Choice of Surgical Options in Kidney Cancer and Surgical Complications

Wasserman, Meredith; Sobel, David; Pareek, Gyan

doi:10.1016/j.semnephrol.2019.12.005

Cited by 13 publications

(44 citation statements)

References 54 publications

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“…Over the last decade, robotic assisted laparoscopic partial nephrectomy has become the primary treatment modality for clinical T1 renal tumors [1][2][3] . The use of nephron sparing surgery leads to improved preservation of renal function, reduction of metabolic and cardiovascular sequelae, and acceptable oncologic outcome 2,[4][5][6][7][8][9] . Although partial nephrectomy is the most commonly performed procedure for small renal tumors, the impact of predictable preoperative variables has not been well evaluated [10][11][12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

Identifying Preoperative Predictors of Operative Time and Their Impact on Outcomes in Robot-Assisted Partial Nephrectomy

Krishnan

Zappia

Calaway

et al. 2022

Journal of Endourology

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Objective: To identify preoperative characteristics in patients with renal masses that influence operative time during robot-assisted partial nephrectomy (RAPN) and evaluate the relationship between operative time and length of stay, complication rates, and overall outcome. Methods:We queried our institutional database to identify a cohort of patients who underwent RAPN by two experienced robotic surgeons between 2012 and 2019. A multivariable regression model was developed to analyze operative time, length of stay, and any grade complication within 30 days postoperatively using bootstrap resampling technique.Results: A total of 392 patients were included. On multivariable analyses, prior abdominal surgery (p=0.001) was associated with 22 minute increase in operating room time; as well as adhesive perirenal fat (22 minutes, p=0.001). For each one unit increase in nephrometry score, there was a four minute increase in operating room time (p=0.028), and for each one cm increase in tumor size, there was an associated 12 minute increase in operating room time (p<0.001). For each one year increase in age, there was an associated 0.024 day increase in length of stay [(odds ratio (0.013-0.035)]; additionally, for every one cm increase in tumor size there was a 0.18 day associated increase in length of stay [OR (0.070-0.28)]. Each one hour increase in operating room time was associated with a 0.25 day increased length of stay [OR (0.092, 0.41)]. Only tumor size was found to be associated with any grade complication. Conclusions:Patients with a history of abdominal surgery, larger complex tumors, and significant Gerota's fat undergoing robotic partial nephrectomy should anticipate longer operative times. Older patients with larger tumors and longer operative times can anticipate a longer length of stay. Tumor size appears to be the common determinant of all three outcomes: operative time, length of stay, and any grade Clavien complication.

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Section: Introductionmentioning

confidence: 99%

Identifying Preoperative Predictors of Operative Time and Their Impact on Outcomes in Robot-Assisted Partial Nephrectomy

Krishnan

Zappia

Calaway

et al. 2022

Journal of Endourology

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“…The reported complications were mostly vascular injury and organ injury, which had more serious and dangerous consequences and often required further surgical intervention or conversion to open surgery [13,33,34]. In retroperitoneal laparoscopic surgery, peritoneal injury was not uncommon; however, reported cases were not frequent.…”

Section: Discussionmentioning

confidence: 99%

The Modification and Optimization of Retroperitoneal Laparoscopic Radical Nephrectomy for the Treatment of Localized Renal Cell Carcinoma

Zhang

Zhou

Bai

et al. 2020

Preprint

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Background: We report our modified surgical technique of retroperitoneal laparoscopic radical nephrectomy (RLRN) and assess its perioperative outcomes and postoperative complications, with a focus on operative time (OT). Methods: We retrospectively analyzed a single-center, single-surgeon cohort of 130 consecutive patients who underwent RLRN between January 2015 and March 2019. A study group of 65 patients who received modified RLRN was compared with a control group of 65 patients who received classical RLRN. OT, estimated blood loss ( EBL ), perioperative complications, postoperative first exhaust time (PFET), pathological stage, and postoperative hospital stay (PHS) were compared between the two groups. Results: All demographic, clinical, and pathological variables were comparable between the groups. No differences were observed in perioperative complications (p=0.648), peritoneal injuries (p=0.843), PFET (p=0.448), pathological stage (p=0.767), and PHS (p=0.304). The modified RLRN group resulted in a significantly reduced overall OT (53.8±8.4 min vs. 60.5±10.6 min, p=0.000), peritoneal injury intervention subgroup OT (56.3±9.8 min vs. 75.2±12.4 min, p=0.000), and EBL (55.7±10.1 mL vs. 62.3±11.6 mL, p=0.001) compared with the classical RLRN group. We observed a significant reduction in OT and EBL but no increase in postoperative complications, PFET, or PHS with modified versus traditional RLRN for localized renal carcinoma.Conclusions: Findings from this study present a modified RLRN surgical technique that is standardized, more precise, and has better practicability.

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“…Surgical intervention is the standard treatment for all stages of RCC, although the approach and techniques vary depending on the stage and the patient' s clinical condition. 14,16,17 However, active surveillance (AS) is an option for patients for whom the risks of aggressive treatment outweigh the benefits. Excluded from AS are patients who are reasonable candidates for aggressive treatment if the size and infiltrative characteristics, internal growth, or pathology of the renal mass suggest progression of the malignancy.…”

Section: Treatment Options: An Over Viewmentioning

confidence: 99%

“…The surgeon may elect to perform PN as an open procedure or through a laparoscopic, robotassisted approach. 14,16,17 • Radiofrequency ablation (application of heat) and cryoablation (application of cold/freezing) are options in patients with Stage I RCCs smaller than 3 cm. An important advantage for radiofrequency ablation and cryoablation techniques compared with PN is their superior ability to preserve renal tissue.…”

Section: Treatment Options: An Over Viewmentioning

confidence: 99%