Tumor–parenchyma interface and long-term oncologic outcomes after robotic tumor enucleation for sporadic renal cell carcinoma

Minervini, Andrea; Campi, Riccardo; Maida, Fabrizio Di; Montagnani, Ilaria; Tellini, Riccardo; Tuccio, Agostino; Siena, Giampaolo; Vittori, Gianni; Lapini, A.; Mari, Andrea; Carini, Marco

doi:10.1016/j.urolonc.2018.08.014

Cited by 45 publications

(49 citation statements)

References 28 publications

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“…Robot-assisted partial nephrectomy (RAPN) realizes precision with a stable view and wide range operability and is indicated for more complex tumors. To achieve maximal normal parenchymal preservation, tumor enucleation, which removes the tumor along with the peritumoral pseudocapsule (PC), could be an ideal surgical method 1 , 2 . The feasibility and efficacy of this technique were evaluated in several studies 3 – 6 .…”

Section: Introductionmentioning

confidence: 99%

Detection of a peritumoral pseudocapsule in patients with renal cell carcinoma undergoing robot-assisted partial nephrectomy using enhanced MDCT

Toguchi

Takagi

Ogawa

et al. 2021

Sci Rep

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To investigate the detection of peritumoral pseudocapsule (PC) using multi-detector row computed tomography (MDCT) for tumors resected by robot-assisted laparoscopic partial nephrectomy (RAPN) for T1 renal cell carcinoma (RCC). Study participants included 206 patients with clinical T1 RCC who underwent RAPN between October 2017 and February 2018. Two radiologists who were blinded to the pathological findings evaluated the computed tomography (CT) images. Radiological diagnosis of a PC was defined by a combination of observations, including a low-attenuation rim between the tumor and renal cortex in the cortico-medullary phase and a high-attenuation rim at the edge of the tumor in the nephrogenic or excretory phase. A PC was detected on CT in 156/206 tumors (76%) and identified by pathology in 182/206 (88%) tumors including 153/166 (92%) clear cell RCC, 13/14 (93%) papillary RCC, and 7/16 (44%) chromophobe RCC. In the whole cohort, CT findings showed a sensitivity of 81.3% (148/182), specificity of 66.7% (16/24), and positive predictive value of 94.9% (148/156). When the data were stratified according to pathological subtypes, MDCT was observed to have a sensitivity of 86.9% (133/153) and specificity of 61.5% (8/13) in clear cell RCC, sensitivity of 38.5% (5/13) and specificity of 100% (1/1) in papillary RCC, and sensitivity of 44.4% (4/7) and specificity of 66.7% (6/9) in chromophobe RCC. A low or high-attenuation rim around the tumor in the cortico-medullary or nephrographic-to-excretory phase indicates a PC of RCC, though the accuracy is not satisfactory even with 64- or 320-detector MDCT.

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Section: Introductionmentioning

confidence: 99%

Detection of a peritumoral pseudocapsule in patients with renal cell carcinoma undergoing robot-assisted partial nephrectomy using enhanced MDCT

Toguchi

Takagi

Ogawa

et al. 2021

Sci Rep

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“…Successively, the same group reported that there were no significant predictors of partial vs absent PC invasion. Based on these findings, they suggest that a binomial reporting system of PC invasion (complete vs partial or absent) might be of superior clinical relevance compared to i-Cap score [31].…”

Section: Discussionmentioning

confidence: 98%

Accuracy of magnetic resonance imaging to identify pseudocapsule invasion in renal tumors

et al. 2019

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Purpose To evaluate accuracy of MRI in detecting renal tumor pseudocapsule (PC) invasion and to propose a classification based on imaging of PC status in patients with renal cell carcinoma. Methods From January 2017 to June 2018, 58 consecutive patients with localized renal cell carcinoma were prospectively enrolled. MRI was performed preoperatively and PC was classified, according to its features, as follows: MRI-Cap 0 (absence of PC), MRI-Cap 1 (presence of a clearly identifiable PC), MRI-Cap 2 (focally interrupted PC), and MRI-Cap 3 (clearly interrupted and infiltrated PC). A 3D image reconstruction showing MRI-Cap score was provided to both surgeon and pathologist to obtain complete preoperative evaluation and to compare imaging and pathology reports. All patients underwent laparoscopic partial nephrectomy. In surgical specimens, PC was classified according to the renal tumor capsule invasion scoring system (i-Cap). Results A concordance between MRI-Cap and i-Cap was found in 50/58 (86%) cases. ρ coefficient for each MRI-cap and iCap categories was: MRI

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“…This dissection plane is not reliably present in all renal tumors. In fact, an estimated 5% of tumors lack any discernible pseudocapsule [4] and it is incomplete in approximately one-third of clear cell tumors [5].…”

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confidence: 99%

“…Third, the pseudocapsule may be invaded by cancer in up to 20% of cases [4], raising further concerns regarding the oncologic safety of enucleation. Indeed, it has been suggested that larger tumors (twofold greater risk per cm), endophytic growth pattern, and papillary histology (sevenfold higher risk) are associated with higher rates of complete invasion of the pseudocapsule [4]. While we can assess tumor size with imaging, we lack accurate tools to identify papillary histology preoperatively.…”

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confidence: 99%

“…Finally, the quality of data supporting oncologic safety for routine enucleation is suboptimal. While several series report promising outcomes with enucleation [4,7,8] these are mostly single-institution retrospective analyses without long-term follow-up and that suffer from a lack of standardization and randomization, introducing a considerable risk of selection bias [8]. Furthermore, the majority of these reports included an overwhelming proportion of small renal masses, and outcomes for larger and more complex masses remain largely unknown.…”

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confidence: 99%

See 1 more Smart Citation

Tumor Enucleation is Appropriate During Partial Nephrectomy: Against

Tsivian

Packiam

Thompson

2019

European Urology Focus

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Tumor–parenchyma interface and long-term oncologic outcomes after robotic tumor enucleation for sporadic renal cell carcinoma

Cited by 45 publications

References 28 publications

Detection of a peritumoral pseudocapsule in patients with renal cell carcinoma undergoing robot-assisted partial nephrectomy using enhanced MDCT

Detection of a peritumoral pseudocapsule in patients with renal cell carcinoma undergoing robot-assisted partial nephrectomy using enhanced MDCT

Accuracy of magnetic resonance imaging to identify pseudocapsule invasion in renal tumors

Tumor Enucleation is Appropriate During Partial Nephrectomy: Against

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