Survival outcomes in patients with large (≥7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: Results of a multicenter cohort with long-term follow-up

Janssen, Martin; Linxweiler, Johannes; Terwey, S.; Rugge, S.; Ohlmann, Carsten-Henning; Becker, Frank; Thomas, Ch.; Neisius, Andreas; Thüroff, Joachim W.; Siemer, Stefan; Stöckle, Michael; Roos, Frederik C.

doi:10.1371/journal.pone.0196427

Cited by 40 publications

(24 citation statements)

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“…In this context, partial nephrectomy (PN) has proven to be oncologically equal to radical nephrectomy for small renal masses and locally advanced tumours 3 . Since the first laparoscopic partial nephrectomy (LPN) in 1993 and the first robot‐assisted partial nephrectomy (RAPN) in 2004, the standard approach for PN has been a matter of debate 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Open versus robot‐assisted partial nephrectomy: A longitudinal comparison of 880 patients over 10 years

Zeuschner

Greguletz

Meyer

et al. 2020

Robotics Computer Surgery

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Background Most comparisons between robot‐assisted partial nephrectomy (RAPN) and open partial nephrectomy (OPN) indicate the superiority of RAPN, but the learning curve is often not considered. Methods All consecutive partial nephrectomies from the very first RAPN at a single tertiary referral centre (n = 818, 500 RAPN vs. 313 OPN) were retrospectively analyzed. Complications, success rates and surgical outcomes were compared. Inequalities between cohorts and the inherent learning curve were controlled by subgroup comparisons, regression analyses, and propensity score matching. Results Overall, RAPN had fewer complications, less blood loss, and shorter length of stay. However, an inherent learning curve caused higher complications for the first 4 years. Thereafter, perioperative outcomes clearly favoured RAPN, even for more complex tumours. Conclusions In one of the largest monocentric cohorts over more than 10 years, RAPN was found to be superior to OPN. However, not all advantages of RAPN are immediate because a learning curve must be passed.

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Section: Introductionmentioning

confidence: 99%

Open versus robot‐assisted partial nephrectomy: A longitudinal comparison of 880 patients over 10 years

Zeuschner

Greguletz

Meyer

et al. 2020

Robotics Computer Surgery

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“…Fifteen retrospective studies including 5,056 patients who underwent nephrectomy (PN, 1975; RN, 3081) were included by careful selection (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Among the included studies, the majority of cases were from the USA, and the remainder were varied.…”

Section: Resultsmentioning

confidence: 99%

Partial Nephrectomy Versus Radical Nephrectomy for Clinical T2 or Higher Stage Renal Tumors: A Systematic Review and Meta-Analysis

et al. 2021

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ObjectiveThe choice of surgical method for clinically diagnosed T2 or higher stage kidney cancer remains controversial. Here, we systematically reviewed and collected published comparative studies on renal function, oncologic outcomes, and perioperative results of partial nephrectomy (PN) versus radical nephrectomy (RN) for larger renal tumors (T2 and above), and performed a meta-analysis.Evidence AcquisitionFollowing searches of PubMed, Web of Science, and Embase, the original studies on PN vs. RN in the treatment of T2 renal cancer were screened through strict inclusion and exclusion criteria. RevMan 5.4 was used for data analysis of the perioperative results, renal function, and oncologic outcomes of the two surgical methods for T2 renal tumor therapy. The weighted mean difference was used as the combined effect size for continuous variables, while the odds ratio (OR) or risk ratio (RR) was used as the combined effect size for binary variables. Both variables used a 95% confidence interval (CI) to estimate statistical accuracy. In cases with low heterogeneity, the fixed-effects model was used to pool the estimated value; otherwise, the random-effects model was used when significant heterogeneity was detected.ResultsFifteen retrospective studies including 5,056 patients who underwent nephrectomy (PN: 1975, RN: 3081) were included. The decline in estimated GFR (eGFR) after PN was lower than RN [(MD: −11.74 ml/min/1.73 m2; 95% CI: −13.15, −10.32; p < 0.00001)]. The postoperative complication rate of PN was higher than that of PN (OR: 2.09; 95% CI: 1.56, 2.80; p < 0.00001)], and the postoperative overall survival (OS) of PN was higher than that of RN (HR: 0.77; 95% CI: 0.65, 0.90; p = 0.002), and tumor recurrence (RR, 0.69; 95% CI: 0.53, 0.90; p = 0.007). No obvious publication bias was found in the funnel chart of the OS rates of the two groups of patients.ConclusionsPN is beneficial for patients with T2 renal tumors in terms of OS and renal function protection. However, it is also associated with a higher risk of surgical complications.

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“…Input parameters varied widely between surgeries (Figure 2). Appendix A presents all input parameters, their sources 26,27,36–45,28,46–55,29,56–65,30,66–75,31,76–82,32–35 , and the corresponding model output for each semi-elective surgery.…”

Section: Resultsmentioning

confidence: 99%

Minimizing Population Health Loss in Times of Scarce Surgical Capacity

Gravesteijn¹,

Krijkamp

Busschbach

et al. 2020

Preprint

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Background COVID-19 has put unprecedented pressure on healthcare systems worldwide, leading to a reduction of the available healthcare capacity. Our objective was to develop a decision model that supports prioritization of care from a utilitarian perspective, which is to minimize population health loss. Methods A cohort state-transition model was developed and applied to 43 semi-elective non-paediatric surgeries commonly performed in academic hospitals. Scenarios of delaying surgery from two weeks were compared with delaying up to one year, and no surgery at all. Model parameters were based on registries, scientific literature, and the World Health Organization global burden of disease study. For each surgery, the urgency was estimated as the average expected loss of Quality-Adjusted Life-Years (QALYs) per month. Results Given the best available evidence, the two most urgent surgeries were bypass surgery for Fontaine III/IV peripheral arterial disease (0.23 QALY loss/month, 95%-CI: 0.09-0.24) and transaortic valve implantation (0.15 QALY loss/month, 95%-CI: 0.09-0.24). The two least urgent surgeries were placing a shunt for dialysis (0.01, 95%-CI: 0.005-0.01) and thyroid carcinoma resection (0.01, 95%-CI: 0.01-0.02): these surgeries were associated with a limited amount of health lost on the waiting list. Conclusion Expected health loss due to surgical delay can be objectively calculated with our decision model based on best available evidence, which can guide prioritization of surgeries to minimize population health loss in times of scarcity. This tool should yet be placed in the context of different ethical perspectives and combined with capacity management tools to facilitate large-scale implementation.

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Survival outcomes in patients with large (≥7cm) clear cell renal cell carcinomas treated with nephron-sparing surgery versus radical nephrectomy: Results of a multicenter cohort with long-term follow-up

Cited by 40 publications

References 38 publications

Open versus robot‐assisted partial nephrectomy: A longitudinal comparison of 880 patients over 10 years

Open versus robot‐assisted partial nephrectomy: A longitudinal comparison of 880 patients over 10 years

Partial Nephrectomy Versus Radical Nephrectomy for Clinical T2 or Higher Stage Renal Tumors: A Systematic Review and Meta-Analysis

Minimizing Population Health Loss in Times of Scarce Surgical Capacity

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