Editorial Comment on: Contemporary Perioperative Morbidity and Mortality Rates of Minimally Invasive vs Open Partial Nephrectomy in Obese Patients with Kidney Cancer by Khalil et al. (From: Khalil MI, Ubeda J, Soehner T, et al. J Endourol 2019;920–927; DOI: 10.1089/end.2019.0310)

BACKGROUND Obesity has a significant association with renal cell carcinoma (RCC). Surgery is the preferred treatment of demarcated RCC. Obesity increases the complexity of surgical outcomes. There is a paucity of data regarding surgical technique outcomes in obese patients. OBJECTIVE We investigated short- and long-term renal outcomes in obese patients post-RCC surgery through open, laparoscopic, or robotic partial nephrectomy. METHODS This is a retrospective chart review of obese patients after open, laparoscopic, or robotic partial-nephrectomies over 12 years at a single center. The obese (BMI ≥ 30) and the non-obese (BMI< 30) patients were studied in 2-time frames: short (3-6 months post-surgery), or long (> 6 months) and followed up to 4 years. RESULTS Of the 140 patients, 75 were obese and 65 were non-obese. In the obese, 3-6 months after minimally-invasive surgery, the odds of having a decrease or no change in creatinine values were 0.62 times lower compared to open surgery. Over 6 months after minimally-invasive surgery, the odds were 1.24 times higher. Neither of these results were statistically significant. In the non-obese group, at 3-6 months after minimally-invasive surgery, the same odds were 4.86 times higher. This was statistically significant (P<0.05). Over 6 months after minimally invasive surgery, the odds were 4.13 times higher. This was not statistically significant. CONCLUSIONS We observed non-statistically significant preservation of renal function in obese patients undergoing OPN at 3-6 months postoperatively. Conversely, after 6 months, the same was true for MIPN, indicating a long-term benefit of MIPN. In the non-obese, MIPN was favored over OPN. CLINICALTRIAL na

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Editorial Comment on: Perioperative Morbidity of Open Versus Minimally Invasive Partial Nephrectomy: A Contemporary Analysis of the National Surgical Quality Improvement Program by Pereira et al.

Journal of Endourology ◽

10.1089/end.2017.0885 ◽

2018 ◽

Vol 32 (2) ◽

pp. 124-124

Author(s):

Uzoma Arnold Anele ◽

Riccardo Autorino

Keyword(s):

Quality Improvement ◽

Editorial Comment ◽

Minimally Invasive ◽

Partial Nephrectomy ◽

Quality Improvement Program ◽

Improvement Program ◽

Surgical Quality ◽

Perioperative Morbidity ◽

Open Versus

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Partial Nephrectomy A Comparison between Different Modalities

Journal of Kidney Cancer and VHL ◽

10.15586/jkcvhl.v8i2.179 ◽

2021 ◽

Vol 8 (2) ◽

pp. 34-39

Author(s):

Ahmed Al Asker ◽

Abdulmalik Addar ◽

Mohammed Alghamdi ◽

Saud Alawad ◽

Mohammed Alharbi ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Hospital Stay ◽

Partial Nephrectomy ◽

Kidney Cancer ◽

Tumor Size ◽

Robotic Partial Nephrectomy ◽

Chi Square ◽

Open Partial Nephrectomy ◽

Institutional Review

Kidney cancer, with 4% of all malignancies, is one of the most common malignancies occurring among in adults. In Saudi Arabia, kidney cancer comprises 2.3% of all cancers, and its incidence has increased by 33%. Partial nephrectomy (PN) is considered as the gold standard for T1 renal masses.In this retrospective study, we did a chart review for all patients who underwent PNs between April 2013 and February 2019. Data comprised pre-sentation, tumor size, type of procedure (open vs. laparoscopic vs. robotic), and intra- and post-operative complications. Chi-square, ANOVA, and cross-tabulation were done using SPSS software. P > 0.05 was considered significant. Approval was obtained from the institutional review board of King Abdullah International Medical Research Center.In all, 69 patients were identified: 26 (37.7%) males and 43 (62.3%) females, with mean age = 54.53 ± 13.21 years; mean body mass index = 32.36 ± 7.03, and mean tumor size = 3.7 ± 1.72 cm. In terms of presentation, most patients (50, 72.4%) presented incidentally as opposed to symptomatic presentation. Of these patients, 18 (26.1%) underwent open partial nephrectomy (OPN), 29 (42%) laparoscopic partial nephrec-tomy (LPN), and 22 (31.9%) robotic partial nephrectomy (RPN). On comparing minimally invasive surgery (MIS) PN with OPN, we found that OPN had more blood loss and a longer hospital stay but a shorter operating room (OR) time.Results of PN irrespective of the procedure type, whether it was OPN, LPN, or RPN, were similar if performed by experienced surgeons. However, open procedures involved a higher blood loss, more operative time, and longer hospital stay when compared with minimally invasive techniques.

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