Partial versus radical nephrectomy for complex renal mass: multicenter comparative analysis of functional outcomes (Rosula collaborative group)

Cerrato, Clara; Meagher, Margaret; Autorino, Riccardo; Simone, Giuseppe; Yang, Bo; Uzzo, Robert G.; Kutikov, Alexander; Porpiglia, Francesco; Capitanio, Umberto; Montorsi, Francesco; Porter, James; Beksaç, Alp Tuna; Puri, Dhruv; Nguyen, Minh-Khai; Wang, Luke L.; Hakimi, Kevin; Dhanji, Sohail; Liu, Franklin; Cerruto, Maria Angela; Pandolfo, Savio Domenico; Minervini, Andrea; Lau, Clayton; MONISH, Aron; Eun, Daniel; Mottrie, Alexandre; Mir, Carmen; Sundaram, Chandru P.; Antonelli, Alessandro; Kaouk, Jihad; Derweesh, Ithaar

doi:10.23736/s2724-6051.23.05123-6

Cited by 13 publications

(8 citation statements)

References 41 publications

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“…Lastly, EAU guidelines also report, among risk factors for more aggressive cancer, patients’ related characteristics, such as ethnicity, with African-American patients having worse outcomes, advancing age, tobacco consumption, delayed surgery, high comorbidity and performance indices scores, and several blood-based biomarkers even if no prognostic biomarkers are validated for clinical use (LE: 3) [ 43 , 44 , 45 , 46 , 47 ]. These latter characteristics are mentioned in the AUA/SUO, but the panel considers them to be not widely available, easily identified, or measured, thereby limiting broad applicability.…”

Section: Resultsmentioning

confidence: 99%

Upper Tract Urothelial Cancer: Guideline of Guidelines

Pandolfo,

Cilio,

Aveta

et al. 2024

Cancers

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Background: Upper tract urothelial carcinoma (UTUC) is a rare disease with a potentially dismal prognosis. We systematically compared international guidelines on UTUC to analyze similitudes and differences among them. Methods: We conducted a search on MEDLINE/PubMed for guidelines related to UTUC from 2010 to the present. In addition, we manually explored the websites of urological and oncological societies and journals to identify pertinent guidelines. We also assessed recommendations from the International Bladder Cancer Network, the Canadian Urological Association, the European Society for Medical Oncology, and the International Consultation on Bladder Cancer, considering their expertise and experience in the field. Results: Among all the sources, only the American Urologist Association (AUA), European Association of Urology (EAU), and the National Comprehensive Cancer Network (NCCN) guidelines specifically report data on diagnosis, treatment, and follow-up of UTUC. Current analysis reveals several differences between all three sources on diagnostic work-up, patient management, and follow-up. Among all, AUA and EAU guidelines show more detailed indications. Conclusions: Despite the growing incidence of UTUC, only AUA, EAU, and NCCN guidelines deal with this cancer. Our research depicted high variability in reporting recommendations and opinions. In this regard, we encourage further higher-quality research to gain evidence creating higher grade consensus between guidelines.

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Section: Resultsmentioning

confidence: 99%

Upper Tract Urothelial Cancer: Guideline of Guidelines

Pandolfo,

Cilio,

Aveta

et al. 2024

Cancers

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“…The primary goals of PN include control tumors, avoid perioperative complications, and renal functional preservation ( 18 ). Compared to RN, PN has demonstrated superior renal functional preservation in patients who underwent surgery for renal tumors ( 19 , 20 ). It was confirmed that preoperative renal function, quantity of preserved renal parenchyma, and warm ischemia time (WIT) were related to postoperative renal function after PN, among which WIT is an important and modifiable factor that can be modified by adapting surgical technique ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

How many cases are required to achieving early proficiency in purely off-clamp robot-assisted partial nephrectomy?

Zhang,

Wang,

Liu

et al. 2024

Front. Surg.

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Background and purposeOff-clamp robot-assisted partial nephrectomy (Offc-RAPN) is a technically challenging procedure that can effectively avoid renal ischemia owing to the absence of hilar vessel preparation and clamping. However, data on the learning curve (LC) for this technique are limited. The purpose of this study was to assess the LC of Offc-RAPN and compare the perioperative outcomes between different learning phases.MethodsThis retrospective study included 50 consecutive patients who underwent purely Offc-RAPN between January 2022 and April 2023. Multidimensional cumulative sum (CUSUM) analysis method was used to assess LC. Spearman's correlation and LOWESS analysis were performed to analyze the continuous variables of perioperative outcomes. Baseline characteristics and perioperative outcomes were compared using χ2-test, t-test and U-test.ResultsCUSUM analysis identified two LC phases: phase I (the first 24 cases) and phase II (the subsequent 26 cases). Phase II showed significant reductions in mean operative time (133.5 vs. 115.31 min; p = 0.04), mean console time (103.21 vs. 81.27 min; p = 0.01), and mean postoperative length of stay (5.33 vs. 4.30 days; p = 0.04) compared to phase I. However, no significant differences were observed in other perioperative outcomes or baseline characteristics between the two LC phases.ConclusionsOffc-RAPN performed by a surgeon with experience in laparoscopic and robotic surgeries achieved early proficiency in 24 cases. Moreover, Offc-RAPN alone is safe and feasible even in the initial phase of the LC for an experienced surgeon.

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“…Furthermore, changes in the dimensions of an SRM during thermal ablation also contribute to predicting the likelihood of LTP [13,62]. As the RCC shrinks, there is a reduction in the probability of local recurrence, owing to the decreased number of viable tumor cells.…”

Section: Imaging In Post-ablative Techniques Follow-up: Strategies An...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…However, it is widely recognized that SRMs usually are low-grade, slow-progressing tumors with limited metastatic potential [8,9]. To mitigate surgery-related morbidity and preserve renal function, ablative techniques have been developed as an alternative to PN in patients with SRMs [9][10][11][12][13][14][15][16][17]. Particularly, these techniques should be preferred in elderly patients with multiple comorbidities and pre-existing renal conditions, such as chronic kidney disease, hereditary and/or multiple tumors, and cases of solitary kidneys [18,19].…”

Section: Introductionmentioning

confidence: 99%

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Ablative Treatments for Small Renal Masses and Management of Recurrences: A Comprehensive Review

Aveta,

Iossa,

Spena

et al. 2024

Life

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This review focuses on ablative techniques for small renal masses (SRMs), including radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), and irreversible electroporation (IRE), and discusses recurrence management. Through an extensive literature review, we outline the procedures, outcomes, and follow-up strategies associated with each ablative method. The review provides a detailed examination of these techniques—RFA, CA, MWA, and IRE—elucidating their respective outcomes. Recurrence rates vary among them, with RFA and CA showing comparable rates, MWA demonstrating favorable short-term results, and IRE exhibiting promise in experimental stages. For managing recurrences, various strategies are considered, including active surveillance, re-ablation, or salvage surgery. Surveillance is preferred post-RFA and post-CA, due to slow SRM growth, while re-ablation, particularly with RFA and CA, is deemed feasible without additional complications. Salvage surgery emerges as a viable option for larger or resistant tumors. While ablative techniques offer short-term results comparable to surgery, further research is essential to understand their long-term effects fully. Decisions concerning recurrence management should consider individual and tumor-specific factors. Imaging, notably contrast-enhanced ultrasounds, plays a pivotal role in assessing treatment success, emphasizing the necessity of a multidisciplinary approach for optimal outcomes. The lack of randomized trials highlights the need for further research.

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Partial versus radical nephrectomy for complex renal mass: multicenter comparative analysis of functional outcomes (Rosula collaborative group)

Cited by 13 publications

References 41 publications

Upper Tract Urothelial Cancer: Guideline of Guidelines

Upper Tract Urothelial Cancer: Guideline of Guidelines

How many cases are required to achieving early proficiency in purely off-clamp robot-assisted partial nephrectomy?

Ablative Treatments for Small Renal Masses and Management of Recurrences: A Comprehensive Review

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