Background Aim of this study was to evaluate and compare perioperative outcomes of transperitoneal (TP) and retroperitoneal (TR) approaches in a multi-institutional cohort of minimally invasive partial nephrectomy (MI-PN). Material and methods All consecutive patients undergone MI-PN for clinical T1 renal tumors at 26 Italian centers (RECORd2 project) between 01/2013 and 12/2016 were evaluated, collecting the pre-, intra-, and postoperative data. The patients were then stratified according to the surgical approach, TP or RP. A 1:1 propensity score (PS) matching was performed to obtain homogeneous cohorts, considering the age, gender, baseline eGFR, surgical indication, clinical diameter, and PADUA score. Results 1669 patients treated with MI-PN were included in the study, 1256 and 413 undergoing TP and RP, respectively. After 1:1 PS matching according to the surgical access, 413 patients were selected from TP group to be compared with the 413 RP patients. Concerning intraoperative variables, no differences were found between the two groups in terms of surgical approach (lap/robot), extirpative technique (enucleation vs standard PN), hilar clamping, and ischemia time. Conversely, the TP group recorded a shorter median operative time in comparison with the RP group (115 vs 150 min), with a higher occurrence of intraoperative overall, 21 (5.0%) vs 9 (2.1%); p = 0.03, and surgical complications, 18 (4.3%) vs 7 (1.7%); p = 0.04. Concerning postoperative variables, the two groups resulted comparable in terms of complications, positive surgical margins and renal function, even if the RP group recorded a shorter median drainage duration and hospital length of stay (3 vs 2 for both variables), p < 0.0001. Conclusions The results of this study suggest that both TP and RP are feasible approaches when performing MI-PN, irrespectively from tumor location or surgical complexity. Notwithstanding longer operative times, RP seems to have a slighter intraoperative complication rate with earlier postoperative recovery when compared with TP.

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Background. Circulating Tumor Cells (CTCs) correlate with adverse prognosis in breast, colorectal, lung and prostate cancer patients. Little data is available for Renal Cell Carcinoma (RCC). Materials and Methods. We designed a multicenter prospective observational study to assess the correlation between CTC counts and Progression Free Survival (PFS) in metastatic RCC patients treated with an anti-angiogenic tyrosine kinase inhibitor as a first-line regimen; Overall Survival (OS) and response were secondary objectives. CTC counts were enumerated by the Cellsearch ® system at 4 time points: day 0 of treatment, day 28, day 56 and then at progression, or at 12 months in the absence of progression. Results. 195 eligible patients with a median age of 69 years were treated with sunitinib (77.5%) or pazopanib (21%). At baseline, 46.7% of patients had 1 or more CTCs/mL (range, 1 to 263). Thirty patients had ≥ 3 CTCs, with a median PFS of 5.8 vs 15 months in the remaining patients (p = 0.002), HR = 1.99, independently of the International Metastatic RCC Database Consortium (IMDC) score at multivariate analysis (HR: 1.91, 95% CI: 1.16-3.14). Patients with ≥ 3 CTCs had a shorter estimated OS of 13.8 months vs 52.8 months in those with <3 CTCs (p = 0.003), HR = 1.99 (multivariate analysis HR: 1.67, 95% CI: 0.95-2.93). Baseline CTC counts did not correlate with response, as well as having CTC sequencing counts ≥ 1, 2, 3, 4 or 5. Conclusions. We provide prospective evidence that the presence of 3 or more CTCs at baseline is associated with a significantly shorter PFS and OS in mRCC patients. The Oncologist ;9999:• • Implications for Practice: In this prospective study we evaluated whether the presence of circulating tumor cells (CTC) in the peripheral blood correlate with activity of first-line tyrosine kinase inhibitors in metastatic Renal Cell Carcinoma (RCC).