Preservation of Renal Function Following Partial or Radical Nephrectomy Using 24-Hour Creatinine Clearance

Clark, Aaron T.D.; Breau, Rodney H.; Morash, Chris; Fergusson, Dean; Doucette, Steve; Cagiannos, Ilias

doi:10.1016/j.eururo.2008.03.037

Cited by 65 publications

(38 citation statements)

References 30 publications

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“…Though previous work has demonstrated the impact of surgical approach on estimates of renal function 2,137 , this is the first demonstration of hard outcomes of renal failure. This is an important finding in and of itself, given the current lack of data in this aspect of the literature along with the continuing debate regarding the overall benefit of PN compared to RN across a spectrum of outcomes.…”

Section: Discussionmentioning

confidence: 99%

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

European Urology Supplements

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The surgical management of renal masses involves either radical nephrectomy (RN) or partial nephrectomy (PN). PN has been associated with better long-term renal function, and has also been linked to improved cardiac morbidity and overall survival. However, the relationship between treatment choice and definitive outcomes of chronic kidney disease (CKD) are lacking. Our aim was to examine whether PN is associated with a lower risk of end-stage renal disease (ESRD) requiring renal replacement therapy.We performed a population-based, retrospective cohort study with data from linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed renal cell carcinoma (RCC) diagnosed between 1995 and 2010. Cox proportional hazards (PH) models, propensity score models, and competing risks models were used to assess the impact of treatment choice. PN compared to RN reduces the risk of ESRD requiring renal replacement therapy in a modern cohort of patients (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). PN is associated with a lower risk of new-onset CKD, lower risk of cardiac morbidity, and improved overall survival. We provide further evidence for the benefit of PN compared to RN, particularly related to definitive outcomes of renal failure.iii ACKNOWLEDGEMENTS

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Section: Discussionmentioning

confidence: 99%

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

European Urology Supplements

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“…[10][11][12][13] Partial nephrectomy is the more complex surgical procedure and is associated with increased risk of perioperative complications compared to radical nephrectomy. 14,15 Therefore, patients are offered partial nephrectomy if the perceived benefits outweigh the subjective risk.…”

Section: Discussionmentioning

confidence: 99%

The association between renal tumour scoring systems and ischemia time during open partial nephrectomy

Lavallée¹,

Desantis

Kamal

et al. 2013

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Preoperative patient characteristics (age, gender, preoperative renal function, diabetes, hypertension, smoking history, heart disease) and ischemia time were abstracted from medical records. Preoperative computed tomography (CT) images were reviewed and tumours were characterized using three scoring systems: (1) R.E.N.A.L. nephrometry score (radius, exophytic/endophytic properties, nearness of tumour to the collecting system or sinus in millimetres, anterior/posterior, location relative to polar lines); (2) preoperative aspects and dimensions used for anatomic (PADUA) classification; and (3) Centrality index (C index). Patients without preoperative CT and patients treated with laparoscopic partial nephrectomy were excluded. Results: During the study period, 78 patients met the inclusion criteria. Median R.E.N.A.L. score was 7 (interquartile range [IQR] 5-8), median PADUA score was 8 (IQR 7-10), and mean C index was 3.9 (standard deviation [SD] 2.1). Mean ischemia time was 23.4 (SD 10.8) minutes. Five individual tumour characteristics (diameter, nearness to collecting system, anterior/posterior location, medial/lateral location, and collecting system involvement) were strongly associated with ischemia time (p < 0.05). Increased R.E.N.A.L. score (1.5 minutes per unit 95%CI 0.08, 2.9, p = 0.04) and PADUA score (2.0 minutes per unit 95%CI 0.5, 3.5, p = 0.009) were significantly associated with ischemia time. An increasing C index score was also associated with ischemia time (-1.1 minutes per unit 95%CI -2.2, 0.04, p = 0.06), but the association was not statistically significant. Conclusion: Renal tumour characteristics are associated with ischemia time. The proposed scoring systems are useful descriptors of surgical complexity and should be used when describing partial nephrectomy patients. Prospective evaluation and refinement of scoring systems are required to create an optimized model prior to widespread application. IntroductionThe decision to perform radical versus partial nephrectomy for renal tumours is currently based on the subjective assessment of feasibility and patient preferences. Renal tumour scoring systems are designed to characterize tumours, facilitate cohort comparisons and allow for the prediction of surgical outcomes. Three scoring systems have been proposed and require validation: (1) R.E.N.A.L. nephrometry score (radius, exophytic/endophytic properties, nearness of tumour to the collecting system or sinus in millimeters, anterior/ posterior, location relative to polar lines); (2) preoperative aspects and dimensions used for anatomic (PADUA) classification; and (3) Centrality index (C index).1-3 The R.E.N.A.L. and PADUA systems categorize tumour characteristics and provide an overall score with a high score associated with more complex features. The C index method derives one number that reflects tumour size and distance from the centre of the kidney with a lower score representing tumours that are larger and closer to the kidney centre.Scoring systems are helpful if they are able to predict...

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“…Studies have shown similar oncological outcomes with less impact on renal function in comparison with radical nephrectomy [8][9][10]. However, complication rates associated with partial nephrectomy may approach 20%, whether performed openly or laparoscopically [11].…”

Section: Introductionmentioning

confidence: 98%

“…Patients were assessed regularly for evidence of any complications and serum creatinine levels were monitored daily for at least 3 days. Patients were followed for a mean (range) of 15 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) months. Routine postoperative cross-sectional imaging was undertaken at 3 months to assess for evidence of disease recurrence or metastasis and then 6-monthly or annually thereafter.…”

Section: Specimen Analysismentioning

confidence: 99%

Laparoscopic high‐intensity focused ultrasound for renal tumours: a proof of concept study

et al. 2010

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Study Type – Therapy (case series) Level of Evidence What’s known on the subject? and What does the study add? Renal cancer is increasingly diagnosed when tumours are small and asymptomatic, during routine abdominal imaging. Whilst surgery is an effective and potentially curative option, it carries a significant risk of complications. Recent work suggests that thermally ablative therapies (RFA, cryotherapy, HIFU) may be suitable minimally invasive treatment options in selected patients. The success of extracorporeal HIFU has been limited by the abdominal wall and rib‐cage limiting energy delivery. For this study, a purpose‐built laparoscopic HIFU probe was designed to allow direct application of the transducer to the tumour surface, thus facilitating tumour destruction. Successful and accurate tumour destruction was demonstrated, paving the way for further clinical trials, subject to device modifications. OBJECTIVE To test and establish clinical proof of concept for a laparoscopic high‐intensity focused ultrasound (HIFU) device that facilitates delivery of ultrasound by direct application of a probe to the tumour surface. PATIENTS AND METHODS Twelve patients with renal tumours were treated with laparoscopic HIFU using a newly designed probe inserted via an 18‐mm laparoscopic port. HIFU treatment was targeted at a pre‐defined proportion of the tumour and immediate laparoscopic partial or radical nephrectomy was then performed. RESULTS No tumour ablation was seen in the first five patients which made modifications in the treatment protocol necessary. After this, definite histological evidence of ablation was seen in the remaining seven patients. The ablated zones were within the targeted area in all patients and no intra‐lesional skipping was seen. Subcapsular skipping was seen at the probe–tumour interface in two patients with viable tumour cells seen at microscopy. One patient did not undergo surgical extirpation; subsequent biopsy revealed no viable tumour cells. There were no intraoperative or postoperative complications directly related to HIFU therapy and patients have reached a mean (range) follow‐up of 15 (8–24) months with no evidence of metastatic disease or late complications. CONCLUSIONS Tumour ablation with laparoscopic HIFU is feasible. Homogenous ablation can be achieved with no vital tissue within the targeted zone. The technique is associated with low morbidity and may have a role in the definitive management of small tumours.

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Preservation of Renal Function Following Partial or Radical Nephrectomy Using 24-Hour Creatinine Clearance

Cited by 65 publications

References 30 publications

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

The association between renal tumour scoring systems and ischemia time during open partial nephrectomy

Laparoscopic high‐intensity focused ultrasound for renal tumours: a proof of concept study

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