The preoperative stratification of patients based on renal scan data is unable to predict the functional outcome after partial nephrectomy

ABSTRACT Introduction: eGFR-categories are used to predict functional outcome after partial nephrectomy (PN); no study categorized patients according to preoperative renal scan (RS) data. Aim of the study was to evaluate if stratification of patients according to RS is a reliable method to predict minor/major loss of renal function after PN. Materials and Methods: We considered patients who underwent PN and RS pre-/post-PN for T1 tumor in our Institution (2007-2017). Demographics, perioperative and specifically functional data were analysed. On the basis of the baseline Split Renal Function (SRF), patients were stratified into risk-categories: 1) baseline operated-kidney SRF range 45-55%; 2) baseline operated-kidney SRF <45%. Risk categories were analysed with postoperative functional outcome: postoperative operated-kidney SRF decrease below 90% of baseline was considered significant loss of function. Contingency tables and univariate/multivariate regression were analysed looking for independent factors of postoperative functional impairment. Results: 224 patients were analysed, 125 (55.8%) maintained >90% of their baseline function. Worse probability of maintaining ≥90 baseline renal function was found in patients with Charlson's Comorbidity Index (CCI≥3) (p=0.004) and patients with PADUA score ≥8 (p=0.023). After stratification by baseline renal function, ischemia was the only independent factor: no effect on patients with poorer baseline renal function. Patients with baseline SRF 45-55% who did not experience ischemia had the highest probability to maintain ≥90% baseline SRF (p=0.028). Ischemia >25 minutes was detrimental (p=0.017). Conclusions: Stratification of patients by SRF before PN is not a reliable predictor of renal functional outcome. Ischemia seems to scarcely influence patients with poorer renal function.

The percentage of resected and ischemic volume determined by a geometric model is a significant predictor of renal functional change after partial nephrectomy

ABSTRACT Purpose The percentage of parenchyma preserved plays a predominant role in predicting renal function after partial nephrectomy (PN). Currently there is no standard method to estimate preserved renal parenchyma. In this study we propose a formula of the percentage of resected and ischemic volume (PRAIV) determined by a geometric model and evaluate the relationships between renal functional change and PRAIV as well as other clinical parameters. Materials and Methods We identified 71 patients who underwent open PN between January 2004 and April 2014. Assuming the kidney to be an ellipsoid with bilaterally equal volume and tumor to be a sphere, we calculated PRAIV by integral calculus. Nadir estimated glomerular filtration rate (eGFR) between postoperative 3 and 12 months were recorded. The correlation between percent eGFR reduction, PRAIV, and other clinical parameters were examined. Results On univariate analysis, age (p=0.03), depth of tumor invasion (p=0.004), C index (p=0.003), RAIV (p=0.04), and PRAIV (p<0.001) were correlated with percent reduction of eGFR. However, only age (p=0.007) and PRAIV (p<0.001) were significantly correlated with percent reduction of eGFR on multivariate analysis. Depicting these values along the regression line, we found R2 was 0.194 and 0.073 for PRAIV and age, respectively. Conclusions PRAIV determined by a geometric model is a significant predictor of renal functional change after PN. Using PRAIV, we can estimate percent eGFR reduction preoperatively for better patient consultation and surgical planning.

Three-dimensional reconstructive kidney volume analyses according to the endophytic degree of tumors during open partial or radical nephrectomy

ABSTRACT Objectives To investigate the renal function outcomes and contralateral kidney volume change measured by using a 3-dimensional reconstructive method after open partial nephrectomy (PN) or open radical nephrectomy (RN) according to the endophytic degree of tumors. Materials and Methods We included 214 PN and 220 RN patients. According to the endophytic degree of the tumors, we divided patients into 3 groups. Patients were assessed for renal function and kidney volume change both preoperatively and postoperatively at 6 months. Kidney volume was calculated by using personal computer-based software. Subgroup analyses was performed for tumor >4cm. Results Larger and complex tumors were more frequent in the RN group than PN group. Among patients with exophytic and mild endophytic tumors, the mean postoperative renal function was well preserved in PN group and the mean contralateral kidney volume significantly increased in the RN compared to the PN group (PN, 145.55 to 149.98mL; 3.0% versus RN, 143.93 to 169.64mL;17.9% p=0.006). However, in fully endophytic tumors, compensatory hypertrophy of the contralateral kidney was similar between PN and RN (PN, 138.16 to 159.64mL; 15.5 % versus RN, 138.65 to 168.04mL; 21.2% p=0.416) and renal functional outcomes were similar between both groups. These results were also confirmed in tumors >4cm in size. Conclusions In fully endophytic tumors, especially large tumors, the postoperative renal function and contralateral kidney volume were similar; therefore, we should consider RN preferentially as surgical option for these tumors.

Oncological and functional outcomes of salvage renal surgery following failed primary intervention for renal cell carcinoma

Purpose To assess the oncologic and functional outcomes of salvage renal surgery following failed primary intervention for RCC. Materials and Methods We performed a retrospective review of patients who underwent surgery for suspected RCC during 2004-2012. We identified 839 patients, 13 of whom required salvage renal surgery. Demographic data was collected for all patients. Intraoperative and postoperative data included ischemic duration, blood loss and perioperative complications. Preoperative and postoperative assessments included abdominal CT or magnetic resonance imaging, chest CT and routine laboratory work. Estimated glomerular filtration rate (eGFR) was calculated according to the Modification of Diet in Renal Disease equation. Results The majority (85%) of the patients were male, with an average age of 64 years. Ten patients underwent salvage partial nephrectomy while 3 underwent salvage radical nephrectomy. Cryotherapy was the predominant primary failed treatment modality, with 31% of patients undergoing primary open surgery. Pre-operatively, three patients were projected to require permanent post-operative dialysis. In the remaining 10 patients, mean pre- and postoperative serum creatinine and eGFR levels were 1.35 mg/dL and 53.8 mL/min/1.73 m2 compared to 1.43 mg/dL and 46.6 mL/min/1.73 m2, respectively. Mean warm ischemia time in 10 patients was 17.4 min and for all patients, the mean blood loss was 647 mL. The predominant pathological stage was pT1a (8/13; 62%). Negative surgical margins were achieved in all cases. The mean follow-up was 32.9 months (3.5-88 months). Conclusion While salvage renal surgery can be challenging, it is feasible and has adequate surgical, functional and oncological outcomes. .

Terapia anti-angiogénica en el manejo del cáncer renal de células claras metastásico / Antiangiogenic therapy in metastatic clear cell renal cancer

Con la aparición de la terapia anti-angiogénica hace algunos años y dado a sus promisorios resultados en el manejo del cáncer renal metastático, nuestra intención es presentar una puesta al día sobre este tema, realizando para tal efecto una revisión bibliográfica completa de los trabajos mas relevantes usando como fuente la base de datos PUBMED (1996-2007) sobre la terapia antiangiogenica en el manejo del cáncer renal metastásico. El siguiente artículo hace hincapié sobre la fisiopatología de la génesis del cáncer renal y de la acción de los agentes anti-angiogénicos, los resultados de las series clínicas publicadas, las características de los agentes anti-angiogénicos y algunos enfoques terapéuticos en los cuales podrían tener un rol en el futuro.

We present an update of the molecular targeted therapy in advanced renal cell carcinoma due to their promising results. We make a complete revision in PUBMED database (1996-2007) of the most relevant studies in molecular targeted therapy for the management of metastasis renal cell carcinoma. The emphasis was done in the physiopathology of renal cell carcinoma and molecular targeted therapy, the results of clinical trials, the characteristics of these drugs and their role in future directions.

Presentación clínica y abordaje quirúrgico del adenocarcinoma de células renales en pacientes atendidos en el Servicio de Urología del HEALF enero 2000- agosto 2004 / Clinical presentation and surgical boarding of the adenocarcinoma of renal cells in patients assisted in the Service Urology of the HEALF january 2000- august 2004

Se ha realizado un estudio tipo descriptivo de revisión de casos en los pacientes que fueron nefroctomizados por adenocarcinoma renal en el Hospital Escuela Antonio Lenín Fonseca durante el período de enero 2000- agosto 2004, con el objetivo de describir el comportamiento de su cuadro clínico, la cirugía realizada, y el estudio TNM que presentaron los pacientes. El universo lo conformaron los pacientes que se atendieron con diagnóstico de tumor renal en nuestra unidad. Para cumplir los objetivos, revisamos todos los expedientes de los pacientes que fueron sometidos a nefrectomía parciales, totales o radicales, que tuvieran un estadio clínico basados en estudios diagnósticos por imágenes y que tuvieran disponible el reporte anatomopatológico de la pieza quirúrgica...

Carcinoma de células renais / Renal cell carcinoma: a case report

O carcinoma de células renais é a neoplasia renal maligna mais frequente em adultos. Este tumor pode atingir a veia cava inferior e as câmaras direitas do coraçäo como um trombo intra-luminal. Os fatores de risco mais comumente relacionados säo a hereditariedade, agentes químicos, irradiaçäo, dieta, obesidade e o fumo. Este trabalho relata dois casos desta patologia que ocorreram com os filhos de um mesmo casal, tendo sido diagnosticados num intervalo de aproximadamente 15 dias

Angiomiolipoma Renal

Se presenta el caso de una mujer de 63 años de edad quien ingresa por cuadro súbito de dolor abdominal secundario a hemorragia intra abdominal por ruptura de angiomiolipoma renal. El angiomiolipoma renal es una neoplasia de origen hamartomatoso, constituida por una mezcla de tejido adiposo, vasos sanguíneos y fibras musculares lisas; al examen microscópico no presenta evidencia de malignidad. Se revisa la literatura disponible de esta rara neoplasia renal vista por segunda vez en Bucaramanga

Manifestaçöes sistêmicas do carcinoma de células renais / Systemic manifestations of renal cell carcinoma

As manifestaçöes sistêmicas do carcinoma de células renais säo pouco divulgadas e só recentemente passaram a ter melhor explicaçäo fisiopatológica. Estas alteraçöes estäo presentes em cerca de 1/3 dos casos, säo em geral, de aparecimento precoce e costumam regredir com a remoçäo do tumor. O conhecimento destes sintomas e sinais paraneoplásicos é importante para um diagnóstico precoce, que pode ser decisivo para a evoluçäo do paciente