Short term and Long-term renal outcomes in obese patients after minimally invasive vs. open partial nephrectomy for the treatment of renal cancer – A retrospective study (Preprint)

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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Contemporary Perioperative Morbidity and Mortality Rates of Minimally Invasive vs Open Partial Nephrectomy in Obese Patients with Kidney Cancer

Journal of Endourology ◽

10.1089/end.2019.0310 ◽

2019 ◽

Vol 33 (11) ◽

pp. 920-927

Author(s):

Mahmoud I. Khalil ◽

Joel Ubeda ◽

Thomas Soehner ◽

Naleen Raj Bhandari ◽

Nalin Payakachat ◽

...

Keyword(s):

Minimally Invasive ◽

Partial Nephrectomy ◽

Kidney Cancer ◽

Mortality Rates ◽

Morbidity And Mortality ◽

Obese Patients ◽

Open Partial Nephrectomy ◽

Perioperative Morbidity

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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)

Journal of Endourology ◽

10.1089/end.2019.0623 ◽

2019 ◽

Vol 33 (11) ◽

pp. 928-928

Author(s):

Thomas Jarrett

Keyword(s):

Editorial Comment ◽

Minimally Invasive ◽

Partial Nephrectomy ◽

Kidney Cancer ◽

Mortality Rates ◽

Morbidity And Mortality ◽

Obese Patients ◽

Open Partial Nephrectomy ◽

Perioperative Morbidity

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RE: Jarrett T, 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;33:928; DOI: 10.1089/end.2019.0623)

Journal of Endourology ◽

10.1089/end.2019.29068.khy ◽

2019 ◽

Vol 33 (11) ◽

pp. 929-929

Author(s):

Mahmoud I. Khalil ◽

Rodney Davis ◽

Mohamed H. Kamel

Keyword(s):

Editorial Comment ◽

Minimally Invasive ◽

Partial Nephrectomy ◽

Kidney Cancer ◽

Mortality Rates ◽

Morbidity And Mortality ◽

Obese Patients ◽

Open Partial Nephrectomy ◽

Perioperative Morbidity

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Robotic and laparoscopic liver surgery for colorectal liver metastases: an experience from a German Academic Center

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02113-1 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Mirhasan Rahimli ◽

Aristotelis Perrakis ◽

Vera Schellerer ◽

Andrew Gumbs ◽

Eric Lorenz ◽

...

Keyword(s):

Abdominal Surgery ◽

Minimally Invasive ◽

Liver Surgery ◽

Colorectal Liver Metastases ◽

Survival Rates ◽

Long Term Outcomes ◽

Short Term ◽

Minimally Invasive Liver Surgery ◽

Previous Abdominal Surgery

Abstract Background Minimally invasive liver surgery (MILS) in the treatment of colorectal liver metastases (CRLM) is increasing in incidence. The aim of this work was to present our experience by reporting short-term and long-term outcomes after MILS for CRLM with comparative analysis of laparoscopic (LLS) and robotic liver surgery (RLS). Methods Twenty-five patients with CRLM, who underwent MILS between May 2012 and March 2020, were selected from our retrospective registry of minimally invasive liver surgery (MD-MILS). Thirteen of these patients underwent LLS and 12 RLS. Short-term and long-term outcomes of both groups were analyzed. Results Operating time was significantly longer in the RLS vs. the LLS group (342.0 vs. 200.0 min; p = 0.004). There was no significant difference between the laparoscopic vs. the robotic group regarding length of postoperative stay (8.8 days), measured blood loss (430.4 ml), intraoperative blood transfusion, overall morbidity (20.0%), and liver surgery related morbidity (4%). The mean BMI was 27.3 (range from 19.2 to 44.8) kg/m2. The 30-day mortality was 0%. R0 resection was achieved in all patients (100.0%) in RLS vs. 10 patients (76.9%) in LLS. Major resections were carried out in 32.0% of the cases, and 84.0% of the patients showed intra-abdominal adhesions due to previous abdominal surgery. In 24.0% of cases, the tumor was bilobar, the maximum number of tumors removed was 9, and the largest tumor was 8.5 cm in diameter. The 1-, 3- and 5-year overall survival rates were 84, 56.9, and 48.7%, respectively. The 1- and 3-year overall recurrence-free survival rates were 49.6 and 36.2%, respectively, without significant differences between RLS vs. LLS. Conclusion Minimally invasive liver surgery for CRLM is safe and feasible. Minimally invasive resection of multiple lesions and large tumors is also possible. RLS may help to achieve higher rates of R0 resections. High BMI, previous abdominal surgery, and bilobar tumors are not a barrier for MILS. Laparoscopic and robotic liver resections for CRLM provide similar long-term results which are comparable to open techniques.

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