Kidney Cancer I: Partial Nephrectomy & Kidney Preservation Strategies (V01)
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You have accessJournal of UrologyKidney Cancer I: Partial Nephrectomy & Kidney Preservation Strategies (V01)1 Apr 2020Kidney Cancer I: Partial Nephrectomy & Kidney Preservation Strategies (V01) View All Author Informationhttps://doi.org/10.1097/JU.0000000000000826AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement PDF downloadLoading ...Keywords:
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No AccessJournal of UrologyAdult Urology1 Mar 2012National Trends in the Use of Partial Nephrectomy: A Rising Tide That Has Not Lifted All Boats Sanjay G. Patel, David F. Penson, Baldeep Pabla, Peter E. Clark, Michael S. Cookson, Sam S. Chang, S. Duke Herrell, Joseph A. Smith, and Daniel A. Barocas Sanjay G. PatelSanjay G. Patel Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , David F. PensonDavid F. Penson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee Vanderbilt University Medical Center, Tennessee Valley Veterans Administration Health System, Nashville, Tennessee , Baldeep PablaBaldeep Pabla Vanderbilt University School of Medicine, Nashville, Tennessee , Peter E. ClarkPeter E. Clark Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , Michael S. CooksonMichael S. Cookson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , Sam S. ChangSam S. Chang Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , S. Duke HerrellS. Duke Herrell Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , Joseph A. SmithJoseph A. Smith Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , and Daniel A. BarocasDaniel A. Barocas Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee View All Author Informationhttps://doi.org/10.1016/j.juro.2011.10.173AboutFull TextPDF Cite Export CitationSelect Citation formatNLMAMAIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Treatment of organ confined renal masses with partial nephrectomy has durable oncologic outcomes comparable to radical nephrectomy. Partial nephrectomy is associated with lower risk of chronic kidney disease and in some series with better overall survival. We report a contemporary analysis on national trends of partial nephrectomy use to determine partial nephrectomy use over time, and whether nontumor related factors such as structural attributes of the treating institution or patient characteristics are associated with the underuse of partial nephrectomy. Materials and Methods: We performed an analysis of the NIS (National Inpatient Sample), which contains 20% of all United States inpatient hospitalizations. We included patients who underwent radical or partial nephrectomy for a renal mass between 2002 and 2008. Survey weights were applied to obtain national estimates of nephrectomy use and to evaluate nonclinical predictors of partial nephrectomy. Results: A total of 46,396 patients were included in the study for a weighted sample of 226,493. There was an increase in partial nephrectomy use from 15.3% in 2002 to 24.7% in 2008 (p <0.001). On multivariate analysis hospital attributes (urban teaching status, nephrectomy volume, geographic region) and patient socioeconomic status (higher income ZIP code and private/HMO payer) were independent predictors of partial nephrectomy use. Conclusions: Since 2002 the national use of partial nephrectomy for the management of renal masses has increased. However, the adoption of partial nephrectomy at smaller, rural and nonacademic hospitals lags behind that of larger hospitals, urban/teaching hospitals and higher volume centers. A lower rate of partial nephrectomy use among patients without private insurance and those living in lower income ZIP code areas highlights the underuse of partial nephrectomy as a quality of care concern. References 1 : Increasing incidence of all stages of kidney cancer in the last 2 decades in the United States: an analysis of Surveillance, Epidemiology and End Results program data. J Urol2002; 167: 57. 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Monn M, Bahler C, Flack C, Dube H and Sundaram C (2014) The Impact of Hospital Volume on Postoperative Complications Following Robot-Assisted Partial NephrectomyJournal of Endourology, 10.1089/end.2014.0265, VOL. 28, NO. 10, (1231-1236), Online publication date: 1-Oct-2014. Autorino R, Zargar H and Kaouk J (2014) Robotic-assisted laparoscopic surgery: recent advances in urologyFertility and Sterility, 10.1016/j.fertnstert.2014.05.033, VOL. 102, NO. 4, (939-949), Online publication date: 1-Oct-2014. Couapel J, Bensalah K, Bernhard J, Pignot G, Zini L, Lang H, Rigaud J, Salomon L, Bellec L, Soulié M, Vaessen C, Rouprêt M, Jung J, Mourey E, Bigot P, Bruyère F, Berger J, Ansieau J, Gimel P, Salome F, Hubert J, Pfister C, Baumert H, Timsit M, Méjean A and Patard J (2013) Is there a volume–outcome relationship for partial nephrectomy?World Journal of Urology, 10.1007/s00345-013-1213-1, VOL. 32, NO. 5, (1323-1329), Online publication date: 1-Oct-2014. Valerio M, El-Shater Bosaily A, Emberton M and Ahmed H (2014) Defining the level of evidence for technology adoption in the localized prostate cancer pathwayUrologic Oncology: Seminars and Original Investigations, 10.1016/j.urolonc.2013.10.008, VOL. 32, NO. 6, (924-930), Online publication date: 1-Aug-2014. Wiener S, Kiziloz H, Dorin R, Finnegan K, Shichman S and Meraney A (2014) Predictors of Postoperative Decline in Estimated Glomerular Filtration Rate in Patients Undergoing Robotic Partial NephrectomyJournal of Endourology, 10.1089/end.2013.0640, VOL. 28, NO. 7, (807-813), Online publication date: 1-Jul-2014. Laviana A and Hu J (2014) Current controversies and challenges in robotic-assisted, laparoscopic, and open partial nephrectomiesWorld Journal of Urology, 10.1007/s00345-014-1277-6, VOL. 32, NO. 3, (591-596), Online publication date: 1-Jun-2014. Liu J, Leppert J, Maxwell B, Panousis P and Chung B (2014) Trends and perioperative outcomes for laparoscopic and robotic nephrectomy using the National Surgical Quality Improvement Program (NSQIP) database11Financial Support: JTL is supported by Award no. DK089086 from the National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).Urologic Oncology: Seminars and Original Investigations, 10.1016/j.urolonc.2013.09.012, VOL. 32, NO. 4, (473-479), Online publication date: 1-May-2014. 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Smaldone M and Kutikov A (2012) Assessing the management of localized kidney cancerNature Reviews Urology, 10.1038/nrurol.2012.45, VOL. 9, NO. 4, (186-188), Online publication date: 1-Apr-2012. Volume 187Issue 3March 2012Page: 816-821 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Keywordskidney neoplasmsphysician's practice patternsnephrectomyMetrics Author Information Sanjay G. Patel Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author David F. Penson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee Vanderbilt University Medical Center, Tennessee Valley Veterans Administration Health System, Nashville, Tennessee More articles by this author Baldeep Pabla Vanderbilt University School of Medicine, Nashville, Tennessee More articles by this author Peter E. Clark Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Galil Medical. More articles by this author Michael S. Cookson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Endo. More articles by this author Sam S. Chang Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Sanofi-Aventis, Endo, Allergan and Centocor Ortho Biotech. More articles by this author S. Duke Herrell Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Aesculap Inc., Covidien Surgical Devices, Veran Medical Tech, Wilex and Galil Medical. More articles by this author Joseph A. Smith Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Steba Pharmaceuticals. More articles by this author Daniel A. Barocas Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Ferring, Dendreon and Allergan. More articles by this author Expand All Advertisement PDF downloadLoading ...
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Background: Despite their potential benefits to patients, the adoption of partial nephrectomy and laparoscopic kidney cancer surgery has been both gradual and concentrated in select hospitals. Objective: We assessed the degree to which adjusting for hospital structural characteristics modifies the association between hospital nephrectomy volume and patient receipt of partial nephrectomy and/or laparoscopic kidney cancer surgery. Research Design and Subjects: From the Nationwide Inpatient Sample, we identified an unweighted sample of 4943 patients who underwent kidney cancer surgery in 2003. Main Outcome Measure: Our primary outcomes were patient receipt of (1) partial nephrectomy and/or (2) laparoscopic kidney cancer surgery. Results: Our weighted analytic cohort comprised 34,045 cases. Overall, 16% of patients received a partial nephrectomy, and 17% underwent laparoscopic surgery; at high-nephrectomy-volume hospitals the proportions increased to 22% and 26%, respectively. Hospital structural characteristics varied across nephrectomy-case volume strata. In unadjusted models, patients treated at hospitals in the highest-nephrectomy-volume tercile were more likely than those treated at low-volume facilities to receive a partial nephrectomy [Risk RatioPN (RRPN) 2.2; 95% confidence interval (CI), 1.6–2.8] or laparoscopic surgery (RRlap 2.9; 95% CI, 2.0–4.0). Adjusting for differences in hospital structure attenuated the association between hospital nephrectomy volume and use of partial nephrectomy or laparoscopy by 60% (adjusted RRPN 1.4; 95% CI, 0.9–2.2) and 12% (adjusted RRlap 2.5; 95% CI, 1.4–4.1), respectively. Conclusions: Changes to the hospital environment may facilitate greater use of partial nephrectomy at hospitals that infrequently perform kidney cancer surgery. Efforts to increase the uptake of laparoscopy are probably best directed at surgeon-specific adoption barriers.
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In the last ten years, the number of organ preservation surgeries for kidney cancer significantly increased. Per literature data, the incidence of recurrences after partial nephrectomy is between 2.9 and 11 %, mostly they are located in the operated or contralateral kidney. Positive surgical margin, high stage and histological subtype of the tumor, as well as hereditary diseases, can serve as predictors for recurrences. In renal cancer recurrences, radical nephrectomy, ablation therapy and repeat tumor resection are possible treatment methods. Kidney resection, same as in primary renal tumors, leads to chronic kidney disease and cardiovascular complications. Different ablation methods, despite their low invasiveness, are not always technically possible. Therefore, in patients with kidney cancer recurrence and satisfactory functional status, repeat partial nephrectomy can be a method of choice. The literature describes the outcomes of open repeat kidney resection with high incidence of general and severe complications. The number of these complications significantly decreased due to the use of robot-assisted access for resection of recurrent renal tumors. Functional characteristics of repeat kidney resections do not significantly decrease, especially in robot-assisted partial nephrectomy. Oncological outcomes of these surgeries remain intermediate, further prospective multi-center trials are needed for their confirmation.
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This chapter addresses the role of ancillary surgical procedures during kidney cancer surgery, namely the benefits and harms associated with lymphadenectomy and adrenalectomy. Curative treatment of renal cell carcinoma is primarily surgical via partial nephrectomy (removal of the tumor with preservation of the kidney) or total/radical nephrectomy (removal of the entire tumor-bearing kidney). The chapter also addresses a series of focused clinical questions that are addressed in a systematic fashion, including a comprehensive literature search, a rating of the quality of evidence, and an assessment of ratio of benefit and harm of a given treatment option. The clinical questions are: In patients with a renal tumor who are receiving nephrectomy, should retroperitoneal lymphadenectomy also be performed? and In patients with a renal tumor who are receiving nephrectomy, should ipsilateral adrenalectomy also be performed?
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You have accessJournal of UrologyKidney Cancer I: Partial Nephrectomy & Kidney Preservation Strategies (V01)1 Apr 2020Kidney Cancer I: Partial Nephrectomy & Kidney Preservation Strategies (V01) View All Author Informationhttps://doi.org/10.1097/JU.0000000000000826AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement PDF downloadLoading ...
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Purpose of review Provider volume has been shown to affect outcomes of various surgical procedures. Because of its technical complexity, it is likely that partial nephrectomy outcomes can be affected by hospital and/or surgeon volume. However, until recently, there were few publications on the subject. Our objective is to discuss recent findings on the impact of surgical volume on partial nephrectomy outcomes. Recent findings Two studies found a link between the number of partial nephrectomy performed at an institution and postoperative outcomes. Data extrapolated from articles on learning curve of laparoscopic partial nephrectomy suggest that surgeon volume can also affect partial nephrectomy outcomes. Partial nephrectomy is underused in low-volume centers. Robotic partial nephrectomy has a shorter learning curve compared to laparoscopic partial nephrectomy and may increase the use of partial nephrectomy vs. radical nephrectomy. Results on the impact of provider volume on the surgical approach are conflicting. Summary There are few publications suggesting an impact of hospital volume on partial nephrectomy outcomes but the importance of the surgeon volume remains unclear. Higher surgical volume is associated with increased use of partial nephrectomy.
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Malignant tumors of renal parenchyma remain a problem for a clinician in view of the lacking distinctive algorithm and treatment policy based principally on the diagnosis terms. Optimal treatment, surgical, is represented by two kinds of operations: preserving and radical. Out of 292 patients admitted to the clinic from 1974 to 1990, 243 (83%) underwent surgery which was conservative in 37 (15.2%) cases. Five-year survival of surgical cases was 65.5%, in nonsurgical ones 7%. The stage of renal cancer was diagnosed as I. Renal resection was universal. There were 2 cases of heminephrectomy for cancer of the fused kidney. Histologically, the tumors appeared hypernephroid carcinoma. One patient was followed up for 10 years, 11 for 5 years. Recurrences occurred in 3 cases only, massive metastasizing in 5 years in 1 case. Dysfunctions of the kidney indicate inadequacy of the organ-preserving surgery while hypofunction of the contralateral kidney suggests possibility of the organ preservation. When it is feasible technically, the residual part of the parenchyma is functionally capable and the pelviureteral system is effective, resection of the kidney is recommended even in intact contralateral kidney. Such intervention is no less radical than nephrectomy.
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Partial nephrectomy (PN) enables surgeons to obtain both radical resection of renal tumor and maximal preservation of normal kidney, which brings benefits on survival time and life quality for patients with early stage kidney cancer. Nevertheless, how to select the patients suitable for PN still remains a clinical challenge. In this article, by analyzing the domestic and overseas application status of PN, we summarized the advantages and disadvantages of PN for patients at different stages as well as difficulties and risks in PN on complicated renal tumor. The appropriate surgical indications could benefit more patients with kidney cancer through PN.
Key words:
Kidney neoplasms; Partial nephrectomy; Laparoscopy; Robot
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