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1.
Rev. colomb. anestesiol ; 50(3): e201, July-Sept. 2022. tab
Article in English | LILACS | ID: biblio-1388929

ABSTRACT

Abstract Introduction: Robot-assisted laparoscopic surgery is currently the surgical treatment of choice for small renal masses. Objective: Reviewing the anesthetic management and perioperative morbidity of patients undergoing robotic-assisted laparoscopic partial nephrectomy (RALPN) from 2009 to 2019 at Hospital Universitario Donostia. Methods: Retrospective, descriptive, observational study involving 343 patients. Results: 95 % of the patients were ASA II-III. Transient renal artery clamping was performed in 91 %, with a mean ischemia time of 17.79 minutes. The mean duration of the procedure under balanced general anesthesia was 184 min. Standard monitoring was performed along with invasive arterial pressure monitoring (IAP), central venous catheter (CVC) and EV1000 platform (Edwards®) for complex patients. Complications were recorded in 40 patients (11.67 %). Patients under anti-aggregation therapy experienced more bleeding than non-anti-aggregation patients (p 0.04) but did not require more transfusions. Patients with a higher anesthetic risk did not experience more complications. No statistically significant association was found between worsening renal function and the occurrence of intraoperative complications. 21 patients (6 %) were readmitted due to complications; the most frequent complication was renal artery pseudoaneurysm that required endovascular embolization. Conclusions: It should be highlighted that after ten years of experience with this technique, the patients with a higher anesthetic risk have not experienced serious perioperative complications. RALPN is a safe technique that demands a careful anesthetic support. A robot-assisted approach alone is not a guarantee for success without strong teamwork.


Resumen Introducción La cirugía laparoscópica asistida por robot es actualmente el tratamiento quirúrgico de elección para masas renales de pequeño tamaño. Objetivo Revisión del manejo anestésico y morbilidad perioperatoria de los pacientes sometidos a nefrectomía parcial laparoscópica asistida por robot (NPLAR) desde 2009 a 2019 en el Hospital Universitario Donostia Metodología Estudio retrospectivo observacional descriptivo sobre 343 pacientes. Resultados El 95 % de los pacientes eran ASA II-III. En el 91 % se realizó pinzamiento transitorio de la arteria renal, con un tiempo medio de isquemia de 17,79 minutos. La duración media de la intervención bajo anestesia general balanceada fue de 184 minutos. Se realizó monitorización estándar junto con monitorización de presión arterial invasiva (PAI), catéter venoso central (CVC) y plataforma EV1000 (Edwards®) para pacientes complejos. Se registraron complicaciones en 40 pacientes (11,67 %). En los pacientes en tratamiento con antiagregantes hubo mayor sangrado que en los no antiagregados (p = 0,04), pero no requirieron más transfusiones. Los pacientes con un mayor riesgo anestésico no sufrieron más complicaciones. No se encontró asociación estadísticamente significativa entre el empeoramiento de la función renal y la existencia de complicaciones intraoperatorias. El 6 %, es decir, 21 pacientes, reingresaron por complicaciones de las cuales, la más frecuente fue el pseudoaneurisma de la arteria renal que necesitó embolización endovascular. Conclusiones Tras diez años realizando esta técnica se puede destacar que, aunque los pacientes presentan un riesgo anestésico elevado no han tenido complicaciones perioperatorias graves. La NPLAR es una técnica segura que precisa un cuidadoso soporte anestésico. La tecnología robótica no garantiza por sí misma el éxito sin un buen trabajo en equipo.

2.
Int. braz. j. urol ; 48(4): 625-635, July-Aug. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1385131

ABSTRACT

ABSTRACT Purpose The predictors of trifecta achievement in partial nephrectomy (PN) were poorly inquired and remained a controversial area of discovery. To evaluate predictive factors of trifecta achievement in patients undergoing PN. Materials and Methods A systematic literature search was performed to identify relevant articles. Only studies focusing on postoperative trifecta achievement and exploring its predictor with multivariable analyses were included. The trifecta achievement was defined as negative surgical margins, warm ischemia time <25 minutes, and no complications. Merged odds ratio (OR) and 95% confidence interval (CI) were used to evaluate the predictive effect. Results Thirteen studies with 7066 patients meeting the inclusion criteria were included. The rate of trifecta achievement ranged from 43.3% to 78.6%. Merged results showed that preoperative eGFR (OR: 1.01, 95% CI: 1.00, 1.02, P=0.02), operative time (OR: 0.99, 95% CI: 0.99, 1.00, P=0.02), estimated blood loss (OR: 1.00, 95% CI: 1.00, 1.00, P <0.001), tumor size (OR: 0.70, 95% CI: 0.58, 0.84, P <0.001), medium (OR: 0.39, 95% CI: 0.18, 0.84, P=0.02) and high PADUA score (OR: 0.23, 95% CI: 0.08, 0.64, P=0.005) were independently associated with trifecta achievement. A publication bias was identified for tumor size. Sensitivity analysis confirmed the stability of result for tumor size. Conclusions Larger tumor size, medium and high PADUA score are associated with decreased probability of trifecta achievement. After verifying by further high-quality studies, these variables can be incorporated into tools to predict probability of trifecta achievement during clinical practice.

3.
Radiol. bras ; 55(4): 242-252, Aug. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1394561

ABSTRACT

Abstract In recent years, the development of new imaging techniques and scoring systems have improved the diagnosis and management of small renal masses. Imaging-based nephrometry scoring systems play an interesting role in the planning of nephron-sparing surgery, providing surgeons with the information necessary to determine the complexity of the renal mass, to deliver the appropriate postoperative care, and to predict adverse outcomes. The aim of this study was to review nephrometry scoring systems, evaluating their characteristics and the relationships among them. The urology and radiology communities should decide which nephrometry scoring system will prevail and be used in daily practice.


Resumo O diagnóstico e o manejo das pequenas massas renais têm sido aprimorados nos últimos anos com o desenvolvimento de técnicas de imagem e escores que desempenham papel interessante no planejamento da nefrectomia parcial, fornecendo informações importantes ao cirurgião para determinar o tipo de tratamento em relação a complexidade da massa renal, cuidados pós-operatórios e previsão de complicações após as cirurgias. O objetivo deste estudo é revisar os escores de nefrometria, suas características e relações entre eles no cenário da cirurgia. Os serviços de urologia e radiologia devem decidir qual é o melhor escore de nefrometria para ser utilizado na prática diária.

4.
Int. braz. j. urol ; 48(3): 493-500, May-June 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1385110

ABSTRACT

ABSTRACT Objectives: The aim of this study was to evaluate whether criteria exist to guide election between the use the three- or four-arm technique in robotic partial nephrectomy (RPN) instead of just the surgeon's preference. Material and Methods: We performed a retrospective review of 80 patients submitted to RPN from May 2016 to February 2020. The patients were divided into two groups of 40, the first submitted to the surgical procedure with use of three robotic arms and the second with four arms. The group division was performed independently of the complexity of the cases, age or gender of the patients and laterality of the renal lesions. Peri- and postoperative data were analyzed for comparison between the two groups. Results: Both techniques had similar oncological outcomes (positive tumor margins), renal function preservation (warm ischemia time) and hemorrhagic complications (estimated blood loss and renal artery pseudoaneurysm), with a small difference in the need for blood transfusion, favoring the technique with three arms. Conclusions: The two robotic partial nephrectomy techniques had similar oncological and postoperative outcomes, with minimal perioperative complications. The three-arm technique is safe and feasible regardless of the complexity and size of the tumor. Additionally, the use of the three-arm technique reduced surgery costs by US$ 413.00 per patient.

5.
Rev. colomb. cir ; 37(2): 330-337, 20220316. ilus
Article in Spanish | LILACS | ID: biblio-1362996

ABSTRACT

Introducción. El tumor de Wilms es la neoplasia abdominal más común en pacientes pediátricos. En la mayoría de los casos se presenta como una masa unilateral indolora en el abdomen. El objetivo de este artículo fue presentar el caso de una paciente de 4 años con tumor de Wilms unilateral derecho manejado con cirugía mínimamente invasiva en el Hospital Universitario del Valle. Métodos. Revisión de la historia clínica e imágenes de la paciente, descripción de la técnica quirúrgica y revisión de la literatura del manejo de tumor de Wilms unilateral. Caso clínico. Paciente femenina de 4 años quien consultó en abril de 2019 por un cuadro clínico de dolor abdominal y sensación de masa en flanco derecho. Se realizó ecografía abdominal donde se encontró imagen nodular heterogénea de contornos definidos en riñón derecho, con riñón izquierdo normal. Se hizo diagnóstico de tumor de Wilms unilateral y se llevó a cirugía mediante abordaje mínimamente invasivo, con buena evolución postoperatoria. Conclusión. La cirugía es el pilar del manejo, y la nefrectomía mediante abordaje laparoscópico para casos seleccionados, en manos entrenadas, tiene la suficiente eficacia, seguridad y cumplimiento de los principios quirúrgicos y oncológicos que provee la cirugía abierta.


Introduction. Wilms tumor is the most common abdominal neoplasm in pediatric patients. In most cases it presents as a painless unilateral mass in the abdomen. The objective of this article was to present the case of a 4-year-old patient with right unilateral Wilms tumor managed with minimally invasive surgery at the Hospital Universitario del Valle. Methods. Review of the patient's clinical history and images, description of the surgical technique and review of the literature on the management of unilateral Wilms tumor.Clinical case. A 4-year-old female patient who consulted on April 4, 2019 with a clinical presentation of abdominal pain and sensation of mass in the right flank. Abdominal ultrasound was performed where a heterogeneous nodular image of defined contours was found in the right kidney, with a normal left kidney. A diagnosis of unilateral Wilms tumor was made and surgery was carried out using a minimally invasive approach, with good postoperative evolution. Conclusion. Wilms tumor is the most common abdominal neoplasm in pediatric patients. The most common presentation is a painless palpable mass. Surgery is the mainstay of management, and nephrectomy using a laparoscopic approach for selected cases, in trained hands, has sufficient efficacy, safety, and compliance with surgical and oncological principles that open surgery provides.


Subject(s)
Humans , Female , Child, Preschool , Wilms Tumor , Minimally Invasive Surgical Procedures , Kidney Neoplasms , Laparoscopy , Nephrectomy
6.
Int. braz. j. urol ; 47(4): 777-783, Jul.-Aug. 2021. tab
Article in English | LILACS | ID: biblio-1286766

ABSTRACT

ABSTRACT Hypothesis: Partial Nephrectomy is oncological safe in patients with pT3a RCC. Purpose: To compare the oncological and functional outcomes of patients with pT3a RCC scheduled for PN and RN. Materials and Methods: We retrospectively reviewed patients with pT3a N0 M0 RCC who underwent partial or radical nephrectomy from 2005 to 2016. Perioperative characteristics, including estimated glomerular filtration rate, tumor size, pathological histology, and RENAL nephrometry score, were compared between patients scheduled for partial or radical nephrectomy. We used multivariable Cox proportional hazards regression models to compare overall survival, cancer-specific survival, and recurrence-free survival between planned procedure type. Results: Of the 589 patients, 369 (63%) and 220 (37%) were scheduled for radical and partial nephrectomy, respectively; 26 (12%) of the scheduled partial nephrectomy cases were intraoperatively converted to radical nephrectomy. After adjusting for tumor size and histology, there were no statistically significant differences in overall survival (hazard ratio 0.66; 95% CI, 0.38-1.13), cancer-specific survival (hazard ratio 0.53; 95% CI, 0.16-1.75), or recurrence-free survival (hazard ratio 0.66; 95% CI, 0.34-1.28) between patients scheduled for partial or radical nephrectomy. Fewer patients scheduled for partial nephrectomy had estimated glomerular filtration rate reductions 3 to 9 months after surgery than patients scheduled for radical nephrectomy. Conclusion: We found no evidence that patients scheduled to undergo partial nephrectomy had poorer oncologic outcomes than patients scheduled to undergo radical nephrectomy. In select patients with pT3a renal cell carcinoma in whom partial nephrectomy is deemed feasible by the surgeon, partial nephrectomy should not be discouraged.


Subject(s)
Humans , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/pathology , Kidney Neoplasms/surgery , Kidney Neoplasms/pathology , Retrospective Studies , Treatment Outcome , Neoplasm Staging , Nephrectomy
7.
Rev. nefrol. diál. traspl ; 41(2): 2-10, jun. 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1377127

ABSTRACT

RESUMEN Introducción: El uso de la nefrectomía parcial para el tratamiento del carcinoma de células renales en estadios tempranos se ha convertido en una de las intervenciones preferidas para estos pacientes en la Argentina. Sin embargo, sus resultados en el país a largo plazo aún se desconocen. En este estudio analizamos la progresión a enfermedad renal crónica y aparición de metástasis posterior a nefrectomía parcial y radical, en pacientes con carcinoma de células renales. Material y métodos: Se realizó un estudio de cohorte retrospectivo. Se incluyeron a todos los pacientes con carcinoma renal de células claras en estadio T1 que, entre 2006 y 2012, se sometieron a nefrectomía parcial en nuestro hospital. Se realizó un seguimiento hasta enero del 2018. Resultados: Se incluyeron 32 pacientes (19 con nefrectomía radical y 13 con nefrectomía parcial). Comparado con el grupo de nefrectomía parcial, los individuos sometidos a nefrectomía radical presentaron mayor progresión a enfermedad renal crónica (nefrectomía radical 63,2% vs nefrectomía parcial 15,4%; p=0,007). No existieron diferencias en el tiempo de seguimiento de ambos grupos (nefrectomía radical 69,3 ± 23,8 vs nefrectomía parcial 72,5 ± 26,9 meses; p=0,73). Los sujetos sometidos a nefrectomía radical tuvieron 11 veces mayor riesgo de progresión a enfermedad renal crónica que los de nefrectomía parcial (HR ajustado 11,12, IC95 1,24-99,9; p=0,031) ajustado por los demás factores de riesgo tradicionales. Ningún paciente con estadio T1a presentó metástasis durante todo el seguimiento, independientemente del tipo de cirugía. Conclusión: En nuestro estudio, la nefrectomía parcial preserva mejor la función renal a largo plazo que la nefrectomía radical y tiene un excelente perfil de seguridad oncológico en pacientes con carcinoma de células renales en estadio T1a. La nefrectomía radical fue un factor de riesgo independiente de progresión a enfermedad renal crónica.


ABSTRACT Introduction: Partial nephrectomy to treat early-stage renal cell carcinoma has become one of the surgeries of choice for patients in Argentina. However, long-term results in the country are unknown. In this study, we analyzed the progression to chronic kidney disease and the appearance of metastasis after partial or radical nephrectomy in renal cell carcinoma patients. Methods: A retrospective, cohort study was conducted. We included all patients suffering from T1 stage clear cell renal carcinoma who, between 2006 and 2012, underwent partial nephrectomy in our hospital. Follow-up continued until January 2018. Results: Thirty-two patients were included (19 had undergone radical nephrectomy and 13, partial nephrectomy). Subjects who had radical nephrectomy showed a more rapid progression to chronic kidney disease as compared to the subjects in the partial nephrectomy group (radical nephrectomy 63.2% vs. partial nephrectomy 15.4%; p=0.007). There were no differences in the follow-up period in both groups (radical nephrectomy 69.3% ± 23.8 months vs. partial nephrectomy 72.5 ± 26.9 months; p=0.73). Risk of progression to end-stage chronic kidney disease was 11 times higher for subjects who had undergone radical nephrectomy as compared to subjects who had had partial nephrectomy (adjusted HR 11.12; 95% CI: 1.24-99.9; p=0.031), adjusted by the rest of traditional risk factors. None of the T1a patients had metastasis during follow-up, regardless of the type of surgery. Conclusion: According to the findings of our study, partial nephrectomy preserves long-term renal function better than radical nephrectomy and has an excellent oncologic safety profile in T1a stage renal cell carcinoma patients. Radical nephrectomy was an independent risk factor of progression to chronic kidney disease.

8.
Medisur ; 19(3): 503-507, 2021. graf
Article in Spanish | LILACS | ID: biblio-1287331

ABSTRACT

RESUMEN Los tumores del tracto urinario superior representan menos del 5 % de todas las neoplasias uroteliales, con un porcentaje de recurrencia superior al 90 % y una supervivencia a los 5 años que oscila entre el 30-60 %. Por tales razones se presenta el caso de un paciente de 79 años que fue ingresado en el Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos, con un cuadro clínico caracterizado por hematuria, sin otra sintomatología. Mediante estudios imagenológicos le fue diagnosticado un tumor en la pelvis del riñón derecho. Se realizó tratamiento quirúrgico, practicándose una nefrectomía total, cuyo resultado histológico fue un carcinoma de células transicionales grado II con infiltración a planos musculares. La evolución clínica fue favorable luego de un año de la cirugía. Podemos concluir que en el diagnóstico precoz tienen un papel fundamental las imágenes tomográficas, pues permitieron identificar un tumor de las vías excretoras urinarias superiores en pelvis renal derecha. Se trazó una estrategia terapéutica inicialmente quirúrgica y a continuación quimioterapia; se logró una evolución satisfactoria y contribuir a la sobrevida de este paciente.


ABSTRACT Upper urinary tract tumors represent less than 5% of all urothelial neoplasms, with a recurrence rate greater than 90% and a 5-year survival that ranges from 30-60%. Therefore a 79-years-old patient was admitted to the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos, with a medical history characterized by hematuria, without other symptoms. Through imaging studies, he was diagnosed with a tumor in the pelvis of the right kidney. Surgical treatment was performed and a total nephrectomy was performed, the histological result of which was a grade II transitional cell carcinoma with infiltration to the muscular planes. The clinical evolution was favorable one year after surgery. We conclude that tomographic images play a fundamental role in early diagnosis, since they allowed the identification of a tumor of the upper urinary excretory tract in the right renal pelvis. A therapeutic strategy was initially designed for surgery and then chemotherapy; a satisfactory evolution was achieved and contributes to the survival of this patient.


Subject(s)
Humans , Male , Aged , Urologic Neoplasms/diagnostic imaging , Antineoplastic Agents/therapeutic use , Clinical Evolution , Urologic Neoplasms/surgery , Survivorship
9.
Rev. cienc. med. Pinar Rio ; 25(3): e4878, 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1289145

ABSTRACT

RESUMEN Introducción: el carcinoma renal de células claras con diferenciación sarcomatoide es un tumor infrecuente. Objetivo: reportar el diagnóstico de un carcinoma renal de células claras con diferenciación sarcomatoide. Presentación del caso: se trata de un hombre de 59 años de edad, fumador inveterado, quien asistió a consulta por dolor lumbar y hematuria. Los estudios de imagen mostraron una lesión tumoral en riñón derecho. Se indicó tratamiento quirúrgico y el estudio histopatológico informó un carcinoma renal de células claras con diferenciación sarcomatoide. Recibió quimioterapia y se mantiene actualmente en seguimiento por Oncología. Conclusiones: el carcinoma renal de células claras con diferenciación sarcomatoide es infrecuente. El tratamiento de elección es quirúrgico y el estudio anatomopatológico confirma el diagnóstico certero.


ABSTRACT Introduction: clear cell type renal carcinoma with sarcomatoid differentiation is a rare tumor. Objective: to report the diagnosis of a clear cell type renal carcinoma with sarcomatoid differentiation. Case report: a 59-year-old, heavy smoker male patient, attending to the doctor's office presenting lumbar pain and hematuria. The imaging studies showed a tumor lesion in the right kidney. Surgical treatment was indicated and the histopathological study reported a clear cell type renal carcinoma with sarcomatoid differentiation. The patient underwent chemotherapy and at present he maintains oncological follow-up. Conclusions: clear cell type renal carcinoma with sarcomatoid differentiation is rare. The treatment of election is surgery and pathology report confirms the true diagnosis.

10.
Int. braz. j. urol ; 47(3): 566-573, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1154486

ABSTRACT

ABSTRACT Background: Tyrosine kinase inhibitors (TKI) and immunotherapy improved survival in metastatic renal cell carcinoma (mRCC). Disparities in treatment access are present in healthcare systems globally. The aim of this study was to analyze survival outcomes of mRCC patients treated with first-line TKIs in the public (PHS) and private (PrS) health system in a Brazilian Cancer Center. Materials and Methods: Records from all mRCC patients treated with first-line TKIs from 2007-2018 were reviewed retrospectively. Categorial variables were compared by Fisher's exact test. Survival was estimated by Kaplan-Maier method and survival curves were compared using the log-rank test. Prognostic factors were adjusted by Cox regression model. Results: Of the 171 eligible patients, 37 (21.6%) were PHS patients and 134 (78.4%) were PrS patients. There were no difference in age, gender, or sites of metastasis. PHS patients had worse performance status (ECOG ≥2, 35.1% vs. 13.5%, p=0.007), poorer risk score (IMDC poor risk, 32.4% vs. 16.4%, p=0.09), and less nephrectomies (73% vs. 92.5%, p=0.003) than PrS patients. Median lines of therapy was one for PHS versus two for PrS patients (p=0.03). Median overall survival (OS) was 16.5 versus 26.5 months (p=0.002) and progression-free survival (PFS), 8.4 versus 11 months (p=0.01) for PHS and PrS patients, respectively. After adjusting for known prognostic factors on multivariate analysis, PHS patients still had a higher risk of death (HR: 1.61, 95% CI: 1.01-2.56, p=0.047). Conclusion: Patients with mRCC treated via the PHS had worse overall survival, possibly due to poorer prognosis at presentation and less drug access.


Subject(s)
Humans , Carcinoma, Renal Cell/drug therapy , Kidney Neoplasms/drug therapy , Prognosis , Brazil , Retrospective Studies , Treatment Outcome , Disease-Free Survival , Sunitinib
11.
Article in Chinese | WPRIM | ID: wpr-911930

ABSTRACT

Objective:To analyze the characteristics of prenatal MRI and postnatal CT images of fetal congenital mesoblastic nephroma (CMN).Methods:We retrospectively recruited three women with a singleton pregnancy suspected of having fetal CMN by prenatal imaging examination and confirmed by postpartum surgical resection and pathological examination at Guangzhou Women and Children Medical Center from August 2017 to April 2019. The prenatal MRI, postnatal CT, and pathological examination data were analyzed to summarize the image features of fetal CMN using descriptive statistical analysis.Results:(1) The total number of deliveries in the setting during the same period was 57 716, and the incidence of CMN was 0.005% (3/57 716). All the cases were male and born through cesarean section due to polyhydramnios for case 1 and 2 and sudden fetal distress, fetal pericardial effusion with enlarged mass in the third trimester for case 3. (2) Prenatal MRI examination found that the lesions in case 1 and 3 were located in the left kidney, and in the right kidney in case 2. The tumors in the three cases were all around with clear borders and hyperintense signal on T2-weighed imaging (T2WI). Iso-signal on T1WI was noted for case 1 and 2, a slightly hypointense signal on T1-weighed imaging (T1WI), and a hyperintense signal on diffused weighed imaging were noted for case 3. (3) Postnatal CT plain scan showed uniform density tumor in cases 1 and 2 with "packing sign" in CT enhancement. Non-uniform density, internal, larger and high-density bleeding tumor was found in case 3, and the CT enhancement manifested as nodular, non-uniform, and intratumoral bleeding. (4) Postoperative pathological examination revealed that cases 1 and 2 were classic types, and case 3 was cellular type.Conclusions:In this study, the prenatal MRI characteristic of CMN is a uniform signal, iso-signal on T1WI for classic type and non-uniform signal, and reduced signal on T1WI for cellular type. In classic type cases, postnatal CT enhancement showed a "packing sign." In contrast, in cellular type cases, the CT plain scan is manifested as non-uniform, intratumoral bleeding, and the enhancement pattern showed nodular and non-uniform enhancement. However, the results of this study is limited due to the small sample size and studies with larger sample size is needed in the future.

12.
Chinese Journal of Urology ; (12): 944-945, 2021.
Article in Chinese | WPRIM | ID: wpr-911157

ABSTRACT

Glomus tumor of kidney is very rare in clinic. One case with glomus tumor of the kidney was reported. CT demonstrated a well-defined mass located at the lower pole of the left kidney. The mass densely enhanced in arterial phase and constantly enhanced in venous and portal phase. Laparoscopic enucleation of left renal tumor was successfully performed. The pathological diagnosis was glomus tumor of the kidney. Recurrence and metastasis were not seen after 35 months follow-up.

13.
Chinese Journal of Urology ; (12): 941-943, 2021.
Article in Chinese | WPRIM | ID: wpr-911156

ABSTRACT

Renal collecting duct carcinoma(CDC) is rare in clinic, complicated with clear cell renal cell carcinoma(ccRCC) of one kidney is extremely rare. We reported a case CDC complicated with ccRCC of one kidney. The patient was admitted as left low back pain and gross hematuria, preoperative CT examination showed that one tumor was found in the upper middle pole and another tumor at lower pole of the left kidney, and multiple enlarged lymph nodes in the medial edge of the kidney. CT diagnosis was renal collecting duct carcinoma complicated with clear cell carcinoma of the left kidney, retroperitoneal lymphatic metastasis and underwent radical nephrectomy. Postoperative pathological diagnosis was CDC(upper middle pole) complicated with ccRCC(lower pole)of the left kidney. The patients were treated with sunitinib for 6 months and survived 13 months, and died of extensive metastasis.

14.
Chinese Journal of Urology ; (12): 890-895, 2021.
Article in Chinese | WPRIM | ID: wpr-911144

ABSTRACT

Objective:To investigate the clinical feasibility and effectiveness of 3D visualization and mixed reality technique in the partial nephrectomy of renal tumor, and to evaluate its role in the communication between doctors and patients.Methods:82 patients with renal tumors confirmed by imaging examination including 33 patients in our hospital and 49 patients admitted to the Beijing Cancer Hospital from June 2018 to December 2020, all of whom were single tumors without local or distant metastasis, and in line with the indications of endoscopic partial nephrectomy, but without other systemic serious diseases. These patients were randomly divided into observation group (n=41) and control group (n=41). Both groups were scanned with 64-slice spiral CT before operation, while the CT images in the observation group were generated by DICOM data, modeled by three-dimensional reconstruction software and uploaded to mixed reality glasses for the preoperative planning, doctor-patient communication and intraoperative guidance. In this study, 82 patients underwent laparoscopic partial nephrectomy. Questionnaires and scales were used to compare the awareness of disease and/or satisfaction with 3D visual images between the two groups. The intraoperative time of tumor detection, operative time, renal heat ischemia time and intraoperative blood loss in 2 groups were recorded to evaluate preoperative planning and intraoperative guidance. In addition, the recovery time of gastrointestinal function, indwelling time of urinary catheter, indwelling time of drainage tube in operation area, length of hospital stays after surgery and pathological type, as well as serum creatinine level and glomerular filtration rate (GFR) value in patients at 6 months after operation were used to evaluate the postoperative recovery.Results:Before surgery, the concentrations of serum creatinine in patients with the observation group and control group were (66.8±17.5) μmol/L and (70.5±13.7) μmol/L, and the GFR were (40.8±7.6) ml/min and (38.9±6.8) ml/min, respectively. All the 82 cases were operated successfully. The number of correct responses of patients in the observation group and control group about basic kidney physiology, kidney anatomy and surgical plan was (5 vs.4), (2 vs.1), (7 vs.4), the difference among which was statistically significant ( P<0.05). In the observation group, the points of patients in understanding their own kidney, disease, specific surgical plan, and risk of surgical complications were 9.5±1.61, 9.3±0.84, 9.7±0.53, and 8.5±2.21 respectively. The tumor detection time was (35.2±5.6) min, the operation time was (100.2±20.1) min, and the renal warm ischemia time was (22.7±8.6) min in the observation group, which was significantly shorter than that in the control group (43.2±6.7) min, (123.2±23.50) min, (33.2±7.8) min. However, there was no significant difference in the amount of bleeding (103.2±22.8 ml vs.112.5±19.5 ml), postoperative recovery time of gastrointestinal function (1.7±0.8 d vs.1.8±1.2 d), indwelling time of urinary catheter (3.9±1.6 d vs.4.2±1.0 d), indwelling time of drainage tube in operation area (4.6±1.3 d vs.4.9±1.7 d), length of hospital stays (6.9±1.5 d vs.7.2±1.3 d), pathological type, and the changes of serum creatinine (10.1±19.0 vs.9.6±11.3) and the amplitude of GRF (19.4±9.5 vs.18.5±10.7) fluctuation in the affected side 6 months after operation (19.4±9.5 vs.18.5±10.7) ( P>0.05). Conclusions:The application of 3D visualization and mixed reality technology in preoperative planning and intraoperative guidance of partial nephrectomy could improve patients' cognitive understanding of renal anatomy, tumor characteristics and surgical operation, and make doctor-patient communication smoother. It can reduce the risk of surgery to a certain extent, reduce the renal heat ischemia and the operation time, and remove the tumor more accurately.

15.
Chinese Journal of Urology ; (12): 885-889, 2021.
Article in Chinese | WPRIM | ID: wpr-911143

ABSTRACT

Objective:To explore the safety and efficacy of laparoscopic non-blocking partial nephrectomy assisted by high power lateral green laser in the treatment of T 1a renal tumor. Methods:The clinical data of 10 patients with T1a stage renal tumor from February 2021 to April 2021 in department of urology, Gongli hospital affiliated to Naval Military Medical University were retrospectively analyzed. There were 7 males and 3 females, aged 47.0-74.0 years, with average of(58.8±9.7)years old. The diameter of the tumor ranged from 2.0 cm to 3.8 cm, with an average of (3.1±0.6)cm. There were 6 cases on the left side and 4 cases on the right side, locate on lumbar side in 9 cases and ventral sied in 1 case. The R. E.N.A.L score was 4.0-6.0, with an average of (5.0±0.8). The preoperative creatinine was 66.9-90.1μmol/L, with an average of (75.1±9.0)μmol/L, preoperative GFR of 44. 6- 67. 3 ml /min, with an average of(56.7±7.7)ml/min, preoperative hemoglobin level of 119.0-156.0g/L, with an average of (135.8±11.4)g/L. All patients underwent laparoscopic non-blocking partial nephrectomy assisted by 180w lateral green laser, free the surrounding area of the tumor fully and completely expose the renal tumor. The laser fiber was placed through the green laser hand piece, and the fiber was connected with normal saline to wash the strip. The initial green laser vaporization power was set at 80W, and the hemostasis power at 35W.About 3mm away from the edge of the tumor, and one optical fiber away from the renal parenchyma, the renal parenchyma was cut with 80W power. In order to reduce the interference by smoke, high-pressure flushing was used through the optical fiber while vaporizing, and an attractor was used to push and peel the tumor. In case of bleeding during operation, hemostatic power can be used to close the bleeding point and gradually advance until the tumor was completely removed. The wounds of renal inner medulla and renal outer cortex were continuously sutured in 1-3 layers with barbed suture. It involved 9 cases via retroperitoneal approach and 1 case via abdominal approach. The operation time, postoperative hemoglobin decrease, extraction time of negative pressure drainage, postoperative hospital stay, postoperative pathology and postoperative complications were recorded, and the serum creatinine level and GFR level of the affected side were followed up 1 month after operation.Results:All the operations were successfully completed, and there was no conversion to open surgery or radical nephrectomy. One case changed to scissors fast resection and sutured hemostasis due to severe intraoperative bleeding. The operation time was 90.0-120.0 min, with the average of (104.5±9.0)min. The postoperative hemoglobin level was 96.0-132.0g/L, with an average of (115.2±11.8)g/L, and the difference was statistically significant ( P<0.05). The postoperative hemoglobin decreased from 12.0g/L to 25.0g/L, with an average of (20.6±4.6)g/L. The time of vacuum drainage was 5.0-7.0 days, with an average of (5.7±0.7)d. Postoperative hospital stay was 6.0-8.0 days, with an average of (6.7±0.7)d. No bleeding, urinary leakage and other complications occurred in all patients. There were 7 cases of clear cell carcinoma, 2 cases of papillary renal cell carcinoma and 1 case of angiomyolipoma. All margins were negative. One month after operation, creatinine ranged from 66.0 to 90.4μmol/L, with an average of (76.8±8.3)μmol/L, which was not significantly different compared with that before operation ( P>0.05). One month after operation, GFR was 45.1-60.8 ml/min, and with an average of (55.5±4.7)ml/min, and there was no significant difference compared with preoperative data( P>0.05). Conclusions:For T 1aN 0M 0 stage and exophytic renal tumors, laparoscopic non-blocking partial nephrectomy assisted by lateral green laser is safe and effective.

16.
Chinese Journal of Urology ; (12): 862-863, 2021.
Article in Chinese | WPRIM | ID: wpr-911134

ABSTRACT

End-stage renal disease(ESRD) patients with malignant renal tumor has its unique clinicopathological characteristics, and there are currently few domestic related studies. A retrospective analysis was performed on the clinical data of 16 ESRD patients with malignant renal tumor in Jiangxi Provincial People's Hospital. Their ages ranged from 20 to 70 yrs (mean 47.6 yrs). Most of the patients were asymptomatic and all underwent radical nephrectomy or radical nephroureterectomy. Clear cell carcinoma occurred in 11 cases, and papillary renal cell carcinoma in 2 cases. The vast majority of 13 cases were low-stage, low-grade tumors. All 13 cases were followed up for an average of 43.7 months and no recurrence or metastasis was found. In addition, the patients of renal sarcomatoid carcinoma, renal pelvis carcinoma and renal sarcoma survived for 2 to 20 months with poor prognosis.

17.
Chinese Journal of Urology ; (12): 735-739, 2021.
Article in Chinese | WPRIM | ID: wpr-911106

ABSTRACT

Objective:To investigate the CT features and surgical treatment of mixed epithelial and stromal tumor of the kidney (MESTK).Methods:From April 2015 to August 2018, 13 patients with MESTK confirmed by pathology at the First Affiliated Hospital, College of Medicine, Zhejiang University, were enrolled in this study and their clinical data were analyzed retrospectively. These patients included 3 males and 10 females, with age ranging from 22 to 80 years old and the median age of 37 years old. Two patients complained of lumbar discomfort with urinary urgency and another 2 patients presented with hematuria. Nine patients were asymptomatic and their renal lesions were detected by abdominal ultrasonography for physical examination or other reasons. There were 2 cases had a history of polycystic kidney disease, 1 patient took contraceptive for 2 years, and 3 cases took antihypertensive agents for 5-10 years. The other patients denied any administration of hormone or other medicine for long time. The urine routine test was normal for these patients except for 2 patients did not take this test before operation. The creatinine value ranged from 45 to 486 μmol/L, with the median value of 67 μmol/L. The scope of glomerular filtration rate (GFR) was 6.98 to 132.28 ml/min, with the median value of 109.28 ml/min. The preoperative computer tomography (CT) showed single neoplasm in 11 patients and no obvious neoplasm was found in 2 patients who had polycystic kidney disease. Moreover, these lesions presented cystic neoplasm for 8 cases, cystic-solid neoplasm for 2 cases and solid neoplasm for 3 cases. Long diameter was measured about 2.5 to 7.5 cm, with the median of 5 cm, and calcification was found in 4 cases. These tumors manifested mild to moderate enhancement and delayed-enhancement for tumor parenchyma and intracapsular septum. The CT attenuation value was from 20 to 55 Hounsfield unit (HU). Base on the R. E.N.A.L. score system, these renal lesions got 4 to 10 points, with the median value of 7 points. Before operation, just 1 case was diagnosed as angiomyolipoma and 2 cases were diagnosed as polycystic kidney disease. No definitive diagnosis was made for the other 10 cases by CT imaging. In addition, the tumor staging based on preoperative imaging was made at T1a for 8 cases and T1b for 3 cases. Among these cases, 2 patients with polycystic kidney disease underwent open radical nephrectomy due to recurrent hematuria and uremia. One patient underwent laparoscopic radical nephrectomy due to perirenal fat adhesion. Partial nephrectomy was performed in remaining 10 patients by open surgery for 6 patients, robotic surgery for 3 patients and laparoscopic surgery for 1 patient. These renal tumors and 0.5-1.0 cm surrounding normal renal parenchyma were removed during operation.Results:In this study, 8 patients had blood loss of 30 to 100 ml during open operation, and 5 patients had blood loss of 20 to 100 ml during laparoscopic or robotic surgery. The warm ischemic time during partial nephrectomy was around 17 to 40 min, with the median value of 20 min. All of 13 cases were diagnosed as MESTK by postoperative pathology and the surgical margin was negative. There were no serious complications or special treatment after operation. The follow-up time ranged from 12 to 41 months, with the median time of 21 months. Obvious signs of tumor recurrence or metastasis were not detected in 13 cases during follow-up.Conclusions:CT images of MESTK mostly presented cystic or cystic-solid lesions, and solid lesions were relatively rare. This disease always showed mild to moderate enhancement and delayed enhancement of septal or tumor parenchyma. If there is coarse calcification in the lesions, it is more likely to be diagnosed as MESTK. Partial nephrectomy is preferred and radical nephrectomy should be considered when perirenal fat adhesion is suggested by the preoperative CT images.

18.
Chinese Journal of Urology ; (12): 725-729, 2021.
Article in Chinese | WPRIM | ID: wpr-911104

ABSTRACT

Objective:To investigate the effect and safety of using the fourth arm in robot assisted partial nephrectomy via retroperitoneal approach.Methods:The clinical data of 480 patients with newly diagnosed renal tumors treated in the First Affiliated Hospital of Medical College of Zhejiang University from January 2016 to December 2018 were analyzed retrospectively. All patients underwent robot assisted partial nephrectomy with the fourth arm and were divided into two groups according to the surgical approaches. There were 312 cases in the retroperitoneal group, 198 males and 114 females, aged 18-82 years, with an average of 54.0 years. The tumors were located in the right kidney in 152 cases (48.7%), left kidney in 155 cases(49.7%), double kidney in 5 cases (1.6%), with tumor size of (3.5±2.7) cm, R.E.N.A.L. score of 4-5 in 105 cases (33.7%), 6-8 in 143 cases(45.8%), and 9-12 in 64 cases (20.5%). There were 168 cases in the transperitoneal group, 105 males and 63 females, the age ranged from 21 to 79 years, with an average of 53.2 years. The tumors were located in the right kidney in 85 cases (50.6%), left kidney in 78 cases (46.4%), double kidney in 3 cases (1.8%), with tumor size of (3.8±2.9) cm, R.E.N.A.L. score of 4-5 in 52 cases (31.0%), 6-8 in 81 cases (48.2%), and 9-12 in 35 cases (20.8%). In the retroperitoneal group, the patients were placed in the 90 ° lateral position on the healthy side, the lens hole cannula was placed 2-3 cm above the iliac crest, and one operation hole cannula was placed 8 cm away from the lens hole cannula on the ventral and dorsal sides respectively. The included angle between the two operation holes and the lens hole was 150°-180°. The fourth arm operation hole was established 8 cm away from the ventral operation hole, and the included angle between the connecting line and the horizontal line is ≤15°. The fourth arm operating hole was placed with ProGrasp forceps, which can be used to push away fat, peritoneum, traction and lift kidney, etc., so as to obtain satisfactory operating space and position. The perioperative conditions and surgical complications of the two groups were compared.Results:The operations were successfully completed in both groups, and there was no conversion to open surgery. The installation time of retroperitoneal group and transperitoneal group were (12.3±5.3)min and (7.8±3.8)min respectively, the console time was (70.5±17.1)min and (89.4±23.9)min respectively, the warm ischemia time was (17.3±8.2)min and (19.2±9.1)min respectively, the intraoperative bleeding volume was (115.2±47.3)ml and (125.8±52.1)ml respectively, and the intestinal recovery time was (1.5±1.8)d and (2.7±2.4)d respectively.The postoperative hospital stay was(6.3±1.8)d and (7.4±2.8)d, respectively ( P<0.05). The positive rates of incision margin in retroperitoneal group and transperitoneal group were 0(0 cases) and 0.6% (1 case). The time of indwelling drainage tube was (4.6±2.5)d and (4.9±2.8)d, respectively, and there was no significant difference ( P>0.05). The incidence of postoperative complications in the retroperitoneal group was lower than that in the transperitoneal group (67 cases, 21.5% vs. 51 cases, 30.3%, P=0.031). There was significant difference in the incidence of Clavien grade Ⅰ-Ⅱ complications (62 cases, 19.8% vs. 48 cases, 28.6%, P=0.030). There was no significant difference in the incidence of Clavien grade Ⅲ-Ⅳ complications (5 cases, 1.6% vs. 3 cases, 1.9%, P>0.05). Conclusions:Compared with the transperitoneal approach, the retroperitoneal approach with the fourth arm robot assisted partial nephrectomy is safe and effective, with shorter operation time, warm ischemia time, postoperative recovery time and fewer complications.

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Chinese Journal of Urology ; (12): 721-724, 2021.
Article in Chinese | WPRIM | ID: wpr-911103

ABSTRACT

Objective:To explore the safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy in the treatment of cystic renal masses.Methods:The 19 patients with cystic renal masses undergoing laparoscopic microwave ablation combined with partial nephrectomy from November 2017 to December 2019 were retrospectively analyzed. There were 13 males and 6 females. The average age was 46.2 years. The mean body mass index was (25.8±3.1) kg/m 2. The masses located in the left kidney in 7 cases and the right kidney in 12 cases. The ECOG scores were 0. The mean maximum diameter of the tumors was (2.8±1.3) cm. Five cases were diagnosed with Bosniak Ⅲ and 14 cases with Bosniak Ⅳ. According to R. E.N.A.L. scoring, 11 cases were of low difficulty (4-6 points), 7 cases of medium difficulty (7-9 points) and 1 case of high difficulty (10-12 points). The cystic renal masses were ablated by laparoscopic microwave ablation, then followed by partial nephrectomy. Postoperative complications were observed and the prognosis was assessed by CT or MRI. Results:The mean duration of operation was (84.0±20.8) min. The median intraoperative blood loss was 20 (10-50) ml. The median duration of postoperative hospitalization was 3 (2-6) d, and no complications such as bleeding, infection, gross hematuria or urine leakage were observed. According to the malignant degree of cystic renal masses, the patients were divided into low-risk group and high-risk group. The patients with benign cystic kidney tumors or with low biological malignancy were considered as the low-risk group, while the patients with high malignant pathology were considered as the high-risk group. In the low-risk group, there were 4 patients, including 1 patient with papillary adenoma, 1 patient with renal angiomyolipoma, 1 patient with low-grade malignant potential multilocular cystic renal tumor, and 1 patient with renal chromophobe carcinoma (stage T 1a). In the high-risk group, there were 15 cases, including 14 cases of clear cell renal cell carcinoma (AJCC pathological stage: T 1a stage 11 cases, T 1b stage 3 cases; WHO/ISUP classification: 7 cases in grade 1, 6 cases in grade 2, and 1 case in grade 3); 1 case of Type 2 papillary renal cell carcinoma (stage T 1b, grade 2). The median follow-up was 20 months (12-37 months). Both groups survived, and no signs of tumor recurrence, implantation or metastasis were found in chest and abdomen imaging. Blood tests were performed regularly, and no significant abnormalities occurred. Conclusions:The safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy for the treatment of cystic renal masses is satisfactory, and postoperative pathology is clear, providing a potential option for cystic renal masses treatment.

20.
Chinese Journal of Urology ; (12): 502-506, 2021.
Article in Chinese | WPRIM | ID: wpr-911058

ABSTRACT

Objective:To explore the feasibility and safty of robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy in treatment of Ⅳa grade tumor thrombus without cardiopulmonary bypass and thoracotomy.Methods:The clinical data of 4 patients with renal cell carcinoma and Ⅳa grade tumor thrombus by robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy from January 2013 to June 2019 were retrospectively analyzed. The median age was 53.5 (53-70) years. The average body mass index was 23.25 (20.7-26.3) kg/m 2. The tumors were located on the right side in 2 cases. The average maximum diameter of the tumor was 8.1 (3.6-11.2) cm.Preoperative tumor thrombus of all patients was classified as Ⅳa. The average preoperative length of tumor thrombus in vena cava was 12.3 (11.8-18.0) cm. All the operations were performed under multidisciplinary cooperation of urology, hepatobiliary, cardiovascular, ultrasound and anesthesiologist team. Surgical procedure: Robot assisted liver mobilization was used to expose the inferior vena cava. Under the guidance of intraoperative ultrasound, the central tendon and pericardium of diaphragm were dissected until the inferior vena cava and right atrium in the superior pericardium were exposed. The first porta hepatis and inferior vena cava were blocked in turn.The vena cava thrombectomy and inferior vena cava reconstruction were performed. Results:All the operations were completed without conversion. The median operation time was 553.5 (338-642) minutes, and the median time of the first porta hepatis occlusion was 18.1 (14-32)minutes. The median blood loss was 1 900(1 000-2 600)ml. All patients were transferred to ICU after operation. The median length of stay in ICU was 7(4-8) days, and the median time of indwelling drainage tube was 8(4-12) days. The average postoperative hospital stay was 13(11-20) days. There were 1 case of grade Ⅱ and 3 cases of grade Ⅲ complications (Clavien classification). One case had paroxysmal supraventricular tachycardia, one case had lymphatic fistula, one case had pleural effusion with atelectasis, and one case had hepatic and renal insufficiency and lymphatic fistula. The complications were improved after treatment. There was no perioperative death.Conclusions:Robot assisted trans-diaphragmatic intropericardial inferior vena cava occlusion and thrombectomy is an alternative method for the treatment of Ⅳa grade inferior vena cava tumor thrombus. Using this method, Ⅳa grade tumor thrombus can be treated without cardiopulmonary bypass and thoracotomy, with controllable complications and zero perioperative mortality.

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