Background/Aim: We investigated the prognostic nutritional index (PNI), comprised of lymphocytes and albumin, as a potential prognosticator of metastatic urothelial carcinoma (mUC) patients receiving pembrolizumab. Patients and Methods: Sixty-five patients were retrospectively enrolled and classified as low (<40) and high (≥40) based on pretreatment PNI. Progression-free survival (PFS), overall survival (OS) and response rates were evaluated. Results: In the low PNI group, significantly shorter PFS and OS were observed. PNI was shown to be an independent predictor of PFS and OS in the multivariate analysis. C-index for both PFS and OS improved with the addition of PNI to the model described in the KEYNOTE-045 study. Significantly more patients experienced initial disease progression in the low PNI group. Conclusion: PNI is a useful predictor of prognosis and disease progression in mUC patients receiving pembrolizumab. Patients and MethodsPatients. This retrospective observational study recruited 67 consecutive patients with mUC or relapsed urothelial carcinoma receiving pembrolizumab after the failure of at least one platinum-1607

Objective To evaluate the quality of recovery in patients who underwent robot‐assisted partial nephrectomy and to compare the outcomes of the transperitoneal or retroperitoneal approach. Methods This study included 121 patients who underwent robot‐assisted partial nephrectomy under general anesthesia from April 2019 to September 2019 at Tokyo Women’s Medical University, Tokyo, Japan. Quality of recovery was defined according to the QoR‐40 Japanese version. The participants responded to the QoR‐40 Japanese version on three designated days. The patients were assigned to two groups according to the surgical approach: transperitoneal or retroperitoneal. A multivariate logistic regression analysis was carried out to identify independent factors associated with better quality of recovery. Results Out of the 121 patients, 56 (46%) and 65 (54%) patients were included in the transperitoneal and retroperitoneal group, respectively. Although the QoR‐40 Japanese version scores were not different between the two groups at admission, a better quality of recovery was observed in the retroperitoneal group than in the transperitoneal group at discharge based on the total score: physical comfort, emotional state, physical independence and pain. A multivariate analysis showed that the retroperitoneal approach and male sex were associated with a better QoR‐40 Japanese version score at discharge. Conclusions A retroperitoneal approach offers better quality of recovery than a transperitoneal approach, and therefore it might represent the optimal approach in selected patients undergoing robot‐assisted partial nephrectomy.

Objectives To compare surgical and functional outcomes between robot‐assisted laparoscopic partial nephrectomy and open partial nephrectomy in patients with renal cell carcinoma with stage 4 chronic kidney disease. Methods This was a retrospective analysis of 60 patients with stage 4 chronic kidney disease (estimated glomerular filtration rate 15–30 ml/min/1.73 m2) who underwent partial nephrectomy for T1 renal cell carcinoma between April 2004 and April 2020. We compared perioperative outcomes according to the surgical approach. Multivariable analysis was performed to identify predictive factors for end‐stage renal disease. Results Robot‐assisted laparoscopic partial nephrectomy and open partial nephrectomy were performed in 31 and 29 patients, respectively. The median age was 68 years and 17% of all patients were women. Patient and tumor characteristics did not differ between groups. The operative time (155.2 vs. 221.0 min, p < 0.0001) and the postoperative length of hospital stay (5.2 vs. 10.6 days, p = 0.0083) were significantly shorter, and the estimated blood loss was lower (53.4 vs. 363.2 ml, p = 0.0003) in the robot‐assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group. Preoperative estimated glomerular filtration rate was the only significant predictor of end‐stage renal disease after partial nephrectomy on multivariable analysis. Conclusions Both procedures preserved renal function in this patient cohort, delaying the requirement for postoperative dialysis. Furthermore, robot‐assisted laparoscopic partial nephrectomy was associated with shorter operative time and postoperative length of hospital stay, as well as lesser estimated blood loss than open partial nephrectomy.

Purpose We investigated operative time according to procedure phases in robot‐assisted laparoscopic partial nephrectomy (RAPN) and identify variables associated with longer operative time in each procedure phase. Methods This retrospective, single‐center study included 108 patients who underwent RAPN conducted by an experienced surgeon. Operative time was divided into dissection, resection, tumor bed suture, and renorrhaphy and hemostasis phases, which were derived from the iPhone application “My Intuitives.” Multivariate analyses were performed to identify possible predictors such as sex, body mass index, tumor complexity, and surgical approach for longer operative time in each phase. Results The median console time was 65 min, and median operative times in dissection, resection, tumor bed suture, and renorrhaphy and hemostasis phases were 41, 8, 9, and 8 min, respectively. In the multivariate analysis, longer console time was observed in high complexity tumors (vs. low, OR: 8.01, 95% CI: 1.94–33.0) and transperitoneal approach (vs. retroperitoneal approach, OR: 3.62, 95% CI: 1.94–33.0). High complexity tumors were significantly associated with longer operative time in all procedure phases, and the male sex was associated with a longer operative time in the dissection phase than the female sex (OR: 3.61, 95% CI: 1.18–11.0). Conclusion The identified significant predictive factors associated with longer operative time were the male sex and high complexity in the dissection phase, high complexity in the resection phase, in the tumor bed suture phase as well as in the renorrhaphy and hemostasis phase. These findings may help to predict the difficulty of performing RAPN in terms of operative time.

Angiomyolipoma is a common benign renal tumor. It is typically composed of adipose tissue and hence is easily diagnosed by using imaging methods such as ultrasonography, computed tomography, and magnetic resonance imaging. However, it is difficult to differentiate an atypical angiomyolipoma such as a fat-poor angiomyolipoma from a malignant tumor by using these imaging methods. We report a case of a fat-poor angiomyolipoma with cyst-like changes in a 35-year-old man. The angiomyolipoma was initially suspected to be a cystic renal cell carcinoma according to preoperative imaging studies. A 5-cm cystic tumor with an enhanced septal wall and exophytic formation was present in the middle section of the left kidney. The patient underwent partial nephrectomy. Pathological findings showed necrosis and hematoma in almost the entire lesion, with a small amount of adipose and muscle tissue. Finally, a fat-poor angiomyolipoma was diagnosed.