Peritumoral pseudocapsule status according to pathological characteristics from robot‐assisted laparoscopic partial nephrectomy for localized renal cell carcinoma

Abstract

Objective To investigate peritumoral pseudocapsule status in patients with renal cell carcinoma who underwent robot‐assisted laparoscopic partial nephrectomy, and to examine predictive factors associated with the absence of peritumoral pseudocapsule. Methods A total of 367 patients with clinical T1 renal cell carcinoma who underwent robot‐assisted laparoscopic partial nephrectomy were divided into two groups according to peritumoral pseudocapsule status. The groups were compared in terms of patient and tumor characteristics. Multivariate logistic regression analysis was carried out to identify predictive factors for the absence of peritumoral pseudocapsule. Results Of the 367 tumors, 323 (88%) were surrounded by a peritumoral pseudocapsule. The mean tumor size was 30 mm, and 70% of the patients were male. Tumors with a peritumoral pseudocapsule had a larger diameter than those without (31 vs 26 mm; P = 0.0008). A peritumoral pseudocapsule was observed in 92% of the clear cell, in 89% of the papillary and in 86% of the clear cell papillary renal cell carcinoma cases compared with just 50% in the chromophobe renal cell carcinoma cases (P < 0.0001). Sex, age, Fuhrman grade and tumor complexity did not differ among patients. A multivariate analysis showed that smaller tumor size (≥34 vs <34 mm, odds ratio 3.31; P = 0.0023) and chromophobe renal cell carcinoma (vs other subtypes, odds ratio 12.5; P < 0.0001) predicted an absence of peritumoral pseudocapsule. Conclusions Small tumor size and chromophobe renal cell carcinoma were significant predictors of a lack of peritumoral pseudocapsule, suggesting that a positive surgical margin must be avoided for these tumors when an enucleation technique is used for robot‐assisted laparoscopic partial nephrectomy.

Differences in clinical and computed tomography imaging features between two types of mixed epithelial and stromal tumor of the kidney: Suggestions for patient management

“…Thus, MESTK Type B in our study presents as a multiloculated lesion with regular or irregular septa, which is different from type A (28). In addition, type B lesions have more capsules, caused by compression of adjacent renal tissue by the tumors correlating with the larger size of these tumors (29,30).…”

Differentiating the clinical and computed tomography imaging features of mixed epithelial and stromal tumors of the kidney to establish a treatment plan

“…14 In addition, cystic type lesions have more capsules, caused by compression of adjacent renal tissue by the tumors correlating with the larger size of these tumors. 31,32 Limitations of this study are the small number of MESTK cases, retrospective design, and single-center study. With advances in imaging modalities and the rising popularity of health examination, diagnosis of asymptomatic and small MESTK will increase and promote a better treatment plan for patients' management.…”

Clinical outcomes and effect on intraoperative blood loss and postoperative pain of patients undergoing retroperitoneal laparoscopic partial nephrectomy for complex renal tumors

“…Both surgeries were performed by the same group of doctors. The specific steps of performing the OPN treatment were as follows: patients were lying on the healthy side to perform general anesthesia with endotracheal intubation and then had their waist raised after routine disinfection and draping, a 12–15-cm-long incision was made at the lower edge of the 12th rib or between the 11th rib via retroperitoneal approach, the tissues were incised layer by layer to fully expose the peri-renal fascia for routine probing by a self-retractor, and then the peritoneum was pushed forward appropriately to cut open the gerota fascia and separate the peri-renal fascia with the fat layer by layer; after that, the renal artery and the kidney were freed to fully expose the tumor lesion, the renal capsule was cut open by an electrocoagulation knife at 5 mm away from the lesion edge and the excision extension was marked, the renal artery was blocked by the Bulldog vascular clamps, and then the tumor lesion was completely excised along the marking line, as well as partial normal renal parenchymal tissue; after that, the wound was sutured and covered with gauze to stop bleeding, the Bulldog clamps were taken out to observe for signs of bleeding, a drainage tube was indwell, the incision was closed up, and the wound was bound up [ 7 – 9 ].…”

“…Therefore, it is difficult to enucleate or excise complex renal tumors while preserving the nephron because of the deep encapsulation of renal parenchyma and the relatively close proximity to the anatomically complex renal collecting system. As research has progressed, surgical methods including retroperitoneal laparoscopic partial nephrectomy (RLPN), robot-assisted partial nephrectomy (RAPN), and open partial nephrectomy (OPN) have been widely applied in various renal tumor diseases, thus expanding the scope of indications [ 7 – 9 ]. In this study, we compared the clinical efficacy of RLPN with OPN in the treatment of complex renal tumors and analyzed the effect on intraoperative blood loss and postoperative pain in patients, as reported as follows.…”