Outcomes and Predictors of Clinical T1 to Pathological T3a Tumor Up-Staging after Robotic Partial Nephrectomy: A Multi-Institutional Analysis

Gorin, Michael A.; Ball, Mark W.; Pierorazio, Phillip M.; Tanagho, Youssef S.; Bhayani, Sam B.; Kaouk, Jihad; Rogers, Craig G.; Stifelman, Michael; Khalifeh, Ali; Kumar, Ramesh; Sivarajan, Ganesh; Allaf, Mohamad E.

doi:10.1016/j.juro.2013.06.014

Cited by 95 publications

(95 citation statements)

References 22 publications

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“…30 While we have not compared the rates of margin positivity between LPN and open partial nephrectomy, as this would be limited by selection bias, it is worth considering whether the tumours in this series may have been better managed with open partial nephrectomy if the indication was truly mandatory. It must also be acknowledged that this is a very select group of patients, with most being treated for presumed clinical T1/2 disease.…”

Section: Discussionmentioning

confidence: 98%

Clinical outcomes following laparoscopic management of pT3 renal masses: A large, multi-institutional cohort

Nayak

Patel

Bjazevic

et al. 2015

CUAJ

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Introduction: We described the clinical and oncological outcomes of patients treated by laparoscopic surgery for non-metastatic pT3 renal cell carcinoma (RCC). Methods: We queried a multi-institutional database for patients diagnosed with non-metastatic pathological T3 RCC from 13 Canadian centres treated laparoscopically (radical or partial nephrectomy) between 2008 and 2014. Clinical and pathological outcomes were evaluated. Progression was defined as the development of recurrence or metastatic disease. Log-rank testing and Kaplan-Meier statistical methods assessed for differences and estimated progression-free survival (PFS). Results: In total, 176 patients were identified with a median age of 64 years. The median tumour size was 7.0 cm. Pre-clinical stage was cT1 to cT4 in 39%, 28%, 30% and 3%, respectively. The median blood loss was 150 mL (range: 0-6000) and the median operative time was 124 minutes (range: 60-360). Most lesions were clear cell RCC (80%). After a median follow-up of 17.6 months (range: 0.2-75.0), disease progression occurred in 26% (46/176) of patients, consisting of local recurrence in 7% (3/46), and metastatic disease in 93% (43/46). The 3-year PFS was 67%, with a median PFS of 49 months. Of those who progressed, the median time to progression was 10.3 months. Conclusions: This study is the largest cohort of pT3 RCC patients treated laparoscopically in the literature and suggests that for properly selected patients, laparoscopic management of locally advanced renal masses yields acceptable short-term oncological outcomes.

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Section: Discussionmentioning

confidence: 98%

Clinical outcomes following laparoscopic management of pT3 renal masses: A large, multi-institutional cohort

Nayak

Patel

Bjazevic

et al. 2015

CUAJ

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“…Sokhi et al reported the sensitivity of CT for sinus fat, perirenal fat and renal vein invasion up to 88, 83, 69% respectively [9]. Previously conducted studies reported T3a upstaging rate of 13.3–30.7% [12–14]. …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, previous studies have revealed conflicting findings regarding the prognoses and risk factors for T3a upstaging [12–15]. …”

Section: Introductionmentioning

confidence: 99%

Pathological T3a Upstaging of Clinical T1 Renal Cell Carcinoma: Outcomes According to Surgical Technique and Predictors of Upstaging

et al. 2016

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PurposeTo evaluate the prognosis of pT3a upstaging from cT1 renal cell carcinoma, and to compare the outcomes of partial or radical nephrectomy in cases of pT3a upstaging.Materials and MethodsWe reviewed the records of patients who underwent partial or radical nephrectomy for cT1 at our center between January 2001 and October 2013. We compared the 2-year recurrence-free survivals for cases with pT1 or pT3a upstaging, and for partial or radical nephrectomy in cases with pT3a upstaging. Clinicopathological parameters were analyzed in univariate and multivariate analyses to evaluate their associations with upstaging.ResultsAmong the 1,009 eligible patients, 987 patients were included in the analysis. The mean follow-up was 48.5 ± 27.8 months in whole patients. The 2-year recurrence-free survival was worse in the pT3a upstaging group, compared to the pT1 group (87.3% vs. 98.7%; p < 0.001). Partial nephrectomy and radical nephrectomy had no significant difference in 2-year recurrence-free survivals (91.9% vs. 83.7%; p = 0.251). The multivariate analysis revealed that upstaging was associated with old age, cT1b stage, clinical symptoms, and a high Fuhrman grade.ConclusionsPathological T3a upstaging of cT1 renal cell carcinoma was associated with a poorer prognosis, compared to pT1 disease. However, the surgical technique (radical or partial nephrectomy) did not affect the recurrence rate. Therefore, clinicians should select the treatment method based on the clinical stage, and consider the pathological stage during the follow-up.

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“…After PN, an high tumor complexity was associated with higher grade malignancy, 25 and with pathological tumor up-staging. 26 Few studies on highly complex RCC are available, and most with short follow-up, therefore whether the correlation between adverse pathological findings/poor survival outcome and higher nephrometry score is stronger than that with higher TNM stage is still debated. In a study on 80 patients treated 27 In another study of 19 RPN in RCC with moderate-high nephrometry score, 28 no increased progression rate was found, but with a median follow-up of 22 months only.…”

Section: Discussionmentioning

confidence: 99%

Simple enucleation for the treatment of highly complex renal tumors: Perioperative, functional and oncological results

Serni

Vittori

Frizzi

et al. 2015

European Journal of Surgical Oncology (EJSO)

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Aim: To assess the role of simple enucleation (SE) for the treatment of highly complex renal tumors. Methods: Overall, 96 Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) classification score 10 to 13 renal tumors were treated with SE at our institution. All conventional perioperative variables, surgical, functional and oncological results were gathered in a prospectively maintained database. Survival curves were generated using a KaplaneMeier method. Univariate analysis assessed the outcome differences. Results: Mean (AE1s.d.) clinical tumor diameter was 4.8 (AE1.6 cm). 70.8% of patients had !cT1b stage. The PADUA score was recorded as 10, 11, 12 and 13 in 57.3%, 29.2%, 11.5%, and 2.1% of tumors respectively. Overall, 76 patients were treated with an open approach and 20 robotically. Mean warm ischemia time (WIT) was 19.2 min, and WIT greater than 25 min occurred in 14.6% of cases. Positive surgical margin (PSM) rate was 3.6% and trifecta was achieved in 64.3% of patients. Postoperative surgical complications occurred in 24% of patients, with 14.6% Clavien-Dindo grade 1e2, 8.3% grade 3, and 1% grade 4. Five-year cancer specific survival (CSS), recurrent free survival (RFS), and overall survival (OS) rates resulted 96.1%, 90.8% and 88.0%, respectively. Overall, 4.2% of patients experienced progressive disease. At follow-up, the mean decrease of eGFR from preoperative value was 13.9 ml/min. This was not significantly correlated with PADUA score (p ¼ 0.69). The surgical approach was neither a predictor of Trifecta outcome, nor of postoperative complications, WIT >25 min or PSM rate. Conclusions: SE is an effective treatment for highly-complex renal tumors, with a potential key role to widen the NSS (nephron sparing surgery) indications according to guidelines.

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Outcomes and Predictors of Clinical T1 to Pathological T3a Tumor Up-Staging after Robotic Partial Nephrectomy: A Multi-Institutional Analysis

Cited by 95 publications

References 22 publications

Clinical outcomes following laparoscopic management of pT3 renal masses: A large, multi-institutional cohort

Clinical outcomes following laparoscopic management of pT3 renal masses: A large, multi-institutional cohort

Pathological T3a Upstaging of Clinical T1 Renal Cell Carcinoma: Outcomes According to Surgical Technique and Predictors of Upstaging

Simple enucleation for the treatment of highly complex renal tumors: Perioperative, functional and oncological results

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