Patients who were treated with laparoscopy were most concerned with success and complication. Preference for LESS was influenced by concerns for cosmesis, sex, age, and surgical indication.
Objective
To assess the association between Nephrometry Score (NS) and prolonged warm ischemia time (WIT) in patients undergoing robotic partial nephrectomy (RPN) for clinically localized renal masses.
Methods
We queried our prospectively maintained kidney cancer database to identify all patients undergoing RPN for localized tumors from 2007–2012. Patient and tumor characteristics were compared between complexity groups using ANOVA and Chi square tests. Multivariable logistic regression models were used to examine the relationship between NS complexity and warm ischemia >30 minutes.
Results
375 patients (mean age 59±11 years, mean CCI 1.0 ±1.3) undergoing RPN under warm ischemia for clinically localized renal tumors (mean tumor size 3.1±1.5 cm, mean NS 6.8±1.8) met inclusion criteria and had NS available. Stratified by complexity, groups differed with respect to age at surgery, tumor size, proximity to the hilum, collecting system entry, EBL, and operative time (all p values ≤ 0.05). Significant differences in mean warm ischemia time were observed when comparing low (19.4±12.1 min), intermediate (28.6±12.8 min) and high (36.1±13.7 min) NS complexity groups (p<0.0001). Adjusting for confounders, patients with intermediate (OR 2.1 [CI 1.2–3.9]) and high (OR 3.7 [CI 1.1–11.8]) NS complexity were more likely to require prolonged warm ischemia time when compared to patients with low complexity tumors.
Conclusions
In our large institutional cohort, quantification of anatomic complexity using the NS is associated with WIT greater than 30 minutes in patients undergoing RPN for localized renal tumors. This provides further evidence that standardized reporting of tumor anatomic complexity affords meaningful outcome comparisons.
Concurrent primary carcinoid tumor and primary mucinous adenocarcinoma arising within a mature cystic teratoma of a horseshoe kidney is a rare event and has been reported once in the literature. We present the first case where this tumor subtype has metastasized to lymph nodes. Treatment included open partial nephrectomy, lymph node dissection, and adjuvant chemotherapy with temozolomide and capecitabine. Due to the rare combination of tumor histologies, it is unlikely that this cohort will ever be able to be adequately studied to determine a standard of care. Thus extrapolation of treatment methods of similar tumors will continue to guide treatment.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.