Minimally invasive vs open nephrectomy in the modern era: does approach matter?

Golombos, David M.; Chughtai, Bilal; Trinh, Quoc‐Dien; Thomas, Dominique; Mao, Jialin; Te, Alexis E.; O’Malley, Padraic; Scherr, Douglas S.; Pizzo, Joseph Del; Hu, Jim C.; Sedrakyan, Art

doi:10.1007/s00345-017-2040-6

Cited by 40 publications

(41 citation statements)

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“…As such, early diagnosis is paramount to optimizing survival [19]. Early detection of smaller tumours may allow increasing use of minimally invasive techniques such as robotic or laparoscopic partial nephrectomy and tumour ablation, reducing rates of open surgery with associated high morbidity and hospital stay [21–24]. Modern systemic therapies used in the treatment of metastatic RCC, such as sunitinib, pazopanib, axitinib and nivolumab, are highly expensive and the median cost of anticancer drugs is rising, as is patient life expectancy, and therefore, duration of treatment [25, 26].…”

Section: Resultsmentioning

confidence: 99%

Epidemiology and screening for renal cancer

et al. 2018

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PurposeThe widespread use of abdominal imaging has affected the epidemiology of renal cell carcinoma (RCC). Despite this, over 25% of individuals with RCC have evidence of metastases at presentation. Screening for RCC has the potential to downstage the disease.MethodsWe performed a literature review on the epidemiology of RCC and evidence base regarding screening. Furthermore, contemporary RCC epidemiology data was obtained for the United Kingdom and trends in age-standardised rates of incidence and mortality were analysed by annual percentage change statistics and joinpoint regression.ResultsThe incidence of RCC in the UK increased by 3.1% annually from 1993 through 2014. Urinary dipstick is an inadequate screening tool due to low sensitivity and specificity. It is unlikely that CT would be recommended for population screening due to cost, radiation dose and increased potential for other incidental findings. Screening ultrasound has a sensitivity and specificity of 82–83% and 98–99%, respectively; however, accuracy is dependent on tumour size. No clinically validated urinary nor serum biomarkers have been identified. Major barriers to population screening include the relatively low prevalence of the disease, the potential for false positives and over-diagnosis of slow-growing RCCs. Individual patient risk-stratification based on a combination of risk factors may improve screening efficiency and minimise harms by identifying a group at high risk of RCC.ConclusionThe incidence of RCC is increasing. The optimal screening modality and target population remain to be elucidated. An analysis of the benefits and harms of screening for patients and society is warranted.Electronic supplementary materialThe online version of this article (10.1007/s00345-018-2286-7) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Epidemiology and screening for renal cancer

et al. 2018

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“…This confirmed the result of previous studies regarding the faster recovery and better postoperative discomfort. 23 , 27 , 28…”

Section: Discussionmentioning

confidence: 99%

Demographic characteristics and complications of open and minimal invasive surgeries for renal cell carcinoma: a population-based case–control study in Taiwan

Chang

Liu

et al. 2018

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IntroductionRenal cell carcinoma (RCC) is one of the most lethal urological malignancies, and surgeries remain the mainstay for localized RCC. This study aimed to compare the selection of open surgery and minimally invasive kidney surgery for RCCs for the aspects of complication, medical costs, and patient preference.Materials and methodsWe conducted a population-based case–control study by using the National Health Insurance Research Database of Taiwan, which included data from 23 million Taiwanese residents. Patients newly diagnosed with RCC during 2006–2012 were included. We compared the general characteristics, underlying disease, complications, hospital stay, postoperative analgesic dosage, and medical costs between open group and minimally invasive group.ResultsA total of 3,172 patients who received radical nephrectomy (RN) or partial nephrectomy (PN) for RCC were included. The mean age was 61.1 years, with a male to female ratio of 1.88. In the minimally invasive groups, the mean hospital stay was significantly shorter than in open groups (12.4 days in open RN versus 10.3 days in minimally invasive RN, and 9.7 days in open PN versus 8.2 days in minimally invasive PN). There was no significant difference between the medical costs and the incidence of major bleeding complication between the open group and the minimally invasive group. Female patients and patients with higher monthly income were more likely to receive minimally invasive surgery.ConclusionDuring past decades, open RN has gradually been replaced by minimally invasive surgeries and PN. Compared to open surgeries, minimally invasive surgeries could lead to less postoperative pain and faster recovery. Economic status of the patients potentially hinders them from receiving minimally invasive surgeries, which may cost more.

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“…Increased use of laparoscopic surgery may also influence surgical decisions for older patients. Laparoscopic RN has been found to have similar oncological outcomes to open RN, with fewer surgical complications and less time in hospital ; however, there is some evidence from patient cohort studies and matched‐control studies that PN may be beneficial in terms of survival and kidney function for older patients . A study matching PN‐ and RN‐treated patients with stage 1 tumours on age, sex and a range of clinical factors, including tumour size, showed significantly longer overall survival for older patients (aged > 65 years) treated with PN compared with RN .…”

Section: Introductionmentioning

confidence: 99%

Age at diagnosis and the surgical management of small renal carcinomas: findings from a cross‐sectional population‐based study

et al. 2018

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Minimally invasive vs open nephrectomy in the modern era: does approach matter?

Abstract: After widespread adoption of minimally invasive approaches to radical nephrectomy across the United States, oncologic standards remain preserved with improved perioperative outcomes at no additional cost burden.

Cited by 40 publications

References 29 publications

Epidemiology and screening for renal cancer

Epidemiology and screening for renal cancer

Demographic characteristics and complications of open and minimal invasive surgeries for renal cell carcinoma: a population-based case–control study in Taiwan

Age at diagnosis and the surgical management of small renal carcinomas: findings from a cross‐sectional population‐based study

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Minimally invasive vs open nephrectomy in the modern era: does approach matter?

Abstract: After widespread adoption of minimally invasive approaches to radical nephrectomy across the United States, oncologic standards remain preserved with improved perioperative outcomes at no additional cost burden.

Cited by 40 publications

References 29 publications

Epidemiology and screening for renal cancer

Epidemiology and screening for renal cancer

Demographic characteristics and complications of open and minimal invasive surgeries for renal cell carcinoma: a population-based case&ndash;control study in Taiwan

Age at diagnosis and the surgical management of small renal carcinomas: findings from a cross‐sectional population‐based study

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Demographic characteristics and complications of open and minimal invasive surgeries for renal cell carcinoma: a population-based case–control study in Taiwan