Impact of the CKD-EPI Equation for Estimating Renal Function on Eligibility for Cisplatin-based Chemotherapy in Patients With Urothelial Cancer

2012 ◽  
Vol 10 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Che-Kai Tsao ◽  
Erin Moshier ◽  
Sonia M. Seng ◽  
James Godbold ◽  
Steven Grossman ◽  
...  
Keyword(s):  
Renal Function ◽  
Urothelial Cancer

scholarly journals Randomized Phase II/III Trial Assessing Gemcitabine/ Carboplatin and Methotrexate/Carboplatin/Vinblastine in Patients With Advanced Urothelial Cancer “Unfit” for Cisplatin-Based Chemotherapy: Phase II—Results of EORTC Study 30986

2009 ◽  
Vol 27 (33) ◽  
pp. 5634-5639 ◽  
Author(s):  
Maria De Santis ◽  
Joaquim Bellmunt ◽  
Graham Mead ◽  
J. Martijn Kerst ◽  
Michael Leahy ◽  
...  
Keyword(s):  
Renal Function ◽  
Phase Ii ◽  
Urothelial Cancer ◽  
Performance Status ◽  
Risk Groups ◽  
Treatment Modalities ◽  
Time Curve ◽  
Randomized Phase Ii ◽  
Advanced Urothelial Cancer ◽  
Group 2

PurposeThere is no standard treatment for patients with advanced urothelial cancer who are ineligible (“unfit”) for cisplatin-based chemotherapy (CHT). To compare the activity and safety of two CHT combinations in this patient group, a randomized phase II/III trial was conducted by the EORTC (European Organisation for Research and Treatment of Cancer). We report here the phase II results of the study.Patients and MethodsCHT-naïve patients with measurable disease and impaired renal function (30 mL/min < glomerular filtration rate [GFR] < 60 mL/min) and/or performance status (PS) 2 were randomly assigned to receive either GC (gemcitabine 1,000 mg/m2on days 1 and 8 and carboplatin area under the serum concentration-time curve [AUC] 4.5) for 21 days or M-CAVI (methotrexate 30 mg/m2on days 1, 15, and 22; carboplatin AUC 4.5 on day 1; and vinblastine 3 mg/m2on days 1, 15, and 22) for 28 days. End points of response and severe acute toxicity (SAT) were evaluated with respect to treatment group, renal function, PS, and Bajorin risk groups.ResultsThree of 178 patients who were ineligible or did not start treatment were excluded. SAT was reported in 13.6% of patients on GC and in 23% on M-CAVI. Overall response rates were 42% (37 of 88) for GC and 30% (26 of 87) for M-CAVI. Patients with PS 2 and GFR less than 60 mL/min and patients in Bajorin risk group 2 showed a response rate of only 26% and 20% and an SAT rate of 26% and 25%, respectively.ConclusionBoth combinations are active in this group of unfit patients. However, patients with PS 2 and GFR less than 60 mL/min do not benefit from combination CHT. Alternative treatment modalities should be sought in this subgroup of poor-risk patients.

scholarly journals Challenges and management of laparoscopic treatment of pyonephrosis caused by calculi

2020 ◽  
Author(s):  
Jun Liu ◽  
Liang Chen ◽  
Lizhe An ◽  
Kai Ma ◽  
Xiongjun Ye ◽  
...  
Keyword(s):  
Renal Function ◽  
Clinical Data ◽  
Urothelial Cancer ◽  
Operation Time ◽  
Complete Loss ◽  
Dynamic Imaging ◽  
Laparoscopic Treatment ◽  
Transperitoneal Approach ◽  
Peking University ◽  
Endoscopic Lithotripsy

Abstract Background: Calculous pyonephrosis is a disease characterized by infectious hydronephrosis associated with pyogenic destruction of the renal parenchyma, with complete or almost complete loss of renal function.Methods: The clinical data of laparoscopic nephrolithotomy performed at Peking University People’s Hospital from May 2017 to June 2020 were analyzed retrospectively. Eight patients (2 men; 6 women) aged 27 to 65 years (average age, 45.8 years) were included. Among them, 7 patients were treated with retroperitoneal approach and 1 patient by transperitoneal approach. All patients had received more than one endoscopic lithotripsy before nephrectomy. Renal dynamic imaging and computed tomography revealed the absence of function in pyonephrosis before nephrectomy. General clinical data and perioperative data were recorded. All nephrectomies were performed by the same physician.Results: Laparoscopic surgery was successfully performed in 7 patients; however, 1 patient underwent open surgery because of bleeding. The operation time, average operation time, and blood loss were 1.5–4.5 hours, 3.4 hours, and 100–1000 ml (average, 300 ml), respectively. The postoperative pathology showed inflammatory renal disease in 6 patients, xanthogranulomatous pyelonephritis in 1 patient, and high-grade urothelial cancer in 1 patient. The average postoperative hospital stay was 4.4 days. None of the patients experienced severe complications and poor healing of endoscopic wounds.Conclusion: For patients with complicated calculous pyonephrosis, renal inflammation could not be effectively controlled, and renal function was seriously damaged. Thus, kidneys should be immediately resected. With laparoscopy, patients may recover quickly, but surgeons require enough experience when performing laparoscopy to achieve safety.

scholarly journals Treatment of Distal Upper Tract Urothelial Cancer with Distal Ureterectomy Preserves Renal Function without Increasing Local Recurrence Rate Compared with Radical Nephroureterectomy

2021 ◽  
Vol 5 (1) ◽  
pp. 86-90
Author(s):  
Mahesh Bahadur Adhikari ◽  
Woon Chau Tsang ◽  
Ho Yee Tiong
Keyword(s):  
Renal Function ◽  
Hospital Stay ◽  
Urothelial Carcinoma ◽  
Urothelial Cancer ◽  
Upper Tract Urothelial Carcinoma ◽  
Radical Nephroureterectomy ◽  
Upper Tract ◽  
Duration Of Surgery ◽  
Upper Tract Urothelial Cancer ◽  
Distal Ureterectomy

Introduction: Kidney sparing surgery like endoscopic resection and distal ureterectomy has been recently proposed as alternative surgical options to manage distal Upper Tract Urothelial Cancer. This study aims to compare the surgical, oncological and functional outcomes of distal ureterectomy and Radical Nephroureterectomy for distal Upper Tract Urothelial Carcinoma.  Methods and Material: Out of 57 patients with Upper Tract Urothelial Carcinoma treated surgically at a single institution between 2010 and 2016, nineteen patients had distal Upper Tract Urothelial Carcinoma. A retrospective review was performed on these 19 patients (11 Radical Nephroureterectomy and 8 distal ureterectomy). Radical Nephroureterectomy was performed using an open or laparoscopic approach (n= 4 and 7 respectively). All Distal Ureterectomy patients were performed via an open extra-peritoneal Gibson incision. Pelvic lymphadenectomy and Subsequent ureteroneocystostomy in the Distal Ureterectomy group was performed directly and was augmented by psoas hitch or using boari flap reconstruction. Demographic, clinical features and post-operative outcomes were compared between the Radical Nephroureterectomy and Distal Ureterectomy groups.  Results: There was a trend towards shorter mean duration of surgery (238±34 vs. 286 ±90 min) and length of hospital stay (LOS) (7.6±2.8 vs. 17.3±20.7 days) in the Distal Ureterectomy group compared to the Radical Nephroureterectomy group (P=NS). Peri-operative Complication of Clavien grade 1-2 was seen in 4(33.33%) Radical Nephroureterectomy and 3 (37.5%) Distal Ureterectomy cases respectively. All patients had high grade Upper Tract Urothelial Carcinoma with equivalent pTNM staging in both groups with clear surgical margins. Immediate post-operative renal function improvement was statistically significant in the Distal Ureterectomy group (Radical Nephroureterectomy 2.27±5.93 vs 10.86±9.92 Distal Ureterectomy, p=0.034). Three out of 11 Radical Nephroureterectomy group patients required dialysis.  Conclusions: Local recurrences were similar after Distal Ureterectomy and Radical Nephroureterectomy with equivalent pathological outcomes in distal Upper Tract Urothelial Carcinoma. There was a clear trend towards shorter hospital stay and better renal function preservation in favor of Distal Ureterectomy with fewer patients requiring dialysis. 

scholarly journals Challenges and management of laparoscopic treatment of pyonephrosis caused by calculi

2020 ◽  
Author(s):  
Jun Liu ◽  
Liang Chen ◽  
Lizhe An ◽  
Kai Ma ◽  
Xiongjun Ye ◽  
...  
Keyword(s):  
Renal Function ◽  
Clinical Data ◽  
Urothelial Cancer ◽  
Operation Time ◽  
Complete Loss ◽  
Dynamic Imaging ◽  
Laparoscopic Treatment ◽  
Transperitoneal Approach ◽  
Peking University ◽  
Endoscopic Lithotripsy

Abstract Background: Calculous pyonephrosis is a disease characterized by infectious hydronephrosis associated with pyogenic destruction of the renal parenchyma, with complete or almost complete loss of renal function.Methods: The clinical data of laparoscopic nephrolithotomy performed at Peking University People’s Hospital from May 2017 to June 2020 were analyzed retrospectively. Eight patients (2 men; 6 women) aged 27 to 65 years (average age, 45.8 years) were included. Among them, 7 patients were treated with retroperitoneal approach and 1 patient by transperitoneal approach. All patients had received more than one endoscopic lithotripsy before nephrectomy. Renal dynamic imaging and computed tomography revealed the absence of function in pyonephrosis before nephrectomy. General clinical data and perioperative data were recorded. All nephrectomies were performed by the same physician.Results: Laparoscopic surgery was successfully performed in 7 patients; however, 1 patient underwent open surgery because of bleeding. The operation time, average operation time, and blood loss were 1.5–4.5 hours, 3.4 hours, and 100–1000 ml (average, 300 ml), respectively. The postoperative pathology showed inflammatory renal disease in 6 patients, xanthogranulomatous pyelonephritis in 1 patient, and high-grade urothelial cancer in 1 patient. The average postoperative hospital stay was 5.3 days. One patient had a Clavien–Dindo Grade IIIb complication (severe hematuria), which required laparotomy, and was found that there was bleeding of ureteral stump. None of the patients experienced poor healing of endoscopic wounds.Conclusion: For patients with complicated calculous pyonephrosis, renal inflammation could not be effectively controlled, and renal function was seriously damaged. Thus, kidneys should be immediately resected. With laparoscopy, patients may recover quickly, but surgeons require enough experience when performing laparoscopy to achieve safety.

Sign in / Sign up

Export Citation Format

Share Document