scholarly journals Is There a Role for Neoadjuvant Targeted Therapy to Downsize Primary Tumors for Organ Sparing Strategies in Renal Cell Carcinoma?

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
A. Bex ◽  
B. K. Kroon ◽  
R. de Bruijn
Keyword(s):  
Renal Function ◽  
Targeted Therapy ◽  
Treatment Strategies ◽  
Clinical Problem ◽  
Current Evidence ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Primary Tumors ◽  
Risk Of Death ◽  
Nephron Sparing

With an increasing number of small renal masses being diagnosed organ-preserving treatment strategies such as nephron-sparing surgery (NSS) or radiofrequency and cryoablation are gaining importance. There is evidence that preserving renal function reduces the risk of death of any cause, cardiovascular events, and hospitalization. Some patients have unfavourable tumor locations or large tumors unsuitable for NSS or ablation which is a clinical problem especially in those with imperative indications to preserve renal function. These patients may benefit from downsizing primary tumors by targeted therapy. This paper provides an overview of the current evidence, safety, controversies, and ongoing trials.

Tumor Anatomy Scoring and Renal Function for Nephron-Sparing Treatment Selection in Patients With Small Renal Masses: A Microsimulation-Based Decision Analysis

2016 ◽  
Vol 207 (2) ◽  
pp. 344-353 ◽  
Author(s):  
Stella K. Kang ◽  
William C. Huang ◽  
Edward Y. Skolnik ◽  
Debra A. Gervais ◽  
R. Scott Braithwaite ◽  
...  
Keyword(s):  
Renal Function ◽  
Decision Analysis ◽  
Treatment Selection ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Nephron Sparing

scholarly journals Renal Function Loss After Cryoablation of Small Renal Masses in Solitary Kidneys: European Registry for Renal Cryoablation Multi-Institutional Study

2020 ◽  
Vol 34 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Seshadri Sriprasad ◽  
Mohammed Aldiwani ◽  
Shiv Pandian ◽  
Tommy K. Nielsen ◽  
Mohamed Ismail ◽  
...  
Keyword(s):  
Renal Function ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Function Loss ◽  
European Registry

scholarly journals Intraoperative ultrasound in robot-assisted partial nephrectomy: State of the art

2018 ◽  
Vol 90 (3) ◽  
pp. 195-198 ◽  
Author(s):  
Giacomo Di Cosmo ◽  
Enrica Verzotti ◽  
Tommaso Silvestri ◽  
Andrea Lissiani ◽  
Roberto Knez ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
State Of The Art ◽  
Short Review ◽  
Robot Assisted ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Ischemia Time ◽  
Oncological Safety ◽  
Nephron Sparing ◽  
Operative Ultrasound

Introduction: Nephron-sparing surgery (NSS) is of one of the most studied fields in urology due to the balancing between renal function preservation and oncological safety of the procedure. Aim of this short review is to report the state of the art of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during robotassisted partial nephrectomy (RAPN). Material and methods: We performed a literature review by electronic database on Pubmed about the use of intra-operative US in RAPN to evaluate the usefulness and the feasibility of this procedure. Results: Several studies analyzed the use of different US probes during RAPN. Among them some focused on using contrastenhanced ultra sonography (CEUS) for improving the dynamic evaluation of microvascular structure allowing the reduction of ischemia time (IT). We reported that nowaday the use of intraoperative US during RAPN could be helpful to improve the preservation of renal tissue without compromising oncological safety. Moreover, during RAPN there is no need for assistant to hand the US probe increasing surgeon autonomy. Conclusions: The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument during this key step of the partial nephrectomy procedure. Moreover US could be useful to reduce ischemia time (IT). The advantages of nephron-sparing surgery over radical nephrectomy is well established with a pool of data providing strong evidence of oncological and survival equivalency. With the progressive growth of robot-assisted partial nephrectomy (RAPN) techniques, the use of several tools has been progressively developed to help the surgeon in the identification of masses and its vascular net. In this short review we tried to analyze the current use of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during RAPN.

scholarly journals MP14-11 COST IMPLICATIONS OF NEPHRON SPARING OPTIONS FOR THE MANAGEMENT OF SMALL RENAL MASSES

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Jeffrey Leow* ◽  
Ye Wang ◽  
Melissa Huynh ◽  
Alice Yu ◽  
Keng Siang Png ◽  
...  
Keyword(s):  
Small Renal Masses ◽  
Renal Masses ◽  
Nephron Sparing ◽  
Cost Implications

Treating the Two Extremes in Renal Cell Carcinoma: Management of Small Renal Masses and Cytoreductive Nephrectomy in Metastatic Disease

2014 ◽  
pp. e214-e221 ◽  
Author(s):  
Dae Y. Kim ◽  
Christopher G. Wood ◽  
Jose A. Karam
Keyword(s):  
Renal Cell Carcinoma ◽  
Targeted Therapy ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Renal Mass ◽  
Cytoreductive Nephrectomy ◽  
Renal Cell Carcinomas ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Renal Mass Biopsy

OVERVIEW: The incidental renal mass represents a heterogeneous group that contains both benign and malignant pathologies. The majority of renal cell carcinomas are discovered incidentally, without the presence of symptoms directly related to the mass, and are closely associated with the term small renal masses because of the discovery before the onset of symptoms. In general, small renal masses are defined as 4 cm or smaller, and may account for greater than half of renal cell carcinoma diagnosis. The use of renal mass biopsy may offer additional pathological information but the clinician must be reminded of the technical and diagnostic limitations of renal mass biopsy. Patient-dependent factors, such as life expectancy and comorbidities, guide the management of small renal masses, which include active surveillance, partial nephrectomy, radical nephrectomy, and ablative techniques (cryoablation and radiofrequency ablation). Partial nephrectomy has demonstrated durable oncologic control for small renal masses while preserving renal function and, if feasible, is the current treatment of choice. In the other extreme of the renal cell carcinomas spectrum and in the presence of metastatic disease, the removal of the renal primary tumor is termed cytoreductive nephrectomy. Two randomized trials (SWOG 8949 and EORTC 30947) have demonstrated a survival benefit with cytoreductive nephrectomy before the initiation of immunotherapy. These two studies have also been the motivation to perform cytoreductive nephrectomy in the targeted therapy era. Currently, there are two ongoing randomized prospective trials accruing to investigate the timing and relevance of cytoreductive nephrectomy in the contemporary setting of targeted therapy.

Renal function and oncologic outcomes in nephron sparing surgery for renal masses in solitary kidneys

2010 ◽  
Vol 29 (3) ◽  
pp. 343-348 ◽  
Author(s):  
Daniel J. Lee ◽  
Greg Hruby ◽  
Mitchell C. Benson ◽  
James M. McKiernan
Keyword(s):  
Renal Function ◽  
Nephron Sparing Surgery ◽  
Oncologic Outcomes ◽  
Renal Masses ◽  
Nephron Sparing

scholarly journals Laparoscopic Nephrectomy,Ex VivoPartial Nephrectomy, and Autotransplantation for the Treatment of Complex Renal Masses

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Jasmir Gopal Nayak ◽  
Joshua Koulack ◽  
Thomas Brian McGregor
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Ex Vivo ◽  
Laparoscopic Nephrectomy ◽  
Cell Renal Cell Carcinoma ◽  
Renal Masses ◽  
Local Experience ◽  
Nephron Sparing ◽  
Stable Renal Function ◽  
Clinical Dilemma

In the contemporary era of minimally invasive surgery, very few T1/T2 renal lesions are not amenable to nephron-sparing surgery. However, centrally located lesions continue to pose a clinical dilemma. We sought to describe our local experience with three cases of laparoscopic nephrectomy,ex vivopartial nephrectomy, and autotransplantation. Laparoscopic donor nephrectomy was performed followed by immediate renal cooling and perfusion with isotonic solution. Back-table partial nephrectomy, renorrhaphy, and autotransplantation were then performed. Mean warm ischemia (WIT) and cold ischemic times (CIT) were 2 and 39 minutes, respectively. Average blood loss was 267 mL. All patients preserved their renal function postoperatively. Final pathology confirmed pT1, clear cell renal cell carcinoma with negative margins in all. All are disease free at up to 39 months follow-up with stable renal function. In conclusion, the described approach remains a viable option for the treatment of complex renal masses preserving oncological control and renal function.

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