Interpreting nephrometry scores with three-dimensional virtual modelling for better planning of robotic partial nephrectomy and predicting complications

Bianchi, Lorenzo; Schiavina, Riccardo; Bortolani, Barbara; Cercenelli, Laura; Gaudiano, Caterina; Carpani, Giulia; Rustici, Arianna; Droghetti, Matteo; Mottaran, Angelo; Boschi, Sara; Salvador, M.; Chessa, F.; Cochetti, Giovanni; Golfieri, Rita; Bertaccini, Alessandro; Marcelli, Emanuela

doi:10.1016/j.urolonc.2021.07.024

Cited by 17 publications

(15 citation statements)

References 18 publications

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“… 54 In Europe, similarly, the proportion of patients diagnosed with early-stage RCC has experienced an upward trend over the past few decades, owing to the influence of stage migration. 55 Besides, it is similar to the epidemiological trend of kidney cancer in China that the incidence, mortality, ASIR and ASMR increased in most European Union (EU) 15+ countries and World Health Organization (WHO) regions from 1990 to 2019. 56 Chinmay et al also reported the mortality-to-incidence ratio (MIR) decreased in all EU countries and WHO regions.…”

Section: Discussionmentioning

confidence: 59%

Epidemiological Trends of Kidney Cancer Along with Attributable Risk Factors in China from 1990 to 2019 and Its Projections Until 2030: An Analysis of the Global Burden of Disease Study 2019

Xu¹,

Zhang²,

Xia³

et al. 2023

CLEP

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Background Understanding the past and future burden of kidney cancer in China over years provides essential references for optimizing the prevention and management strategies. Methods The data on incidence, mortality, disability-adjusted life-years (DALYs) and age-standardized rates of kidney cancer in China, 1990–2019, were collected from the database of Global Burden of Disease Study 2019. The estimated annual percentage change (EAPC) was calculated to depict the trends of kidney cancer burden, and Bayesian age-period-cohort analysis was used to predict the incidence and mortality in the next decade. Results Over the past 30 years, the number of new kidney cancer cases sharply increased from 11.07 thousand to 59.83 thousand, and the age-standardized incidence rate (ASIR) tripled from 1.16/100,000 to 3.21/100,000. The mortality and DALYs also presented an increasing pattern. Smoking and high body mass index were mainly risk factors for kidney cancer. We predicted that by 2030, the incident cases and deaths of kidney cancer would increase to 126.8 thousand and 41.8 thousand, respectively. Conclusion In the past 30 years, the kidney cancer burden gradually increased in China, and it will continue to rise in the next decade, which reveals more targeted intervention measures are necessary.

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Section: Discussionmentioning

confidence: 59%

Epidemiological Trends of Kidney Cancer Along with Attributable Risk Factors in China from 1990 to 2019 and Its Projections Until 2030: An Analysis of the Global Burden of Disease Study 2019

Xu¹,

Zhang²,

Xia³

et al. 2023

CLEP

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“…Before surgery, many aspects should be investigated: planning a conversion to RN, surgical technique, transperitoneal or retroperitoneal approach, selection of blood vessels for clamping, tumor resection margin and need of UCS suture. In the current era of precision surgery, the introduction of 3D models allow to simplify the anatomical knowledge of renal mass and to easily assess the surgical complexity (14), allowing a patient-tailored approach for PN (15).…”

Section: Discussionmentioning

confidence: 99%

“…Segmentation was achieved using D2P ™ software ('DICOM to PRINT'; 3D Systems Inc., Rock Hill, SC). The segmentation results and the anatomical correctness of the reconstructed 3D virtual models (14,15) were reviewed and validated by surgeons and radiologists.…”

Section: D Modelingmentioning

confidence: 99%

“…Thus, a critical and detailed comprehension of tumour's complexity is essential to achieve optimal success of PN. Nowadays, 3D models facilitate the understanding of renal anatomy (11,12) and are more accurate to assess with higher accuracy surgical complexity of renal masses compared to 2D imaging (13,14) and to predict surgical outcomes (15). Likewise in prostate cancer robotic surgery (16)(17)(18)(19), 3D models may have strong implications for surgical planning.…”

Section: Introductionmentioning

confidence: 99%

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3D renal model for surgical planning of partial nephrectomy: A way to improve surgical outcomes

et al. 2022

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Objectiveto evaluate the impact of 3D model for a comprehensive assessment of surgical planning and quality of partial nephrectomy (PN).Materials and methods195 patients with cT1-T2 renal mass scheduled for PN were enrolled in two groups: Study Group (n= 100), including patients referred to PN with revision of both 2D computed tomography (CT) imaging and 3D model; Control group (n= 95), including patients referred to PN with revision of 2D CT imaging. Overall, 20 individuals were switched to radical nephrectomy (RN). The primary outcome was the impact of 3D models-based surgical planning on Trifecta achievement (defined as the contemporary absence of positive surgical margin, major complications and ≤30% postoperative eGFR reduction). The secondary outcome was the impact of 3D models on surgical planning of PN. Multivariate logistic regressions were used to identify predictors of selective clamping and Trifecta’s achievement in patients treated with PN (n=175).ResultsOverall, 73 (80.2%) patients in Study group and 53 (63.1%) patients in Control group achieved the Trifecta (p=0.01). The preoperative plan of arterial clamping was recorded as clampless, main artery and selective in 22 (24.2%), 22 (24.2%) and 47 (51.6%) cases in Study group vs. 31 (36.9%), 46 (54.8%) and 7 (8.3%) cases in Control group, respectively (p<0.001). At multivariate logistic regressions, the use of 3D model was found to be independent predictor of both selective or super-selective clamping and Trifecta’s achievement.Conclusion3D-guided approach to PN increase the adoption of selective clamping and better predict the achievement of Trifecta.

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“…Acknowledging these limitations, the current paper represents the largest series so far to explore the clinical and surgical predictors of PSMs after robot-assisted PN that is verified through a standardized tumor-resection reporting system. In this scenario, we identified future perspectives to improve preoperative surgical planning and maximize both oncological and functional outcomes: (1) three dimensional reconstructions [ 29 , 30 ] can enhance the perceiving of tumor anatomy and vascularization, allowing a wiser and more accurate choice of the most appropriate resection technique; (2) integrating preoperative nomograms [ 6 ] and novel radiological scores [ 31 ] in a more comprehensive decision-making tool can contribute to tailoring surgical approaches to patients eligible for PN; (3) to accredit only high-volume centers to perform PN might pave the way to the employment of such novel technologies in everyday clinical practice, maximizing postoperative outcomes and cost-effectiveness of PN. However, larger studies are warranted to confirm our results in different clinical scenarios and to assess the impact of resection technique on mid- and long-term functional and oncologic outcomes after PN.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Positive Surgical Margins after Robot-Assisted Partial Nephrectomy for Localized Renal Tumors: Insights from a Large Multicenter International Prospective Observational Project (The Surface-Intermediate-Base Margin Score Consortium)

Maida

Campi

Lane

et al. 2022

JCM

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Background: To explore predictors of positive surgical margins (PSM) after robotic partial nephrectomy (PN) in a large multicenter international observational project, harnessing the Surface-Intermediate-Base (SIB) margin score to report the resection technique after PN in a standardized way. Methods: Data from consecutive patients with cT1-2N0M0 renal masses treated with PN from September 2014 to March 2015 at 16 tertiary referral centers and included in the SIB margin score International Consortium were prospectively collected. For the present study, only patients treated with robotic PN were included. Uni- and multivariable analysis were fitted to explore clinical and surgical predictors of PSMs after PN. Results: Overall, 289 patients were enrolled. Median (IQR) preoperative tumor size was 3.0 (2.3–4.2) cm and median (IQR) PADUA score was 8 (7–9). SIB scores of 0–2 (enucleation), 3–4 (enucleoresection) and 5 (resection) were reported in 53.3%, 27.3% and 19.4% of cases, respectively. A PSM was recorded in 18 (6.2%) patients. PSM rate was 4.5%, 11.4% and 3.6% in case of enucleation, enucleoresection and resection, respectively. Patients with PSMs had tumors with a higher rate of contact with the urinary collecting system (55.6% vs. 27.3%; p < 0.001) and a longer median warm ischemia time (22 vs. 16 min; p = 0.02) compared with patients with negative surgical margins, while no differences emerged between the two groups in terms of other tumor features (i.e., pathological diameter, PADUA score). In multivariable analysis, only enucleoresection (SIB score 3–4) versus enucleation (SIB score 0–2) was found to be an independent predictor of PSM at final pathology (HR: 2.68; 95% CI: 1.25–7.63; p = 0.04), while resection (SIB score 5) was not. Conclusions: In our experience, enucleoresection led to a higher risk of PSMs as compared to enucleation. Further studies are needed to assess the differential impacts of resection technique and surgeon’s experience on margin status after robotic PN.

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Interpreting nephrometry scores with three-dimensional virtual modelling for better planning of robotic partial nephrectomy and predicting complications

Cited by 17 publications

References 18 publications

Epidemiological Trends of Kidney Cancer Along with Attributable Risk Factors in China from 1990 to 2019 and Its Projections Until 2030: An Analysis of the Global Burden of Disease Study 2019

Epidemiological Trends of Kidney Cancer Along with Attributable Risk Factors in China from 1990 to 2019 and Its Projections Until 2030: An Analysis of the Global Burden of Disease Study 2019

3D renal model for surgical planning of partial nephrectomy: A way to improve surgical outcomes

Predictors of Positive Surgical Margins after Robot-Assisted Partial Nephrectomy for Localized Renal Tumors: Insights from a Large Multicenter International Prospective Observational Project (The Surface-Intermediate-Base Margin Score Consortium)

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