scholarly journals Open Partial Nephrectomy in Renal Cancer: A Feasible Gold Standard Technique in All Hospitals

2008 ◽  
Vol 2008 ◽  
pp. 1-9 ◽  
Author(s):  
J. M. Cozar ◽  
M. Tallada
Keyword(s):  
Partial Nephrectomy ◽  
Gold Standard ◽  
Radical Nephrectomy ◽  
Young Patients ◽  
Standard Technique ◽  
Tumor Diameter ◽  
Cancer Specific Survival ◽  
Renal Masses ◽  
Open Partial Nephrectomy ◽  
Gold Standard Technique

Introduction. Partial nephrectomy (PN) is playing an increasingly important role in localized renal cell carcinoma (RCC) as a true alternative to radical nephrectomy. With the greater experience and expertise of surgical teams, it has become an alternative to radical nephrectomy in young patients when the tumor diameter is 4 cm or less in almost all hospitals since cancer-specific survival outcomes are similar to those obtained with radical nephrectomy.Materials and Methods. The authors comment on their own experience and review the literature, reporting current indications and outcomes including complications. The surgical technique of open partial nephrectomy is outlined.Conclusions. Nowadays, open PN is the gold standard technique to treat small renal masses, and all nonablative techniques must pass the test of time to be compared to PN. It is not ethical for patients to undergo radical surgery just because the urologists involved do not have adequate experience with PN. Patients should be involved in the final treatment decision and, when appropriate, referred to specialized centers with experience in open or laparoscopic partial nephrectomies.

Comparison of partial nephrectomy for tumors greater than 7 cm to radical nephrectomy and effect on overall survival.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 323-323 ◽  
Author(s):  
S. Vourganti ◽  
W. Linehan ◽  
G. Bratslavsky
Keyword(s):  
Overall Survival ◽  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Survival Advantage ◽  
Oncologic Outcomes ◽  
Rank Test ◽  
Kidney Tumors ◽  
Cancer Specific Survival ◽  
Renal Masses ◽  
Entire Cohort

323 Background: As growing evidence indicates the importance of renal functional preservation, there is an increased utilization of partial nephrectomy (PN) performed for small renal masses (SRM). The optimal cutoff size for PN has been based on historical observation of low metastatic rates for SRM and increasing metastatic potential with increase in size of the primary tumor. We aim to evaluate the outcomes of patients treated by PN or radical nephrectomy (RN) for tumors greater than 7 cm. Methods: SEER 17 database was queried to identify patients treated for kidney tumors between 1983 and 2007. We excluded cases treated for non-RCC histology, not treated surgically, and those without specified size. Patients were included if treated by PN or RN with tumor size between 7 and 20 cm. Demographic information included age, gender, and race. The comparison of RCC-specific and overall survival was performed for the entire cohort and stratified by SEER stage (localized, regional, or distant). The survival was compared using Kaplan-Meier method with log rank test to identify significant differences. Results: We identified a total of 18,927 patients treated for RCC that included 18,575 cases of RN and 352 treated with PN. There were no differences in age, gender, or race (Caucasian vs. non-Caucasian) between patients treated by RN or PN (p>0.05). The mean size for tumors treated by PN was 9.7 cm vs. 10.2 cm for RN (p<0.01) and there was more localized disease in the PN group (p<0.01). The overall median survival for patients treated with PN was 108 months vs. 80 months for patients treated with RN (p<0.01). The cancer-specific survival for the entire cohort treated with PN was 195 months vs. 145 months for RN (p<0.01). When stratified by stage, there were no differences in the cancer specific survival between PN and RN groups (p>0.05). Conclusions: PN for tumors 7 to 20 cm is not associated with inferior oncologic outcomes but may provide survival advantage. While patient selection may have influenced overall survival outcomes, PN may provide survival advantage by maximizing renal reserve. These findings may be best answered in a randomized trial to establish if there should be a size cutoff for nephron sparing surgery. No significant financial relationships to disclose.

scholarly journals Feasibility of nephron sparing surgery in giant oncocytoma

2014 ◽  
Vol 8 (1-2) ◽  
pp. 96
Author(s):  
Albert El Hajj ◽  
Ruban Thanigasalam ◽  
Isabelle Boulay ◽  
Vincent Molinié ◽  
Bernard Escudier ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Young Patients ◽  
Normal Functioning ◽  
Renal Masses ◽  
First Case ◽  
Nephron Sparing ◽  
Benign Tumours ◽  
Functioning Kidney

Oncocytomas represent 3 to 7% of renal masses and behave as benign tumours. Nephron-sparing procedures are preferred for biopsy confirmed lesions; however, giant oncocytomas have been generally treated by radical nephrectomy. We report the first case of partial nephrectomy in a 45-year-old man who presented with a 20-cm oncocytoma. At the 1 year follow-up, he had a normal functioning kidney. Despite the difficulty of this procedure, partial nephrectomy for very large benign tumours can be considered in appropriately selected young patients.

scholarly journals Trends in the Management of Small Renal Masses: A Survey of Members of the Endourological Society

2017 ◽  
Vol 4 (3) ◽  
pp. 10-19 ◽  
Author(s):  
Anand Mohapatra ◽  
Aaron Potretzke ◽  
John Weaver ◽  
Barrett Anderson ◽  
Joel Vetter ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Treatment Modalities ◽  
Percutaneous Ablation ◽  
Robotic Partial Nephrectomy ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Open Partial Nephrectomy ◽  
The Past

Treatment modalities for small renal masses (SRMs) include open or minimally invasive radical or partial nephrectomy, and laparoscopic or percutaneous ablations. Members of the Endourological Society were surveyed to evaluate how practitioner and clinical practice characteristics may be associated with the management of SRMs over time. The survey assessed characteristics of urologists (recency of residency and fellowship training, clinical practice type and location, and treatment modalities available) and their management of SRMs over the past year and over the course of the year 5 years prior. Of the 1495 surveys e-mailed, there were 129 respondents (8.6%). Comparing the past year to 5 years prior, there was increasing utilization of robotic partial nephrectomy (p < 0.001) and robotic radial nephrectomy (p = 0.031). In contrast, there was decreasing utilization of open partial nephrectomy (p < 0.001), open radical nephrectomy (p = 0.039), laparoscopic partial nephrectomy (p = 0.002), and laparoscopic radical nephrectomy (p = 0.041). Employment of laparoscopic ablation decreased (p = 0.001), but that of percutaneous ablation did not change significantly. For masses treated with image-guided therapy, there was increasing utilization of microwave ablation (p = 0.008) and decreasing usage of radiofrequency ablation (p = 0.002). Future studies should focus on the most effective treatment modalities based on provider, patient, and tumor characteristics.

scholarly journals Oncological outcomes of partial nephrectomy for tumours larger than 4 cm: A systematic review

2014 ◽  
Vol 8 (1-2) ◽  
pp. 61 ◽  
Author(s):  
Tarek H El-Ghazaly ◽  
Ross J Mason ◽  
Ricardo A Rendon
Keyword(s):  
Systematic Review ◽  
Partial Nephrectomy ◽  
Survival Rates ◽  
Cancer Specific Survival ◽  
Renal Masses ◽  
Oncological Outcomes ◽  
Medical Associations ◽  
Nephron Sparing ◽  
Pubmed Search ◽  
Exact Size

Introduction: Many medical associations recommend nephron-sparing surgery (NSS) for tumours larger than 4 cm amenable to partial nephrectomy (PN). These recommendations are, however, mostly based on isolated reports. We systematically review the oncological outcomes of partial nephrectomy procedures performed for tumours larger than 4-cm.Methods: A PubMed search was carried out using keywords “partial nephrectomy” and “nephron sparing” for records dating back to 1995. In total, 2136 abstracts were analyzed; from these, 174 studies were scrutinized. We identified 32 manuscripts reporting size-specific cancer-specific survival rates for masses greater than 4 cm. From each of these studies, we recorded the number of PN, tumour diameter, follow-up duration, 5- and 10-year recurrence, overall and cancer-specific survival rates (OS, CSS). We also calculated weighted OS and CSS rates.Results: This systematic review includes 2445 patients with renal tumours larger than 4 cm who underwent PN: 1858 patients with tumours between 4 to 7 cm, 410 patients with tumours larger than 7 cm and 177 patients with tumours greater than 4 cm (exact size unknown). Our analysis revealed weighted 5-year CSS rates of 95.4%, 86.2% and 93.9% for tumours 4 to 7 cm, >7 cm, and all tumours >4 cm, respectively. The respective 5-year OS rates were 84.7%, 76.4%, and 84.7%.Conclusions: We found excellent 5-year CSS and OS rates for patients with tumours 4 to 7 cm treated with PN. These outcomes compare favourably to those reported in historical radical nephrectomy (RN) series for similarly sized tumours. Thus, PN is an acceptable and often preferred treatment for renal masses >4 cm which are amenable to nephron-sparing procedures.

scholarly journals Retroperitoneal hand-assisted laparoscopic nephrectomy and partial nephrectomy

2013 ◽  
Vol 3 (1) ◽  
pp. 3 ◽  
Author(s):  
Nosratollah Nezakatzgoo ◽  
Janet Colli ◽  
Matthew Mutter ◽  
Sheg Aranmolate ◽  
Robert Wake
Keyword(s):  
Partial Nephrectomy ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Oral Intake ◽  
Pathological Examination ◽  
Tumor Diameter ◽  
Renal Masses ◽  
Estimated Blood Loss ◽  
Average Operative Time

The purpose of the present paper is to describe our technique and experience with retroperitoneal hand-assisted laparoscopic (HAL) nephrectomies as an alternative to the transperitoneal approach. Eight retroperitoneal HAL nephrectomies and one partial nephrectomy were performed. Several excisional techniques were employed incorporating the Harmonic scalpel or Ligasure device. Hemostatic agents were used to cover the renal defect. Surgical bolsters were sutured to the renal capsule with pleget reinforcements to aid in hemostasis. The average operative time was 210 min and estimated blood loss 110 mL. Mean change in hematocrit was 3 units and creatinine was 1 point. No patient required a transfusion. There were no major complications, with a mean follow-up of fourteen months. On average, patients resumed oral intake in 2 days, and were discharged in 3 days. Pathological examination revealed that two lesions were benign and seven malignant. Tumor diameter averaged 3 cm. There were no positive surgical margins. In conclusion, we have demonstrated the feasibility of retroperitoneal laparoscopic hand-assisted nephrectomy and partial nephrectomy surgery for solid renal masses.

scholarly journals Isolated Arthroscopic Radial Styloidectomy: The Three-Portal Approach

2020 ◽  
Vol 09 (04) ◽  
pp. 353-356
Author(s):  
Guillaume Herzberg ◽  
Marion Burnier
Keyword(s):  
Gold Standard ◽  
Standard Technique ◽  
New Technique ◽  
Clear Definition ◽  
Current Gold Standard ◽  
Clear View ◽  
A New Technique ◽  
Portal Technique ◽  
Gold Standard Technique ◽  
Technical Trick

Abstract Background The current gold-standard technique for radial styloidectomy is arthroscopic. The use of only two dorsal portals may not allow a crystal-clear view of the dorsal arthritic rim of the radius because of the dorsal capsule synovitis. Objectives To propose a new technique for isolated arthroscopic radial styloidectomy. The addition of a volar radial portal and a sequential procedure are presented. Patients and Methods Two trochars for alternatively viewing from volar radial or 3–4 are used. A 1–2 portal is used for instrumentation with a motorized burr. We have been using the three-portal technique in 34 cases (26 isolated). Results This modification of the classic arthroscopic radial styloidectomy is technically easy and the view of the dorsal rim of the radius provides a clear definition and treatment of the dorso-radial arthritic pathology. Conclusions The authors recommend this technical trick to perform an easy and comprehensive isolated palliative or curative arthroscopic radial styloidectomy.

scholarly journals Safety and efficacy of retroperitoneal sutureless zero ischemia laparoscopic partial nephrectomy for low nephrometry score masses

2019 ◽  
Vol 91 (3) ◽  
Author(s):  
Emanuele Corongiu ◽  
Pietro Grande ◽  
Angelo Di Santo ◽  
Giorgio Pagliarella ◽  
Stefano Squillacciotti ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Intraoperative Complications ◽  
Functional Results ◽  
Laparoscopic Partial Nephrectomy ◽  
Tumor Diameter ◽  
Selective Embolization ◽  
Renal Masses ◽  
Nephrometry Score ◽  
Estimated Blood Loss ◽  
Zero Ischemia

Objectives: To evaluate oncological feasibility and oncological and functional results of retroperitoneal sutureless zero ischemia laparoscopic partial nephrectomy (LPN). Patients and methods: Patients with posterior renal masses with low nephrometry score (RENAL ≤ 7) treated who underwent retroperitoneal sutureless zero ischemia.in a single center from January 2016 to November 2017. Clinical, surgical and pathological data were prospectively collected. Complications were reported according to the modified Clavien classification. Results: Retroperitoneal sutureless zero ischemia laparoscopic partial nephrectomy was performed on 15 patients. The indication for nephron-sparing surgery was elective in 11 (73%) patients and imperative in 4 (27%). Median RENAL score was 5 (IQR: 5-7), median tumor diameter 25 mm (IQR: 20-35). In 11 cases, the tumor was located polar (85%), and in 2 cases hilar (15%). There were no intraoperative complications. No cases were converted to radical nephrectomy, and in no case parenchyma suture was necessary. Median operative time was 90 min (IQR:40-150), in no case clamping of the renal artery was necessary, median hospital stay was 4 days, median estimated blood loss (EBL) was 310 (180-500) ml. Pathological analysis showed renal cell carcinoma in 11 patients (85%), 9 (60%) staged T1a and 2 (13%) T1b. In 4 (27%) an oncocytoma was found. There were no positive surgical margins. One patient developed a major postoperative complication (postoperative renal bleeding requiring super-selective embolization). Trifecta rate was 93%. Conclusions: Sutureless retroperitoneal zero ischemia LPN for the treatment of low-complexity posterior renal masses showed to be safe and feasible. Longer follow-up and higher numbers of patients are, however, warranted to draw definitive conclusions on functional outcomes.

scholarly journals Clinical Case Employing Two Different Biomaterials in Bone Regeneration

2020 ◽  
Vol 10 (13) ◽  
pp. 4516
Author(s):  
Roberto Ghiretti ◽  
Carlo F. Grottoli ◽  
Alberto Cingolani ◽  
Giuseppe Perale
Keyword(s):  
Bone Regeneration ◽  
Gold Standard ◽  
Bone Substitute ◽  
Clinical Case ◽  
Hybrid Approach ◽  
Standard Technique ◽  
Surgical Strategies ◽  
Calcium Phosphosilicate ◽  
Gold Standard Technique

The case of a 59-year-old woman lacking bone in the lower left side of her mandible, and treated with two different biomaterials for bone regeneration, is reported here. Specifically, two different anatomical sites damaged by two different pathologies were studied: a radicular fracture and peri-implantitis. The sites were treated via xenograft bone substitute and calcium phosphosilicate, respectively. Follow-up evaluations showed that the two different methodologies employing different materials in the same organism undergoing the same metabolic processes achieved the same good results. This represents a significant change in current surgical strategies for the dental region: instead of focusing on a single gold-standard technique, it is possible to follow a hybrid approach by adapting the biomaterial and the protocol used to the specificities of the defect.

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