Nephron-sparing surgery for malignancies in kidney allografts

Varotti, Giovanni; Bertocchi, M.; Barabani, Caterina; Terulla, Alessia; Fontana, I.

doi:10.1111/tri.12641

Cited by 6 publications

(7 citation statements)

References 9 publications

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“…From 1988 to 2016, a total of 56 studies were found reporting on SRMs in transplanted allograft kidneys . Our literature search yielded one multicenter retrospective case series, 19 single‐institution case series, and 36 case reports.…”

Section: Resultsmentioning

confidence: 99%

Solid Renal Masses in Transplanted Allograft Kidneys: A Closer Look at the Epidemiology and Management

Griffith

Amin

Waingankar

et al. 2017

American Journal of Transplantation

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The objective of this review is to explore the available literature on solid renal masses (SRMs) in transplant allograft kidneys to better understand the epidemiology and management of these tumors. A literature review using PubMed was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Fifty-six relevant studies were identified from 1988 to 2015. A total of 174 SRMs in 163 patients were identified, with a mean tumor size of 2.75 cm (range 0.5-9.0 cm). Tumor histology was available for 164 (94.3%) tumors: clear cell renal cell carcinoma (RCC; 45.7%), papillary RCC (42.1%), chromophobe RCC (3%), and others (9.1%). Tumors were managed by partial nephrectomy (67.5%), radical nephrectomy (19.4%), percutaneous radiofrequency ablation (10.4%), and percutaneous cryoablation (2.4%). Of the 131 patients (80.3%) who underwent nephron-sparing interventions, 10 (7.6%) returned to dialysis and eight (6.1%) developed tumor recurrence over a mean follow-up of 2.85 years. Of the 110 patients (67.5%) who underwent partial nephrectomy, 3.6% developed a local recurrence during a mean follow-up of 3.12 years. The current management of SRMs in allograft kidneys mirrors management in the nontransplant population, with notable findings including an increased rate of papillary RCC and similar recurrence rates after partial nephrectomy in the transplant population despite complex surgical anatomy.

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Section: Resultsmentioning

confidence: 99%

Solid Renal Masses in Transplanted Allograft Kidneys: A Closer Look at the Epidemiology and Management

Griffith

Amin

Waingankar

et al. 2017

American Journal of Transplantation

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“…NSS techniques such as enucleation, wedge resection, and PN are now considered the treatment of choice for patients with T1aN0M0 RCC in native kidneys[ 32 , 33 ]. Albeit encouraging, experience in recipients with allograft RCC is limited[ 7 , 9 , 11 , 39 , 42 , 47 ]. Available studies demonstrate that with NSS excellent oncological outcomes can be obtained in patients with T1aN0M0 lesions.…”

Section: Treatment Options and Treatment-specific Outcomesmentioning

confidence: 99%

“…Local recurrence rates of less than 5%, lower post-operative complication rates (between 15% and 21%, depending on the series), marginal impact on allograft function, and the possibility to treat residual or relapsing neoplasms with further conservative strategies support NSS over transplantectomy. Successful resection of localised RCC greater than 4 cm in maximal diameter remains anecdotal and therefore should not favour the use of NSS over graftectomy[ 39 , 41 ]. Main limitations of NSS compared to AT are invasiveness, higher technical difficulty, and increased risk of peri-operative complications[ 7 , 14 , 18 ].…”

Section: Treatment Options and Treatment-specific Outcomesmentioning

confidence: 99%

“…Main limitations of NSS compared to AT are invasiveness, higher technical difficulty, and increased risk of peri-operative complications[ 7 , 14 , 18 ]. Most cases of NSS in transplant setting have been performed using an open technique but minimally invasive approaches have been also described[ 39 , 41 ]. The tumour can be resected getting access to the allograft via a retro- or an intra-peritoneal route depending on the location of the mass[ 39 ].…”

Section: Treatment Options and Treatment-specific Outcomesmentioning

confidence: 99%

“…Most cases of NSS in transplant setting have been performed using an open technique but minimally invasive approaches have been also described[ 39 , 41 ]. The tumour can be resected getting access to the allograft via a retro- or an intra-peritoneal route depending on the location of the mass[ 39 ]. In case of lesions very close to the vessels, renal pedicle control is advised[ 39 ].…”

Section: Treatment Options and Treatment-specific Outcomesmentioning

confidence: 99%

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Treatment options for localised renal cell carcinoma of the transplanted kidney

Motta¹,

Ferraresso²,

Lamperti³

et al. 2020

WJT

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Currently, there is no consensus among the transplant community about the treatment of renal cell carcinoma (RCC) of the transplanted kidney. Until recently, graftectomy was universally considered the golden standard, regardless of the characteristics of the neoplasm. Due to the encouraging results observed in native kidneys, conservative options such as nephron-sparing surgery (NSS) (enucleation and partial nephrectomy) and ablative therapy (radiofrequency ablation, cryoablation, microwave ablation, high-intensity focused ultrasound, and irreversible electroporation) have been progressively used in carefully selected recipients with early-stage allograft RCC. Available reports show excellent patient survival, optimal oncological outcome, and preserved renal function with acceptable complication rates. Nevertheless, the rarity and the heterogeneity of the disease, the number of options available, and the lack of long-term follow-up data do not allow to adequately define treatment-specific advantages and limitations. The role of active surveillance and immunosuppression management remain also debated. In order to offer a better insight into this difficult topic and to help clinicians choose the best therapy for their patients, we performed and extensive review of the literature. We focused on epidemiology, clinical presentation, diagnostic work up, staging strategies, tumour characteristics, treatment modalities, and follow-up protocols. Our research confirms that both NSS and focal ablation represent a valuable alternative to graftectomy for kidney transplant recipients with American Joint Committee on Cancer stage T1aN0M0 RCC. Data on T1bN0M0 lesions are scarce but suggest extra caution. Properly designed multi-centre prospective clinical trials are warranted.

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