Trends in the surgical management of renal cell carcinoma in a contemporary tertiary care setting

Junejo, Noor Nabi; Alkhateeb, Sultan; Alrumayyan, Majed Faisal; Alkhatib, Khalid; Alzahrani, Hassan Messfer; Alotaibi, Mohammed; Al-Othman, Khalid; Al-Hussain, Turki; Altaweel, Waleed

doi:10.4103/ua.ua_151_20

Cited by 4 publications

(3 citation statements)

References 45 publications

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“…Most of the patients had pT1 stage disease (66%), but there was also a significant number of pT3 stages (26%). Distribution of the pathologic T stage is shown in Table 1 , and it was comparable to those reported in similar studies ( 17 ).…”

Section: Discussionsupporting

confidence: 86%

Trends in Surgical Management of Renal Neoplasms: Single Center Results in the Last Decade

Knežević

2023

ACC

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Kidney neoplasms account for 2.2% of total neoplasms worldwide 1 . Renal cell carcinoma (RCC) accounts for 2% of global cancer incidence and mortality, making it the seventh most common neoplasm 1 . It has a male predominance, with a relative risk of 1.7 when compared to women, and with a higher incidence in developed countries 1 . Survival depends on the stage at the time of diagnosis; stage I, localized cancer has 93%, while stage IV has a 12% 5-year survival rate 1 . The mortality rate among all cancer deaths is 1.8%, and it remained the same in the last 35 years despite a doubling incidence, most likely due to improvements in diagnostics and treatment 1 . Today, most cases are diagnosed incidentally, using ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI). RCC has several subtypes, but the most common are clear cell, papillary, and chromophobe carcinoma, which account for 75%, 10%, and 5% of

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Section: Discussionsupporting

confidence: 86%

Trends in Surgical Management of Renal Neoplasms: Single Center Results in the Last Decade

Knežević

2023

ACC

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“…Cytoreductive nephrectomy is reserved as an option for metastatic renal cell carcinoma [46]. Open nephrectomy (ON) is still performed in a quarter of cases [47].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Epidural Analgesia on Quality of Recovery (QoR) after Open Radical Nephrectomy: Randomized, Prospective, and Controlled Trial

Kovač,

Juginović,

Delić

et al. 2024

JPM

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No studies are currently evaluating the quality of recovery (QoR) after open radical nephrectomy (ORN) and epidural morphine analgesia. This was a randomized, prospective, and controlled study that explored the QoR on the first postoperative day after ORN. Eighty subjects were randomized into two groups. The first group received general anesthesia combined with epidural anesthesia and postoperative epidural analgesia with morphine and ropivacaine. The second group received general anesthesia and continuous postoperative intravenous analgesia with tramadol. Both groups received multimodal analgesia with metamizole. The primary outcome measure was the total QoR-40 score. The secondary outcome measures were QoR-15, QoR-VAS, and the visual analog scale (VAS) for pain, anxiety, and nausea. The median difference in the QoR-40 score after 24 postoperative hours between the two groups of patients was 10 (95% CI: 15 to 5), p < 0.0001. The median score and IQR of QoR-40 during the first 24 postoperative hours in the epidural group was 180 (9.5), and in the control group, it was 170 (13). The general independence test for secondary outcomes between groups was significant (p < 0.01). QoR-VAS was correlated with QoR-40 (r = 0.63, p ≤ 0.001) and with QoR-15 (r = 0.54, p ≤ 0.001). The total QoR-40 and QoR-15 alpha coefficients with a 95% CI were 0.88 (0.85–0.92) and 0.73 (0.64–0.81), respectively. There was a significant difference in the QoR between the epidural and the control groups after ORN. The QoR-40 and QoR-15 showed good convergent validity and reliability.

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“…Despite a rising trend toward minimally invasive technics, open nephrectomy (ON) is still performed in a quarter of cases [6], especially in tumors with central localization for partial ON (as minimally invasive radical nephrectomy should not be performed in patients with T1 tumors for whom a partial nephrectomy is feasible by any approach [3]) or large tumors with/without cava thrombus (total ON). A major drawback of ON is postoperative pain and its known association with impaired recovery and higher postoperative complication rates [7,8].…”

Section: Introductionmentioning

confidence: 99%

Is Continuous Wound Infiltration a Better Option for Postoperative Pain Management after Open Nephrectomy Compared to Thoracic Epidural Analgesia?

Crettenand

Assayed-Leonardi

Rohrer

et al. 2023

JCM

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Background: Despite increasingly advanced minimally invasive percutaneous ablation techniques, surgery remains the only evidence-based therapy in curative intent for larger (>3–4 cm) renal tumors. Although minimally invasive surgery using (robotic-assisted) laparoscopic or retroperitoneoscopic approaches has gained popularity, open nephrectomy (ON) is still performed in 25% of cases, especially in tumors with central localization (partial ON) or large tumors with/without cava thrombus (total ON). As postoperative pain is one of the drawbacks of ON, our study aims to assess recovery and post-operative pain management using continuous wound infiltration (CWI) compared to thoracic epidural analgesia (TEA). Methods: Since 2012, all patients undergoing ON at our tertiary cancer center at CHUV have been included in our prospective ERAS® (enhanced recovery after surgery) registry that is centrally stored in ERAS® Interactive Audit System (EIAS) secured server. This study represents an analysis of all patients operated on with partial or total ON at our center between 2012 and 2022. An additional analysis was performed for the estimations of the total cost of CWI and TEA, based on the diagnosis-related group method. Results: 92 patients were included and analyzed in this analysis (n = 64 (70%) with CWI; n = 28 (30%) with TEA). Adequate oral pain control was earlier achieved in the CWI group compared to the TEA group (median 3 vs. 4 days; p = 0.001), whereas immediate postoperative pain relief was better in the TEA group (p = 0.002). Consequently, opioid use was higher in the CWI group (p = 0.004). Still, reported nausea was lower in the CWI group (p = 0.002). Median time to bowel recovery was similar in both groups (p = 0.03). A shorter LOS (0.5 days) was observed in patients managed with CWI, although this was not statistically significant (p = 0.06). The use of CWI has reduced total hospital costs by nearly 40%. Conclusions: TEA has better results in terms of postoperative pain management compared to CWI following ON. However, CWI is better tolerated, and causes less nausea and earlier recovery, which leads to a shorter length of stay. Given its simplicity and cost-effectiveness, CWI should be encouraged for ON.

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Trends in the surgical management of renal cell carcinoma in a contemporary tertiary care setting

Cited by 4 publications

References 45 publications

Trends in Surgical Management of Renal Neoplasms: Single Center Results in the Last Decade

Trends in Surgical Management of Renal Neoplasms: Single Center Results in the Last Decade

The Effect of Epidural Analgesia on Quality of Recovery (QoR) after Open Radical Nephrectomy: Randomized, Prospective, and Controlled Trial

Is Continuous Wound Infiltration a Better Option for Postoperative Pain Management after Open Nephrectomy Compared to Thoracic Epidural Analgesia?

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