Surgical Treatment of Completely Endophytic Renal Tumor: a Systematic Review

Perez-Ardavin, Javier; Sánchez-González, José Vicente; Martínez-Sarmiento, Manuel; Monserrat-Monfort, J.J.; García-Olaverri, Jorge; Boronat-Tormo, F.; Donoso, C.D. Vera

doi:10.1007/s11934-019-0864-x

Cited by 18 publications

(28 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…6 Among these, TERTs represent a highly complex situation to cope with. TERTs are defined as tumors completely surrounded by renal healthy parenchyma, not visible on the surface of the kidney, and represent one of the most challenging scenarios for the urologist because of their complex detection and removal, 7 which is often characterized by long ischemia time, higher rate of urinary system violation and more frequent peri-and postoperative complications than those reported for exophytic renal masses. 8 Accordingly, in a recent systematic review, management of TERTs was recommended to be referred to highly experienced centers.…”

Section: Introductionmentioning

confidence: 99%

Expanding the limits of nephron‐sparing surgery: Surgical technique and mid‐term outcomes of purely off‐clamp robotic partial nephrectomy for totally endophytic renal tumors

et al. 2022

View full text Add to dashboard Cite

Objectives: To report surgical technique, perioperative, oncological, and mid-term functional outcomes in a single-center purely off-clamp robotic partial nephrectomy series for totally endophytic masses. Methods: A retrospective analysis of a prospectively collected, institutional review board-approved renal cancer database was carried out to include patients with a totally endophytic renal tumor treated with off-clamp robotic partial nephrectomy between January 2013 and December 2020 at our center. Our database was queried to identify cases that had been assigned 3 points for the "E" domain of the R.E.N.A.L. nephrometry score and 3 points for the "exophytic rate" domain of the PADUA (Preoperative Aspects and Dimensions Used for an Anatomical) nephrometry score. Preoperative indocyanine green renal mass marking was performed in 33 patients, in whom the tumor was vascularized by a specific feeding artery. Surgical steps, perioperative, oncological and functional data were reported. Results: Fifty-six consecutive patients with totally endophytic renal masses were treated. The median tumor diameter was 3 cm, and median PADUA and R.E.N.A.L. scores were both 10. The median operative time was 82 min. Low-grade Clavien complications occurred in two patients (3.6%) and high-grade Clavien complications were observed in four patients (7.1%). Positive surgical margins were detected in one patient; 2-year recurrence-free, cancer-specific, and overall survival rates were 100%, 100%, and 98.2%, respectively. At a median follow-up of 24 months, new onset of chronic kidney disease stage 3b occurred in one patient. At last follow-up, the median estimated glomerular filtration rate was 77 mL/min, with a median estimated glomerular filtration rate percent decrease of 5.5%. Trifecta was achieved in 91% of patients. Conclusions: Purely off-clamp robotic partial nephrectomy is a feasible and safe surgical approach, even in totally endophytic renal tumors, providing a favorable perioperative complications rate, excellent oncological outcomes, and negligible impact on renal function at mid-term follow-up. Indocyanine green preoperative marking of endophytic renal tumors represents a useful tool for rapid intraoperative identification of the mass, real-time control of resection margins, and a more precise dissection.

show abstract

Section: Introductionmentioning

confidence: 99%

Expanding the limits of nephron‐sparing surgery: Surgical technique and mid‐term outcomes of purely off‐clamp robotic partial nephrectomy for totally endophytic renal tumors

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Studies have reported ( 20 ) that the stress of tumor resection surgery releases a large number of glucocorticoids, thereby leading to an imbalance of immune function. To a certain extent, it increases pathogen infection and susceptibility and risk of recurrence, with a somber prognosis.…”

Section: Discussionmentioning

confidence: 99%

Impact of Laparoscopic Partial Nephrectomy and Open Partial Nephrectomy on Outcomes of Clear Cell Renal Cell Carcinoma

Liu

2021

Front. Surg.

View full text Add to dashboard Cite

Objective: To analyze the impact of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) on outcomes of complex clear cell renal cell carcinoma (ccRCC).Methods: A total of 132 high-complex ccRCC patients with a Radius Exophytic Nearness Anterior Location (R.E.N.A.L) score ≥7 enrolled in our hospital between January 2018 and June 2020 were matched and assigned to an LPN group (given LPN treatment) and an OPN group (given OPN treatment), with 66 cases in each group. Two weeks and 3 months after the operation, the renal indexes, inflammatory factors, basic perioperative conditions, and incidence of complications were compared.Results: Two weeks after the operation, the levels of SCr and CysC were elevated, with higher levels observed in the LPN group (all P < 0.05), and the eGFR levels were reduced, with a lower result in the LPN group. Three months after the operation, the two groups observed decreased levels of SCr and CysC, and an increased level of eGFR; moreover, the decreased SCr and CysC levels were still higher, and the increased eGFR was lower than those before the operation (P < 0.05). The levels of CRP and TNF-α in the two groups increased after the operation, with a lower outcome in the LPN group (P < 0.05). Moreover, the LPN group had less intraoperative blood loss and shorter postoperative length of hospital stay but longer blocking time compared to the OPN group (P < 0.05). Patients in the LPN group were recorded with a lower complication incidence compared with the OPN group (3.03 vs. 15.15%, P < 0.05).Conclusion: Both LPN and OPN enjoy significant efficacy in the treatment of complex ccRCC and effectively protect renal function. Moreover, LPN is a more acceptable option for complex ccRCC due to its numerous benefits in postoperative stress response, complications, recovery. which is worthy of promotion with safety and feasibility.

show abstract

“…For example, several previous reports, including an international multicenter study, revealed that RAPN for patients with cT1b renal tumors can be performed safely; however, the warm ischemia and console times in these patients were both significantly longer than those in patients with cT1a tumors 7,20 . Similarly, although there is a lack of studies directly comparing the outcomes of RAPN for completely endophytic tumors and for exophytic tumors, a recent systematic review concluded that PN for completely endophytic tumors should be performed by experienced surgeons, regardless of the surgical approach 21 . In contrast, RAPN was reported to be a safe, effective, and feasible approach for hilar tumors with no increased risk of adverse events, particularly in comparison with RAPN for with non‐hilar tumors, but only if conducted by experienced robotic surgeons 8,9 .…”

Section: Discussionmentioning

confidence: 99%

Perioperative outcomes in patients undergoing robot‐assisted partial nephrectomy: Comparative assessments between complex and non‐complex renal tumors

Motoyama

Sato

Watanabe

et al. 2020

Asian J Endoscop Surgery

View full text Add to dashboard Cite

Introduction The aim of this study was to investigate the effects of renal tumor complexity on perioperative outcomes in patients receiving robot‐assisted partial nephrectomy (RAPN). Methods This study included 153 consecutive patients with cT1 renal masses undergoing RAPN and analyzed their perioperative outcomes, particularly tumor complexity. In this series, cT1b, completely endophytic, hilar, and cystic tumors were considered complex tumors. Patients with tumors that met at least one of the complex criterion were placed in the complex tumor group; patients with tumors that did not meet any of the complex criteria were placed in the non‐complex tumor group. Results Of the 153 patients, 54 (35.3%) had complex tumors; specifically, 18 (11.8%) had cT1b tumors, 15 (9.8%) had completely endophytic tumors, 28 (18.3%) had hilar tumors, and 8 (5.2%) had cystic tumors. The non‐complex group included 99 patients (64.7%). The complex tumor group had significantly longer warm ischemia and console times than the non‐complex tumor group, but there was no significant difference between them in the achievement of the trifecta. Both warm ischemia and console times were significantly correlated with the number of complex factors. Multivariate analyses of complex factors demonstrated that completely endophytic and cT1b tumors were independently associated with warm ischemia time and console time, respectively. Conclusions For patients with complex tumors, RAPN may be a feasible procedure with acceptable perioperative outcomes. However, special attention should be paid to long warm ischemia and console times, particularly in those with completely endophytic and/or cT1b tumors.

show abstract

Surgical Treatment of Completely Endophytic Renal Tumor: a Systematic Review

Cited by 18 publications

References 24 publications

Expanding the limits of nephron‐sparing surgery: Surgical technique and mid‐term outcomes of purely off‐clamp robotic partial nephrectomy for totally endophytic renal tumors

Expanding the limits of nephron‐sparing surgery: Surgical technique and mid‐term outcomes of purely off‐clamp robotic partial nephrectomy for totally endophytic renal tumors

Impact of Laparoscopic Partial Nephrectomy and Open Partial Nephrectomy on Outcomes of Clear Cell Renal Cell Carcinoma

Perioperative outcomes in patients undergoing robot‐assisted partial nephrectomy: Comparative assessments between complex and non‐complex renal tumors

Contact Info

Product

Resources

About