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Saitta C, Afari JA, Autorino R, Capitanio U, Porpiglia F, Amparore D, Piramide F, Cerrato C, Meagher MF, Noyes SL, Pandolfo SD, Buffi NM, Larcher A, Hakimi K, Nguyen MV, Puri D, Diana P, Fasulo V, Saita A, Lughezzani G, Casale P, Antonelli A, Montorsi F, Lane BR, Derweesh IH. Development of a novel score (RENSAFE) to determine probability of acute kidney injury and renal functional decline post surgery: A multicenter analysis. Urol Oncol 2023; 41:487.e15-487.e23. [PMID: 37880003 DOI: 10.1016/j.urolonc.2023.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To create and validate 2 models called RENSAFE (RENalSAFEty) to predict postoperative acute kidney injury (AKI) and development of chronic kidney disease (CKD) stage 3b in patients undergoing partial (PN) or radical nephrectomy (RN) for kidney cancer. METHODS Primary objective was to develop a predictive model for AKI (reduction >25% of preoperative eGFR) and de novo CKD≥3b (<45 ml/min/1.73m2), through stepwise logistic regression. Secondary outcomes include elucidation of the relationship between AKI and de novo CKD≥3a (<60 ml/min/1.73m2). Accuracy was tested with receiver operator characteristic area under the curve (AUC). RESULTS AKI occurred in 452/1,517 patients (29.8%) and CKD≥3b in 116/903 patients (12.8%). Logistic regression demonstrated male sex (OR = 1.3, P = 0.02), ASA score (OR = 1.3, P < 0.01), hypertension (OR = 1.6, P < 0.001), R.E.N.A.L. score (OR = 1.2, P < 0.001), preoperative eGFR<60 (OR = 1.8, P = 0.009), and RN (OR = 10.4, P < 0.0001) as predictors for AKI. Age (OR 1.0, P < 0.001), diabetes mellitus (OR 2.5, P < 0.001), preoperative eGFR <60 (OR 3.6, P < 0.001) and RN (OR 2.2, P < 0.01) were predictors for CKD≥3b. AUC for RENSAFE AKI was 0.80 and 0.76 for CKD≥3b. AKI was predictive for CKD≥3a (OR = 2.2, P < 0.001), but not CKD≥3b (P = 0.1). Using 21% threshold probability for AKI achieved sensitivity: 80.3%, specificity: 61.7% and negative predictive value (NPV): 88.1%. Using 8% cutoff for CKD≥3b achieved sensitivity: 75%, specificity: 65.7%, and NPV: 96%. CONCLUSION RENSAFE models utilizing perioperative variables that can predict AKI and CKD may help guide shared decision making. Impact of postsurgical AKI was limited to less severe CKD (eGFR<60 ml/min 71.73m2). Confirmatory studies are requisite.
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Affiliation(s)
- Cesare Saitta
- University of California: San Diego Health System, San Diego, CA; Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Jonathan A Afari
- University of California: San Diego Health System, San Diego, CA
| | | | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Federico Piramide
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Clara Cerrato
- University of California: San Diego Health System, San Diego, CA; Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Sabrina L Noyes
- Spectrum Health, Grand Rapids, Michigan State University College of Human Medicine, Grand Rapids, MI
| | | | - Nicolò M Buffi
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Kevin Hakimi
- University of California: San Diego Health System, San Diego, CA
| | - Mimi V Nguyen
- University of California: San Diego Health System, San Diego, CA
| | - Dhruv Puri
- University of California: San Diego Health System, San Diego, CA
| | - Pietro Diana
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Vittorio Fasulo
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Giovanni Lughezzani
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Brian R Lane
- Spectrum Health, Grand Rapids, Michigan State University College of Human Medicine, Grand Rapids, MI
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Ochoa-Arvizo M, García-Campa M, Santos-Santillana KM, Klatte T, García-Chairez LR, González-Colmenero AD, Pallares-Méndez R, Cervantes-Miranda DE, Plata-Huerta HH, Rodriguez-Gutierrez R, Gutiérrez-González A. Renal functional and cardiovascular outcomes of partial nephrectomy versus radical nephrectomy for renal tumors: a systematic review and meta-analysis. Urol Oncol 2023; 41:113-124. [PMID: 36642639 DOI: 10.1016/j.urolonc.2022.11.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 10/17/2022] [Accepted: 11/27/2022] [Indexed: 01/16/2023]
Abstract
This systematic review and meta-analysis aimed to evaluate the postoperative renal and cardiovascular outcomes of partial nephrectomy (PN) versus radical nephrectomy (RN) for the treatment of renal carcinoma. A systematic literature search was performed on scientific databases including Scopus, Web of Science, MEDLINE, and EMBASE from their inception to September 2021. Studies comparing renal and cardiovascular outcomes between PN and RN in patients with renal cancer were included. The generic inverse variance method with random-effects models was used to determine the pooled hazard ratios and odds ratio for each outcome. Quality Assessment for observational studies was guided by the New-Castle Ottawa Scale. Overall, a total of 31 studies (n=51,866) reported renal outcomes, while 11 studies (n= 101,678) reported cardiovascular outcomes. When compared to PN, RN had a higher rate of new-onset postoperative EGFR <60 mL/min/1.73 m2 (HR 3.39; CI 2.45 - 4.70; I2=93%; P=<0.00001) and EGFR <45 mL/min/1.73 m2 (HR 4.70; CI 2.26 - 9.79; I2=98%; P=<0.0001). No difference was observed in new-onset advanced kidney disease and end-stage renal disease. A 19% reduction in cardiovascular events was observed in the PN group (HR 0.81; CI 0.70 - 0.93, P=0.002). No protective effect of PN was observed in new-onset or worsening hypertension (HR 0.85; CI 0.64 - 1.14, P=0.28) nor myocardial infarction (HR 0.86; CI 0.71 - 1.04, P=0.13). PN was associated with a decreased risk of postoperative early-stage CKD and cardiovascular events compared with RN. However, no benefit of PN over RN was observed in advanced CKD, new-onset or worsening hypertension, myocardial infarction, and cardiovascular mortality.
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Affiliation(s)
- Mario Ochoa-Arvizo
- Edinburgh Medical School: Clinical Sciences, The University of Edinburgh, Edinburgh, UK; Department of Urology, IRCSS "Regina Elena" National Cancer Institute, Rome, Italy.
| | - Mariano García-Campa
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Karla M Santos-Santillana
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Tobias Klatte
- Department of Urology, Charite-Universitaetmedizin, Berlin, Germany
| | - Luis R García-Chairez
- Department of Urology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Alejandro D González-Colmenero
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Rigoberto Pallares-Méndez
- Department of Urology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Daniel E Cervantes-Miranda
- Department of Urology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Hiram H Plata-Huerta
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Rene- Rodriguez-Gutierrez
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, México
| | - Adrián Gutiérrez-González
- Department of Urology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
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Narroway HG, Kovacic JL, Bourke BM, Louis-Johnsun M, Latif ER, Bourke VC. Selective Angioembolisation of Iatrogenic Renal Artery Pseudoaneurysms Following Minimally Invasive Urological Procedures: A Single Centre Case Series. Vasc Endovascular Surg 2022; 56:15385744221108041. [PMID: 35680559 DOI: 10.1177/15385744221108041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The purpose of this study was to report our centre's experience using selective angioembolisation in the treatment of iatrogenic renal artery pseudoaneurysms (RAP) following minimally invasive urological procedures. METHODS Our retrospective analysis included four consecutive patients treated with angioembolisation for iatrogenic RAP between October 2016 and October 2021. Data on demographics, minimally invasive urological intervention, clinical features, imaging findings, embolization procedure and perioperative details were collected. Rates of technical and clinical success, defined as 1. total occlusion of the extravasation site on completion digital subtraction angiography (DSA), and 2. resolution of symptoms, signs, and serum hemoglobin (Hb) derangements secondary to RAP, were analysed. Renal function, measured by serum creatinine (Cr) and estimated glomerular filtration rate (eGFR), was recorded prior to and post - angioembolisation procedure and compared. RESULTS Mean time between urological intervention and angioembolisation was 9 days (range, 2-17 days). Rates of technical and clinical success were 100% and 100% respectively. No additional angioembolisation procedures were required, and there were no peri or post-operative complications identified during mean follow-up of 662 days (range, 30-1845 days). Mean serum Cr prior to and post angioembolisation was 83 mmol/L and 79.5 mmol/L. Mean eGFR prior to and post angioembolisation was 73.8 and 77.8 mL/min/1.73 m2. In all patients, no significant difference was observed in serum Cr and eGFR prior to and post angioembolisation. CONCLUSION Iatrogenic renal artery pseudoaneurysms can occur following a range of minimally invasive urological procedures. This retrospective review highlights the utility of angioembolisation as a safe and effective treatment with high clinical and technical success rates. Further studies involving larger populations are required to validate its broader application.
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Affiliation(s)
- Harry G Narroway
- Department of Vascular Surgery, 90112Gosford Hospital, Gosford, NSW, Australia
| | - James L Kovacic
- Department of Urology, 90112Gosford Hospital, Gosford, NSW, Australia
| | - Bernard M Bourke
- Department of Vascular Surgery, 90112Gosford Hospital, Gosford, NSW, Australia
| | | | - Edward R Latif
- Department of Urology, 90112Gosford Hospital, Gosford, NSW, Australia
| | - Victor C Bourke
- Department of Vascular Surgery, 90112Gosford Hospital, Gosford, NSW, Australia
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Alvim RG, Tin AL, Nogueira L, Wong NC, Fonseca RC, Sjoberg DD, Hakimi AA, Touijer KA, Russo P, Coleman JA. Functional and Oncological Outcomes of Renal Surgery for Hilar Tumors: Informing the Decisions in Risk-Adapted Management. Urology 2021; 157:174-180. [PMID: 34331997 DOI: 10.1016/j.urology.2021.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/05/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe the safety and efficacy of partial nephrectomy (PN) in comparison to radical nephrectomy (RN) for surgically managed renal hilar tumors. MATERIALS AND METHODS We retrospectively reviewed institutional records of patients with a small (<5 cm) solitary renal (hilar or non-hilar) mass who underwent PN or RN between 2008 and 2018. Hilar tumors were defined as those at medial position, abutting the renal vessels. Recurrence-free, cancer-specific, and overall survival were estimated using the Kaplan-Meier method. RESULTS Of 1,951 eligible patients, 399 had hilar tumors (292 scheduled for PN, 107 RN) and 1,552 had non-hilar tumors (scheduled for PN). We found no significant differences in survival measures between hilar and non-hilar tumors in patients selected for PN. Patients scheduled for PN for hilar tumors had higher rates of ≥grade II postoperative surgical complications compared to patients scheduled to receive PN for non-hilar tumors (13% vs 8.6%; log-rank P = .018) and non-statistically significantly elevated rates of ≥grade II complications compared to patients scheduled for RN for hilar tumors (13% vs 6.5%; difference 6%, 95% CI 0.4%, 13%; log-rank P = .07). CONCLUSION PN for hilar and non-hilar renal masses (<5cm) experience comparable oncologic outcomes though increased risk of complications for hilar masses. PN for hilar tumors was associated with better renal function and overall survival with non-statistically elevated risk of grade II or higher complications than RN. A renal tumor located at the hilum should not be a contra-indication for performing PN.
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Affiliation(s)
- Ricardo G Alvim
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amy L Tin
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lucas Nogueira
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Surgery Department, Urology Service, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Nathan C Wong
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Renato C Fonseca
- Surgery Department, Urology Service, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Daniel D Sjoberg
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Karim A Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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Olivero A, Basso L, Barabino E, Milintenda P, Testino N, Chierigo F, Dell'oglio P, Neumaier CE, Suardi N, Terrone C. The impact of visceral adipose tissue on post -operative renal Function after Radical Nephrectomy for renal cell carcinoma. Minerva Urol Nephrol 2021; 73:789-795. [PMID: 33769015 DOI: 10.23736/s2724-6051.21.04096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the usefulness of pre-operative visceral (VAT) and subcutaneous adipose tissue (SAT) evaluation in the prediction of Acute Kidney Injury (AKI) and decrease of eGFR at 12 months after radical nephrectomy (RN). METHODS We relied on 112 patients who underwent RN between January 2010 and March 2017 at a single institution. Images from the pre-operatory CT scan were analyzed and both SAT and VAT assessments were carried out on a cross-sectional plane. eGFR was measured before surgery, at 7 days, and 12 months after surgery. ROC analysis was used to compare the diagnostic value of BMI, VAT ratio, and abdominal circumference in predicting AKI. Logistic regression models were fitted to predict the new onset of AKI, and the progression from chronic kidney disease (CKD) stage 1-3a to CKD stage 3b or from 3b to 4 at 12 months follow-up. Two logistic regression models were also performed to assess the predictors for AKI and CKD stage progression. The predictive accuracy was quantified using the receiver operating characteristic-derived area under the curve. RESULTS Sixty-six patients (58.9%) had AKI after RN. Thirty-five (31.3%) patients were upgraded to CKD IIIb or from CKD stage IIIb to CKD IV. In the ROC analysis, VAT% performed better than the BMI and abdominal circumference (AUC = 0.66 vs 0.49 and 0.54, respectively). At multivariable analyses, VAT reached an independent predictor status for AKI (OR: 1.03) and for CKD stage at 12 months Follow-up (OR: 1.05). Inclusion of VAT% into the multivariable models was associated with the highest accuracy both for AKI (AUC = 0.700 vs 0.570) and CKD stage progression (AUC = 0.848 vs 0.800). CONCLUSIONS In patients undergoing RN, preoperative visceral adipose tissue ratio significantly predicts AKI incidence and is significantly predictive of 12 months CKD stage worsening.
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Affiliation(s)
- Alberto Olivero
- Department of Urology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy -
| | - Luca Basso
- Department of Radiology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy
| | - Emanuele Barabino
- Department of Radiology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy
| | - Paolo Milintenda
- Department of Urology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy
| | - Nicolò Testino
- Department of Urology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy
| | - Francesco Chierigo
- Department of Urology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy
| | - Paolo Dell'oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Carlo E Neumaier
- Diagnostic imaging and senology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy
| | - Nazareno Suardi
- Department of Urology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy
| | - Carlo Terrone
- Department of Urology, San Martino Policlinico Hospital, University of Genoa, Genova, Italy
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Peddada AV, Anderson D, Blasi OC, McCollough K, Jennings SB, Monroe AT. Nephron-Sparing Robotic Radiosurgical Therapy for Primary Renal Cell Carcinoma: Single-Institution Experience and Review of the Literature. Adv Radiat Oncol 2020; 5:204-211. [PMID: 32280820 PMCID: PMC7136638 DOI: 10.1016/j.adro.2019.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 09/28/2019] [Accepted: 10/06/2019] [Indexed: 01/20/2023] Open
Abstract
PURPOSE We report our single-institution stereotactic body radiation therapy (SBRT) experience on stage I renal cancer with prospectively collected toxicity and efficacy data. METHODS AND MATERIALS A total of 21 patients with solitary renal tumors, including 14 surgical candidates who refused surgery (66%), were treated with SBRT. Histologic confirmation was obtained on all patients before treatment; 2 had transitional cell carcinoma and 19 had renal cell carcinoma. The median age was 71 years (range, 58-88). Nearly all patients received 48 Gy in 3 fractions. RESULTS The median follow-up was 78 months (range, 5-107). At 5 years post treatment, the local tumor control rate was 100%. Tumor size decreased by a median value of 5.3% at 1 year post treatment, 15.6% at 2 years post treatment, and 15.4% at 5 years post treatment. Glomerular filtration rate had decreased by a median value of 1.5% at 1 year post treatment, 7.0% at 2 years post treatment, and 14.2% at 5 years post treatment. Three patients experienced grade 1 toxicity; no other treatment-related adverse effects were reported. CONCLUSIONS SBRT is a promising noninvasive treatment in the management of primary renal cell carcinoma, with evolving clinical evidence demonstrating encouraging results with respect to local control and toxicity.
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Affiliation(s)
| | | | - Olivier C. Blasi
- Colorado Associates in Medical Physics, Penrose Cancer Center, Colorado Springs, Colorado
| | - Kiernan McCollough
- Colorado Associates in Medical Physics, Penrose Cancer Center, Colorado Springs, Colorado
| | - Scott B. Jennings
- Department of Urology, DaVita Medical Group, Colorado Springs, Colorado
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Varela-Santoyo E, Escamilla-López MI, Izquierdo-Tolosa CD, Arroyave-Ramírez AM, Buerba-Vieregge HH, Dorantes-Heredia R, Motola-Kuba D, Ruiz-Morales JM. Impact of the Type of Analgesic Therapy on Postsurgical Complications of Patients with Kidney Cancer Undergoing Nephrectomy. Oncology 2019; 98:117-122. [PMID: 31715614 DOI: 10.1159/000504258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/20/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The treatment of kidney cancer usually involves surgery, and in some cases systemic therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to control postsurgical pain in patients undergoing nephrectomy for renal cancer. Nevertheless, the association between these drugs and adverse postsurgical outcomes, including deterioration of renal function, is not fully established. METHODS This retrospective cohort study included patients >18 years old with kidney cancer undergoing nephrectomy between January 2006 and January 2018. The primary endpoint was to determine the impact of postsurgical analgesic therapy (NSAIDs vs. acetaminophen) on renal function and postsurgical complications. This study was approved by our scientific and bioethical committee. RESULTS One hundred patients were included in the final analysis. Clear-cell renal-cell carcinoma was the most frequent histologic subtype. Adequate acute pain control was accomplished in 91% of the patients during hospitalization. Twenty percent of the patients presented postsurgical complications. Bleeding-related complications were the most frequent (9%), followed by surgical-site infection (6%) and acute renal injury (6%). The administration of NSAIDs was not related to any postsurgical complication in comparison with the use of acetaminophen (21.3 vs. 17.9%, respectively). The length of hospital stay did not differ between patients treated with NSAIDs and those treated with acetaminophen (the average stay was 4 days for both groups, p = 0.32). CONCLUSION The use of NSAIDs was not related to acute kidney injury, postsurgical complications, or prolonged hospital stay in patients with renal cancer undergoing nephrectomy.
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Affiliation(s)
- Edgar Varela-Santoyo
- Medical Oncology Research Unit, Médica Sur Hospital and Clinical Foundation, Mexico City, Mexico
| | | | | | | | | | - Rita Dorantes-Heredia
- Anatomic Pathology Research Unit, Médica Sur Hospital and Clinical Foundation, Mexico City, Mexico
| | - Daniel Motola-Kuba
- Medical Oncology Research Unit, Médica Sur Hospital and Clinical Foundation, Mexico City, Mexico
| | - José Manuel Ruiz-Morales
- Medical Oncology Research Unit, Médica Sur Hospital and Clinical Foundation, Mexico City, Mexico,
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8
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Lam JKJ, Tan SY, Chong KT. Is partial nephrectomy worth performing compared to radical nephrectomy for small, localised renal cortical tumours in geriatric patients? Singapore Med J 2019; 61:190-193. [PMID: 31680178 DOI: 10.11622/smedj.2019136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study aimed to evaluate the likelihood of progression to chronic kidney disease (CKD) in a cohort of geriatric Asian patients who underwent either partial nephrectomy (PN) or radical nephrectomy (RN) for localised pT1 kidney tumours. METHODS Geriatric patients aged > 65 years who underwent PN or RN from 2005 to 2014 for localised kidney masses < 7 cm at a single institution were reviewed retrospectively. Preoperative and postoperative estimated glomerular filtration rates (eGFRs) were calculated using the Modification of Diet in Renal Disease Study equation. Clinicopathological data was analysed for new-onset CKD after at least five years of follow-up. Postoperative complications were measured using the modified Clavien classification system. RESULTS Among 67 patients, 36.4% had diabetes mellitus and 80.3% had hypertension. Pre-existing CKD with eGFR ≤ 60 mL/min/1.73 m2 was present in 23.3% of PN and 43.2% of RN patients. RN and PN patients had similar postoperative morbidity. Those who underwent PN had immediate decline followed by gradual improvement of kidney function at six months after surgery. This improvement was sustained even for patients with four years of clinical follow-up. Among patients with normal preoperative kidney function, new-onset CKD after surgery was found in 20.0% and 52.9% of PN and RN patients, respectively (p = 0.007). CONCLUSION In our study, geriatric patients who underwent PN for localised kidney mass < 7 cm had immediate decline but gradual and sustained improvement in kidney function. PN also resulted in less new-onset CKD through a five-year follow-up period.
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de Cássio Zequi S, da Costa WH, Korkes F, dos Reis RB, Busato WFS, Matheus WE, da Silva Neto DCV, de Almeida e Paula F, Carvalhal GF, Nogueira L, de Carvalho Fernandes R, Silva AGE, Sasse AD, Fay AP, Jardim DL, Bastos DA, da Rosa DAR, Wierman E, Kater F, Schutz FA, Maluf FC, de Oliveira FNG, Morbeck IAP, Rinck JA, da Trindade KM, Maia MC, Souza VC, Monteiro FSM, Soares A. Renal cell cancer treatment: an expert panel recommendation from the Latin American cooperative group-genitourinary and the Latin American renal cancer group: focus on surgery. Ther Adv Urol 2019; 11:1756287219872324. [PMID: 31523281 PMCID: PMC6734614 DOI: 10.1177/1756287219872324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/28/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Renal cell cancer (RCC) is one of the 10 most common cancers in the world,
and its incidence is increasing, whereas mortality is declining only in
developed countries. Therefore, two collaborative groups, The Latin American
Oncology Cooperative Group-Genitourinary Section (LACOG-GU) and the Latin
American Renal Cancer Group (LARCG), held a consensus meeting to develop
this guideline. Methods: Issues (134) related to the treatment of RCC were previously formulated by a
panel of experts. The voting panel comprised 26 specialists (urologists and
medical oncologists) from the LACOG-GU/LARCG. A consensus was reached if 75%
agreement was achieved. If there was less concordance, a new discussion was
undertaken, and a consensus was determined by the most votes after a second
voting session. Results: The expert meeting provided recommendations that were in line with the global
literature; 75.0% of the recommendations made by the panel of experts were
evidence-based level A, 22.5% of the recommendations were level B, and 2.5%
of the recommendations were level D. Conclusions: This review suggests recommendations for the surgical treatment of RCC
according to the LACOG-GU/LARCG experts.
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Affiliation(s)
| | | | - Fernando Korkes
- Hospital Israelita Albert Einstein, São Paulo,
Brazil
- ABC Medical School, Santo André, Brazil
| | | | | | | | | | | | - Gustavo Franco Carvalhal
- Escola de Medicina e Hospital São Lucas da
Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre,
Brazil
| | - Lucas Nogueira
- Hospital das Clínicas da Universidade Federal
de Minas Gerais, Belo Horizonte, Brazil
| | - Roni de Carvalho Fernandes
- Faculdade de Ciências Médicas da Santa Casa de
São Paulo, Brazil
- Hospital Central da Santa Casa de Misericórdia
de São Paulo, Brazil
| | | | | | - André P. Fay
- Escola de Medicina e Hospital São Lucas da
Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre,
Brazil
- Grupo Oncoclínicas, Porto Alegre, Brazil
| | | | | | | | | | - Fabio Kater
- Beneficência Portuguesa de São Paulo,
Brazil
| | | | - Fernando Cotait Maluf
- Hospital Israelita Albert Einstein, São Paulo,
Brazil
- Beneficência Portuguesa de São Paulo,
Brazil
- Hospital Santa Lúcia, Brasilia, Brazil
| | | | | | | | - Karine Martins da Trindade
- Hospital São Carlos/Oncocentro, Fortaleza,
Brazil
- Santa Casa de Misericórdia de Fortaleza,
Fortaleza, Brazil
| | | | | | | | - Andrey Soares
- Hospital Israelita Albert Einstein, São Paulo,
Brazil
- Centro Paulista de Oncologia, São Paulo,
Brazil
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10
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National Norwegian Practice Patterns for Surgical Treatment of Kidney Cancer Tumors ≤7cm: Adherence to Changes in Guidelines May Improve Overall Survival. Eur Urol Oncol 2019; 1:252-261. [PMID: 31102628 DOI: 10.1016/j.euo.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/22/2018] [Accepted: 04/10/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Guidelines on surgical treatment for kidney cancer (KC) have changed over the last 10 yr. We present population-based data for patients with KC tumors ≤7cm from 2008 to 2013 to investigate whether surgical practice in Norway has changed according to guidelines. OBJECTIVE To assess the predictors of treatment and survival after KC surgery. DESIGN, SETTING, AND PARTICIPANTS We identified all surgically treated KC patients with tumors ≤7cm without metastasis diagnosed during 2008-2013 (2420 patients) from the Cancer Registry of Norway. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Relationships with outcomes were analyzed using joinpoint regression, multivariate logistic regression, Kaplan-Meier survival estimates, Cox regression, relative survival (RS), and competing-risk analyses. RESULTS AND LIMITATIONS The mean follow-up was 5.2 yr. There was a 28% increase in the number of patients undergoing surgical treatment over the study period. Joinpoint regression revealed a significant annual increase in partial nephrectomy (PN) and a small reduction in radical nephrectomy (RN). PN increased from 43% to 66% for tumors ≤4cm and from 10% to 18% for tumors of 4.1-7cm. Minimally invasive (MI) RN increased from 53% to 72% and MI PN from 25% to 64%, of which 55% of procedures were performed with robotic assistance in 2013. The geographical distribution of treatment approaches differed significantly. Both PN and MI approaches were more frequent in high-volume hospitals. Cox regression analysis revealed that PN, age, and Fuhrman grade and stage were independent predictors of survival. There were no significant differences in cancer-specific survival (p=0.8). The 5-yr RS for T1a disease was higher after PN than after RN. CONCLUSIONS The rate of PN for tumors ≤7cm increased in the 6-yr study period. MI approaches increased for both RN and PN. This treatment shift coincides with the new guideline recommendations in 2010. The possible better survival for patients undergoing PN compared to RN indicates the importance of following evidence-based guidelines. PATIENT SUMMARY The use of partial nephrectomy and minimally invasive surgery for kidney cancer tumors increased in Norway from 2008 to 2013 according to population-based data, coinciding with guideline changes. The study illustrate that adherence to guidelines may improve patient outcomes.
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11
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Partial versus radical nephrectomy in very elderly patients: a propensity score analysis of surgical, functional and oncologic outcomes (RESURGE project). World J Urol 2019; 38:151-158. [DOI: 10.1007/s00345-019-02665-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/31/2019] [Indexed: 01/20/2023] Open
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12
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Kitley W, Sulek J, Sundaram C, Bahler CD. Treatment Trends and Long-Term Survival Associated with Cryotherapy and Partial Nephrectomy for Small Renal Masses in the National Cancer Database Using Propensity Score Matching. J Endourol 2019; 33:408-414. [PMID: 30808185 DOI: 10.1089/end.2018.0548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective: Trends in the utilization of ablative therapy are unknown for the treatment of small renal masses. Our goal is to utilize the National Cancer Database (NCDB) to both assess the utilization of ablative therapies and long-term survival. Materials and Methods: The NCDB captures 70% of all cancer cases in the United States and was queried between 1998 and 2012 for renal cell carcinomas that were treated with ablative therapy, partial nephrectomy (PN), or radical nephrectomy. The analysis was limited to clinical stage T1a. Propensity score matching was used in 1:1 fashion. Kaplan-Meier survival analysis and a Cox proportional hazards model were used to compare overall survival (OS) for cryotherapy and PN. Results: A total of 119,240 cases of clinical stage T1a renal masses were treated between 1998 and 2012. Cryotherapy peaked at 927 (9.1%) cases in 2010 and had 913 (8.4%) in 2012. PN accounted for 18% of the cases in 1998, but surpassed the utilization of nephrectomy in 2008. By 2012, PN accounted for 6766 (62%) of renal mass cases. After matching, Kaplan-Meier OS was lower for cryotherapy compared with PN at 24 (94.5% vs 96.5%), 48 (86.8% vs 90.9%), and 96 months (66.0% vs 74.9%). Cryotherapy also had a lower OS (hazard ratio 1.46; p < 0.001) on adjusted analysis. Conclusion: Cryotherapy for small renal masses plateaued at 9% utilization in 2009. Cryotherapy had a lower OS than PN for tumors >2 cm on adjusted analysis, but this result should be used with caution until confirmed in randomized studies.
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Affiliation(s)
- Weston Kitley
- Department of Urology, Indiana University, Indianapolis, Indiana
| | - Jay Sulek
- Department of Urology, Indiana University, Indianapolis, Indiana
| | - Chandru Sundaram
- Department of Urology, Indiana University, Indianapolis, Indiana
| | - Clint D Bahler
- Department of Urology, Indiana University, Indianapolis, Indiana
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13
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Hamilton ZA, Capitanio U, Lane BR, Larcher A, Yim K, Dey S, Cotta BH, Meagher MF, Kirmiz S, Bezinque A, Eldefrawy A, Bradshaw A, Ryan S, Carenzi C, Wan F, Proudfoot J, Montorsi F, Derweesh IH. Should partial nephrectomy be considered “elective” in patients with stage 2 chronic kidney disease? A comparative analysis of functional and survival outcomes after radical and partial nephrectomy. World J Urol 2019; 37:2429-2437. [DOI: 10.1007/s00345-019-02650-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/21/2019] [Indexed: 01/09/2023] Open
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14
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Ellis RJ, Edey DP, Del Vecchio SJ, McStea M, Campbell SB, Hawley CM, Johnson DW, Morais C, Jordan SJ, Francis RS, Wood ST, Gobe GC, Cancer Alliance Queensland. End-Stage Kidney Disease following Surgical Management of Kidney Cancer. Clin J Am Soc Nephrol 2018; 13:1641-1648. [PMID: 30266837 PMCID: PMC6237064 DOI: 10.2215/cjn.06560518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 08/20/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVES We investigated the incidence of ESKD after surgical management of kidney cancer in the Australian state of Queensland, and described patterns in the initiation of kidney replacement therapy resulting from kidney cancer across Australia. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS All newly diagnosed cases of kidney cancer in the Australian state of Queensland between January of 2009 and December of 2014 were ascertained through the Queensland Cancer Registry. There were 2739 patients included in our analysis. Patients who developed ESKD were identified using international classification of disease-10-coded hospital administrative data. Incidence rate and 3-year cumulative incidence were calculated, and multivariable Cox proportional hazards models were used to identify factors associated with ESKD. Additional descriptive analysis was undertaken of Australian population data. RESULTS The incidence rate of ESKD in all patients was 4.9 (95% confidence interval [95% CI], 3.9 to 6.2) per 1000 patient-years. The 3-year cumulative incidence was 1.7%, 1.9%, and 1.0% for all patients, and patients managed with radical or partial nephrectomy, respectively. Apart from preoperative kidney disease, exposures associated with increased ESKD risk were age≥65 years (adjusted hazard ratio [aHR], 2.0; 95% CI, 1.2 to 3.2), male sex (aHR, 2.3; 95% CI, 1.3 to 4.3), preoperative diabetes (aHR, 1.8; 95% CI, 1.0 to 3.3), American Society of Anesthesiologists classification ≥3 (aHR, 4.0; 95% CI, 2.2 to 7.4), socioeconomic disadvantage (aHR, 1.6; 95% CI, 0.9 to 2.7), and postoperative length of hospitalization ≥6 days (aHR, 2.1; 95% CI, 1.4 to 3.0). Australia-wide trends indicate that the rate of kidney replacement therapy after oncologic nephrectomy doubled between 1995 and 2015, from 0.3 to 0.6 per 100,000 per year. CONCLUSIONS In Queensland between 2009 and 2014, one in 53 patients managed with radical nephrectomy and one in 100 patients managed with partial nephrectomy developed ESKD within 3 years of surgery. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_09_28_CJASNPodcast_18_1_.mp3.
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Affiliation(s)
- Robert J. Ellis
- Departments of Nephrology and
- Centre for Kidney Disease Research, Faculty of Medicine
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
- Cancer Causes and Care Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia; and
| | - Daniel P. Edey
- Centre for Kidney Disease Research, Faculty of Medicine
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | - Sharon J. Del Vecchio
- Urology, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, Faculty of Medicine
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | - Megan McStea
- Australasian Kidney Trials Network
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | | | - Carmel M. Hawley
- Departments of Nephrology and
- Centre for Kidney Disease Research, Faculty of Medicine
- Australasian Kidney Trials Network
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
| | - David W. Johnson
- Departments of Nephrology and
- Centre for Kidney Disease Research, Faculty of Medicine
- Australasian Kidney Trials Network
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
| | - Christudas Morais
- Urology, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, Faculty of Medicine
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | - Susan J. Jordan
- Schools of Public Health and
- Cancer Causes and Care Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia; and
| | - Ross S. Francis
- Departments of Nephrology and
- Centre for Kidney Disease Research, Faculty of Medicine
- Australasian Kidney Trials Network
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
| | - Simon T. Wood
- Urology, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, Faculty of Medicine
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | - Glenda C. Gobe
- Centre for Kidney Disease Research, Faculty of Medicine
- Biomedical Sciences, and
- NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
| | - Cancer Alliance Queensland
- Departments of Nephrology and
- Urology, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Kidney Disease Research, Faculty of Medicine
- Australasian Kidney Trials Network
- Schools of Public Health and
- Biomedical Sciences, and
- NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Australia
- Kidney Disease Research Collaborative, Translational Research Institute, Brisbane, Australia
- Cancer Causes and Care Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia; and
- Australian and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
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15
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Suk-Ouichai C, Wu J, Dong W, Tanaka H, Wang Y, Zhang J, Caraballo E, Remer E, Li J, Isharwal S, Campbell SC. Tumor Contact Surface Area As a Predictor of Functional Outcomes After Standard Partial Nephrectomy: Utility and Limitations. Urology 2018. [DOI: 10.1016/j.urology.2018.02.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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16
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Kassouf W, Monteiro LL, Drachenberg DE, Fairey AS, Finelli A, Kapoor A, Lattouf JB, Leveridge MJ, Power NE, Pouliot F, Rendon RA, Sabbagh R, So AI, Tanguay S, Breau RH. Canadian Urological Association guideline for followup of patients after treatment of non-metastatic renal cell carcinoma. Can Urol Assoc J 2018; 12:231-238. [PMID: 30139427 DOI: 10.5489/cuaj.5462] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Wassim Kassouf
- Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Adrian S Fairey
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Anil Kapoor
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Robert Sabbagh
- Division of Urology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Simon Tanguay
- Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
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17
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Edgcumbe P, Singla R, Pratt P, Schneider C, Nguan C, Rohling R. Follow the light: projector-based augmented reality intracorporeal system for laparoscopic surgery. J Med Imaging (Bellingham) 2018; 5:021216. [PMID: 29487888 DOI: 10.1117/1.jmi.5.2.021216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/22/2018] [Indexed: 01/20/2023] Open
Abstract
A projector-based augmented reality intracorporeal system (PARIS) is presented that includes a miniature tracked projector, tracked marker, and laparoscopic ultrasound (LUS) transducer. PARIS was developed to improve the efficacy and safety of laparoscopic partial nephrectomy (LPN). In particular, it has been demonstrated to effectively assist in the identification of tumor boundaries during surgery and to improve the surgeon's understanding of the underlying anatomy. PARIS achieves this by displaying the orthographic projection of the cancerous tumor on the kidney's surface. The performance of PARIS was evaluated in a user study with two surgeons who performed 32 simulated robot-assisted partial nephrectomies. They performed 16 simulated partial nephrectomies with PARIS for guidance and 16 simulated partial nephrectomies with only an LUS transducer for guidance. With PARIS, there was a significant reduction [30% ([Formula: see text])] in the amount of healthy tissue excised and a trend toward a more accurate dissection around the tumor and more negative margins. The combined point tracking and reprojection root-mean-square error of PARIS was 0.8 mm. PARIS' proven ability to improve key metrics of LPN surgery and qualitative feedback from surgeons about PARIS supports the hypothesis that it is an effective surgical navigation tool.
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Affiliation(s)
- Philip Edgcumbe
- University of British Columbia, MD/PhD Program, Vancouver, Canada
| | - Rohit Singla
- University of British Columbia, Department of Electrical and Computer Engineering, Vancouver, Canada
| | - Philip Pratt
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Caitlin Schneider
- University of British Columbia, Department of Electrical and Computer Engineering, Vancouver, Canada
| | - Christopher Nguan
- University of British Columbia, Department of Urological Sciences, Vancouver, Canada
| | - Robert Rohling
- University of British Columbia, Department of Electrical and Computer Engineering, Vancouver, Canada.,University of British Columbia, Department of Mechanical Engineering, Vancouver, Canada
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18
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Taweemonkongsap T, Suk-Ouichai C, Chotikawanich E, Jitpraphai S, Woranisarakul V, Ramart P, Phinthusophon K, Amornvesukit T, Leewansangtong S, Srinualnad S, Nualyong C. The Impact of Arterial Clamping Technique in Robot-Assisted Partial Nephrectomy on Renal Function and Surgical Outcomes: Six-Year Experience at Siriraj Hospital, Thailand. Urol Int 2018; 100:301-308. [DOI: 10.1159/000486319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/12/2017] [Indexed: 01/20/2023]
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19
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Leppert JT, Lamberts RW, Thomas IC, Chung BI, Sonn GA, Skinner EC, Wagner TH, Chertow GM, Brooks JD. Incident CKD after Radical or Partial Nephrectomy. J Am Soc Nephrol 2018; 29:207-216. [PMID: 29018140 PMCID: PMC5748903 DOI: 10.1681/asn.2017020136] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/19/2017] [Indexed: 01/30/2023] Open
Abstract
The comparative effectiveness of partial nephrectomy versus radical nephrectomy to preserve kidney function has not been well established. We determined the risk of clinically significant (stage 4 and higher) CKD after radical or partial nephrectomy among veterans treated for kidney cancer in the Veterans Health Administration (2001-2013). Among patients with preoperative eGFR≥30 ml/min per 1.73 m2, the incidence of CKD stage 4 or higher after radical (n=9759) or partial nephrectomy (n=4370) was 7.9% overall. The median time to stage 4 or higher CKD after surgery was 5 months, after which few patients progressed. In propensity score-matched cohorts, partial nephrectomy associated with a significantly lower relative risk of incident CKD stage 4 or higher (hazard ratio, 0.34; 95% confidence interval [95% CI], 0.26 to 0.43, versus radical nephrectomy). In a parallel analysis of patients with normal or near-normal preoperative kidney function (eGFR≥60 ml/min per 1.73 m2), partial nephrectomy was also associated with a significantly lower relative risk of incident CKD stage 3b or higher (hazard ratio, 0.15; 95% CI, 0.11 to 0.19, versus radical nephrectomy) in propensity score-matched cohorts. Competing risk regression models produced consistent results. Finally, patients treated with a partial nephrectomy had reduced risk of mortality (hazard ratio, 0.55; 95% CI, 0.49 to 0.62). In conclusion, compared with radical nephrectomy, partial nephrectomy was associated with a marked reduction in the incidence of clinically significant CKD and with enhanced survival. Postoperative decline in kidney function occurred mainly in the first year after surgery and appeared stable over time.
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Affiliation(s)
- John T Leppert
- Departments of Urology,
- Division of Urology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
- Stanford Kidney Cancer Research Program, Department of Urology, Stanford University, Stanford, California
- Medicine, and
| | | | | | - Benjamin I Chung
- Departments of Urology
- Stanford Kidney Cancer Research Program, Department of Urology, Stanford University, Stanford, California
| | - Geoffrey A Sonn
- Departments of Urology
- Stanford Kidney Cancer Research Program, Department of Urology, Stanford University, Stanford, California
| | - Eila C Skinner
- Departments of Urology
- Stanford Kidney Cancer Research Program, Department of Urology, Stanford University, Stanford, California
| | - Todd H Wagner
- Division of Urology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
- Stanford Kidney Cancer Research Program, Department of Urology, Stanford University, Stanford, California
- Surgery, Stanford University School of Medicine, Stanford, California
| | - Glenn M Chertow
- Stanford Kidney Cancer Research Program, Department of Urology, Stanford University, Stanford, California
- Medicine, and
| | - James D Brooks
- Departments of Urology
- Stanford Kidney Cancer Research Program, Department of Urology, Stanford University, Stanford, California
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20
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Wu J, Suk-Ouichai C, Dong W, Antonio EC, Derweesh IH, Lane BR, Demirjian S, Li J, Campbell SC. Analysis of survival for patients with chronic kidney disease primarily related to renal cancer surgery. BJU Int 2017; 121:93-100. [PMID: 28834125 DOI: 10.1111/bju.13994] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To evaluate predictors of long-term survival for patients with chronic kidney disease primarily due to surgery (CKD-S). Patients with CKD-S have generally good survival that approximates patients who do not have CKD even after renal cancer surgery (RCS), yet there may be heterogeneity within this cohort. PATIENTS AND METHODS From 1997 to 2008, 4 246 patients underwent RCS at our centre. The median (interquartile range [IQR]) follow-up was 9.4 (7.3-11.0) years. New baseline glomerular filtration rate (GFR) was defined as highest GFR between nadir and 6 weeks after RCS. We retrospectively evaluated three cohorts: no-CKD (new baseline GFR of ≥60 mL/min/1.73 m2 ); CKD-S (new baseline GFR of <60 mL/min/1.73 m2 but preoperative GFR of ≥60 mL/min/1.73 m2 ); and CKD due to medical aetiologies who then require RCS (CKD-M/S, preoperative and new baseline GFR both <60 mL/min/1.73 m2 ). Analysis focused primarily on non-renal cancer-related survival (NRCRS) for the CKD-S cohort. Kaplan-Meier analysis assessed the longitudinal impact of new baseline GFR (45-60 mL/min/1.73 m2 vs <45 mL/min/1.73 m2 ) and Cox regression evaluated relative impact of preoperative GFR, new baseline GFR, and relevant demographics/comorbidities. RESULTS Of the 4 246 patients who underwent RCS, 931 had CKD-S and 1 113 had CKD-M/S, whilst 2 202 had no-CKD even after RCS. Partial/radical nephrectomy (PN/RN) was performed in 54%/46% of the patients, respectively. For CKD-S, 641 patients had a new baseline GFR of 45-60 mL/min/1.73 m2 and 290 had a new baseline GFR of <45 mL/min/1.73 m2 . Kaplan-Meier analysis showed significantly reduced NRCRS for patients with CKD-S with a GFR of <45 mL/min/1.73 m2 compared to those with no-CKD or CKD-S with a GFR of 45-60 mL/min/1.73 m2 (both P ≤ 0.004), and competing risk analysis confirmed this (P < 0.001). Age, gender, heart disease, and new baseline GFR were all associated independently with NRCRS for patients with CKD-S (all P ≤ 0.02). CONCLUSION Our data suggest that CKD-S is heterogeneous, and patients with a reduced new baseline GFR have compromised survival, particularly if <45 mL/min/1.73 m2 . Our findings may have implications regarding choice of PN/RN in patients at risk of developing CKD-S.
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Affiliation(s)
- Jitao Wu
- Glickman Urological and Kidney Institute, Cleveland, OH, USA.,Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Chalairat Suk-Ouichai
- Glickman Urological and Kidney Institute, Cleveland, OH, USA.,Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wen Dong
- Glickman Urological and Kidney Institute, Cleveland, OH, USA.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | | | - Ithaar H Derweesh
- Department of Urology, University of California San Diego Health System, San Diego, CA, USA
| | - Brian R Lane
- Division of Urology, Spectrum Health, Michigan State University, Grand Rapids, MI, USA
| | - Sevag Demirjian
- Glickman Urological and Kidney Institute, Cleveland, OH, USA
| | - Jianbo Li
- Glickman Urological and Kidney Institute, Cleveland, OH, USA.,Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
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21
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Zabell J, Demirjian S, Lane BR, Derweesh IH, Isharwal S, Suk-Ouichai C, Wu J, Palacios DA, Campbell SC. Predictors of Long-Term Survival after Renal Cancer Surgery. J Urol 2017; 199:384-392. [PMID: 28859893 DOI: 10.1016/j.juro.2017.08.096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE Renal cancer surgery can adversely impact long-term function and survival. We evaluated predictors of chronic kidney disease 5 years and nonrenal cancer mortality 10 years after renal cancer surgery. MATERIALS AND METHODS We analyzed the records of 4,283 patients who underwent renal cancer surgery from 1997 to 2008. Radical and partial nephrectomy were performed in 46% and 54% of patients, respectively. Cumulative probability ordinal modeling was used to predict chronic kidney disease status 5 years after surgery and multivariable logistic regression was used to predict nonrenal cancer mortality at 10 years. Relevant patient, tumor and functional covariates were incorporated, including the preoperative glomerular filtration rate (A), the new baseline glomerular filtration rate after surgery (B) and the glomerular filtration rate loss related to surgery (C), that is C = A - B. In contrast, partial or radical nephrectomy was not used in the models due to concerns about strong selection bias associated with the choice of procedure. RESULTS Multivariable modeling established the preoperative glomerular filtration rate and the glomerular filtration rate loss related to surgery as the most important predictors of the development of chronic kidney disease (Spearman ρ = 0.78). Age, gender and race had secondary roles. Significant predictors of 10-year nonrenal cancer mortality were the preoperative glomerular filtration rate, the new baseline glomerular filtration rate, age, diabetes and heart disease (all p <0.05). Multivariable modeling established age and the preoperative glomerular filtration rate as the most important predictors of 10-year nonrenal cancer mortality (c-index 0.71) while the glomerular filtration rate loss related to surgery only changed absolute mortality estimates 1% to 3%. CONCLUSIONS Glomerular filtration rate loss related to renal cancer surgery, whether due to partial or radical nephrectomy, influences the risk of chronic kidney disease but it may have less impact on survival. In contrast, age and the preoperative glomerular filtration rate, which reflects general health status, are more robust predictors of nonrenal cancer mortality, at least in patients with good preoperative function or mild chronic kidney disease.
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Affiliation(s)
- Joseph Zabell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sevag Demirjian
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian R Lane
- Department of Urology, Spectrum Health Medical Group, Michigan State University, Grand Rapids, Michigan
| | - Ithaar H Derweesh
- Department of Urology, University of California-San Diego Health System, San Diego, California
| | - Sudhir Isharwal
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Chalairat Suk-Ouichai
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Division of Urology, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jitao Wu
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio; Department of Urology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | | | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
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22
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Damasceno-Ferreira JA, Bechara GR, Costa WS, Pereira-Sampaio MA, Sampaio FJB, Souza DBD. The relationship between renal warm ischemia time and glomerular loss. An experimental study in a pig model. Acta Cir Bras 2017; 32:334-341. [PMID: 28591362 DOI: 10.1590/s0102-865020170050000002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/07/2017] [Indexed: 02/07/2023] Open
Abstract
Purpose: To investigate the glomerular number after different warm ischemia times. Methods: Thirty two pigs were assigned into four groups. Three groups (G10, G20, and G30) were treated with 10, 20, and 30 minutes of left renal warm ischemia. The sham group underwent the same surgery without renal ischemia. The animals were euthanized after 3 weeks, and the kidneys were collected. Right kidneys were used as controls. The kidney weight, volume, cortical-medullar ratio, glomerular volumetric density, volume-weighted mean glomerular volume, and the total number of glomeruli per kidney were obtained. Serum creatinine levels were assessed pre and postoperatively. Results: Serum creatinine levels did not differ among the groups. All parameters were similar for the sham, G10, and G20 groups upon comparison of the right and left organs. The G30 group pigs' left kidneys had lower weight, volume, and cortical-medullar ratio and 24.6% less glomeruli compared to the right kidney. A negative correlation was found between warm ischemia time and glomerular number. Conclusions: About one quarter of glomeruli was lost after 30 minutes of renal warm ischemia. No glomeruli loss was detected before 20 minutes of warm ischemia. However, progressive glomerular loss was associated with increasing warm ischemia time.
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Affiliation(s)
- José Aurelino Damasceno-Ferreira
- Master, Postgraduate Program in Physiopathology and Surgical Sciences, Urogenital Research Unit, Universidade Estadual do Rio de Janeiro (UERJ). Assistant Professor, Department of Veterinary Clinical Pathology, Universidade Federal Fluminense (UFF), Niteroi-RJ, Brazil. Conception and design of the study, acquisition and interpretation of data, final approval
| | - Gustavo Ruschi Bechara
- Master, Postgraduate Program in Physiopathology and Surgical Sciences, Urogenital Research Unit, UERJ, Rio de Janeiro-RJ, Brazil. Acquisition and interpretation of data, manuscript preparation, final approval
| | - Waldemar Silva Costa
- PhD, Visiting Researcher, Postgraduate Program in Physiopathology and Surgical Sciences, Urogenital Research Unit, UERJ, Rio de Janeiro-RJ, Brazil. Conception and design of the study, acquisition and interpretation of data, final approval
| | - Marco Aurélio Pereira-Sampaio
- PhD, Associate Professor, Postgraduate Program in Physiopathology and Surgical Sciences, Urogenital Research Unit, UERJ, Rio de Janeiro-RJ. Associate Professor, Department of Morphology, UFF, Niteroi-RJ, Brazil. Conception and design of the study, acquisition and interpretation of data, manuscript preparation, final approval
| | - Francisco José Barcellos Sampaio
- PhD, Full Professor, Head, Postgraduate Program in Physiopathology and Surgical Sciences. Head, Urogenital Research Unit, UERJ, Rio de Janeiro-RJ, Brazil. Conception and design of the study, acquisition and interpretation of data, final approval
| | - Diogo Benchimol De Souza
- PhD, Associate Professor, Postgraduate Program in Physiopathology and Surgical Sciences, Urogenital Research Unit, UERJ, Rio de Janeiro-RJ, Brazil. Conception and design of the study, acquisition and interpretation of data, manuscript preparation, final approval
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Luo Y, Chen SS, Bai L, Luo L, Zheng XG, Wang S. Nephron Sparing Surgery Has Better Oncologic Outcomes Than Extirpative Nephrectomy in T1a but Not in T1b or T2 Stage Renal Cell Carcinoma. Med Sci Monit 2017; 23:3480-3488. [PMID: 28717119 PMCID: PMC5529611 DOI: 10.12659/msm.903563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/11/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the benefit of nephron sparing surgery (NSS) compared with extirpative nephrectomy in different tumor stages of renal cell carcinoma. MATERIAL AND METHODS We reviewed the Surveillance, Epidemiology and End Results (SEER) database for NSS and extirpative nephrectomy in localized (stages T1-2N0M0) renal cell carcinoma diagnosed after 2004. We used the variable screening function of the SEER database to identified 55,947 cases that met inclusion and exclusion criteria for survival analysis. Overall mortality and cancer-specific mortality were the primary index outcomes. Stratification analysis was done by T stage subgroups. We also performed survival analysis using propensity score analysis, and changed the survival model to the competing-risk model for cancer-specific mortality analysis. RESULTS Overall, NSS significantly decreased the risk of overall mortality (HR 0.717, 0.668-0.769) and cancer-specific mortality (HR 0.604, 0.525-0.694) when compared to extirpative nephrectomy. In subgroup analysis, NSS had a lower overall mortality risk and cancer-specific mortality compared to extirpative nephrectomy only for T1a stage renal cell carcinoma (HR 0.654, 0.599-0.714, p<0.01 and HR 0.554, 0.458-0.670, p<0.01, respectively), but not for T1b or T2 stage. The propensity score analysis, which included standardized mortality ratio weight adjustment, showed the same results. Additionally, for cancer-specific mortality, a competing-risk model gave the exactly same outcome. CONCLUSIONS Compared to extirpative nephrectomy, NSS provided superior overall survival and cancer-specific survival for localized renal cell carcinoma only in T1a stage, not in T1b or T2 stage. NSS should be recommended when the surgery is possible. Further prospective study is needed to confirm this result.
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Affiliation(s)
- You Luo
- Corresponding Authors: You Luo, e-mail: , Sen Wang, e-mail:
| | | | | | | | | | - Sen Wang
- Corresponding Authors: You Luo, e-mail: , Sen Wang, e-mail:
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24
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Quantitative computer-aided diagnostic algorithm for automated detection of peak lesion attenuation in differentiating clear cell from papillary and chromophobe renal cell carcinoma, oncocytoma, and fat-poor angiomyolipoma on multiphasic multidetector computed tomography. Abdom Radiol (NY) 2017; 42:1919-1928. [PMID: 28280876 DOI: 10.1007/s00261-017-1095-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the performance of a novel, quantitative computer-aided diagnostic (CAD) algorithm on four-phase multidetector computed tomography (MDCT) to detect peak lesion attenuation to enable differentiation of clear cell renal cell carcinoma (ccRCC) from chromophobe RCC (chRCC), papillary RCC (pRCC), oncocytoma, and fat-poor angiomyolipoma (fp-AML). MATERIALS AND METHODS We queried our clinical databases to obtain a cohort of histologically proven renal masses with preoperative MDCT with four phases [unenhanced (U), corticomedullary (CM), nephrographic (NP), and excretory (E)]. A whole lesion 3D contour was obtained in all four phases. The CAD algorithm determined a region of interest (ROI) of peak lesion attenuation within the 3D lesion contour. For comparison, a manual ROI was separately placed in the most enhancing portion of the lesion by visual inspection for a reference standard, and in uninvolved renal cortex. Relative lesion attenuation for both CAD and manual methods was obtained by normalizing the CAD peak lesion attenuation ROI (and the reference standard manually placed ROI) to uninvolved renal cortex with the formula [(peak lesion attenuation ROI - cortex ROI)/cortex ROI] × 100%. ROC analysis and area under the curve (AUC) were used to assess diagnostic performance. Bland-Altman analysis was used to compare peak ROI between CAD and manual method. RESULTS The study cohort comprised 200 patients with 200 unique renal masses: 106 (53%) ccRCC, 32 (16%) oncocytomas, 18 (9%) chRCCs, 34 (17%) pRCCs, and 10 (5%) fp-AMLs. In the CM phase, CAD-derived ROI enabled characterization of ccRCC from chRCC, pRCC, oncocytoma, and fp-AML with AUCs of 0.850 (95% CI 0.732-0.968), 0.959 (95% CI 0.930-0.989), 0.792 (95% CI 0.716-0.869), and 0.825 (95% CI 0.703-0.948), respectively. On Bland-Altman analysis, there was excellent agreement of CAD and manual methods with mean differences between 14 and 26 HU in each phase. CONCLUSION A novel, quantitative CAD algorithm enabled robust peak HU lesion detection and discrimination of ccRCC from other renal lesions with similar performance compared to the manual method.
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25
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Correas JM, Delavaud C, Gregory J, Le Guilchet T, Lamhaut L, Timsit MO, Méjean A, Hélénon O. Ablative Therapies for Renal Tumors: Patient Selection, Treatment Planning, and Follow-Up. Semin Ultrasound CT MR 2017; 38:78-95. [DOI: 10.1053/j.sult.2016.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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26
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Lopes RI, Lorenzo AJ. Reply by the Authors. Urology 2016; 100:259-260. [PMID: 27890684 DOI: 10.1016/j.urology.2016.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 11/16/2016] [Accepted: 11/18/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Roberto Iglesias Lopes
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
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27
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Gu L, Ma X, Li H, Chen L, Xie Y, Li X, Gao Y, Zhang Y, Zhang X. Comparison of oncologic outcomes between partial and radical nephrectomy for localized renal cell carcinoma: A systematic review and meta-analysis. Surg Oncol 2016; 25:385-393. [PMID: 27916170 DOI: 10.1016/j.suronc.2016.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/21/2016] [Accepted: 09/02/2016] [Indexed: 12/21/2022]
Abstract
To date, there remain uncertainties over the oncological outcomes for partial and radical nephrectomy of localized renal cell carcinoma (RCC). A systematic review and meta-analysis was performed. Eligible studies were retrieved from PubMed, Embase, Cochrane Library and Web of Science databases. The endpoints of oncologic outcomes included overall survival (OS), cancer-specific survival (CSS) and recurrence-free survival (RFS). Multivariable adjusted hazard ratios (HRs) were used to evaluate each endpoint. We used the Newcastle-Ottawa scale to assess risk of bias. Fourteen cohort studies of low to moderate risk of bias involving 28,764 patients were included. Adjusted variables and follow-up length varied between studies. The results showed that patients with localized RCC who underwent partial nephrectomy (PN) had a superior OS (HR: 0.81, 95% confidence interval (CI): 0.74-0.89; P < 0.001) compared with those underwent radical nephrectomy (RN). However, the CSS (HR: 0.85, 95% CI: 0.73-1.01; P = 0.060) and RFS (HR: 0.66, 95% CI: 0.34-1.31; P = 0.239) seem to be similar for patients underwent PN and RN. Most of subgroup analyses according to year of publication, patient population, geographic region and NOS score did not alter the direction of results. PN for localized RCC is associated with better OS, similar CSS and RFS compared with RN based on observational data with low to moderate risk of bias. Methodological limitations of the observational studies included should be considered while interpreting these results.
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Affiliation(s)
- Liangyou Gu
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xin Ma
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Hongzhao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Luyao Chen
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Yongpeng Xie
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China; School of Medicine, Nankai University, Tianjin, China
| | - Xintao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Yu Gao
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Yu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
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28
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Shen K, Johnson DW, Gobe GC. The role of cGMP and its signaling pathways in kidney disease. Am J Physiol Renal Physiol 2016; 311:F671-F681. [PMID: 27413196 DOI: 10.1152/ajprenal.00042.2016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/10/2016] [Indexed: 01/20/2023] Open
Abstract
Cyclic nucleotide signal transduction pathways are an emerging research field in kidney disease. Activated cell surface receptors transduce their signals via intracellular second messengers such as cAMP and cGMP. There is increasing evidence that regulation of the cGMP-cGMP-dependent protein kinase 1-phosphodiesterase (cGMP-cGK1-PDE) signaling pathway may be renoprotective. Selective PDE5 inhibitors have shown potential in treating kidney fibrosis in patients with chronic kidney disease (CKD), via their downstream signaling, and these inhibitors also have known activity as antithrombotic and anticancer agents. This review gives an outline of the cGMP-cGK1-PDE signaling pathways and details the downstream signaling and regulatory functions that are modulated by cGK1 and PDE inhibitors with regard to antifibrotic, antithrombotic, and antitumor activity. Current evidence that supports the renoprotective effects of regulating cGMP-cGK1-PDE signaling is also summarized. Finally, the effects of icariin, a natural plant extract with PDE5 inhibitory function, are discussed. We conclude that regulation of cGMP-cGK1-PDE signaling might provide novel, therapeutic strategies for the worsening global public health problem of CKD.
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Affiliation(s)
- Kunyu Shen
- Centre for Kidney Disease Research, School of Medicine, Translational Research Institute, The University of Queensland, Brisbane, Australia; Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China; and
| | - David W Johnson
- Centre for Kidney Disease Research, School of Medicine, Translational Research Institute, The University of Queensland, Brisbane, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Glenda C Gobe
- Centre for Kidney Disease Research, School of Medicine, Translational Research Institute, The University of Queensland, Brisbane, Australia;
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29
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Raman JD, Jafri SM, Qi D. Kidney function outcomes following thermal ablation of small renal masses. World J Nephrol 2016; 5:283-287. [PMID: 27152264 PMCID: PMC4848151 DOI: 10.5527/wjn.v5.i3.283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/13/2016] [Accepted: 03/23/2016] [Indexed: 02/06/2023] Open
Abstract
The diagnosis of small renal masses (SRMs) continues to increase likely attributable to widespread use of axial cross-sectional imaging. Many of these SRMs present in elderly patients with abnormal baseline renal function. Such patients are at risk for further decline following therapeutic intervention. Renal thermal ablation presents one approach for management of SRMs whereby tumors are treated in situ without need for global renal ischemia. These treatment characteristics contribute to favorable renal function outcomes following kidney tumor ablation particularly in patients with an anatomic or functional solitary renal unit.
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30
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O'Donnell K, Tourojman M, Tobert CM, Kirmiz SW, Riedinger CB, Demirjian S, Lane BR. Proteinuria is a Predictor of Renal Functional Decline in Patients with Kidney Cancer. J Urol 2016; 196:658-63. [PMID: 27018509 DOI: 10.1016/j.juro.2016.03.134] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE Prior studies have shown that 26% to 34% of patients with suspected renal cancers have a glomerular filtration rate less than 60 ml/minute/1.73 m(2) but limited information exists regarding proteinuria. We investigated the extent of proteinuria in patients with renal tumors to determine the impact on the classification and progression of chronic kidney disease. MATERIALS AND METHODS Among 1,622 patients evaluated between 1999 and 2014, 1,016 had preoperative creatinine and proteinuria measurements available. Patients were classified according to the risk of chronic kidney disease progression into low, moderately increased, high and very high risk groups according to 2012 KDIGO guidelines. Predictors of risk group and chronic kidney disease progression were analyzed using univariable and multivariate models. RESULTS Before treatment 32% had a glomerular filtration rate less than 60 ml/minute/1.73 m(2). Preoperative proteinuria was present in 22%. Proteinuria was detected in 30% with a reduced glomerular filtration rate and 18% with a normal glomerular filtration rate. Among the 44% at increased risk for chronic kidney disease progression 24%, 12% and 8% were at moderately increased, high and very high risk, respectively. The presence of proteinuria also reclassified 25% with stage III chronic kidney disease as high or very high risk. KDIGO classification predicted renal functional decline, which occurred in 2.2%, 4.4%, 9.4% and 34.6% at 3 years in low, moderately increased, high and very high risk categories, respectively. Predictors of KDIGO group included age and tumor size (each p <0.001), and the main predictors of renal functional decline were KDIGO group, tumor size and radical nephrectomy (each p <0.0001). CONCLUSIONS Identification of chronic kidney disease using only glomerular filtration rate left 18% of patients undiagnosed. The assessment of glomerular filtration rate and proteinuria classified patients according to risk of chronic kidney disease progression, identifying 44% to be at increased risk. As proteinuria predicted renal functional decline, we advocate for routine evaluation before treatment.
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Affiliation(s)
- Kelly O'Donnell
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | | | - Conrad M Tobert
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Samer W Kirmiz
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | | | - Sevag Demirjian
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian R Lane
- Michigan State University College of Human Medicine, Grand Rapids, Michigan; Spectrum Health Hospital System, Grand Rapids, Michigan.
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