Outcome of Nephron-Sparing Surgery: Elective versus Imperative Indications

Kural, Ali Rıza; Demi̇rkesen, Oktay; Önal, Bülent; Öbek, Can; Tunç, Burçin; Önder, Ali Ulvi; Yalçın, Veli; Solok, Vural

doi:10.1159/000071845

Cited by 38 publications

(33 citation statements)

References 35 publications

(80 reference statements)

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“…Nephron sparing surgery is only advisable to those patients with single kidney or those where contralateral kidney tend to be jeopardised in near future. [67] We currently favor elective simple nephrectomy as the treatment of choice for MCRCC. Families are provided with balanced information, fully informing them of the risks of surgery, and the potential morbidity associated with it, thereby allowing them to take an active part in the decision-making process.…”

Section: Discussionmentioning

confidence: 99%

Multilocular cystic renal cell carcinoma a diagnostic dilemma: A case report in a 30-year-old woman

et al. 2013

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Multilocular cystic renal cell carcinoma (MCRCC), also known as multilocular clear cell renal cell carcinoma (RCC), is a rare cystic tumor of the kidney with an excellent outcome. It occurs in about 3.1-6% of the conventional RCC. It is usually included in the group of tumors of undetermined malignant potential with low nuclear grade. We present a case of MCRCC in a 30-year-old female patient presenting incidentally as an apparently benign-looking multicystic space occupying lesion in the upper pole of right kidney. Right-sided simple nephrectomy was performed, and on histopathologic examination it was found to be MCRCC, stage 1 with Fuhrman nuclear grade 1. Immunohistochemistry with epithelial membrane antigen and vimentin confirmed the diagnosis.

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Section: Discussionmentioning

confidence: 99%

Multilocular cystic renal cell carcinoma a diagnostic dilemma: A case report in a 30-year-old woman

et al. 2013

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“…Nephron-sparing surgery is an effective and reliable treatment in low stage renal tumors [1] . Clamping the renal pedicle allows better visualization, helping accurate tumor excision and hemostatic suturing of the parenchymal defect [2] , however it entails renal ischemia and sometimes leads to ischemic injury when it is prolonged.…”

Section: Introductionmentioning

confidence: 99%

Decrease of Renal Function due to Warm Ischemia after Laparoscopic Partial Nephrectomy: Evaluation Using <sup>99m</sup>Tc-DMSA Renal Scintigraphy

Tachikake

Shigeta²,

Mita³

et al. 2009

Urol Int

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Introduction: The purpose of this study is, using technetium-99m-dimercaptosuccinic acid (^99mTc-DMSA), to evaluate the decrease of renal function caused by warm ischemia. Patients and Methods: The ^99mTc-DMSA scan was performed before and 1, 3 and 6 months after the operation for 19 consecutive patients. The patients were divided into three groups by warm ischemic time (group A: ≤40 min, B: >40 min ∩ ≤60 min, C: >60 min). Renal function of the unresected part was defined as the uptake to unresected part relative to the uptake to the contralateral kidney. The reduction of renal function was expressed as a ratio of the function after the surgery divided by function before the surgery and was compared between the three groups. Results: The reduction in group C after 1 and 3 months tended to be greater than that in group A or B, although not reaching statistical significance (one-way ANOVA test, 1 month: p = 0.15 and 3 months: p = 0.13). There was a significant difference in reduction of renal function between the three groups after 6 months (one-way ANOVA test, p = 0.02). The Scheffé test showed a statistical significance between groups A and C (p < 0.05). Conclusion: Renal function calculated by ^99mTc-DMSA shows that prolonged ischemic time causes significant damage to the kidney.

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“…[67] In a study of 76 patients (50 elective cases and 26 imperative cases), major complications were significantly higher in patients in the absolute arm ( P = 0.000). [6] In a review of 155 cases of open PN between 1980 and 2005, Coffin et al . reported that elective cases were associated with better perioperative outcomes ( P = 0.01).…”

Section: Discussionmentioning

confidence: 99%

“…In the study by Kural et al ., there was no significant change in serum creatinine levels between preoperative and postoperative levels between the two arms. [6] Long et al . showed no difference in CKD upstaging between the two arms and the percentage change in GFR was actually lower in the imperative arm.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative complications and postoperative outcomes of partial nephrectomy for renal cell carcinoma: Does indication matter?

et al. 2017

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Introduction:The aim of the study was to determine whether perioperative complications and postoperative outcomes varied with the indication of partial nephrectomy (PN).Materials and Methods:We reviewed data of 184 consecutive PN for suspected renal cell carcinoma operated between January 2004 and December 2013. Complications using the Clavien-Dindo classification were compared between surgeries for absolute indications (chronic renal failure, bilateral tumors, or solitary kidney), those for relative indications (comorbid illnesses with the potential to affect renal function) and elective indications (patients without risk factors). Complex tumors were defined as size >7 cm, multiple, hilar, and endophytic tumors.Results:Patients with an absolute indication had larger tumors (P = 0.001) and tumors of a higher pathological T-stage (P = 0.03). Minor complications (Clavien 1 and 2) occurred in 25.4% patients in the elective arm versus over 40% in the other arms (P = 0.049). Major complications (Clavien 3+) were less common in the elective arm (3.2% cases vs. 12.7% in the relative arm and 13.8% in the absolute arm) with a trend to significance (P = 0.09). On multivariate analysis, absolute indication (odds ratio [OR] = 2.4, P = 0.04) and surgery for a complex renal mass (OR = 2.5 times, P = 0.03) remained significant predictors of minor complications. Major complications were more common in the relative (OR = 5.5, P = 0.057) and absolute indication arm (OR = 5.231, P = 0.051) with a trend toward significance.Conclusions:Elective indication was associated with fewer complications than PN for relative or absolute indications.

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Outcome of Nephron-Sparing Surgery: Elective versus Imperative Indications

Cited by 38 publications

References 35 publications

Multilocular cystic renal cell carcinoma a diagnostic dilemma: A case report in a 30-year-old woman

Multilocular cystic renal cell carcinoma a diagnostic dilemma: A case report in a 30-year-old woman

Decrease of Renal Function due to Warm Ischemia after Laparoscopic Partial Nephrectomy: Evaluation Using <sup>99m</sup>Tc-DMSA Renal Scintigraphy

Perioperative complications and postoperative outcomes of partial nephrectomy for renal cell carcinoma: Does indication matter?

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