Objective：To investigate the method and effect of nephron-sparing surgery in the treatment of small renal cell carcinoma. Methods： From August 1 997 to October 2008, 48 cases of small renal cell carcinomas were conf...Objective：To investigate the method and effect of nephron-sparing surgery in the treatment of small renal cell carcinoma. Methods： From August 1 997 to October 2008, 48 cases of small renal cell carcinomas were confirmed by surgery and pathology, and reviewed retrospectively. Of the 48 cases, there was 1 patient with bilateral tumors, 8 with solitary kidney tumors, 1 with unilateral tumor and a damaged contralateral kidney, and 38 with unilateral tumors and a normal contralateral kidney; 9 underwent tumor enucleation and the remaining patients received partial nephrectomy. Results：There were no local tumor recurrences and/or tumor metastasis at a mean followup of 60 months. Conclusion： Confirming conclusions from other centers, we have found that nephron-sparing surgery is an effective treatment for small renal cell carcinomas.展开更多
Background:Warm ischemic injury is one of the most important factors affecting renal function in partial nephrectomy(PN).The technique of segmental renal artery clamping emerges as an alternative to conventional renal...Background:Warm ischemic injury is one of the most important factors affecting renal function in partial nephrectomy(PN).The technique of segmental renal artery clamping emerges as an alternative to conventional renal artery clamping for renal hilar control.Objective:To evaluate the feasibility and efficiency of laparoscopic PN(LPN)with segmental renal artery clamping in comparison with the conventional technique.Design,setting,and participants:A total of 75 patients underwent LPN from June 2007 to November 2009.All patients had T1a or T1b tumor in one kidney and a normal contralateral kidney.Thirty-seven patients underwent surgeries with main renal artery clamping,and 38 underwent surgeries with segmental artery clamping.Intervention:All procedures were performed by the same laparoscopic surgeon.Measurements:Blood loss,operation time,warm ischemia(WI)time,and complications affected renal function before and after operation were recorded.Results and limitations:All LPNs were completed without conversion to open surgery or nephrectomy.The novel technique slightly increased WI time(p<0.001)and intraoperative blood loss(p=0.006),while it provided better postoperative affected renal function(p<0.001)compared with the conventional technique.The total complication rate was 12%.Among the 38 cases where segmental renal artery clamping was performed,7 had to convert to the conventional method.Tumor size and location influenced the number of clamped segmental arteries.Long-term postoperative renal function is still awaited.Conclusions:LPN with segmental artery clamping is safe and feasible in clinical practice.It minimizes the intraoperative WI injury and improves early postoperative affected renal function compared with main renal artery clamping.(C)2010 European Association of Urology.Published by Elsevier B.V.All rights reserved.展开更多
Objective:The aim of the study was to evaluate three-dimensional virtual models(3DVMs)usefulness in the intraoperative assistance of minimally-invasive partial nephrectomy in highly complex renal tumors.Methods:At our...Objective:The aim of the study was to evaluate three-dimensional virtual models(3DVMs)usefulness in the intraoperative assistance of minimally-invasive partial nephrectomy in highly complex renal tumors.Methods:At our institution cT1-2N0M0 all renal masses with Preoperative Aspects and Dimensions Used for an Anatomical classification score≥10 treated with minimally-invasive partial nephrectomy were considered for the present study.For inclusion a baseline contrast-enhanced computed tomography in order to obtain 3DVMs,the baseline and postoperative serum creatinine as well as estimated glomerular filtration rate values were needed.These patients,in which 3DVMs were used to assist the surgeon in the planning and intraoperative guidance,were then compared with a control group of patients who underwent minimally-invasive partial nephrectomy with the same renal function assessments,but without 3DVMs.Multivariable logistic regression models were used to predict the margin,ischemia,and complication score achievement.Results:Overall,79 patients met the inclusion criteria and were compared with 143 complex renal masses without 3DVM assistance.The 3DVM group showed better postoperative outcomes in terms of baseline-weighted differential estimated glomerular filtration rate(-17.7%vs.-22.2%,p=0.03),postoperative complications(16.5%vs.23.1%,p=0.03),and major complications(Clavien Dindo>III,2.5%vs.5.6%,p=0.03).At multivariable logistic regression 3DVM assistance independently predicted higher rates of successful partial nephrectomy(odds ratio:1.42,p=0.03).Conclusion:3DVMs represent a useful tool to plan a tailored surgical approach in case of surgically complex masses.They can be used in different ways,matching the surgeon's needs from the planning phase to the demolitive and reconstructive phase,leading towards maximum safety and efficacy outcomes.展开更多
Kidney transplantation is the best replacement treatment for the end-stage renal disease.Currently,the imbalance between the number of patients on a transplant list and the number of organs available constitutes the c...Kidney transplantation is the best replacement treatment for the end-stage renal disease.Currently,the imbalance between the number of patients on a transplant list and the number of organs available constitutes the crucial limitation of this approach.To expand the pool of organs amenable for transplantation,kidneys coming from older patients have been employed;however,the combination of these organs in conjunction with the chronic use of immunosuppressive therapy increases the risk of incidence of graft small renal tumors.This narrative review aims to provide the state of the art on the clinical impact and management of incidentally diagnosed small renal tumors in either donors or recipients.According to the most updated evidence,the use of grafts with a small renal mass,after bench table tumor excision,may be considered a safe option for high-risk patients in hemodialysis.On the other hand,an early small renal mass finding on periodic ultrasound-evaluation in the graft should allow to perform a conservative treatment in order to preserve renal function.Finally,in case of a renal tumor in native kidney,a radical nephrectomy is usually recommended.展开更多
Currently,there is no consensus among the transplant community about the treatment of renal cell carcinoma(RCC)of the transplanted kidney.Until recently,graftectomy was universally considered the golden standard,regar...Currently,there is no consensus among the transplant community about the treatment of renal cell carcinoma(RCC)of the transplanted kidney.Until recently,graftectomy was universally considered the golden standard,regardless of the characteristics of the neoplasm.Due to the encouraging results observed in native kidneys,conservative options such as nephron-sparing surgery(NSS)(enucleation and partial nephrectomy)and ablative therapy(radiofrequency ablation,cryoablation,microwave ablation,high-intensity focused ultrasound,and irreversible electroporation)have been progressively used in carefully selected recipients with early-stage allograft RCC.Available reports show excellent patient survival,optimal oncological outcome,and preserved renal function with acceptable complication rates.Nevertheless,the rarity and the heterogeneity of the disease,the number of options available,and the lack of long-term follow-up data do not allow to adequately define treatment-specific advantages and limitations.The role of active surveillance and immunosuppression management remain also debated.In order to offer a better insight into this difficult topic and to help clinicians choose the best therapy for their patients,we performed and extensive review of the literature.We focused on epidemiology,clinical presentation,diagnostic work up,staging strategies,tumour characteristics,treatment modalities,and follow-up protocols.Our research confirms that both NSS and focal ablation represent a valuable alternative to graftectomy for kidney transplant recipients with American Joint Committee on Cancer stage T1aN0M0 RCC.Data on T1bN0M0 lesions are scarce but suggest extra caution.Properly designed multi-centre prospective clinical trials are warranted.展开更多
Background This multi-center analysis of data from China reviews the management and long-term outcomes of patients with bilateral Wilms tumors(BWT),and explores prognostic risk factors.Methods We retrospectively analy...Background This multi-center analysis of data from China reviews the management and long-term outcomes of patients with bilateral Wilms tumors(BWT),and explores prognostic risk factors.Methods We retrospectively analyzed a cohort of pediatric patients with synchronous BWT treated at 18 pediatric oncology centers in China between 2006 and 2023.The overall survival(OS)and event-free survival(EFS)rates were calculated using Kaplan-Meier methodology.Prognostic risk factors were determined using univariable and multivariable analysis.Results A total of 167 patients with BWT and a median age at diagnosis of 13 months(range 0-78 months)were included in the study.Neoadjuvant chemotherapy was administered to 149 index cases;tumor biopsy was performed before initiating chemotherapy in 70 patients.One hundred and three children underwent bilateral nephron-sparing surgery(NSS)and two hundred fifty-two of the three hundred one kidneys underwent NSS.The four-year OS and EFS rates in the study cohort were 86.5%and 77.8%.After a median follow-up of 50 months,four patients developed renal failure requiring dialysis and a single patient received a kidney transplant 26 months postoperatively.Conclusions Regarding prognostic factors,the results of the multifactor analysis indicate that distant metastasis and positive surgical margins have negative impacts on OS and distant metastasis had a negative effect on EFS.Distant metastasis and positive surgical margins affect the long-term prognosis of BWT.展开更多
文摘Objective：To investigate the method and effect of nephron-sparing surgery in the treatment of small renal cell carcinoma. Methods： From August 1 997 to October 2008, 48 cases of small renal cell carcinomas were confirmed by surgery and pathology, and reviewed retrospectively. Of the 48 cases, there was 1 patient with bilateral tumors, 8 with solitary kidney tumors, 1 with unilateral tumor and a damaged contralateral kidney, and 38 with unilateral tumors and a normal contralateral kidney; 9 underwent tumor enucleation and the remaining patients received partial nephrectomy. Results：There were no local tumor recurrences and/or tumor metastasis at a mean followup of 60 months. Conclusion： Confirming conclusions from other centers, we have found that nephron-sparing surgery is an effective treatment for small renal cell carcinomas.
文摘Background:Warm ischemic injury is one of the most important factors affecting renal function in partial nephrectomy(PN).The technique of segmental renal artery clamping emerges as an alternative to conventional renal artery clamping for renal hilar control.Objective:To evaluate the feasibility and efficiency of laparoscopic PN(LPN)with segmental renal artery clamping in comparison with the conventional technique.Design,setting,and participants:A total of 75 patients underwent LPN from June 2007 to November 2009.All patients had T1a or T1b tumor in one kidney and a normal contralateral kidney.Thirty-seven patients underwent surgeries with main renal artery clamping,and 38 underwent surgeries with segmental artery clamping.Intervention:All procedures were performed by the same laparoscopic surgeon.Measurements:Blood loss,operation time,warm ischemia(WI)time,and complications affected renal function before and after operation were recorded.Results and limitations:All LPNs were completed without conversion to open surgery or nephrectomy.The novel technique slightly increased WI time(p<0.001)and intraoperative blood loss(p=0.006),while it provided better postoperative affected renal function(p<0.001)compared with the conventional technique.The total complication rate was 12%.Among the 38 cases where segmental renal artery clamping was performed,7 had to convert to the conventional method.Tumor size and location influenced the number of clamped segmental arteries.Long-term postoperative renal function is still awaited.Conclusions:LPN with segmental artery clamping is safe and feasible in clinical practice.It minimizes the intraoperative WI injury and improves early postoperative affected renal function compared with main renal artery clamping.(C)2010 European Association of Urology.Published by Elsevier B.V.All rights reserved.
文摘Objective:The aim of the study was to evaluate three-dimensional virtual models(3DVMs)usefulness in the intraoperative assistance of minimally-invasive partial nephrectomy in highly complex renal tumors.Methods:At our institution cT1-2N0M0 all renal masses with Preoperative Aspects and Dimensions Used for an Anatomical classification score≥10 treated with minimally-invasive partial nephrectomy were considered for the present study.For inclusion a baseline contrast-enhanced computed tomography in order to obtain 3DVMs,the baseline and postoperative serum creatinine as well as estimated glomerular filtration rate values were needed.These patients,in which 3DVMs were used to assist the surgeon in the planning and intraoperative guidance,were then compared with a control group of patients who underwent minimally-invasive partial nephrectomy with the same renal function assessments,but without 3DVMs.Multivariable logistic regression models were used to predict the margin,ischemia,and complication score achievement.Results:Overall,79 patients met the inclusion criteria and were compared with 143 complex renal masses without 3DVM assistance.The 3DVM group showed better postoperative outcomes in terms of baseline-weighted differential estimated glomerular filtration rate(-17.7%vs.-22.2%,p=0.03),postoperative complications(16.5%vs.23.1%,p=0.03),and major complications(Clavien Dindo>III,2.5%vs.5.6%,p=0.03).At multivariable logistic regression 3DVM assistance independently predicted higher rates of successful partial nephrectomy(odds ratio:1.42,p=0.03).Conclusion:3DVMs represent a useful tool to plan a tailored surgical approach in case of surgically complex masses.They can be used in different ways,matching the surgeon's needs from the planning phase to the demolitive and reconstructive phase,leading towards maximum safety and efficacy outcomes.
文摘Kidney transplantation is the best replacement treatment for the end-stage renal disease.Currently,the imbalance between the number of patients on a transplant list and the number of organs available constitutes the crucial limitation of this approach.To expand the pool of organs amenable for transplantation,kidneys coming from older patients have been employed;however,the combination of these organs in conjunction with the chronic use of immunosuppressive therapy increases the risk of incidence of graft small renal tumors.This narrative review aims to provide the state of the art on the clinical impact and management of incidentally diagnosed small renal tumors in either donors or recipients.According to the most updated evidence,the use of grafts with a small renal mass,after bench table tumor excision,may be considered a safe option for high-risk patients in hemodialysis.On the other hand,an early small renal mass finding on periodic ultrasound-evaluation in the graft should allow to perform a conservative treatment in order to preserve renal function.Finally,in case of a renal tumor in native kidney,a radical nephrectomy is usually recommended.
文摘Currently,there is no consensus among the transplant community about the treatment of renal cell carcinoma(RCC)of the transplanted kidney.Until recently,graftectomy was universally considered the golden standard,regardless of the characteristics of the neoplasm.Due to the encouraging results observed in native kidneys,conservative options such as nephron-sparing surgery(NSS)(enucleation and partial nephrectomy)and ablative therapy(radiofrequency ablation,cryoablation,microwave ablation,high-intensity focused ultrasound,and irreversible electroporation)have been progressively used in carefully selected recipients with early-stage allograft RCC.Available reports show excellent patient survival,optimal oncological outcome,and preserved renal function with acceptable complication rates.Nevertheless,the rarity and the heterogeneity of the disease,the number of options available,and the lack of long-term follow-up data do not allow to adequately define treatment-specific advantages and limitations.The role of active surveillance and immunosuppression management remain also debated.In order to offer a better insight into this difficult topic and to help clinicians choose the best therapy for their patients,we performed and extensive review of the literature.We focused on epidemiology,clinical presentation,diagnostic work up,staging strategies,tumour characteristics,treatment modalities,and follow-up protocols.Our research confirms that both NSS and focal ablation represent a valuable alternative to graftectomy for kidney transplant recipients with American Joint Committee on Cancer stage T1aN0M0 RCC.Data on T1bN0M0 lesions are scarce but suggest extra caution.Properly designed multi-centre prospective clinical trials are warranted.
基金supported by the high-level clinical specialty construction project of public hospital in capital region of Inner Mongolia Autonomous Region(2023SGGZ0038).
文摘Background This multi-center analysis of data from China reviews the management and long-term outcomes of patients with bilateral Wilms tumors(BWT),and explores prognostic risk factors.Methods We retrospectively analyzed a cohort of pediatric patients with synchronous BWT treated at 18 pediatric oncology centers in China between 2006 and 2023.The overall survival(OS)and event-free survival(EFS)rates were calculated using Kaplan-Meier methodology.Prognostic risk factors were determined using univariable and multivariable analysis.Results A total of 167 patients with BWT and a median age at diagnosis of 13 months(range 0-78 months)were included in the study.Neoadjuvant chemotherapy was administered to 149 index cases;tumor biopsy was performed before initiating chemotherapy in 70 patients.One hundred and three children underwent bilateral nephron-sparing surgery(NSS)and two hundred fifty-two of the three hundred one kidneys underwent NSS.The four-year OS and EFS rates in the study cohort were 86.5%and 77.8%.After a median follow-up of 50 months,four patients developed renal failure requiring dialysis and a single patient received a kidney transplant 26 months postoperatively.Conclusions Regarding prognostic factors,the results of the multifactor analysis indicate that distant metastasis and positive surgical margins have negative impacts on OS and distant metastasis had a negative effect on EFS.Distant metastasis and positive surgical margins affect the long-term prognosis of BWT.
