Effects of diabetes and obesity on renal function recovery in patients under going laparoscopic partial nephrectomy / 现代泌尿外科杂志

【Objective】 To investigate the effects of diabetes and/or obesity on the incidence of acute kidney injury (AKI) and long-term renal function recovery in patients undergoing laparoscopic partial nephrectomy. 【Methods】 A retrospective analysis was performed on 221 patients who underwent laparoscopic partial nephrectomy in Beijing Chaoyang Hospital during Jan.2018 and Dec.2019. Baseline data, incidence of AKI, and renal function recovery after 12 months were analyzed in the diabetic, non-diabetic, diabetic + obese and diabetic + non-obese groups, with estimated glomerular filtration rate (eGFR) reaching 90% of the preoperative level as the standard. Risk factors of AKI were analyzed with univariate and multivariate regression analyses. 【Results】 Compared with the non-diabetic group, the diabetic group had lower preoperative eGFR [ (79.1±12.1)mL/ (min·1.73 m2 )vs. (85.3±10.7)mL/ (min·1.73 m2 ), P=0.01] , higher incidence of AKI (14.0% vs. 11.8%), and lower proportion of patients whose renal function recovered to at least 90% of the preoperative level (73.1% vs.83.5%). Patients with diabetes and obesity were more likely to develop AKI (31.3% vs.3.7%, P=0.039), and diabetic patients without obesity had better renal function recovery (81.3% vs. 60.0%). Multivariate analysis showed gender and operation time were the independent risk factors of AKI. 【Conclusion】 There were no significant differences between diabetic and non-diabetic patients in the incidence of postoperative AKI, or rate of renal function recovery 12 months after surgery. The incidence of AKI significantly increased in diabetic patients with obesity, and the renal function recovery rate decreased one year after surgery. Gender and operation time were the independent risk factors of AKI.

Clinical characteristics and survival analysis of patients with clear cell papillary renal cell carcinoma based on SEER database / 现代泌尿外科杂志

【Objective】 To evaluate the clinical characteristics and survival of patients with rare clear cell papillary renal cell carcinoma (ccpRCC). 【Methods】 Clinical data of ccpRCC cases treated during 2016 and 2019 were analyzed, clinical characteristics were described, and survival was analyzed using the Kaplan-Meier method. 【Results】 In the SEER database, 191 ccpRCC cases with complete clinical data and positive histology were retrieved, including 112 males (58.7%) and 79 females (41.3%), 136 Grade 1-2 (71.2%) cases and 19 Grade 3-4 (10.0%) cases, 174 stage T1 (91.1%) cases and 17 stage T2-3 (8.9%) cases. Distant metastasis (lung metastasis combined with lymph node involvement and major vein involvement) occurred in one case, and vein tumor thrombosis occurred in two patients. Surgery especially radical nephrectomy and partial nephrectomy was performed in 181 patients (94.8%). One patient died due to recurrence, and 4 due to other causes. The 12-month and 24-month survival were 98.5% and 97.4%, respectively. 【Conclusion】 Patients with ccpRCC have low clinical stage and histological grade, minimal tumor progression and distant metastasis, good prognosis and extremely low disease-specific mortality. Radical nephrectomy and partial nephrectomy have significant therapeutic effects.

Comparison between robot-assisted and open radical nephrectomy in the treatment of complex kidney neoplasm >8 cm in diameter / 现代泌尿外科杂志

【Objective】 To compare the feasibility, safety, and efficacy of robot-assisted and open radical nephrectomy for complex kidney neoplasm >8 cm in diameter. 【Methods】 Clinical data of 24 patients with large kidney neoplasm undergoing robot-assisted radical nephrectomy (9 cases, 37.5%) and open radical nephrectomy (15 cases, 62.5%) during Nov.2015 and Aug.2019 were retrospectively analyzed. The surgical parameters, perioperative complications and follow-up outcomes were compared between the two groups. 【Results】 All operations were successful. Compared with the robot group, the open group had a higher incidence of clinical symptoms (93.3% vs.44.4%, P=0.015) and larger maximum tumor diameter (124 mm vs.95 mm, P=0.021). There were no significant differences in other preoperative characteristics between the two groups. The robot group had less intraoperative blood loss (100 mL vs.800 mL, P=0.006) and lower blood transfusion rate (0% vs. 60.0%, P=0.007) than the open group. During the median follow-up of 50 (range: 25-67) months, 4 patients in the open group and 1 in the robot group developed new metastases, and 4 patients in the open group died due to advanced tumor stage. 【Conclusion】 Robot-assisted radical nephrectomy is safe in the treatment of complex and large renal tumors, and causes less intraoperative blood loss than open surgery.

Safety of robot-assisted laparoscopic and laparoscopic heminephrectomy: a meta analysis / 现代泌尿外科杂志

【Objective】 To analyze the differences in efficacy of heminephrectomy with robot-assisted laparoscopy (RARN) and laparoscopic radical nephrectomy (LRN). 【Methods】 The published references in national and international databases on the comparison of clinical outcomes between heminephrectomy RARN and LRN for kidney neoplasms were searched. References were screened strictly according to PICOS criteria, and data including estimated amount of blood loss, operation time, length of hospital stay and complications were extracted from those that met the requirements. Sensitivity analysis was used to eliminate the included articles one by one to confirm the robustness of the results, and funnel plot and Eggers test were used to explore publication bias. 【Results】 A total of 16 studies involving 2 063 patients (1 097 in RARN group and 966 in LRN group) were included. The RARN group had less intraoperative blood loss and shorter hospital stay, but there were no significant differences between the two methods (P>0.05). The incidence of postoperative complications in RARN group was lower than that in LRN group (OR: 0.643, 95%CI: 0.467-0.886, P=0.007). 【Conclusion】 Compared with LRN, RARN has better control of complications in the treatment of renal tumor, but the overall effects of intraoperative bleeding, operation time, and hospital stay are comparable.

Clinical implications of 3D printing technology in preoperative evaluation of partial nephrectomy / 中南大学学报(医学版)

OBJECTIVES@#Renal cancer is a common malignancy of the urinary system, and the partial nephrectomy is a common surgical modality for early renal cancer. 3D printing technology can create a visual three-dimensional model by using 3D digital models of the patient's imaging data. With this model, surgeons can perform preoperative assessment to clarify the location, depth, and blood supply of the tumor, which helps to develop preoperative plans and achieve better surgical outcomes. In this study, the R.E.N.A.L scoring system was used to stratify patients with renal tumors and to explore the clinical application value of 3D printing technology in laparoscopic partial nephrectomy.@*METHODS@#A total of 114 renal cancer patients who received laparoscopic partial nephrectomy in Xiangya Hospital from June 2019 to December 2020 were enrolled. The patients were assigned into an experimental group (n=52) and a control group (n=62) according to whether 3D printing technology was performed, and the differences in perioperative parameters between the 2 groups were compared. Thirty-nine patients were assigned into a low-complexity group (4-6 points), 32 into a moderate-complexity group (7-9 points), and 43 into a high-complexity group (10-12 points) according to R.E.N.A.L score, and the differences in perioperative parameters between the experimental group and the control group in each score group were compared.@*RESULTS@#The experimental group had shorter operative time, renal ischemia time, and postoperative hospital stay (all P<0.05), less intraoperative blood loss (P=0.047), and smaller postoperative blood creatinine change (P=0.032) compared with the control group. In the low-complexity group, there were no statistically significant differences between the experimental group and the control group in operation time, renal ischemia time, intraoperative blood loss, postoperative blood creatinine changes, and postoperative hospital stay (all P>0.05). In the moderate- and high- complexity groups, the experimental group had shorter operative time, renal ischemia time, and postoperative hospital stay (P<0.05 or P<0.001), less intraoperative blood loss (P=0.022 and P<0.001, respectively), and smaller postoperative blood creatinine changes (P<0.05 and P<0.001, respectively) compared with the control group.@*CONCLUSIONS@#Compared with renal tumor patients with R.E.N.A.L score<7, renal cancer patients with R.E.N.A.L score≥7 may benefit more from 3D printing assessment before undergoing partial nephrectomy.

Safety and efficacy of domestic single-port robotic surgery system for extraperitoneal urological surgery / 中华泌尿外科杂志

Objective:To investigate the safety and efficacy of the novel single-port surgical robotic surgical system in extraperitoneal urological surgery.Methods:From February to April 2022, patients was prospectively enrolled who required laparoscopic radical prostatectomy, partial nephrectomy and adrenal tumor resection in urology department. Inclusion criteria were: age ≥ 18 years old; BMI 18.5-30 kg/m 2; American Society of Anesthesiologists (ASA) physical status classification system grades 1 to 3; can cooperate with the completion of the visits and related examinations stipulated in the plan, and participate voluntarily clinical trials, and consent or the guardian agrees to sign the informed consent form; tumor indicators meet one of the following surgical treatment indications: kidney tumor T 1 stage, single, maximum tumor diameter ≤ 4 cm; prostate cancer, stage ≤ T 2b, preoperative PSA ≤ 20 ng /ml; Gleason score ≤ 7; adrenal tumor diameter ≤ 7 cm, for non-functioning adrenal adenoma, tumor diameter ≥ 3 cm. Exclusion criteria were: patients with other malignancies or a history of other malignancies and the investigators believe that they are not suitable for inclusion in this researcher; patients who have received the same type of urological surgery in the past and are not suitable for participating in this study as assessed by the investigators; included Those who have undergone other major surgery within the first 3 months and during the trial period, or who cannot recover from the side effects of any such surgery; syphilis, hepatitis B, HIV infection and carriers; long-term use of anticoagulants or blood system diseases; Unable to use effective contraception during the trial period and other conditions that the investigators deem inappropriate to participate in this trial. All operations were performed by a novel single-port robotic surgical operating system, and all surgical procedures were performed through an extraperitoneal approach. Surgical method: the surgical system is mainly composed of a remote console including a high-definition display, a surgical equipment trolley, a surgical execution system that accommodates a serpentine robotic arm, and a bendable serpentine robotic arm. In this study, the extraperitoneal approach was used. For radical prostatectomy, the patient was placed in a supine position, a longitudinal incision of about 3 cm was made below the umbilicus, the anterior rectus sheath was incised, the extraperitoneal space was separated, and an operating sheath was placed. A 12 mm trocar is placed between the right McBurney point and the umbilicus as an auxiliary hole. For partial nephrectomy and adrenal tumor resection, the patient is placed in the lateral position, and an 3cm incision is made 2 cm above the iliac crest on the midaxillary line as the main operating hole. The skin, subcutaneous tissue, and muscle were incised to the retroperitoneal cavity, and a 12mm trocar was placed at the level of the anterior superior iliac spine on the anterior axillary line as an auxiliary hole. The operation was performed after connecting each robotic arm. After the operation, the specimen was placed in the specimen bag, and a drainage tube is placed in the auxiliary hole, the specimen was taken out, and the incision was closed in turn. Preoperative basic information, operation time, blood loss, incision size, postoperative complications, preoperative and postoperative PSA score, eGFR index, postoperative pathological information and other perioperative information were collected. Results:A total of 17 patients were included in this study, including 6 with prostate cancer, 8 with renal tumor, and 3 with adrenal tumor. There were 9 males and 8 females, with an average age of (56.7±14.6) years and a BMI of (23.3±3.4) kg/m 2. The mean operation time of radical prostatectomy was (244.6±35.1) min, the mean operating time of the chief surgeon was (184.0±39.0) min, and the mean blood loss was (36.6±23.8) ml. Postoperative positive margin was found in 2 cases. The average operation time of partial nephrectomy was (189.6±49.4) minutes, the average operating time of the chief surgeon was (115±39.7) minutes, the average blood loss was (12.7±8.3) ml, and the average warm ischemia time was (23.1±10.8) minutes. There was no significant difference in the eGFR index before and after the operation ( P>0.05). The average operation time of adrenalectomy was (177.6±26.9) min, the average operating time of the chief surgeon was (99±20.4) min, and the average blood loss was (11.6±6.2) ml. The overall average operation time of the three surgical methods was (206.9±50.1) min, the overall average operating time of the chief surgeon was (136.5±51.1) min, the overall average blood loss was (21.0±9.2) ml, and the overall average incision size was (3.5±0.5) cm, all added a 12 mm auxiliary channel, and the overall average hospital stay was (8.1±2.7) days. All operations were successfully completed, and there was no conversion to open surgery during the operation, and no operation holes were added. There was no Clavien-Dindo≥grade 3 complication after operation. Conclusions:The novel single-port robot could safely and effectively perform radical prostatectomy, partial nephrectomy and adrenalectomy which are common in urology through extraperitoneal approach.

Application of constrast-enhanced ultrasound-micro flow imaging technique in differential diagnosis of benign and malignant renal tumors / 中华超声影像学杂志

Objective:To explore the value of constrast-enhanced ultrasound-micro flow imaging (CEUS-MFI) in the differential diagnosis of benign and malignant renal tumors.Methods:Totally 96 patients with renal space occupying found in two-dimensional gray-scale ultrasound examination in the First Affiliated Hospital, College of Medicine, Zhejiang University from November 2020 to August 2021 were collected, and 97 lesions were examined by CEUS-MFI and constrast-enhanced ultrasound(CEUS), respectively. The microvascular morphology and contrast-enhanced characteristics of renal tumors were recorded, ROC curves were constructed, and the diagnostic efficacies of the two methods were compared.Results:In the CEUS examination, the enhancement modes of malignant tumors were mainly fast wash-in(52/66, 78.8%) and fast wash-out (49/66, 74.2%) and high perfusion (56/66, 84.8%), and ring enhancement can be seen in 48.5%(32/66) of the lesions. The enhancement patterns of benign tumors were mainly slow wash-in (17/31, 54.8%) and slow wash-out (20/31, 64.5%) and low perfusion (18/31, 58.1%), and no circular blood flow was found in 31 lesions.In the CEUS-MFI examination, the vascular morphology of malignant tumors was mainly irregular (46/66, 69.7%), 93.9%(62/66) of malignant tumors had circular blood flow. Most of benign tumors were of linear vascular structure(12/31, 38.7%) and dendritic vascular structures (14/31, 45.2%), 93.5% (29/31) of benign tumors showed no circular blood flow. The detection rate of the annular blood flow in malignant tumors by CEUS-MFI was higher than that by CEUS, and the difference was statistically significant (93.9% vs 48.5%, P<0.001). The accuracy, sensitivity, and specificity of diagnosing renal tumors for using CEUS-MFI were 90.7%, 93.9% and 83.8%, respectively; and 84.5%, 92.4% and 67.7%, respectively, for using CEUS. The areas under the ROC curve were 0.898 and 0.814 for using CEUS-MFI and CEUS, respectively, the difference between the two techniques was not significant ( P=0.151). Conclusions:CEUS-MFI can sensitively and clearly display the microvascular morphology inside the tumor, and greatly improve the detection rate of annular blood flow in renal malignant tumors, which provides a new method for clinicians to identify benign and malignant renal tumors.

Nefroma mesoblastico congénito: reporte de un caso / Congenital mesoblastic nephroma: case report

El nefroma mesoblastico congénito es un tumor renal infrecuente, pero común en el periodo neonatal. De comportamiento benigno y pronóstico excelente en su variedad clásica pero en el subtipo celular puede presentar recurrencia local, invasión retroperitoneal y metástasis pulmonares y cerebrales. El tratamiento es la nefrectomía radical. Los factores pronósticos son la edad menor a tres meses y la resección quirúrgica completa. Paciente de 17 días nacida a las 35 semanas por polihidramnios, con diagnóstico prenatal de masa abdominal. Al examen físico masa en flanco derecho e hipertensión arterial (121/79 mm Hg, TAM 77mm Hg). Ecografía abdominal con riñón derecho aumentado de tamaño y voluminosa formación sólida, de 4,4 x 4,3 x 4,8 cm, heterogénea y vascularizada al Doppler en polo inferior. Tomografía de abdomen con formación nodular heterogénea de 5,0 x 4,1 x 5,1 cm en polo inferior del riñón derecho. Se realizó nefrectomía radical derecha sin complicaciones. Evolución en los últimos 20 meses satisfactoria y libre de enfermedad.

Congenital mesoblastic nephroma is an uncommon renal tumor, but frequent in neonates. Classical variety usually benign with excellent prognosis. Cellular cases may be recurrent with retroperitoneal invasion, brain and lung metastasis. Radical nephrectomy is the treatment of choice. Relevant prognostic factors are diagnosis before three months of age and complete resection. A 17 day old patient, borned at 35 weeks due to polyhydramnios, with prenatal diagnosis of abdominal mass. On examination, right flank abdominal mass and arterial hypertension (121/79 mm Hg, MAP 77 mm Hg). Abdominal ultrasound showed an enlarged right kidney with a voluminous solid heterogeneous mass, 4.4 x 4.3 x 4.8 cm in the lower pole, vascularized on Doppler scan. Computed tomography showed a big 5.0 x 4.1 x 5.1 cm, nodular, heterogeneous mass in the lower pole of the right kidney. Right radical nephrectomy was performed with an uneventful recovery. Follow up for the last 20 months satisfactory and free of disease.

Transperitoneal laparoscopic nephrectomy for renal tumour disease versus non-tumour disease: What are the differences in outcomes?

@#Introduction: Laparoscopic nephrectomy is the standard of care for the removal of both non-functioning and tumourbearing kidneys. This study was conducted to compare the characteristics and outcomes follow-ing laparoscopic transperitoneal nephrectomy (TP) for tumour and nontumour disease. Methods: We retro-spectively reviewed all TP nephrectomies performed in the Hospital Sultanah Bahiyah Alor Setar, Kedah between January 2016 and July 2017. Results: A total of 36 eligible cases were identified, 10 of which were for renal tumours and the others for nonfunctioning kidneys. There were no statistically significant differ-ences between the two groups in terms of demographics and comorbidities. We also did not identify any sta-tistically significant differences between the two groups in terms of operating time, blood loss, need for transfusion, septic complications and postoperative recovery. The only significant difference between the groups was the postoperative rise in serum creatinine, which was higher in the tumour disease group (mean rise 23.4 vs 5.35µmol/l; p = 0.012). Conclusions: Our study showed that laparoscopic nephrectomy is both feasible and safe for the treatment of tumour and non-tumour renal disease with low complication rates in both groups.

Radical nephrectomy of a huge renal mass adherent to the liver, diaphragm and aorta: The challenges in the identification and management of synovial sarcoma of the kidney

@#Synovial sarcoma (SS) is a mesenchymal tumor that more rarely affects the kidneys. As of 2020, only around 100 cases of renal SS have been reported. Herein described is a 28-year-old female with a huge mass occupying almost the entire abdomen. Her history, physical examination and imaging suggested a renal cell carcinoma with metastases to the diaphragm, liver and large vessels. A radical nephrectomy was successfully performed, removing an enormous 26-kilogram, 52cm x 37cm x 14cm right renal mass and providing immediate relief. Histopathology surprised the authors with findings of extra-gastrointestinal stromal tumor. 20 months post-surgery, there was tumor recurrence, and a metastasectomy was done. Immunostaining revealed renal synovial sarcoma. To date, the patient remains asymptomatic and disease free. The rarity of renal SS, as well as its ability to mimic more common tumors, makes clinicopathological diagnosis and management difficult. Moreover, the role of chemotherapy for SS remains unclear.

Primary primitive neuroectodermal tumor of the kidney

Renal primitive neuroectodermal tumor (PNET) is a rare entity. It should be differentiated from other primary renal malignancies. The differentiation of the malignant small round cell tumors may be challenging; however, it is essential for better management of the patient. We report a 45-year-old male having complaints of pain in the abdomen, hematuria, and mass in the abdomen for 6 months. Abdominal and pelvic sonography finding showed cystic-solid, right renal mass suggestive of malignancy. On histopathology diagnosed as malignant small round blue cell tumor suggestive of primitive neuroectodermal tumor. On immunohistochemistry, CD99 positivity confirmed the diagnosis of primary PNET of the kidney. We are presenting this case for its rarity, clinical presentation, and pathological findings.

Tumor de Wilms en niños de Costa Rica / (Wilms tumor in Costa Rican children)

Resumen Objetivo: describir las características clínicas del grupo de niños diagnosticados con tumor de Wilms en Costa Rica y cuál es la evolución clínica de acuerdo con los diversos tratamientos que reciben en el Servicio de Oncohematología del Hospital Nacional de Niños. Métodos: este es un estudio descriptivo retrospectivo que analiza un periodo de 20 años de pacientes con diagnóstico de tumor de Wilms confirmado por biopsia. Se revisó 69 expedientes de pacientes con edades entre 0 y 13 años, en los cuales se analizaron los datos clínicos, terapéuticos (quimioterapia, radioterapia) y pronósticos (sobrevida global y libre de enfermedad) de cada uno. Los resultados obtenidos se compararon con los de otros estudios latinoamericanos y europeos. Se realizaron modificaciones en el manejo de los pacientes costarricenses, con base en los resultados obtenidos. Resultados: se analizó una muestra total de 69 casos. Entre los resultados se encontró que los pacientes presentaban una edad promedio diagnóstica de 41,3 meses. El seguimiento promedio fue de 7,4 años. La masa abdominal fue el hallazgo clínico predominante (55%). Además, el estadio III fue el más común (31,8%). La nefrectomía total sin ruptura tumoral fue el procedimiento quirúrgico en la mayoría de los casos. El 80% de los pacientes presentó histología favorable en el análisis histopatológico. En el 51% de los casos se utilizó quimioterapia prequirúrgica. Un 17% de los pacientes presentó metástasis pulmonar. La sobrevida global fue del 73,3% y la sobrevida libre de enfermedad, del 69%. Conclusiones: los pacientes costarricenses con tumor de Wilms localizados tuvieron una sobrevida inferior a la de los países desarrollados, y similar en casos metastásicos.

Abstract Objective: to describe the clinical characteristics of the group of children diagnosed with Wilms' tumor in Costa Rica and what was the clinical evolution according to the different treatments received in the Oncohematology Division of the National Children's Hospital. Methods: this is a retrospective descriptive study that analyzed the patients with diagnosis of Wilms tumor confirmed by biopsy in period of 20 years. We reviewed 69 records of patients aged between 0 and 13 years, in which the clinical, therapeutic (chemotherapy, radiotherapy) and prognostic data (global and disease-free survival) of each one were analyzed. Results: a total sample of 69 cases was analyzed. Among the results, it was found that the patients presented an average age of 41.3 months at the moment of diagnosis. The average follow-up was 7.4 years. The presence of an abdominal mass was the predominant clinical finding (55%). In addition, stage III was the most common (31.8%). Total nephrectomy without tumor rupture was the surgical procedure in the majority of cases. 80% of the patients presented favorable histology in the histopathological analysis. In 51% of cases, pre-surgical chemotherapy was used. 17% of the patients presented pulmonary metastasis. Overall survival was 73.3% and disease free survival was 69%. Conclusions: Costa Rican patients with localized Wilms' tumor had poorer results than that of patients in developed countries, but the survival was similar in metastatic cases.

Influencia del estadio tumoral inicial en la sobrevida de pacientes con adenocarcinoma renal / Initial tumor stage influence on survival of patients with renal adenocarcinoma

Introducción: el adenocarcinoma renal representa hasta el 80 por ciento de los tumores sólidos de este órgano, además de ser el de peor pronóstico. Objetivo: analizar la influencia del estadio tumoral inicial en la sobrevida de pacientes con adenocarcinoma renal. Métodos: se realizó un estudio descriptivo en una muestra de 69 pacientes con diagnóstico de adenocarcinoma renal, atendidos en el Hospital Militar Central Dr. Luis Díaz Soto de enero de 2005 a diciembre de 2014. Las variables estudiadas fueron: edad, sexo, signos y síntomas, exámenes imaginológicos utilizados, estadio tumoral, modalidades terapéuticas empleadas, complicaciones presentadas y la sobrevida posterior al tratamiento. Resultados: prevaleció el grupo de edades de 60-69 años con 46 pacientes (66,7 por ciento) y del sexo masculino con 42 para un 61 por ciento. Predominó el diagnóstico incidental en 52 pacientes (75,4 por ciento). El ultrasonido se empleó en la totalidad de los casos y fue positivo en el 98,6 por ciento. Preponderaron las lesiones en el estadio I en 32 pacientes (46,3 por ciento). La modalidad terapéutica más empleada fue el tratamiento quirúrgico en 65 pacientes (94,2 por ciento), al ser la nefrectomía total por vía lumbar la más practicada con 44 pacientes (63,8 por ciento). La sobrevida a los 5 años fue del 93,7 por ciento. Conclusiones: El diagnóstico del adenocarcinoma renal en estadios iniciales, posibilitó mejor pronóstico y mayor sobrevida de los pacientes. Existió relación directa entre los factores pronósticos, clínicos y tumorales, con la evolución y la mortalidad por adenocarcinoma renal(AU)

Introduction: the renal adenocarcinoma represents until 80 percent of the solid tumors of this organ, besides being that of worse prognosis. Objective: to analyze the influence of the initial tumoral stage in the survival of patient with renal adenocarcinoma. Methods: A descriptive was carried in to sample of 69 patients with diagnosis of renal adenocarcinoma, assisted in the Central Military Hospital Dr. Luis Díaz Soto from January of 2005 to December of 2014. The studied variables were: age, sex, signs and symptoms, imaginologic exams used, tumoral stage, therapeutic modalities employed, complications and the survival later to the treatment. Results: the group of 60-69 year-old ages prevailed with 46 patients (66.7 percent) and of the masculine sex with 42 for 61 percent. The incidental diagnosis prevailed in 52 patients (75.4 percent). The ultrasound was used in the entirety of the cases and it was positive in 98.6 percent. Prevailed the lesions in the I stage in 32 patients (4.3 percent). The therapeutic modality more employed was the surgical treatment in 65 patients (94.2 percent), being the total nephrectomy for lumbar via were practiced in 44 patients (63.8 percent). The survival to the 5 years was of the one 93.7 percent. Conclusions: The diagnosis of the renal adenocarcinoma, in initial stages, facilitates a better prognosis and a bigger survival of the patients. Direct relationship exists among the prognostic factors, clinical and tumoral, with the evolution and the mortality for renal(AU)

Effect of miR-103b on the growth of renal cell carcinoma by activating the expression of P21 protein / 国际外科学杂志

Objective To investigate the effect of miR-103b on the expression of P21 protein in renal cell carcinoma cell line 769-P and ACHN cells,and its effect on the growth of renal cell carcinoma.Methods Renal cancer cells were divided into two groups according to the transfected RNA,miR-103b (experimental group) and dsControl (control group),respectively.Real-time PCR and Western blotting were used to detect the expression of P21,cell cycle-dependent kinase 6,Cyclin D1 mRNA and protein expression.Flow cytometry was used to detect the cell cycle distribution.MTT assay was used to detect cell viability and colony formation assay was used to detect cell proliferation.Measurement data were represented as x ± s.Comparison between groups was analyed using t test.Results Real-time PCR results showed that the relative expression levels of P21,cell cycle-dependent kinase 6 and Cyclin D1 mRNA in 769-P and ACHN which belong to control group cells were 1.00 ±0.10 and 1.02 ±0.27,1.00 ±0.08 and 1.01 ±0.17,1.01 ±0.19 and 1.00 ±0.02.The experimental group was 2.36 ±0.51 and 2.03 ± 0.49,0.33 ± 0.20 and 0.58 ± 0.22,0.48 ± 0.11 and 0.60 ± 0.23,respectively,and the difference was statistically significant (P ＜ 0.05).Western blotting results were consistent with Real-time PCR results.Flow cytometry results showed that compared with the control group,the proportion of cells located in G0/G1 phase in the experimental group increased (P ＜ 0.05),suggesting that the cells were arrested in G0/G1 phase.MTT assay showed that the viability of 769-P and ACHN cells in the experimental group was significantly lower than that in the control group.Colony formation experiments showed that the number of colony formation in the experimental group was significantly less,suggesting that the cell proliferation capacity decreased.Conclusion miR-103b can inhibit the growth of renal cell carcinoma cells by activating the expression of P21 protein and blocking the progression of the renal cell cycle,which provides a theoretical basis for the molecular targeted therapy of renal cell carcinoma.

Application of highly selective renal artery occlusion in laparoscopic partial nephrectomy / 中国内镜杂志

Objective To compare the feasibility and safety of laparoscopic partial renal segmental artery occlusion and renal artery trunk interruption for partial nephrectomy. Methods We reviewed medical records of 65 patients with stage T1 renal tumor from October 2013 to February 2017. Among them, 29 cases underwent partial nephrectomy with high selective segmental renal artery occlusion, and 36 cases underwent partial nephrectomy with renal artery trunk occlusion. Then compare the preoperative and postoperative creatinine changes, intraoperative blood loss, warm ischemia time, operation time, hospitalization time and positive margins of the two methods. Results In all the patients, the procedures were done without conversion to open surgeries. The operation time of the renal artery branch block group is shorter than that of the main renal artery block, but the preoperative and postoperative creatinine changes are smaller than those of the main renal artery occlusion group. There was no significant difference between the two groups in intraoperative blood loss, warm ischemia time and positive margins (P > 0.05); There was no significant difference between the two groups in age, body mass index (BMI) and R.E.N.A.L score of renal tumor (P > 0.05). Conclusion For the stage T1 renal tumor, the selective renal artery branch interruption technique has a longer operation time, but the renal tissue has a small ischemic zone and has little effect on the kidney.

Comparative analysis of the MSCT and pathological characteristics between sarcomatoid renal cell carcinoma and renal clear cell carcinoma / 实用放射学杂志

Objective To explore the MSCT and pathological features of sarcomatoid renal cell carcinoma (SRCC)and to improve the diagnostic accuracy in differentiating SRCC from renal clear cell carcinoma (RCCC).Methods The MSCT findings and pathological features of 19 patients with SRCC and 213 patients with RCCC were reviewed retrospectively.Results On CT imaging,the average diameter of SRCC (65.95 mm±10.75 mm)was significantly larger than that of RCCC (51.88 mm±14.69 mm)(P=0.01);Of 19 SRCC,11 showed hemorrhage,necrosis and cystic degeneration and 1 showed calcification on unenhanced CT scan,while 9 of 213 RCCC showed calcification,there was no statistical difference between the two groups (P=0.07).In addition,10 cases of SRCC had slow and prolonged enhancement while 198 cases of RCCC had a contrast-enhancement pattern of "fast-in-and-fast-out",there was statistically significant difference between the two groups in CT enhancement mode (P＜0.05).SRCC had a high degree of malignancy:in 19 cases,there were 4 cases with involvement of surrounding viscera,4 cases with perirenal effusion or hydronephrosis,5 cases with lymph node enlargement,7 cases with tumor thrombus of renal vein or inferior caval vein and 4 cases with pulmonary metastasis.Pathologically, 11 SRCC (57.89%)contained sarcomatoid component and 17 cases (89.47%)was positive for Vimentin.Conclusion Compared with RCCC,SRCC demonstrates certain characteristics signs at MSCT examination.SRCC is generally larger mass,heterogeneous and continuous ehhancement on the contrast scanning.The diagnosis of SRCC should be considered especially when the lesion has signs of invasiveness or metastatic.

Imaging manifestations of rare primary renal tumors / 实用放射学杂志

Objective To analyze the imaging features of several rare primary renal tumors.Methods The CT and MR images of 1 3 cases with pathologically proved rare primary renal tumors were analyzed retrospectively.The imaging features including location, number,size,shape,margin,density or intensity,internal structures and pattern of enhancement were observed.Results Of the 13 cases,4 were primary renal lymphoma (PRL),which performed as renal hilar mass involving the renal parenchyma in 3 cases and multiple nodules at bilateral kidney in 1 case.3 were hemanyiopericytoma (HA),which located in the renal parenchyma in 1 case and protruded from renal surface in 2 cases.All the HA showed obvious enhancement,with small vessels within the tumor in 2 cases.Two cases of inflammatory myofibroblastic tumor (IMT)were mainly located in renal sinus,among which the renal parenchyma was involved in 1 case. One case with adult Wilms tumor showed mixed heterogeneous signal intensity in both T1-and T2-weighted images,indicating intratumoral hemorrhage.One case of neuroendocrine tumor was located in the renal parenchyma with ipsilateral adrenal and regional lymph node metastasis. One case of metanephric adenoma (MA)demonstrated as renal parenchymal mass with slightly enhancement.One case of meoblastic nephroma (MN)showed as a heterogeneous mass with continuous enhancement.Conclusion The imaging features of rare primary renal tumors are characteristical.It is important to analyze the imaging characteristics carefully in order to improve the diagnostic accuracy.

Assessment of the Perioperative Risk of Different Operation Times on Renal Angiomyolipoma Patients with Rupture and Hemorrhage / 中山大学学报(医学科学版)

[Objective] To investigate the perioperative risk of different operation times on renal angiomyolipoma (AML) patients with rupture and hemorrhage.[Methods] From January 2006 to December 2016,AML patients with rupture and hemorrhage who receiving surgical treatment were recruited.According to the operation time,patients receiving surgery within 7 days after the hemorrhage were classified as short-term operation group.Patients receiving surgery exceeded 30 days after the hemorrhage were classified as long-term operation group.The general and perioperative data were compared between the two groups.[Results] There were no statistically significant differences in age,tumor size,clinical symptoms and operative methods between the two groups.However,as compared to the long-term operation group,the hemorrhage during surgery [(780±451) vs.(572±913) mL,P=0.029],the volume of transfused blood [(2600 ± 1733) vs.(820±582) mL,P=0.027],the nephrectomy rate (60.0％ vs.22.6％,P=0.027) were significantly increased in the short-term operation group.[Conclusions] A long-term operation group for AML patients with rupture and hemorrhage could have a lower perioperative risk.

The application of off-clamping in robotic-assisted partial nephrectomy for the treatment of renal tumors / 中华泌尿外科杂志

Objective To explore the clinical efficacy and safety of off-clamping in robotic-assisted partial nephrectomy (RAPN) for the treatment of renal tumors.Methods From January 2015 to March 2017,the data of 48 patients who underwent off-clamping RAPN were reviewed retrospectively.There were 31 males and 17 females,and the mean age was 57 years (range:23-84 years).The mean tumor size was 3.1 cm (range:1.2-6.4 cm),with the upper,middle,and lower polar tumors account for 35.4％,27.1％,and 37.5％,respectively.The clinical tumor stage was T1N0M0 in all 48 cases,according to the AJCC tumor staging system for renal cancer.Results RAPNs were performed successfully in all 48 cases,without conversion to open surgery.In those patients,the application of off-clamping in robotic-assisted partial nephrectomy was performed in 44 cases.The renal artery and vein was exposed,dissected,isolated and then clamped in 4 cases due to bleeding.The mean surgical time was 85 min (range:75-185 min).The mean estimated blood loss was 134 ml (range:60-270 ml),and no blood transfusion was needed.The wound surface was closed using interrupted suture with Hem-o-lok clips securing each needle point.The mean time for renorrhaphy was 22 min (rang:11-31 min).No intraoperative severe complications such as vascular injury,trauma of abdominal organ occurred.There were 5 complications,including 2 cases of hematuria,2 cases of delayed healing of incision,and 1 case of pneumohypoderma.The pathological diagnosis included 40 cases of renal clear cell carcinoma,3 cases of papillary renal cell carcinoma,and 5 cases of angiomyolipomas.No tumor recurrence or distant metastasis was observed during the average follow-up of 17 months (range 3-27 months).Conclusions Off-clamping RAPN is safe and feasible approach to excise certain kidney tumors.It carries the benefits of less complication,quick recovery,and less ischemia reperfusion renal injury.Off-clamping RAPN would be suitable for those patients with solitary kidneys,renal insufficiency,and bilateral tumors.