan Yacobi
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Kleinmann
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoram Mor
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
20
|
Campain N, Nathan A, Abu-Ghanem Y, Tran M, Patki P, Mumtaz F, Bex A, Barod R. High volume robotic assisted nephro-ureterectomy allows improved perioperative outcomes. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01176-3] [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: 10/20/2022]
|
21
|
Satish P, Kuusk T, Campain N, Abu-Ghanem Y, Neves J, Barod R, El-Sheikh S, Mumtaz F, Patki P, Tran M, Tran-Dang M, Grant L, Klatte T, Bex A. European Association of Urology COVID intermediate prioritisation group is poorly predictive of pathological high-risk among patients with renal tumours. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00996-9] [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: 11/25/2022]
|
22
|
Sehgal R, Wong S, Abu-Ghanem Y, Birks T, Kucheria R, Allen D, Goyal A, Singh P, Ajayi L, Ellis G. What part does ureteroscopy play in the diagnostic pathway of upper tract urothelial carcinoma? A two-year review in a high volume institution. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01175-1] [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: 10/20/2022]
|
23
|
Papadopoulou A, Campain N, Abu-Ghanem Y, Mumtaz F, Barod R, Tran M, Bex A, Patki P. Minimally Invasive Surgery (MIS) in simple nephrectomy – differences in perioperative outcomes based on infectious or noninfectious aetiology. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00560-1] [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: 11/16/2022]
|
24
|
Bedke J, Albiges L, Capitanio U, Giles RH, Hora M, Lam TB, Ljungberg B, Marconi L, Klatte T, Volpe A, Abu-Ghanem Y, Dabestani S, Pello SF, Hofmann F, Kuusk T, Tahbaz R, Powles T, Bex A. The 2021 Updated European Association of Urology Guidelines on Renal Cell Carcinoma: Immune Checkpoint Inhibitor-based Combination Therapies for Treatment-naive Metastatic Clear-cell Renal Cell Carcinoma Are Standard of Care. Eur Urol 2021; 80:393-397. [PMID: 34074559 DOI: 10.1016/j.eururo.2021.04.042] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/29/2021] [Indexed: 12/27/2022]
Abstract
The recent randomized controlled phase III CLEAR trial results are the last to complement immune checkpoint inhibitor (ICI)-based doublet combination therapies for treatment-naïve metastatic clear-cell renal cell carcinoma. The CLEAR trial demonstrated an improved progression-free survival (PFS), overall survival (OS), and an objective response rate (ORR) benefit for the combination of lenvatinib plus pembrolizumab over sunitinib. The CheckMate-9ER trial update demonstrated an ongoing PFS, OS, and quality-of-life benefit for cabozantinib plus nivolumab over sunitinib as did the update of Keynote-426 for axitinib plus pembrolizumab in the intention-to-treat population, with a PFS benefit seen across all International Metastatic Database Consortium (IMDC) subgroups. In the IMDC intermediate- and poor-risk groups, the CheckMate-214 trial of ipilimumab plus nivolumab confirmed the OS benefit with a PFS plateauing after 30 months. The RCC Guidelines Panel recommends three tyrosine kinase inhibitors + ICI combinations of axitinib plus pembrolizumab, cabozantinib plus nivolumab, and lenvatinib plus pembrolizumab across all IMDC risk groups in advanced first-line RCC, and dual immunotherapy of ipilimumab and nivolumab in IMDC intermediate- and poor-risk groups. PATIENT SUMMARY: New data from combination trials with immune checkpoint inhibitors for advanced kidney cancer confirm a survival benefit for lenvatinib plus pembrolizumab, cabozantinib plus nivolumab (with improved quality-of-life), axitinib plus pembrolizumab, and ipilimumab plus nivolumab. These combination therapies are recommended as first-line treatment for advanced kidney cancer.
Collapse
Affiliation(s)
- Jens Bedke
- Department of Urology, University Hospital Tübingen, Tuebingen, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rachel H Giles
- International Kidney Cancer Coalition (IKCC), Duivendrecht, The Netherlands
| | - Milan Hora
- Department of Urology, University Hospital Pilsen and Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK; Department of Surgery, University of Cambridge, Cambridge, UK
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Saeed Dabestani
- Department of Translational Medicine, Division of Urological Cancers, Lund University, Malmö, Sweden
| | | | - Fabian Hofmann
- Department of Urology, Sunderby Sjukhus, Umeå University, Luleå, Sweden
| | - Teele Kuusk
- Department of Urology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Rana Tahbaz
- Department of Urology, Charité University Hospital Berlin, Germany
| | - Thomas Powles
- The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Axel Bex
- The Royal Free London NHS Foundation Trust, London, UK; UCL Division of Surgery and Interventional Science, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| |
Collapse
|
25
|
Bex A, Abu-Ghanem Y, Van Thienen JV, Graafland N, Lagerveld B, Zondervan P, Beerlage H, van Moorselaar J, Kockx M, Van Dam PJ, Szabados B, Blank CU, Powles T, Haanen JBAG. Dynamic changes of the immune infiltrate after neoadjuvant avelumab/axitinib in patients (pts) with localized renal cell carcinoma (RCC) who are at high risk of relapse after nephrectomy (NeoAvAx). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4573 Background: Antibodies targeting PD-1/PD-L1 combined with vascular endothelial growth factor (VEGF) inhibitors are a front-line standard of care for metastatic RCC. Neoadjuvant use of these combinations is associated with tumor downsizing, but dynamic effects on key immune biomarkers are uncertain. We report early dynamic changes in the tumour immune environment after neoadjuvant treatment with avelumab/axitinib. Methods: Neoavax is an open label, single arm, phase II trial, investigating 12 weeks of neoadjuvant avelumab/axitinib prior to nephrectomy in patients with high-risk non-metastatic clear-cell (cc) RCC (cT1b-4N0-1M0). Partial primary tumour response (RECIST 1.1) occurring in ≥25% is the primary endpoint. Biomarker analysis on sequential tissue is an exploratory endpoint. Expression of PD-L1 (SP263), CD8+, CD8-granzyme-B (CD8/GZMB)+, Foxp3+ cells, CD8/CD39+ and major histocompatibility complex class I (MHC-I) were compared on paired samples (pre-treatment biopsy and nephrectomy) (NCT03341845). Results: Paired, sequential tissue from the first 24 patients was analysed for immune biomarker expression. Of these patients, 70% were ≥pT3a, 30% pN1, 58% had ISUP/WHO grade ≥3 with 8% sarcomatoid features. Compared to pre-treatment biopsy there was a significant increase in PD-L1 (p = 0.0002) and CD8+ expression (p = 0.0003) after therapy, whereas changes in CD8/GZMB+, MHC-I and CD8/CD39+ were not significant. Furthermore, neoadjuvant avelumab/axitinib therapy was associated with a significant decrease in Foxp3+ cells (p = 0.009). Conclusions: 12 weeks of neoadjuvant axitinib/avelumab treatment in ccRCC leads to significant dynamic changes in the tumour microenvironment for CD8+, PD-L1 and Foxp3+ expression. High baseline Foxp3+ infiltration is associated with an unfavorable outcome in the majority of solid tumours. The significant on-treatment decrease in Foxp3+ may account for the positive interaction seen between VEGF targeted therapy and immune checkpoint inhibitors in mRCC. If these cells represent regulatory T cells (Tregs), activated CD4 T cells or fragile Tregs remains to be determined. Clinical trial information: NCT03341845.
Collapse
Affiliation(s)
- Axel Bex
- The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | | | | | | | | | | | | | | | | | - Christian U. Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Thomas Powles
- Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free National Health Service Trust,, London, United Kingdom
| | | |
Collapse
|
26
|
Satish P, Kuusk T, Campain N, Abu-Ghanem Y, Neves J, Barod R, El-Sheikh S, Mumtaz F, Patki P, Tran M, Tran-Dang MA, Grant L, Klatte T, Bex A. The European Association of Urology COVID Intermediate-priority Group is Poorly Predictive of Pathological High Risk Among Patients with Renal Tumours. Eur Urol 2021; 80:265-267. [PMID: 34024653 PMCID: PMC8136273 DOI: 10.1016/j.eururo.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Pranav Satish
- UCL Medical School, University College London, London, UK
| | - Teele Kuusk
- Specialist Centre For Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Nick Campain
- Specialist Centre For Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Yasmin Abu-Ghanem
- Specialist Centre For Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Joana Neves
- Specialist Centre For Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Ravi Barod
- Specialist Centre For Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Soha El-Sheikh
- Department of Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Faiz Mumtaz
- Specialist Centre For Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Prasad Patki
- Specialist Centre For Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Maxine Tran
- Specialist Centre For Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - My-Anh Tran-Dang
- Department of Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Lee Grant
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Tobias Klatte
- Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Axel Bex
- UCL Medical School, University College London, London, UK; Specialist Centre For Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.
| |
Collapse
|
27
|
Abu-Ghanem Y, Powles T, Capitanio U, Beisland C, Järvinen P, Stewart GD, Gudmundsson E, Lam TBL, Marconi L, Fernandéz-Pello S, Nisen H, Meijer RP, Volpe A, Ljungberg B, Klatte T, Bensalah K, Dabestani S, Bex A. Should patients with low-risk renal cell carcinoma be followed differently after nephron-sparing surgery vs radical nephrectomy? BJU Int 2021; 128:386-394. [PMID: 33794055 DOI: 10.1111/bju.15415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/10/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether pT1 renal cell carcinoma (RCC) should be followed differently after partial (PN) or radical nephrectomy (RN) based on a retrospective analysis of a multicentre database (RECUR). SUBJECTS A retrospective study was conducted in 3380 patients treated for nonmetastatic RCC between January 2006 and December 2011 across 15 centres from 10 countries, as part of the RECUR database project. For patients with pT1 clear-cell RCC, patterns of recurrence were compared between RN and PN according to recurrence site. Univariate and multivariate models were used to evaluate the association between surgical approach and recurrence-free survival (RFS) and cancer-specific mortality (CSM). RESULTS From the database 1995 patients were identified as low-risk patients (pT1, pN0, pNx), of whom 1055 (52.9%) underwent PN. On multivariate analysis, features associated with worse RFS included tumour size (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14-1.39; P < 0.001), nuclear grade (HR 2.31, 95% CI 1.73-3.08; P < 0.001), tumour necrosis (HR 1.5, 95% CI 1.03-2.3; P = 0.037), vascular invasion (HR 2.4, 95% CI 1.3-4.4; P = 0.005) and positive surgical margins (HR 4.4, 95% CI 2.3-8.5; P < 0.001). Kaplan-Meier analysis of CSM revealed that the survival of patients with recurrence after PN was significantly better than those with recurrence after RN (P = 0.02). While the above-mentioned risk factors were associated with prognosis, type of surgery alone was not an independent prognostic variable for RFS nor CSM. Limitations include the retrospective nature of the study. CONCLUSION Our results showed that follow-up protocols should not rely solely on stage and type of primary surgery. An optimized regimen should also include validated risk factors rather than type of surgery alone to select the best imaging method and to avoid unnecessary imaging. A follow-up of more than 3 years should be considered in patients with pT1 tumours after RN. A novel follow-up strategy is proposed.
Collapse
Affiliation(s)
- Yasmin Abu-Ghanem
- UCL Division of Surgical and Interventional Science, Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Umberto Capitanio
- Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Petrus Järvinen
- Urology, Abdominal Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | | | - Thomas B L Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | | | - Harry Nisen
- Urology, Abdominal Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alessandro Volpe
- Department of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Tobias Klatte
- Department of Surgery, University of Cambridge, Cambridge, UK.,Department of Urology, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Karim Bensalah
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Saeed Dabestani
- Division of Urological Cancers, Department of Translational Medicine, Central Hospital Kristianstad, Lund University, Lund, Sweden
| | - Axel Bex
- UCL Division of Surgical and Interventional Science, Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.,Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
28
|
Neves JB, Vanaclocha Saiz L, Abu-Ghanem Y, Marchetti M, Tran-Dang MA, El-Sheikh S, Barod R, Beisland C, Capitanio U, Cullen D, Klatte T, Ljungberg B, Mumtaz F, Patki P, Stewart GD, Dabestani S, Tran MGB, Bex A. Pattern, timing and predictors of recurrence after surgical resection of chromophobe renal cell carcinoma. World J Urol 2021; 39:3823-3831. [PMID: 33851271 DOI: 10.1007/s00345-021-03683-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/24/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Currently there are no specific guidelines for the post-operative follow-up of chromophobe renal cell carcinoma (chRCC). We aimed to evaluate the pattern, location and timing of recurrence after surgery for non-metastatic chRCC and establish predictors of recurrence and cancer-specific death. METHODS Retrospective analysis of consecutive surgically treated non-metastatic chRCC cases from the Royal Free London NHS Foundation Trust (UK, 2015-2019) and the international collaborative database RECUR (15 institutes, 2006-2011). Kaplan-Meier curves were plotted. The association between variables of interest and outcomes were analysed using univariate and multivariate Cox proportional hazards regression models with shared frailty for data source. RESULTS 295 patients were identified. Median follow-up was 58 months. The five and ten-year recurrence-free survival rates were 94.3% and 89.2%. Seventeen patients (5.7%) developed recurrent disease, 13 (76.5%) with distant metastases. 54% of metastatic disease diagnoses involved a single organ, most commonly the bone. Early recurrence (< 24 months) was observed in 8 cases, all staged ≥ pT2b. 30 deaths occurred, of which 11 were attributed to chRCC. Sarcomatoid differentiation was rare (n = 4) but associated with recurrence and cancer-specific death on univariate analysis. On multivariate analysis, UICC/AJCC T-stage ≥ pT2b, presence of coagulative necrosis, and positive surgical margins were predictors of recurrence and cancer-specific death. CONCLUSION Recurrence and death after surgically resected chRCC are rare. For completely excised lesions ≤ pT2a without coagulative necrosis or sarcomatoid features, prognosis is excellent. These patients should be reassured and follow-up intensity curtailed.
Collapse
Affiliation(s)
- Joana B Neves
- Division of Surgery and Interventional Science, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | | | - Yasmin Abu-Ghanem
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Marta Marchetti
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - My-Anh Tran-Dang
- Department of Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Soha El-Sheikh
- Department of Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Ravi Barod
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Christian Beisland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Umberto Capitanio
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - David Cullen
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Faiz Mumtaz
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Prasad Patki
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Saeed Dabestani
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Maxine G B Tran
- Division of Surgery and Interventional Science, University College London, London, UK
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK
| | - Axel Bex
- Division of Surgery and Interventional Science, University College London, London, UK.
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond street, London, NW3 2QG, UK.
| |
Collapse
|
29
|
Zilberman DE, Abu-Ghanem Y, Raviv G, Rosenzweig B, Fridman E, Portnoy O, Dotan ZA. Oncologic Outcomes Following Robot-Assisted Radical Prostatectomy for Clinical T3 Prostate Disease. Isr Med Assoc J 2021; 23:111-115. [PMID: 33595217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Little is known about oncologic outcomes following robot-assisted-radical-prostatectomy (RALP) for clinical T3 (cT3) prostate cancer. OBJECTIVES To investigate oncologic outcomes of patients with cT3 prostate cancer treated by RALP. METHODS Medical records of patients who underwent RALP from 2010 to 2018 were retrieved. cT3 cases were reviewed. Demographic and pre/postoperative pathology data were analyzed. Patients were followed in 3-6 month intervals with repeat PSA analyses. Adjuvant/salvage treatments were monitored. Biochemical recurrence (BCR) meant PSA levels of ≥ 0.2 ng/ml. RESULTS Seventy-nine patients met inclusion criteria. Median age at surgery was 64 years. Preoperative PSA level was 7.14 ng/dl, median prostate weight was 54 grams, and 23 cases (29.1%) were down-staged to pathological stage T2. Positive surgical margin rate was 42%. Five patients were lost to follow-up. Median follow-up time for the remaining 74 patients was 24 months. Postoperative relapse in PSA levels occurred in 31 patients (42%), and BCR in 28 (38%). Median time to BCR was 9 months. The overall 5-year BCR-free survival rate was 61%. Predicting factors for BCR were age (hazard-ratio [HR] 0.85, 95% confidence interval [95%CI] 0.74-0.97, P = 0.017) and prostate weight (HR 1.04, 95%CI 1.01-1.08, P = 0.021). Twenty-six patients (35%) received adjuvant/salvage treatments. Three patients died from metastatic prostate cancer 31, 52, and 78 months post-surgery. Another patient died 6 months post-surgery of unknown reasons. The 5-year cancer-specific survival rate was 92. CONCLUSIONS RALP is an oncologic effective procedure for cT3 prostate cancer. Adjuvant/salvage treatment is needed to achieve optimal disease-control.
Collapse
Affiliation(s)
- Dorit E Zilberman
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yasmin Abu-Ghanem
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Raviv
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Rosenzweig
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eddie Fridman
- Department of Pathology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orith Portnoy
- Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
30
|
Abu-Ghanem Y, Kleinmann N, Erlich T, Winkler HZ, Zilberman DE. The Impact of Dietary Modifications and Medical Management on 24-Hour Urinary Metabolic Profiles and the Status of Renal Stone Disease in Recurrent Stone Formers. Isr Med Assoc J 2021; 23:12-16. [PMID: 33443336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Dietary modifications and patient-tailored medical management are significant in controlling renal stone disease. Nevertheless, the literature regarding effectiveness is sparse. OBJECTIVES To explore the impact of dietary modifications and medical management on 24-hour urinary metabolic profiles (UMP) and renal stone status in recurrent kidney stone formers. METHODS We reviewed our prospective registry database of patients treated for nephrolithiasis. Data included age, sex, 24-hour UMP, and stone burden before treatment. Under individual treatment, patients were followed at 6-8 month intervals with repeat 24-hour UMP and radiographic images. Nephrolithiasis-related events (e.g., surgery, renal colic) were also recorded. We included patients with established long-term follow-up prior to the initiation of designated treatment, comparing individual nephrolithiasis status before and after treatment initiation. RESULTS Inclusion criteria were met by 44 patients. Median age at treatment start was 60.5 (50.2-70.2) years. Male:Female ratio was 3.9:1. Median follow-up was 10 (6-25) years and 5 (3-6) years before and after initiation of medical and dietary treatment, respectively. Metabolic abnormalities detected included: hypocitraturia (95.5%), low urine volume (56.8%), hypercalciuria (45.5%), hyperoxaluria (40.9%), and hyperuricosuria (13.6%). Repeat 24-hour UMP under appropriate diet and medical treatment revealed a progressive increase in citrate levels compared to baseline and significantly decreased calcium levels (P = 0.001 and 0.03, respectively). A significant decrease was observed in stone burden (P = 0.001) and overall nephrolithiasis-related events. CONCLUSIONS Dietary modifications and medical management significantly aid in correcting urinary metabolic abnormalities. Consequently, reduced nehprolithiasis-related events and better stone burden control is expected.
Collapse
Affiliation(s)
- Yasmin Abu-Ghanem
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Kleinmann
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Erlich
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Harry Z Winkler
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
31
|
Bedke J, Albiges L, Capitanio U, Giles RH, Hora M, Lam TB, Ljungberg B, Marconi L, Klatte T, Volpe A, Abu-Ghanem Y, Dabestani S, Fernández-Pello S, Hofmann F, Kuusk T, Tahbaz R, Powles T, Bex A. Updated European Association of Urology Guidelines on Renal Cell Carcinoma: Nivolumab plus Cabozantinib Joins Immune Checkpoint Inhibition Combination Therapies for Treatment-naïve Metastatic Clear-Cell Renal Cell Carcinoma. Eur Urol 2020; 79:339-342. [PMID: 33357997 DOI: 10.1016/j.eururo.2020.12.005] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 12/22/2022]
Abstract
Longer follow-up and new trial data from phase 3 randomised controlled trials investigating immune checkpoint blockade (PD-1 or its ligand PD-L1) in advanced clear-cell renal cell carcinoma (RCC) have recently become available. The CheckMate 9ER trial demonstrated an improved progression-free survival (PFS) and overall survival (OS) benefit for the combination of cabozantinib plus nivolumab. A Keynote-426 update demonstrated an ongoing OS benefit for pembrolizumab plus axitinib in the intention-to-treat population, with a PFS benefit seen across all International Metastatic Database Consortium (IMDC) subgroups, while an update of CheckMate 214 confirmed the long-term benefit of ipilimumab plus nivolumab in IMDC intermediate and poor risk patients. The RCC Guidelines Panel continues to recommend these tyrosine kinase inhibitors + immunotherapy (IO) combination across IMDC risk groups in advanced first-line RCC and dual immunotherapy of ipilimumab and nivolumab in IMDC intermediate and poor risk. PATIENT SUMMARY: New data from trials of immune checkpoint inhibitors for advanced kidney cancer confirm a survival benefit with the combination of cabozantinib plus nivolumab and pembrolizumab plus axitinib and ipilimumab plus nivolumab. These combination therapies are recommended as first-line treatment for advanced kidney cancer.
Collapse
Affiliation(s)
- Jens Bedke
- Department of Urology, University Hospital Tuebingen, Tuebingen, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rachel H Giles
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands; Patient Advocate, International Kidney Cancer Coalition, Utrecht, The Netherlands
| | - Milan Hora
- Department of Urology, University Hospital Pilsen and Charles University Faculty of Medicine in Pilsen, Pilsen, Czech Republic
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK; Department of Surgery, University of Cambridge, Cambridge, UK
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Saeed Dabestani
- Department of Translational Medicine, Division of Urological Cancers, Lund University, Malmö, Sweden
| | | | - Fabian Hofmann
- Department of Urology, Sunderby Sjukhus, Umeå University, Luleå, Sweden
| | - Teele Kuusk
- Department of Urology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK
| | - Rana Tahbaz
- Department of Urology, Elbe Kliniken, Stade, Germany
| | - Thomas Powles
- The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Axel Bex
- The Royal Free London NHS Foundation Trust, London, UK; UCL Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| |
Collapse
|
32
|
Abu-Ghanem Y, Powles T, Capitanio U, Beisland C, Järvinen P, Stewart GD, Gudmundsson EO, Lam TB, Marconi L, Fernandéz-Pello S, Nisen H, Meijer RP, Volpe A, Ljungberg B, Klatte T, Dabestani S, Bex A. The Impact of Histological Subtype on the Incidence, Timing, and Patterns of Recurrence in Patients with Renal Cell Carcinoma After Surgery-Results from RECUR Consortium. Eur Urol Oncol 2020; 4:473-482. [PMID: 33109495 DOI: 10.1016/j.euo.2020.09.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current follow-up strategies for patients with renal cell carcinoma (RCC) after curative surgery rely mainly on risk models and the treatment delivered, regardless of the histological subtype. OBJECTIVE To determine the impact of RCC histological subtype on recurrence and to examine the incidence, pattern, and timing of recurrences to improve follow-up recommendations. DESIGN, SETTING, AND PARTICIPANTS This study included consecutive patients treated surgically with curative intention (ie, radical and partial nephrectomy) for nonmetastatic RCC (cT1-4, M0) between January 2006 and December 2011 across 15 centres from 10 countries, as part of the euRopEan association of urology renal cell carcinoma guidelines panel Collaborative multicenter consortium for the studies of follow-Up and recurrence patterns in Radically treated renal cell carcinoma patients (RECUR) database project. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The impact of histological subtype (ie, clear cell RCC [ccRCC], papillary RCC [pRCC], and chromophobe RCC [chRCC]) on recurrence-free survival (RFS) was assessed via univariate and multivariate analyses, adjusting for potential interactions with important variables (stage, grade, risk score, etc.) Patterns of recurrence for all histological subtypes were compared according to recurrence site and risk criteria. RESULTS AND LIMITATIONS Of the 3331 patients, 62.2% underwent radical nephrectomy and 37.8% partial nephrectomy. A total of 2565 patients (77.0%) had ccRCC, 535 (16.1%) had pRCC, and 231 (6.9%) had chRCC. The median postoperative follow-up period was 61.7 (interquartile range: 47-83) mo. Patients with ccRCC had significantly poorer 5-yr RFS than patients with pRCC and chRCC (78% vs 86% vs 91%, p = 0.001). The most common sites of recurrence for ccRCC were the lung and bone. Intermediate-/high-risk pRCC patients had an increased rate of lymphatic recurrence, both mediastinal and retroperitoneal, while recurrence in chRCC was rare (8.2%), associated with higher stage and positive margins, and predominantly in the liver and bone. Limitations include the retrospective nature of the study. CONCLUSIONS The main histological subtypes of RCC exhibit a distinct pattern and dynamics of recurrence. Results suggest that intermediate- to high-risk pRCC may benefit from cross-sectional abdominal imaging every 6 mo until 2 yr after surgery, while routine imaging might be abandoned for chRCC except for abdominal computed tomography in patients with advanced tumour stage or positive margins. PATIENT SUMMARY In this analysis of a large database from 15 countries around Europe, we found that the main histological subtypes of renal cell carcinoma have a distinct pattern and dynamics of recurrence. Patients should be followed differently according to subtype and risk score.
Collapse
Affiliation(s)
- Yasmin Abu-Ghanem
- Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, UCL Division of Surgical and Interventional Science, London, UK.
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Umberto Capitanio
- Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Petrus Järvinen
- Abdominal Center, Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | | | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | | | - Harry Nisen
- Abdominal Center, Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Tobias Klatte
- Department of Surgery, University of Cambridge, Cambridge, UK; Department of Urology, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Saeed Dabestani
- Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Axel Bex
- Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, UCL Division of Surgical and Interventional Science, London, UK; Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
33
|
Meerveld-Eggink A, Graafland N, Wilgenhof S, van Thienen J, Grant M, Szabados B, Abu-Ghanem Y, Boleti E, Blank C, Haanen J, Powles T, Bex A. 737P Synchronous metastatic renal cell carcinoma (mRCC) treated with nivolumab and ipilimumab (N+I) and the primary tumour (PT) in place. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
34
|
Abu-Ghanem Y, Fernández-Pello S, Bex A, Ljungberg B, Albiges L, Dabestani S, Giles R, Hofmann F, Hora M, Kuczyk M, Kuusk T, Marconi L, Merseburger A, Tahbaz R, Staehler M, Volpe A, Powles T, Lam T, Bensalah K. Bias of available data makes it unreliable to compare outcomes of thermo-ablation versus surgery for the treatment of T1 renal tumours: A systematic review from the European Association of Urology Renal Cell Cancer Guideline Panel. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33805-2] [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: 11/15/2022] Open
|
35
|
Meerveld-Eggink A, Graafland N, Wilgenhof S, Van Thienen JV, Grant M, Szabados B, Abu-Ghanem Y, Boleti E, Blank CU, Haanen JBAG, Powles T, Bex A. Real-world safety and efficacy data of patients with synchronous metastatic renal cell carcinoma (mRCC) treated with nivolumab and ipilimumab (N+I) and the primary tumour (PT) in place. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e17083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17083 Background: Following CARMENA and SURTIME, upfront cytoreductive nephrectomy (CN) is no longer standard of care. Intermediate and poor risk patients (pts) receive systemic therapy with the PT in place with the option to perform deferred CN in responding pts. This practice has been adopted after the recent shift to immune checkpoint inhibitor combination in frontline for mRCC. We assessed the safety and efficacy of this approach in a real-world population. Methods: A retrospective analysis of a clinical audit from 3 institutional datasets of pts treated with first-line N+I and the PT in place. Pts and tumour characteristics, International Metastatic RCC Database Consortium (IMDC) risk, overall response rate (ORR) in the PT and metastatic sites, time to response (TTR) of the PT, PT- and immune related- (ir) adverse events (AE), deferred CN rate, progression free- (PFS) and overall survival (OS) were assessed. Results: Of 41 pts treated with N+I and the PT in place, 46.3% were IMDC poor risk and 51.2% had > 3 metastatic sites. After a median follow-up of 5.9 (2-10.3) months, 29 had at least 1 CT scan from baseline. Of those, 7 (24.3% [95% confidence interval [CI] 0.10-0.43]) had a partial response (PR) of the PT with a median TTR of 5.3 (2.5-8.6) months. Mean and median PT reduction were 16.9% (+7.6 to -70.3%) and 10% from a baseline mean tumour size of 9.5 (3.8-16.1) cm. Pts with a PT reduction > median (n = 14) had a PR at metastatic sites in 86% (CI 0.57-0.98) and no progressive disease (PD). Pts with PT reduction < median (n = 14) had PR in only 21% and PD at metastatic sites in 57% (CI 0.28-0.82). None of the PT progressed. There was no complete response (CR) at metastatic sites . No CN was performed; 5 pts (12%) developed hematuria grade 1-3, requiring embolisation in 2 (4.9%). Grade 3-4 irAE were observed in 22% of pts. Median PFS and OS are 8.6 months and not reached. Conclusions: N+I with the PT in place is safe and PT reduction is associated with response at metastatic sites. Most PT responded by 6 months. No CR at metastatic sites were observed (compared to a 9% CR rate in the pivotal trial) in this real-world population with a relatively high percentage of poor-risk pts. Furthermore, no deferred CN has been performed, neither for near-CR at metastatic sites nor for PT symptoms.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Axel Bex
- Royal Free London NHS Foundation Trust, UCL Division of Surgery and Interventional Science, London, United Kingdom
| |
Collapse
|
36
|
Horesh N, Abu-Ghanem Y, Erlich T, Rosin D, Gutman M, Zilberman DE, Ramon J, Dotan ZA. Management of Pancreatic Injuries Following Nephrectomy. Isr Med Assoc J 2020; 22:244-248. [PMID: 32286029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Pancreatic injuries during nephrectomy are rare, despite the relatively close anatomic relation between the kidneys and the pancreas. The data regarding the incidence and outcome of pancreatic injuries are scarce. OBJECTIVES To assess the frequency and the clinical significance of pancreatic injuries during nephrectomy. METHODS A retrospective analysis was conducted of all patients who underwent nephrectomy over a period of 30 years (1987-2016) in a large tertiary medical center. Demographic, clinical, and surgical data were collected and analyzed. RESULTS A total of 1674 patients underwent nephrectomy during the study period. Of those, 553 (33%) and 294 patients (17.5%) underwent left nephrectomy and radical left nephrectomy, respectively. Among those, four patients (0.2% of the total group, 0.7% of the left nephrectomy group, and 1.36% of the radical left nephrectomy) experienced iatrogenic injuries to the pancreas. None of the injuries were recognized intraoperatively. All patients were treated with drains in an attempt to control the pancreatic leak and one patient required additional surgical interventions. Average length of stay was 65 days (range 15-190 days). Mean follow-up was 23.3 months (range 7.7-115 months). CONCLUSIONS Pancreatic injuries during nephrectomy are rare and carry a significant risk for postoperative morbidity.
Collapse
Affiliation(s)
- Nir Horesh
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yasmin Abu-Ghanem
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Erlich
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Rosin
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation B, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Ramon
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
37
|
Abu-Ghanem Y, Fernández-Pello S, Bex A, Ljungberg B, Albiges L, Dabestani S, Giles RH, Hofmann F, Hora M, Kuczyk MA, Kuusk T, Marconi L, Merseburger AS, Tahbaz R, Staehler M, Volpe A, Powles T, Lam TB, Bensalah K. Limitations of Available Studies Prevent Reliable Comparison Between Tumour Ablation and Partial Nephrectomy for Patients with Localised Renal Masses: A Systematic Review from the European Association of Urology Renal Cell Cancer Guideline Panel. Eur Urol Oncol 2020; 3:433-452. [PMID: 32245655 DOI: 10.1016/j.euo.2020.02.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/03/2020] [Accepted: 02/18/2020] [Indexed: 01/08/2023]
Abstract
The European Association of Urology (EAU) Renal Cell Carcinoma (RCC) Guideline Panel performed a protocol-driven systematic review (SR) on thermal ablation (TA) compared with partial nephrectomy (PN) for T1N0M0 renal masses, in order to provide evidence to support its recommendations. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed, and only comparative studies published between 2000 and 2019 were included. Twenty-six nonrandomised comparative studies were included, recruiting a total of 167 80 patients. Risk of bias (RoB) assessment revealed high or uncertain RoB across all studies, with the vast majority being retrospective, observational studies with poorly matched controls and short follow-up. Limited data showed TA to be safe, but its long-term oncological effectiveness compared with PN remains uncertain. A quality assessment of pre-existing SRs (n=11) on the topic, using AMSTAR, revealed that all SRs had low confidence rating, with all but two SRs being rated critically low. In conclusion, the current data are inadequate to make any strong and clear conclusions regarding the clinical effectiveness of TA for treating T1N0M0 renal masses compared with PN. Therefore, TA may be cautiously considered an alternative to PN for T1N0M0 renal masses, but patients must be counselled carefully regarding the prevailing uncertainties. We recommend specific steps to improve the evidence base based on robust primary and secondary studies. PATIENT SUMMARY: In this report, we looked at the literature to determine the effectiveness of thermoablation (TA) in the treatment of small kidney tumours compared with surgical removal. We found that TA could cautiously be offered as an option due to many remaining uncertainties regarding its effectiveness.
Collapse
Affiliation(s)
- Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | | | - Axel Bex
- The Royal Free London NHS Foundation Trust and UCL Division of Surgery and Interventional Science, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Laurence Albiges
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - Saeed Dabestani
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Rachel H Giles
- Department of Nephrology and Hypertension, Patient Advocate International Kidney Cancer Coalition (IKCC), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Fabian Hofmann
- Department of Urology, Sunderby Hospital, Sunderby, Sweden
| | - Milan Hora
- Department of Urology, Faculty Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - Markus A Kuczyk
- Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany
| | - Teele Kuusk
- Department of Urology, Royal Free Hospital, London, UK
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Rana Tahbaz
- Department of Urology, Elbe Kliniken Stade, Stade, Germany
| | - Michael Staehler
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Alessandro Volpe
- Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy
| | - Thomas Powles
- Department of Urology, Royal Free Hospital, London, UK
| | - Thomas B Lam
- The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK; Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France.
| |
Collapse
|
38
|
Abu-Ghanem Y, Van Thienen JV, Blank CU, Powles T, TOMBAL BF, Collette L, Haanen JBAG, Bex A. Differences in the exposure to sunitinib in the immediate and deferred cytoreductive nephrectomy (CN) arms of the randomized controlled trial SURTIME. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
703 Background: SURTIME compared immediate CN followed by sunitinib 50mg/day (4/2 weeks on-off) 4 weeks after surgery (n=50) versus 3 cycles sunitinib followed by CN in the absence of progression and continued sunitinib 4 weeks after surgery (n=49). In the intention to treat analysis, the hazard ratio of the secondary endpoint overall survival (OS) favored deferred CN [0.57 (CI: 0.34–0.95, p=0.032)] with a median OS of 32.4 (CI: 14.5-65.3) versus only 15.0 months (CI: 9.3–29.5), following immediate CN. We investigated differences in exposure to systemic therapy between the two arms. Methods: Post-hoc exploratory analysis of number of patients receiving sunitinib, overall response rate (ORR) by RECIST 1.1, length of drug exposure and dose intensity in the immediate and deferred arm. Descriptive methods and 95% confidence intervals (CI) were used. Results: In the deferred arm, 97.7% (CI: 89.3-99.6; n=48) received sunitinib versus only 80% (CI: 66.9-88.7, n=40) in the immediate arm. Following immediate CN, 19.6% had confirmed progression at an interval CT scan 4 weeks after CN compared to baseline and 25% started with sunitinib > 4 weeks after surgery. At week 16, 46.0% had progressed at metastatic sites in the immediate CN arm versus 32.7% in the deferred arm, who had a per-protocol recommendation against nephrectomy. In the deferred arm, 83% completed 3 cycles sunitinib with 77.1% at >90%-120% relative dose intensity and an ORR of 29%, reducing the median sum of target lesions from 162 to 127 mm prior to planned CN.Of the patients who started with sunitinib in the immediate (n=40) or continued in the deferred arm after CN (n=29) median duration of treatment was 140 versus 351 days. Conclusions: With immediate CN fewer patients receive systemic therapy, which is administered later and shorter compared to the deferred approach. Starting systemic therapy with sunitinib leads to early and more profound control of the disease and identification of progression prior to planned CN which may translate into the observed survival benefit. Clinical trial information: NCT01099423.
Collapse
Affiliation(s)
| | | | | | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, Royal Free NHS Trust, London, United Kingdom
| | - Bertrand F. TOMBAL
- Institut d Recherche Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Laurence Collette
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - John B. A. G. Haanen
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Axel Bex
- Royal Free London NHS Foundation Trust, UCL Division of Surgery and Interventional Science, London, United Kingdom
| |
Collapse
|
39
|
Drori T, Abu-Ghanem Y, Kleinmann N, Shvero A, Winkler HZ, Zilberman DE. [A COMPARISON BETWEEN TWO POTASSIUM CITRATE REGIMENS FOR THE TREATMENT OF NEPHROLITHIASIS]. Harefuah 2019; 158:774-777. [PMID: 31823528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND UROCIT-K is a potassium-citrate regimen prescribed for the prevention of kidney stone formation. In 2013, K-CITEK was introduced to the local market as a new potassium-citrate regimen that reduces kidney stone formation in a declared rate of 93. OBJECTIVES We sought to explore the efficacy of K-CITEK versus UROCIT-K. METHODS A prospective database of patients treated with potassium-citrate regimens for nephrolithiasis has been reviewed. Patients were divided into two groups: those who were treated with UROCIT-K only (Group 1) and those who were treated with K-CITEK only (Group 2). The two groups were compared as regards to demographics, length of follow-up, urinary citrate level and stone burden changes, as well as the number of stone events (i.e: colic, surgery) throughout the follow-up period. In a separate analysis another group (Group 3) was checked. This group consisted of patients who were initially treated with UROCIT-K and later on were switched to K-CITEK. RESULTS The study group consisted of 104 patients: 54 patients in Group 1, 38 in group 2 and 12 in group 3. The latter was omitted from analysis due to the small size. Groups 1 and 2 resembled in their demographic data and medical comorbidities. No statistically significant differences were found in terms of change in urinary citrate levels, stone burden or recurrent stone events. CONCLUSIONS K-CITEK for the treatment of kidney stone prevention was found to be as equally effective as UROCIT-K in terms of increasing urinary citrate levels, reducing stone burden and maintaining the intervals between kidney stone events.
Collapse
Affiliation(s)
- Tomer Drori
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nir Kleinmann
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Asaf Shvero
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Harry Z Winkler
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| |
Collapse
|
40
|
Modai J, Avda Y, Shpunt I, Abu-Ghanem Y, Leibovici D, Shilo Y. Prediction of Surgical Intervention for Distal Ureteral Stones. J Endourol 2019; 33:750-754. [DOI: 10.1089/end.2019.0187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jonathan Modai
- Urology Department, Kaplan Medical Center, Rehovot, Israel
| | - Yuval Avda
- Urology Department, Kaplan Medical Center, Rehovot, Israel
| | - Igal Shpunt
- Urology Department, Kaplan Medical Center, Rehovot, Israel
| | | | - Dan Leibovici
- Urology Department, Kaplan Medical Center, Rehovot, Israel
| | - Yaniv Shilo
- Urology Department, Kaplan Medical Center, Rehovot, Israel
| |
Collapse
|
41
|
Abu-Ghanem Y, Ramon J. Impact of perioperative blood transfusions on clinical outcomes in patients undergoing surgery for major urologic malignancies. Ther Adv Urol 2019; 11:1756287219868054. [PMID: 31447936 PMCID: PMC6691668 DOI: 10.1177/1756287219868054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 07/15/2019] [Indexed: 01/17/2023] Open
Abstract
The association between allogeneic perioperative blood transfusion (PBT) and decreased survival among patients undergoing various oncological surgeries has been established in various malignant diseases, including colorectal, thoracic and hepatocellular cancer. However, when focusing on urologic tumors, the significance of PBT and its adverse effect remains debatable, mainly due to inconsistency between studies. Nevertheless, the rate of PBT remains high and may reach up to 62% in patients undergoing major urologic surgeries. Hence, the relatively high rate of PBT among related operations, along with the increasing prevalence of several urologic tumors, give this topic great significance in clinical practice. Indeed, recent retrospective studies, followed by systematic reviews in both prostate and bladder cancer surgery have supported the association that has been demonstrated in several malignancies, while other major urologic malignancies, including renal cell carcinoma and upper tract urothelial carcinoma, have also been addressed retrospectively. It is only a matter of time before the data will be sufficient for qualitative systematic review/qualitative evidence synthesis. In the current study, we performed a literature review to define the association between PBT and the oncological outcomes in patients who undergo surgery for major urologic malignancies. We believe that the current review of the literature will increase awareness of the importance and relevance of this issue, as well as highlight the need for evidence-based standards for blood transfusion as well as more controlled transfusion thresholds.
Collapse
Affiliation(s)
- Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Centre, Tel-Hashomer, Ramat-Gan, 52621, Israel
| | - Jacob Ramon
- Department of Urology, Sheba Medical Centre, Ramat-Gan, Israel
| |
Collapse
|
42
|
Abu-Ghanem Y, Ramon J. Editorial on “Risk prediction models for cancer-specific survival following cytoreductive nephrectomy in the contemporary era”. Ann Transl Med 2019; 7:S36. [DOI: 10.21037/atm.2019.02.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
43
|
Ljungberg B, Albiges L, Abu-Ghanem Y, Bensalah K, Dabestani S, Fernández-Pello S, Giles RH, Hofmann F, Hora M, Kuczyk MA, Kuusk T, Lam TB, Marconi L, Merseburger AS, Powles T, Staehler M, Tahbaz R, Volpe A, Bex A. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update. Eur Urol 2019; 75:799-810. [PMID: 30803729 DOI: 10.1016/j.eururo.2019.02.011] [Citation(s) in RCA: 846] [Impact Index Per Article: 169.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/07/2019] [Indexed: 12/12/2022]
Abstract
CONTEXT The European Association of Urology Renal Cell Carcinoma (RCC) Guideline Panel has prepared evidence-based guidelines and recommendations for the management of RCC. OBJECTIVE To provide an updated RCC guideline based on standardised methodology including systematic reviews, which is robust, transparent, reproducible, and reliable. EVIDENCE ACQUISITION For the 2019 update, evidence synthesis was undertaken based on a comprehensive and structured literature assessment for new and relevant data. Where necessary, formal systematic reviews adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were undertaken. Relevant databases (Medline, Cochrane Libraries, trial registries, conference proceedings) were searched until June 2018, including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm, systematic reviews, and meta-analyses. Where relevant, risk of bias (RoB) assessment, and qualitative and quantitative syntheses of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment. Clinical practice recommendations were developed and issued based on the modified GRADE framework. EVIDENCE SYNTHESIS All chapters of the RCC guidelines were updated based on a structured literature assessment, for prioritised topics based on the availability of robust data. For RCTs, RoB was low across studies. For most non-RCTs, clinical and methodological heterogeneity prevented pooling of data. The majority of included studies were retrospective with matched or unmatched cohorts, based on single- or multi-institutional data or national registries. The exception was for the treatment of metastatic RCC, for which there were several large RCTs, resulting in recommendations based on higher levels of evidence. CONCLUSIONS The 2019 RCC guidelines have been updated by the multidisciplinary panel using the highest methodological standards. These guidelines provide the most reliable contemporary evidence base for the management of RCC in 2019. PATIENT SUMMARY The European Association of Urology Renal Cell Carcinoma Guideline Panel has thoroughly evaluated the available research data on kidney cancer to establish international standards for the care of kidney cancer patients.
Collapse
Affiliation(s)
- Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
| | - Laurance Albiges
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | - Saeed Dabestani
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund, Sweden
| | | | - Rachel H Giles
- Department of Nephrology and Hypertension, Patient Advocate International Kidney Cancer Coalition (IKCC), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Fabian Hofmann
- Department of Urology, Sunderby Hospital, Sunderby, Sweden
| | - Milan Hora
- Department of Urology, Faculty Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - Markus A Kuczyk
- Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany
| | - Teele Kuusk
- Department of Urology, Royal Free Hospital, Pond Street, London, UK
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Thomas Powles
- The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Michael Staehler
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Rana Tahbaz
- Department of Urology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Alessandro Volpe
- Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Axel Bex
- The Royal Free London NHS Foundation Trust, London, UK; UCL Division of Surgery and Interventional Science, London, UK; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| |
Collapse
|
44
|
Bex A, Albiges L, Ljungberg B, Bensalah K, Dabestani S, Giles RH, Hofmann F, Hora M, Kuczyk MA, Lam TB, Marconi L, Merseburger AS, Fernández-Pello S, Tahbaz R, Abu-Ghanem Y, Staehler M, Volpe A, Powles T. Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma. Eur Urol 2018; 74:805-809. [PMID: 30177291 DOI: 10.1016/j.eururo.2018.08.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/07/2018] [Indexed: 11/23/2022]
Abstract
Cytoreductive nephrectomy (CN) has been the standard of care in patients with metastatic clear-cell renal cancer who present with the tumour in place. The CARMENA trial compared systemic therapy alone with CN followed by systemic therapy. This article outlines the new guidelines based on these data. PATIENT SUMMARY: The CARMENA trial demonstrates that immediate cytoreductive nephrectomy should no longer be considered the standard of care in patients diagnosed with intermediate and poor risk metastatic renal cell carcinoma when medical treatment is required. However, the psychological burden poor risk patients experience hearing that removal of their primary tumour will not be beneficial, should be carefully considered.
Collapse
Affiliation(s)
- Axel Bex
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | - Saeed Dabestani
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Rachel H Giles
- Patient Advocate, International Kidney Cancer Coalition (IKCC), Duivendrecht, The Netherlands; Department of Nephrology and Hypertension, Regenerative Medicine Center, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Fabian Hofmann
- Department of Urology, Sunderby Hospital, Sunderby, Sweden
| | - Milan Hora
- Department of Urology, Faculty Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - Markus A Kuczyk
- Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany
| | - Thomas B Lam
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK; Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | - Rana Tahbaz
- Department of Urology, Elbe Kliniken Stade, Stade, Germany
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Michael Staehler
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Alessandro Volpe
- Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Thomas Powles
- The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK
| |
Collapse
|
45
|
Bex A, Albiges L, Staehler M, Bensalah K, Giles RH, Dabestani S, Hofmann F, Hora M, Kuczyk MA, Lam TB, Marconi L, Merseburger AS, Fernández-Pello S, Tahbaz R, Abu-Ghanem Y, Volpe A, Ljungberg B, Escudier B, Powles T. A Joint Statement from the European Association of Urology Renal Cell Cancer Guidelines Panel and the International Kidney Cancer Coalition: The Rejection of Ipilimumab and Nivolumab for Renal Cancer by the Committee for Medicinal Products for Human Use Does not Change Evidence-based Guideline Recommendations. Eur Urol 2018; 74:849-851. [PMID: 30201510 DOI: 10.1016/j.eururo.2018.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Axel Bex
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Laurence Albiges
- Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Michael Staehler
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | - Rachel H Giles
- International Kidney Cancer Coalition (IKCC), Duivendrecht, The Netherlands; Department of Nephrology and Hypertension, Regenerative Medicine Center, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Saeed Dabestani
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Fabian Hofmann
- Department of Urology, Sunderby Hospital, Sunderby, Sweden
| | - Milan Hora
- Department of Urology, Faculty Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - Markus A Kuczyk
- Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany
| | - Thomas B Lam
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK; Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | - Rana Tahbaz
- Department of Urology, Elbe Kliniken Stade, Stade, Germany
| | - Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Alessandro Volpe
- Division of Urology, Maggiore della Carita' Hospital, University of Eastern Piedmont, Novara, Italy
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | | | - Thomas Powles
- The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK.
| |
Collapse
|
46
|
Abu-Ghanem Y, Shvero A, Kleinmann N, Winkler HZ, Zilberman DE. 24-h urine metabolic profile: is it necessary in all kidney stone formers? Int Urol Nephrol 2018; 50:1243-1247. [PMID: 29876775 DOI: 10.1007/s11255-018-1902-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 05/23/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE A 24-h urine metabolic profile (24-UMP) is an integral part of nephrolithiasis work-up. We aimed to explore whether it can be waived under certain circumstances. MATERIALS AND METHODS We reviewed our prospective registry database of patients seen at our outpatient clinic for nephrolithiasis between the years 2010 and 2017. Data included: gender, age at first stone, body mass index (BMI), self-reported comorbidities and family history of nephrolithiasis. A 24-UMP was obtained from each patient under random diet. The following were recorded: urine volume, urinary levels of sodium, calcium, uric acid, oxalate and citrate. Presence of at least one comorbidity (i.e., hypertension/diabetes/hyperlipidemia) was defined as "associated comorbidities" (AC). Their absence was defined as "no comorbidities" (NC). Subjects were divided into two subgroups: first-time and recurrent stone formers, which were further divided into two subgroups: 1st + AC; 1st + NC; recurrent + AC; recurrent + NC. 24-UMPs have been compared between the four groups. RESULTS Four hundred and fifty-seven patients were included in the study. In the AC groups, patients demonstrated higher BMI levels (p = 0.001), and were statistically significantly obese (BMI > 30, p = 0.001) and older at first stone event (p = 0.001). First formers, either with AC or NC were more likely to have low urine volume (LUV) compared with recurrent formers (72.5 vs. 59.5%, p = 0.005). In the remaining metabolic abnormalities, no such differences were observed. CONCLUSIONS First-time stone formers, either with or without AC are likely to demonstrate LUV as their primary metabolic abnormality in 24-UMP. Therefore, 24-UMP may be postponed until recurrent stone event.
Collapse
Affiliation(s)
- Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel. .,Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Asaf Shvero
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Kleinmann
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Harry Z Winkler
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dorit E Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, 52621, Ramat-Gan, Israel.,Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
47
|
Kitrey ND, Vardi Y, Appel B, Shechter A, Massarwi O, Abu-Ghanem Y, Gruenwald I. Low Intensity Shock Wave Treatment for Erectile Dysfunction-How Long Does the Effect Last? J Urol 2018; 200:167-170. [PMID: 29477719 DOI: 10.1016/j.juro.2018.02.070] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE We studied the long-term efficacy of penile low intensity shock wave treatment 2 years after an initially successful outcome. MATERIALS AND METHODS Men with a successful outcome of low intensity shock wave treatment according to the minimal clinically important difference on the IIEF-EF (International Index of Erectile Function-Erectile Function) questionnaire were followed at 6, 12, 18 and 24 months. Efficacy was assessed by the IIEF-EF. Failure during followup was defined as a decrease in the IIEF-EF below the minimal clinically important difference. RESULTS We screened a total of 156 patients who underwent the same treatment protocol but participated in different clinical studies. At 1 month treatment was successful in 99 patients (63.5%). During followup a gradual decrease in efficacy was observed. The beneficial effect was maintained after 2 years in only 53 of the 99 patients (53.5%) in whom success was initially achieved. Patients with severe erectile dysfunction were prone to earlier failure than those with nonsevere erectile dysfunction. During the 2-year followup the effect of low intensity shock wave treatment was lost in all patients with diabetes who had severe erectile dysfunction at baseline. On the other hand, patients with milder forms of erectile dysfunction without diabetes had a 76% chance that the beneficial effect of low intensity shock wave treatment would be preserved after 2 years. CONCLUSIONS Low intensity shock wave treatment is effective in the short term but treatment efficacy was maintained after 2 years in only half of the patients. In patients with milder forms of erectile dysfunction the beneficial effect is more likely to be preserved.
Collapse
Affiliation(s)
- Noam D Kitrey
- Urology Department, Sheba Medical Center, Ramat-Gan, Israel.
| | - Yoram Vardi
- Urology Department, Sheba Medical Center, Ramat-Gan, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Boaz Appel
- Neurourology Unit, Rambam Healthcare Campus, Haifa, Israel
| | - Arik Shechter
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Neurourology Unit, Rambam Healthcare Campus, Haifa, Israel
| | - Omar Massarwi
- Neurourology Unit, Rambam Healthcare Campus, Haifa, Israel
| | | | - Ilan Gruenwald
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Neurourology Unit, Rambam Healthcare Campus, Haifa, Israel
| |
Collapse
|
48
|
Shvero A, Nativ O, Abu-Ghanem Y, Zilberman D, Zaher B, Levitt M, Fridman E, Portnoy O, Ramon J, Dotan ZA. Oncologic Outcomes of Partial Nephrectomy for Stage T3a Renal Cell Cancer. Clin Genitourin Cancer 2017; 16:e613-e617. [PMID: 29174471 DOI: 10.1016/j.clgc.2017.10.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/28/2017] [Accepted: 10/30/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Partial nephrectomy (PN) for clinical stage T3 tumors is controversial. Radical nephrectomy (RN) has been associated with a greater rate of chronic kidney disease, an increased risk of cardiovascular disease, and increased mortality compared with PN. We present our long-term 2-center experience with PN for stage pT3a tumors and compare the oncologic outcomes with those of similar patients treated with RN. MATERIALS AND METHODS We reviewed the data from all patients who had undergone nephrectomy for renal cell carcinoma from 1987 to 2015 in 2 medical centers. The study included 134 patients with pathologic stage T3a tumors, of whom 48 and 86 underwent PN and RN, respectively. We compared the 2 groups (PN and RN) using univariate and multivariate analyses. RESULTS The tumors of all patients with pathologic stage T3a who had undergone PN had been pathologically upstaged from clinical stage T1 or T2. Univariate and multivariate analyses revealed tumor size was significantly different statistically between the study groups (median, 7.0 cm in RN group vs. 4.0 cm in PN group; P < .001). Surgery type was not a predictor of local recurrence (P = .978), metastatic progression (P = .972), death from renal cancer (P = .626), or death from all causes (P = .974) at the 5-year follow-up point. CONCLUSION The results of the present study have shown similar oncologic outcomes between 48 patients with stage pT3a renal cancer who underwent PN and 86 patients who underwent RN. Although PN was not performed on clinical T3a tumors, our findings suggest that PN can also be considered for these tumors and, thus, avoid the long-term complications of RN. However, strict follow-up protocols are mandatory.
Collapse
Affiliation(s)
- Asaf Shvero
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Tel Aviv University, Tel Aviv, Israel.
| | - Ofer Nativ
- Department of Urology, Bnai Zion Medical Center, and Technion-Israel Institute of Technology, Haifa, Israel
| | - Yasmin Abu-Ghanem
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Dorit Zilberman
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Bahouth Zaher
- Department of Urology, Bnai Zion Medical Center, and Technion-Israel Institute of Technology, Haifa, Israel
| | - Max Levitt
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Eddie Fridman
- Department of Pathology, Sheba Medical Center, Tel Hashomer, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Orith Portnoy
- Department of Radiology, Sheba Medical Center, Tel Hashomer, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Jacob Ramon
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Zohar A Dotan
- Department of Urology, Sheba Medical Center, Tel Hashomer, affiliated with Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
49
|
Abu-Ghanem Y, Ramon J, Berger R, Kaver I, Fridman E, Leibowitz-Amit R, Dotan ZA. Positive surgical margin following radical nephrectomy is an independent predictor of local recurrence and disease-specific survival. World J Surg Oncol 2017; 15:193. [PMID: 29096642 PMCID: PMC5668980 DOI: 10.1186/s12957-017-1257-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 10/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Positive surgical margins (PSM) are recognized as an adverse prognostic sign and are often associated with higher rates of local and systemic disease recurrence. The data regarding the oncological outcome for PSM following radical nephrectomy (RN) is limited. We examined the predictive factors for PSM and its influence on survival and site of recurrence in patients treated with RN for renal cell carcinoma (RCC). Methods Clinical, pathologic and follow-up data on 714 patients undergoing RN for kidney cancer were analyzed. Secondary analysis included 44 patients with metastatic RCC upon diagnosis who underwent cytoreductive nephrectomy (CRN). Univariate and multivariable logistic regression models were fit to determine clinicopathologic features associated with PSM. A Cox proportional-hazards regression model was used to test the independent effects of clinical and pathologic variables on survival. Results PSM was documented in 17 cases (2.4%). PSM were associated with tumour size, advanced pathologic stage (pT3 vs. ≤ pT2) and presence of necrosis. On multivariate analysis, cancer-specific survival (CSS) was associated with tumour stage, size, presence of necrosis and PSM. PSM was also associated with local recurrence but not distant metastasis or overall survival (OS). CSS and OS were comparable between the PSM and metastatic RCC groups, but significantly lower than the negative margin group. Conclusions The prevalence of PSM following RN is rare. Pathological data, including advanced stage (> pT2), tumour necrosis and tumour size, are associated with the presence of PSM. PSM is associated with tumour recurrence and CSS. Patients with PSM are a potential group for adjuvant therapy or for more careful and thorough follow-up following surgery.
Collapse
Affiliation(s)
| | - Jacob Ramon
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel
| | - Raanan Berger
- Department of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Issac Kaver
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel
| | - Edi Fridman
- Department of Pathology, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Zohar A Dotan
- Department of Urology, Sheba Medical Center, Ramat Gan, Israel
| |
Collapse
|
50
|
Zendel A, Abu-Ghanem Y, Dux J, Mor E, Zippel D, Goitein D. The Impact of Bariatric Surgery on Thyroid Function and Medication Use in Patients with Hypothyroidism. Obes Surg 2017; 27:2000-2004. [PMID: 28255851 DOI: 10.1007/s11695-017-2616-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bariatric surgery (BS) is effective in treating obesity and its associated comorbidities. However, there is a paucity of data on the effect of BS on thyroid function in hypothyroid patients, specifically in those treated with thyroid hormone replacement therapy (THR). The aim of this study was to assess the effect of BS on thyroid function and on THR dosage in patients with hypothyroidism. METHODS A retrospective analysis of prospectively collected data of all hypothyroid patients who underwent BS between 2010 and 2014 was performed. Data collected included demographic and anthropometric measurements, as well as changes in thyroid hormone levels and THR dosage up to a year from surgery. RESULTS During the study period, 93 hypothyroid patients (85 females, 91%), 83 of which treated with replacement thyroid hormone, underwent BS. Laparoscopic sleeve gastrectomy was performed in 77 (82.8%) and Roux-en-Y gastric bypass in 16 patients. Average age and body mass index (BMI) were 46.6 ± 11.2 years and 43.7 ± 6.4 kg/m2, respectively. Mean BMI and thyroid-stimulating hormone (TSH) significantly deceased after 6 and 12 months following surgery whereas mean free T4 levels remained stable. TSH decrease was directly correlated to baseline TSH but not to BMI reduction. One year after surgery, 11 patients (13.2%) did not require THR, while the rest required a significantly lower average dose (P < 0.02). CONCLUSIONS There is a favorable effect of BS on the hypothyroid bariatric population. This includes improvement of thyroid function and reduction of thyroid medication dosages. Further studies are required to evaluate an influence of THR absorption and compare different types of bariatric surgeries.
Collapse
Affiliation(s)
- Alex Zendel
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer (affiliated with the Sackler School of Medicine, Tel Aviv University), Tel Aviv, Israel
| | - Yasmin Abu-Ghanem
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer (affiliated with the Sackler School of Medicine, Tel Aviv University), Tel Aviv, Israel
| | - Joseph Dux
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer (affiliated with the Sackler School of Medicine, Tel Aviv University), Tel Aviv, Israel
| | - Eyal Mor
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer (affiliated with the Sackler School of Medicine, Tel Aviv University), Tel Aviv, Israel
| | - Douglas Zippel
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer (affiliated with the Sackler School of Medicine, Tel Aviv University), Tel Aviv, Israel
| | - David Goitein
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer (affiliated with the Sackler School of Medicine, Tel Aviv University), Tel Aviv, Israel.
| |
Collapse
|