scholarly journals Predicting Strict Trifecta Outcomes after Robot-Assisted Partial Nephrectomy

2021 ◽  
Vol 8 (4) ◽  
pp. 1-12
Author(s):  
Kaan Karamık ◽  
Yasin Aktaş ◽  
Ahmet Gürkan Erdemir ◽  
Ekrem İslamoğlu ◽  
Mahmut Taha Ölçücü ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Tumor Size ◽  
Surgical Margin ◽  
Risk Groups ◽  
Surgical Complexity ◽  
Comprehensive Comparison ◽  
Training And Research ◽  
The Mean ◽  
Robotic Assisted Partial Nephrectomy ◽  
Anterior Posterior

Nephrometry scores are designed to characterize tumors and stratify the surgical complexity. It remains unclear as to which nephrometry score can accurately predict the surgical outcomes. We aimed to assess the utility of radius, exophytic/endophytic, nearness, anterior/posterior, location (RENAL), preoperative aspects and dimensions used for anatomic classifications (PADUA), and centrality index (C-index) nephrometry scores for predicting the strict Trifecta achievement from a single institution series robotic-assisted partial nephrectomy (RAPN). We retrospectively identified the prospectively maintained robotic surgery database records of 91 patients who underwent RAPN between June 2015 and September 2020 in Antalya Training and Research Hospital. The main outcome of the study was the achievement of strict Trifecta (negative surgical margin, no major urologic complications, warm ischemia time ≤25 min, and ≥85% preservation of estimated glomerular filtration rate). A mul-tivariable analysis was performed to identify the factors of strict Trifecta success. The mean patient age was 55.82 ± 13.37 years with a median clinical tumor size of 3.5 cm (IQR 2.5–4.9). The median RENAL, PADUA, and C-index score were 7(IQR 6–8), 8(IQR 7–10), and 2.01(IQR 1.64–2.72), respectively. A strict Trifecta could be achieved in 54 patients (59.3%). Clinical tumor size (P = 0.011), RENAL risk groups (low:ref-erence; intermediate; P = 0.040; high; P = 0.009), PADUA risk groups (low:reference; intermediate; P = 0.044; high; P = 0.001) and C-index risk groups (low:reference; high; P = 0.015) were the independent predictors of strict Trifecta attainment in the multivariate analysis. None of the nephrometry scores were a superior predictor compared to other nephrometry scores in comparative analysis. RENAL, PADUA, and C-index scores were all independent predictors of a strict Trifecta achievement. Our comprehensive comparison of the three scores identified that none of the nephrometry scores proved to be inferior to others nephrometry scores.

scholarly journals Bleeding during laparoscopic partial nephrectomy: Can a hemostatic matrix help to improve hemostasis?

2016 ◽  
Vol 88 (3) ◽  
pp. 228 ◽  
Author(s):  
Faruk Ozgor ◽  
Abdulmuttalip Simsek ◽  
Ozgu Aydogdu ◽  
Onur Kucuktopcu ◽  
Omer Sarilar ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Tumor Size ◽  
Operation Time ◽  
Demographic Characteristics ◽  
Ischemia Time ◽  
Nephrometry Score ◽  
The Mean ◽  
Group 1

Objectives: To evaluate the possible role of an hemostatic matrix on hemostasis, perioperative outcomes and complications in patients who underwent laparoscopic partial nephrectomy (LPN). Materials and methods: Patients charts were analyzed retrospectively and their demographic characteristics, operative parameters and follow-up results were recorded. Patients were divided into two groups, according to those who used an hemostatic matrix as Group 1 (n = 41) and those who did not used as Group 2 (n = 44). Demographic characteristics of patients, tumor features, operation time, clamping of the renal vessels, ischemia time, suturing of the collecting system, perioperative hemorrhage and complications were evaluated. Histopathological results, surgical margin status, creatinine level and recurrence at the 3rd month of follow up were analyzed. Statistical analyses were performed with SPSS 17.0 and significance was set at p value of < 0.05. Results: The mean RENAL nephrometry score was 5.9 ± 2.0 and the mean tumor size was 35 ± 12 mm. All patients had a single tumor and 44 of them had a tumor in the right kidney. The renal artery was clamped in 79 cases and the mean ischemia time was 20.1 ± 7 minutes. The mean tumor size and the mean RENAL nephrometry score was statistically higher in Group 1 (p: 0.016 and p < 0.001, respectively). Pelvicaliceal repair was more common in Group 1 due to deeper extension of tumors in this group (p: 0.038). In Group 1, less hemorrhage and blood transfusion requirement, with shorter ischemia and operation time was detected. Conclusion: The outcomes of the recent study showed that adjunctive use of an hemostatic matrix improves hemostasis and decreases hemorrhagic complications during LPN. Further prospective studies are required to assess the potential role of an hemostatic matrix in LPN.

Robotic and open partial nephrectomy for tumors in a solitary kidney

2020 ◽  
Vol 13 (5) ◽  
pp. 349-355
Author(s):  
Zain A Abedali ◽  
M Francesca Monn ◽  
Brent E Cleveland ◽  
Jay Sulek ◽  
Clinton D Bahler ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Partial Nephrectomy ◽  
Statistical Significance ◽  
Solitary Kidney ◽  
Level Of Evidence ◽  
Safe Alternative ◽  
Open Partial Nephrectomy ◽  
Robotic Assisted ◽  
The Mean ◽  
Robotic Assisted Partial Nephrectomy

Introduction and objective: Traditionally, patients with renal masses in solitary kidneys were managed with an open partial nephrectomy. With improving techniques, robotic-assisted partial nephrectomy in the setting of a solitary kidney is increasingly utilized. The objective of this study was to compare open partial nephrectomy and robotic-assisted partial nephrectomy outcomes in solitary kidney patients. Methods: A retrospective study of 536 total patients who underwent partial nephrectomy between 2004–2016 was performed. Of these patients, 23 had a renal mass in a solitary kidney. Patient demographics, perioperative values, and surgical outcomes were analyzed using descriptive statistics to compare open partial nephrectomy to robotic-assisted partial nephrectomy. Results: Of the 23 patients in the cohort, 52% ( n=12) underwent open partial nephrectomy and 48% ( n=11) underwent robotic-assisted partial nephrectomy. Patient characteristics were not significantly different. The mean (standard deviation) nephrometry score was 6.9 (1.8) for open partial nephrectomy and 6.1 (1.9) for robotic-assisted partial nephrectomy ( p=0.290). The mean (standard deviation) pre-operative creatinine was 1.2 (0.3) in open partial nephrectomy and 1.5 (0.4) in robotic-assisted partial nephrectomy, which did not reach statistical significance ( p=0.110). No difference in postoperative kidney function, Clavien grade 3 or higher complication rate, blood loss, or hospitalization length was noted. Conclusion: Although traditionally patients with a tumor in a solitary kidney are counseled to undergo open partial nephrectomy, robotic-assisted partial nephrectomy is a safe alternative with no decrease in postoperative renal function when compared with a similar cohort of patients undergoing open partial nephrectomy in a solitary kidney. Level of evidence: Level II

scholarly journals 1532 Strict Trifecta Outcomes of Robotic-Assisted Partial Nephrectomy inT1a and T1b Renal Tumours

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Abdalla ◽  
I Alzouebi ◽  
M Kumar ◽  
T Nambi Rajan
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Robotic Assisted ◽  
Function Change ◽  
Renal Tumours ◽  
Tumour Characteristics ◽  
Robotic Assisted Partial Nephrectomy

Abstract Aim To evaluate and compare strict Trifecta outcomes of robotic assisted partial nephrectomy (RAPN) in patients with T1a and T1b renal tumours. Method A retrospective analysis of 146 consecutive patients undergoing a robotic assisted partial nephrectomy for T1a and T1b renal tumours from 2014-2019. Patient demographics, tumour characteristics, strict trifecta measures including warm ischaemia time, minimal renal function change (≤15% postoperative eGFR decrease), complications, and surgical margin positivity were collected, as well as intra-operative and oncological outcomes. Results In total 146 patients underwent RAPN. 113 patients had T1a tumours, 30 had T1b with a mean tumour size of 2.5cm (0.8-3.9cm) and 4.5cm (4.1-7cm) respectively, and 3 patients had T2a tumours. The nephrometry score was higher in stage T1b patients, however all other variables were similar between the two stage groups. Overall strict Trifecta was 75.5% with 77.9% in T1a group compared to 66.7% in T1b group (p = 0.21). Postoperative renal function was preserved in 102 patients in T1a vs 26 patients in T1b. Approximately 9 patients with T1a had positive surgical margin compared to 3 patients in T1b cohort. Post-operatively 3 patients in T1b (10%) group developed a Clavien Dindo score of 3 complications, compared to none in the T1a group (p 0.009). These were due to pseudoaneurysm and bleeding. No statistical difference in Fuhrman score and tumour types in the two groups. No cancer recurrences were observed during the 30 months follow up period in both T1a and T1b groups. Conclusions RAPN is a feasible treatment choice in selected T1b renal tumours.

scholarly journals Postoperative outcomes of elderly patients undergoing partial nephrectomy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alexandre Ingels ◽  
Sophie Duc ◽  
Karim Bensalah ◽  
Pierre Bigot ◽  
Philippe Paparel ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Elderly Patients ◽  
Partial Nephrectomy ◽  
Tumor Size ◽  
Protective Factor ◽  
Robotic Assisted ◽  
Estimated Blood Loss ◽  
The Mean ◽  
American Society

AbstractTo describe clinical outcomes of patients aged 75 years and above after partial nephrectomy (PN), and to assess independent factors of postoperative complications. We retrospectively reviewed information from our multi-institutional database. Every patient over 75 years old who underwent a PN between 2003 and 2016 was included. Peri-operative and follow up data were collected. Multivariate logistic regression was performed to determine independent predictive factors of postoperative complications. We reviewed 191 procedures including 69 (40%) open-surgery, and 122 (60%) laparoscopic procedures, of which 105 were robot-assisted. Median follow-up was 25 months. The mean age was 78 [75–88]. The American Society of Anesthesiologist’s score was 1, 2, 3 and 4 in 10.5%, 60%, 29% and 0.5% of patients respectively. The mean tumor size was 4.6 cm. Indication of PN was elective in 122 (65%) patients and imperative in 52 patients (28%). The median length of surgery was 150(± 60) minutes, and the median estimated blood loss 200 ml. The mean glomerular filtration rate was 71.5 ml/minute preoperatively, and 62 ml/min three months after surgery. The severe complications (Clavien III-V) rate was 6.2%. On multivariate analysis, the robotic-assisted procedure was an independent protective factor of medical postoperative complications (Odds Ration (OR) = 0.31 [0.12–0.80], p = 0.01). It was adjusted for age and RENAL score, robotic-assisted surgery (OR = 0.22 [0.06–0.79], p = 0.02), and tumor size (OR = 1.13 [1.02–1.26], p = 0.01), but the patients age did not forecast surgical complications. Partial nephrectomy can be performed safely in elderly patients with an acceptable morbidity, and should be considered as a viable treatment option. Robotic assistance is an independent protective factor of postoperative complications.

scholarly journals Kidney ventrally rotation technique in retroperitoneal robot-assisted partial nephrectomy for posterior hilar tumor: technical feasibility and preliminary results

2020 ◽  
Author(s):  
Xiaotao Yin ◽  
Sinan Jiang ◽  
Zhiqiang Shao ◽  
Yongliang Lu ◽  
Jiangxiang Guo ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Case Series ◽  
Surgical Margin ◽  
Operation Time ◽  
Positive Surgical Margin ◽  
Estimated Blood Loss ◽  
Rotation Technique ◽  
The Mean ◽  
Special Location ◽  
Hilar Tumor

Abstract Purpose: The retroperitoneal robotic assisted partial nephrectomy (RAPN) is suitable for tumors locating on the posterior side of the kidney. However, the posterior hilar tumor poses additional surgical challenge due to the special location and poor tumor exposure. A novel kidney ventrally rotation technique to overcome this difficulty during retroperitoneal RAPN was developed, and its efficacy was assessed in a consecutive case series.Methods: From April 2017 to April 2019, a total of 24 patients with posterior renal hilar tumor underwent retroperitoneal RAPN. The kidney ventrally rotation technique was applied in all these cases, which specialized in improving the exposure of posterior hilar tumor by rotating the kidney ventrally. Perioperative data was analyzed to evaluate the efficacy of this technique.Results: The mean tumor size was 4.3 ± 1.7 cm (range 2.5-8 cm), and the median R.E.N.A.L score was 9 (range 7-12). All the 24 patients underwent RAPN successfully without converting to open surgery or radical nephrectomy. The mean operation time was 80 ± 24 min, the mean estimated blood loss was 104 ± 65 ml, and the warm ischemia time was 17.4 ± 6.6 min. No sever complications occurred, and no positive surgical margin was found in all the malignant cases. After 14 months follow-up, no recurrence or metastasis occurred in all cases.Conclusion: Kidney ventrally rotation technique is safe and feasible for improving the exposure of posterior renal hilar tumor during retroperitoneal RAPN. It could be regarded as an efficient method for the management of posterior hilar tumor.KEYWORDS: robotic surgery; partial nephrectomy; posterior hilar tumor; retroperitoneal approach; kidney rotation

scholarly journals The Relationship between Inflammation Markers (CRP, IL-6, sCD40L) and Colorectal Cancer Stage, Grade, Size and Location

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1382
Author(s):  
Olga Martyna Koper-Lenkiewicz ◽  
Violetta Dymicka-Piekarska ◽  
Anna Justyna Milewska ◽  
Justyna Zińczuk ◽  
Joanna Kamińska
Keyword(s):  
Colorectal Cancer ◽  
Linear Regression ◽  
Tumor Size ◽  
Distal Colon ◽  
Proximal Colon ◽  
Model Parameters ◽  
Grade Group ◽  
Who Grade ◽  
The Mean ◽  
Mean Concentration

The aim of the study was the evaluation whether in primary colorectal cancer (CRC) patients (n = 55): age, sex, TNM classification results, WHO grade, tumor location (proximal colon, distal colon, rectum), tumor size, platelet count (PLT), mean platelet volume (MPV), mean platelet component (MCP), levels of carcinoembryonic antigen (CEA), cancer antigen (CA 19-9), as well as soluble lectin adhesion molecules (L-, E-, and P-selectins) may influence circulating inflammatory biomarkers: IL-6, CRP, and sCD40L. We found that CRP concentration evaluation in routine clinical practice may have an advantage as a prognostic biomarker in CRC patients, as this protein the most comprehensively reflects clinicopathological features of the tumor. Univariate linear regression analysis revealed that in CRC patients: (1) with an increase in PLT by 10 × 103/μL, the mean concentration of CRP increases by 3.4%; (2) with an increase in CA 19-9 of 1 U/mL, the mean concentration of CRP increases by 0.7%; (3) with the WHO 2 grade, the mean CRP concentration increases 3.631 times relative to the WHO 1 grade group; (4) with the WHO 3 grade, the mean CRP concentration increases by 4.916 times relative to the WHO 1 grade group; (5) with metastases (T1-4N+M+) the mean CRP concentration increases 4.183 times compared to non-metastatic patients (T1-4N0M0); (6) with a tumor located in the proximal colon, the mean concentration of CRP increases 2.175 times compared to a tumor located in the distal colon; (7) in patients with tumor size > 3 cm, the CRP concentration is about 2 times higher than in patients with tumor size ≤ 3 cm. In the multivariate linear regression model, the variables that influence the mean CRP value in CRC patients included: WHO grade and tumor localization. R2 for the created model equals 0.50, which indicates that this model explains 50% of the variance in the dependent variable. In CRC subjects: (1) with the WHO 2 grade, the mean CRP concentration rises 3.924 times relative to the WHO 1 grade; (2) with the WHO 3 grade, the mean CRP concentration increases 4.721 times in relation to the WHO 1 grade; (3) with a tumor located in the rectum, the mean CRP concentration rises 2.139 times compared to a tumor located in the distal colon; (4) with a tumor located in the proximal colon, the mean concentration of CRP increases 1.998 times compared to the tumor located in the distal colon; if other model parameters are fixed.

Clinical experience of using virtual 3D modelling for pre and intraoperative guidance during robotic-assisted partial nephrectomy

2021 ◽  
pp. 205141582110002
Author(s):  
Lorenz Berger ◽  
Aziz Gulamhusein ◽  
Eoin Hyde ◽  
Matt Gibb ◽  
Teele Kuusk ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Partial Nephrectomy ◽  
Surgical Outcome ◽  
Prospective Cohort ◽  
Three Dimensional ◽  
Two Dimensional ◽  
Dimensional Model ◽  
Three Dimensional Model ◽  
Robotic Assisted ◽  
Robotic Assisted Partial Nephrectomy

Objective: Surgical planning for robotic-assisted partial nephrectomy is widely performed using two-dimensional computed tomography images. It is unclear to what extent two-dimensional images fully simulate surgical anatomy and case complexity. To overcome these limitations, software has been developed to reconstruct three-dimensional models from computed tomography data. We present the results of a feasibility study, to explore the role and practicality of virtual three-dimensional modelling (by Innersight Labs) in the context of surgical utility for preoperative and intraoperative use, as well as improving patient involvement. Methods: A prospective study was conducted on patients undergoing robotic-assisted partial nephrectomy at our high volume kidney cancer centre. Approval from a research ethics committee was obtained. Patient demographics and tumour characteristics were collected. Surgical outcome measures were recorded. The value of the three-dimensional model to the surgeon and patient was assessed using a survey. The prospective cohort was compared against a retrospective cohort and cases were individually matched using RENAL (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, location relative to polar lines) scores. Results: This study included 22 patients. Three-dimensional modelling was found to be safe for this prospective cohort and resulted in good surgical outcome measures. The mean (standard deviation) console time was 158.6 (35) min and warm ischaemia time was 17.3 (6.3) min. The median (interquartile range) estimated blood loss was 125 (50–237.5) ml. Two procedures were converted to radical nephrectomy due to the risk of positive margins during resection. The median (interquartile range) length of stay was 2 (2–3) days. No postoperative complications were noted and all patients had negative surgical margins. Patients reported improved understanding of their procedure using the three-dimensional model. Conclusion: This study shows the potential benefit of three-dimensional modelling technology with positive uptake from surgeons and patients. Benefits are improved perception of vascular anatomy and resection approach, and procedure understanding by patients. A randomised controlled trial is needed to evaluate the technology further. Level of evidence: 2b

scholarly journals Pituitary apoplexy induced by gonadotropin-releasing hormone (GnRH) agonist administration for treatment of prostate cancer: a systematic review

2021 ◽  
Author(s):  
Rishi Raj ◽  
Ghada Elshimy ◽  
Aasems Jacob ◽  
P. V. Akhila Arya ◽  
Dileep C. Unnikrishnan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Pituitary Adenoma ◽  
Gnrh Agonist ◽  
Tumor Size ◽  
Pituitary Apoplexy ◽  
Clinical Presentation ◽  
Pituitary Surgery ◽  
Laboratory Evaluation ◽  
The Mean

Abstract Objective We aimed to review of literature on the clinical presentation, management and outcomes of pituitary apoplexy following gonadotrophic release hormone (GnRH) agonist administration for the treatment of prostate cancer. Methods We used PRISMA guidelines for our systematic review and included all English language original articles on pituitary apoplexy following GnRH agonist administration among prostate cancer patients from Jan 1, 1995 to Dec 31, 2020. Data on patient demographics, prostate cancer type, Gleason score at diagnosis, history of pituitary adenoma, clinical presentation, GnRH agonist, interval to pituitary apoplexy, laboratory evaluation at admission, radiologic findings, treatment of pituitary apoplexy, time to surgery if performed, pathology findings, and clinical/hormonal outcomes were collected and analyzed. Results Twenty-one patients with pituitary apoplexy met our inclusion criteria. The mean age of patients was 70 (60–83) years. Leuprolide was the most common used GnRH agonist, used in 61.9% of patients. Median duration to symptom onset was 5 h (few minutes to 6 months). Headache was reported by all patients followed by ophthalmoplegia (85.7%) and nausea/vomiting (71.4%). Three patients had blindness at presentation. Only 8 cases reported complete anterior pituitary hormone evaluation on presentation and the most common endocrine abnormality was FSH elevation. Tumor size was described only in 15 cases and the mean tumor size was 26.26 mm (18–48 mm). Suprasellar extension was the most common imaging finding seen in 7 patients. 71.4% of patients underwent pituitary surgery, while 23.8% were managed conservatively. Interval between symptoms onset to pituitary surgery was 7 days (1–90 days). Gonadotroph adenoma was most common histopathologic finding. Clinical resolution was comparable, while endocrine outcomes were variable among patients with conservative vs surgical management. Conclusion Although the use of GnRH agonists is relatively safe, it can rarely lead to pituitary apoplexy especially in patients with pre-existing pituitary adenoma. Physicians should be aware of this complication as it can be life threatening. A multidisciplinary team approach is recommended in treating individuals with pituitary apoplexy.

scholarly journals Prognostic Value of Tumor Size in Resected Stage IIIA-N2 Non-Small-Cell Lung Cancer

2020 ◽  
Vol 9 (5) ◽  
pp. 1307 ◽  
Author(s):  
Chih-Yu Chen ◽  
Bing-Ru Wu ◽  
Chia-Hung Chen ◽  
Wen-Chien Cheng ◽  
Wei-Chun Chen ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Prognostic Factors ◽  
Tumor Size ◽  
Small Cell ◽  
Small Cell Lung ◽  
Stage Iiia ◽  
Pathologic Stage ◽  
The Mean ◽  
Eighth Edition ◽  
Resected Stage

The eighth edition of the American Joint Committee on Cancer (AJCC) staging system for lung cancer was introduced in 2017 and included major revisions, especially of stage III. For the subgroup stage IIIA-N2 non-small-cell lung cancer (NSCLC), surgical resection remains controversial due to heterogeneous disease entity. The aim of this study was to evaluate the clinicopathologic features and prognostic factors of patients with completely resected stage IIIA-N2 NSCLC. We retrospectively evaluated 77 consecutive patients with pathologic stage IIIA-N2 NSCLC (AJCC eighth edition) who underwent surgical resection with curative intent in China Medical University Hospital between 2006 and 2014. Survival analysis was conducted, using the Kaplan–Meier method. Prognostic factors predicting overall survival (OS) and disease-free survival (DFS) were analyzed, using log-rank tests and multivariate Cox proportional hazards models. Of the 77 patients with pathologic stage IIIA-N2 NSCLC examined, 35 (45.5%) were diagnosed before surgery and 42 (54.5%) were diagnosed unexpectedly during surgery. The mean age of patients was 59 years, and the mean length of follow-up was 38.1 months. The overall one-, three-, and five-year OS rates were 91.9%, 61.3%, and 33.5%, respectively. Multivariate analysis showed that tumor size <3 cm (hazards ratio (HR): 0.373, p = 0.003) and video-assisted thoracoscopic surgery (VATS) approach (HR: 0.383, p = 0.014) were significant predictors for improved OS. For patients with surgically treated, pathologic stage IIIA-N2 NSCLC, tumor size <3 cm and the VATS approach seemed to be associated with better prognosis.

DOES THE SIZE OF THE SURGICAL MARGIN IN PARTIAL NEPHRECTOMY FOR RENAL CELL CANCER REALLY MATTER?

2002 ◽  
Vol 167 (1) ◽  
pp. 61-64 ◽  
Author(s):  
SUZETTE E. SUTHERLAND ◽  
MARTIN I. RESNICK ◽  
GREGORY T. MACLENNAN ◽  
HOWARD B. GOLDMAN
Keyword(s):  
Partial Nephrectomy ◽  
Renal Cell Cancer ◽  
Renal Cell ◽  
Cell Cancer ◽  
Surgical Margin
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