Bilateral Renal Masses with Different Histopathology Subtypes Treated by Laparoscopic Right Partial Nephrectomy and Bilateral Cryoablation- Results at 5 Years Follow-Up

The purpose of the present paper is to describe our technique and experience with retroperitoneal hand-assisted laparoscopic (HAL) nephrectomies as an alternative to the transperitoneal approach. Eight retroperitoneal HAL nephrectomies and one partial nephrectomy were performed. Several excisional techniques were employed incorporating the Harmonic scalpel or Ligasure device. Hemostatic agents were used to cover the renal defect. Surgical bolsters were sutured to the renal capsule with pleget reinforcements to aid in hemostasis. The average operative time was 210 min and estimated blood loss 110 mL. Mean change in hematocrit was 3 units and creatinine was 1 point. No patient required a transfusion. There were no major complications, with a mean follow-up of fourteen months. On average, patients resumed oral intake in 2 days, and were discharged in 3 days. Pathological examination revealed that two lesions were benign and seven malignant. Tumor diameter averaged 3 cm. There were no positive surgical margins. In conclusion, we have demonstrated the feasibility of retroperitoneal laparoscopic hand-assisted nephrectomy and partial nephrectomy surgery for solid renal masses.

Download Full-text

Cryoablation of cT1 renal masses in the “healthy” patient: Early outcomes from Mayo Clinic.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.433 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 433-433 ◽

Cited By ~ 1

Author(s):

Harras B. Zaid ◽

Thomas D. Atwell ◽

Grant Schmit ◽

Stephen A. Boorjian ◽

William P. Parker ◽

...

Keyword(s):

Local Recurrence ◽

Partial Nephrectomy ◽

Metastatic Disease ◽

Solitary Kidney ◽

Surgical Anatomy ◽

Renal Masses ◽

Time Period ◽

Institutional Experience ◽

Percutaneous Thermal Ablation

433 Background: Current guidelines suggest that percutaneous thermal ablation (PTA) can be utilized in those with significant comorbidity who are unable to tolerate surgery (radical or partial nephrectomy). However, the use of PTA in healthy patients, who are otherwise candidates for surgery, has been limited. Here, we reviewed our institutional experience in healthy patients electing to undergo PTA, specifically cryoablation. Methods: We identified patients ≤65 years undergoing percutaneous cryoablation for solitary, non-metastatic renal masses <7cm (cT1). We further limited our cohort to patients with an ASA score of 1 or 2, and in whom pre-operative eGFR was >60. Clincopathologic characteristics and recurrence patterns (local recurrence within the kidney versus metastatic disease) were evaluated. Results: Between March 2003 and December 2015, 705 patients underwent cryoablation, of whom 43 (6.1%) were deemed to be “healthy”. Median age of this cohort was 57 years (IQR 52−62), with pre-ablation eGFR of 75.6 (IQR 69.0-86.3). Seven patients (16.3%) had a prior partial nephrectomy, and 5 (11.6%) had a solitary kidney. The majority (40, 93.0%) of ablated masses were cT1a, with 3 (7.0%) being cT1b. Median tumor size was 2.0 cm. 27 masses (63.7%) were biopsy-proven renal cell carcinoma (RCC) and 6 (13.6%) were benign; histology was unknown in 10 (22.7%). Follow-up imaging was available for 37 patients. Median radiological follow-up was 22 months (IQR 9-42), during which time 2 patients developed metastatic disease and 1 developed local recurrence; all events were in patients with biopsy-proven RCC. No patients died from RCC during this time period. Conclusions: In this single institution cohort of “healthier” patients with cT1 solitary renal masses, cryoablation offered reasonable short term oncologic control. While longer follow-up data are needed to evaluate for durability, cryoablation in healthy patients, particularly those with challenging surgical anatomy, warrants further study.

Download Full-text

Comparison of Trifecta and Pentafecta Outcomes between T1a and T1b Renal Masses following Robot-Assisted Partial Nephrectomy (RAPN) with Minimum One Year Follow Up: Can RAPN for T1b Renal Masses Be Feasible?

PLoS ONE ◽

10.1371/journal.pone.0151738 ◽

2016 ◽

Vol 11 (3) ◽

pp. e0151738 ◽

Cited By ~ 21

Author(s):

Dae Keun Kim ◽

Lawrence H. C. Kim ◽

Ali Abdel Raheem ◽

Tae Young Shin ◽

Ibrahim Alabdulaali ◽

...

Keyword(s):

Partial Nephrectomy ◽

Robot Assisted ◽

Renal Masses ◽

One Year

Download Full-text

Robotic partial nephrectomy for t1b renal masses: Nearly perfect functional and oncological outcomes at short term follow-up

European Urology Supplements ◽

10.1016/s1569-9056(16)15098-5 ◽

2016 ◽

Vol 15 (6) ◽

pp. 130

Author(s):

I. Tufek ◽

P. Mourmouris ◽

T. Doganca ◽

C. Obek ◽

O.B. Argun ◽

...

Keyword(s):

Partial Nephrectomy ◽

Robotic Partial Nephrectomy ◽

Short Term ◽

Renal Masses ◽

Oncological Outcomes

Download Full-text

Feasibility of nephron sparing surgery in giant oncocytoma

Canadian Urological Association Journal ◽

10.5489/cuaj.1552 ◽

2014 ◽

Vol 8 (1-2) ◽

pp. 96

Author(s):

Albert El Hajj ◽

Ruban Thanigasalam ◽

Isabelle Boulay ◽

Vincent Molinié ◽

Bernard Escudier ◽

...

Keyword(s):

Partial Nephrectomy ◽

Radical Nephrectomy ◽

Young Patients ◽

Normal Functioning ◽

Renal Masses ◽

First Case ◽

Nephron Sparing ◽

Benign Tumours ◽

Functioning Kidney

Oncocytomas represent 3 to 7% of renal masses and behave as benign tumours. Nephron-sparing procedures are preferred for biopsy confirmed lesions; however, giant oncocytomas have been generally treated by radical nephrectomy. We report the first case of partial nephrectomy in a 45-year-old man who presented with a 20-cm oncocytoma. At the 1 year follow-up, he had a normal functioning kidney. Despite the difficulty of this procedure, partial nephrectomy for very large benign tumours can be considered in appropriately selected young patients.

Download Full-text

Comparative Study Assessing Postoperative Renal Loss Using Two Different Partial Nephrectomy Techniques: Off-Clamp versus Standard On-Clamp Surgery

Current Urology ◽

10.1159/000499262 ◽

2020 ◽

Vol 14 (1) ◽

pp. 38-43

Author(s):

Shahid Aquil ◽

Daniel Olvera-Posada ◽

Roshan Navaratnam ◽

David Mikhail ◽

Max A. Levine ◽

...

Keyword(s):

Renal Function ◽

Partial Nephrectomy ◽

Surgical Techniques ◽

Significant Loss ◽

Renal Masses ◽

Postoperative Renal Function ◽

Median Diameter ◽

Comorbidity Index ◽

Matched Study

Objectives: To evaluate a case-matched study comparing postoperative renal function using two surgical techniques: an off-clamp partial nephrectomy (PN) with the aid of the Altrus® device and a standard on-clamp laparoscopic PN. Material and Methods: A total of 36 patients underwent PN. Eighteen had the off-clamp technique and 18 had the standard laparoscopic on-clamp PN. Demographic, clinical, radiological, and perioperative data were collected for analysis. An emphasis on renal function was made by analyzing both the perioperative and follow-up with estimated glomerular filtration rate and MAG3. Results: The median values did not signifcantly differ for age, Charlson Comorbidity Index, and hospital stay in the off-clamp versus on-clamp PN [62.5 (interquartile range, IQR 11) vs. 60 (IQR 16) years, 4 (IQR 2) vs. 5 (IQR 2) and 5 (IQR 1) vs. 4 (IQR 2) days], respectively. The median diameter of the tumors was 33 (IQR 23) versus 41 (IQR 28) mm (p = 0.63), with median R.E.N.A.L. nephrometry scores of 7 (IQR 2) versus 7 (IQR 2) (p = 0.33). There was greater blood loss in the Altrus® (375 vs. 200 ml, p = 0.037). The clamp time in the on-clamp group was 30 (IQR 6) minutes (range 22-68 minutes) compared to 0 minutes in the off-clamp group. There was no difference in hemoglobin or creatinine levels between the groups. However, the on-clamp group had a significant loss in ipsilateral renal function on the MAG3 scan (49 vs. 42%, p = 0.0001), whereas the off-clamp group had no difference (48 vs. 46%, p = 0.72). Conclusions: The off-clamp method for PN is a feasible and safe option with better preservation of ipsilateral renal function when compared with on-clamp PN in the treatment of small renal masses.

Download Full-text

Partial nephrectomy in the setting of metastatic renal cell carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.440 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 440-440

Author(s):

Kara Babaian ◽

Surena F. Matin ◽

Pheroze Tamboli ◽

Nizar M. Tannir ◽

Eric Jonasch ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Partial Nephrectomy ◽

Metastatic Disease ◽

Renal Cell ◽

Renal Mass ◽

Cytoreductive Nephrectomy ◽

Cancer Specific Survival ◽

Renal Masses

440 Background: Up to one-third of patients with renal cell carcinoma present with metastatic disease (mRCC). Cytoreductive nephrectomy remains the standard of care for appropriately selected patients. However, cytoreductive nephrectomy is not always practical. We sought to identify the indications and outcomes for partial nephrectomy (PN) in our cohort of patients with mRCC, with particular attention to different PN subgroups. Methods: Using our institutional database, 30 patients with mRCC who underwent PN between 1996 and 2011 were identified. Demographic, clinical, and pathologic variables were collected. Non-parametric statistics and log-rank tests were used. Cancer specific survival (CSS) was estimated using Kaplan-Meier method according to presentation, tumor size, and presence of metastatic disease, from the time of PN to last follow-up or death. Results: The median age at PN was 57 years (range 32-84). 8 patients presented with bilateral synchronous renal masses; 17 presented with a metachronous contralateral renal mass; and 5 presented with a unilateral renal mass (including 3 in a solitary kidney). Median follow-up after PN was 32 months (range 1-184). Overall, 23 patients (77%) died of disease at a median of 27 months (range 7-86) after PN. Patients who underwent PN for a metachronous contralateral renal mass had a median CSS of 61 months compared to those with bilateral synchronous or unilateral renal masses (CSS 26.5 months, HR 2.98, p =.012 and CSS 31, HR 2.12, p =.069, respectively). Patients who underwent PN for a renal mass ≤4cm and >4cm had a median CSS of 42 and 26.5 months, respectively (HR 2.49, p =.037). Median CSS for patients with and without metastatic disease at original diagnosis was 27 and 61 months, respectively (HR 2.85, p =.013). In this study, patients who became M0 after metastasectomy did not have improved CSS compared to patients who did not (42 and 32 months, p =0.152). Conclusions: Our findings suggest that the burden of disease at initial diagnosis, timing of presentation of the PN index lesion, and the size of the renal mass at PN play an important role in survival. These factors should be taken into consideration when determining which patients would benefit from PN in the setting of mRCC.

Download Full-text