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2.
Urologe A ; 59(1): 32-39, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31915888

RESUMO

BACKGROUND: In the context of living donation, the protection of the donor and the outcome are very important aspects. However, the side selection of the donor nephrectomy is also decisive. In this work, the basics of side selection and the question of whether there are differences regarding the left-sided or right-sided donor nephrectomy are considered. MATERIALS AND METHODS: Living kidney donation data of our center between December 2004 and July 2019 were evaluated in terms of withdrawal side, complications and outcome, as well as the current literature in PubMed. Finally, the results from our center are compared with the current literature. RESULTS: During the investigation period, 152 live donations were carried out in our center. In these cases 66 patients had a left-sided and in 86 cases a right-sided donor nephrectomy. One transplant vein thrombosis occurred in each group. Complications and outcome were similar for the recipient in both groups. It was noticed in the current literature that generally more left-sided donor nephrectomies are performed, most likely due to the preference of the surgeon. Although a low significantly increased risk of transplant vein thrombosis after right-sided donor nephrectomy is described, all authors agree that right-sided donor nephrectomy is a safe procedure with good outcome. CONCLUSIONS: Our own results and the current literature show that the right-sided donor nephrectomy is a safe procedure with only a slightly increased risk of complications compared to the left side and therefore can be recommended. It is clearly safe for the donor and organ, with an equivalent outcome for the recipient. The results are also dependent on the experience of the surgeon.


Assuntos
Transplante de Rim , Doadores Vivos , Nefrectomia/métodos , Coleta de Tecidos e Órgãos/efeitos adversos , Humanos , Laparoscopia , Nefrectomia/efeitos adversos , Coleta de Tecidos e Órgãos/métodos
3.
Curr Urol Rep ; 21(1): 4, 2020 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-31960160

RESUMO

PURPOSE OF REVIEW: This review provides a critical literature overview of the risks and benefits of transplantectomy in patients with a failed allograft. Additionally, it offers a summary of related problems, primarily alloantibody sensitization in the event of nephrectomy and immunosuppression weaning. RECENT FINDINGS: Transplant nephrectomy has high morbidity and mortality rates. The morbidity of transplant nephrectomy (4.3 to 82%) is mostly due to hemorrhage or infection. Mortality rates range from 1.2 to 39%, and most are due to sepsis. Transvascular graft embolization has been described as a less invasive alternative technique for the management of symptomatic graft rejection, with minimal complications compared with transplantectomy. The number of patients with a failed allograft returning to dialysis is increasing. The role of allograft nephrectomy in the management of asymptomatic transplant failure is still controversial and up today continues to depend on the usual clinical practice of each institution. The less invasive transvascular embolization could have applicability in asymptomatic patients with the obvious lower morbidity and mortality rate.


Assuntos
Rejeição de Enxerto/cirurgia , Transplante de Rim/efeitos adversos , Nefrectomia/métodos , Transplantes/cirurgia , Aloenxertos/cirurgia , Rejeição de Enxerto/etiologia , Humanos
4.
Arch Esp Urol ; 73(1): 71-75, 2020 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31950927

RESUMO

INTRODUCTION: There is still limited knowledgeabout surveillance and optimal management for patientswith recurrent chromophobe renal cell carcinoma. OBJECTIVE: Describe our experience in the diagnosis andmanagement in recurrent chromophobe renal cell carcinoma. MATERIAL AND METHOD: Review of medical records ofpatients with chromophobe renal cell carcinoma, selectingthose cases that developed recurrence. RESULTS: Of the 23 patients, 4 developed recurrence andwere the subjects of our analysis. The mean age was 61.5years. Surgical treatment of primary renal tumor consistedof three radical nephrectomies and one partial nephrectomy.The mean time from nephrectomy to disease recurrencewas 6.7 years. One patient had recurrence in the retrovesicalarea, another in bone, and the two others in theretroperitoneum. The treatment for retrovesical recurrencewas an incomplete metastasectomy followed by temsirolimusand subsequent removal of the residual mass, stayingstable. The other three cases were unresectable surgicallyand received sunitinib. One patient now has a stable diseaseand the two others died. CONCLUSIONS: Chromophobe renal cell carcinomashowed a greater tendency to metastasize, so requires asurveillance protocol based on the risk of recurrence.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Humanos , Rim , Neoplasias Renais/diagnóstico , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Nefrectomia , Estudos Retrospectivos
5.
J Cancer Res Clin Oncol ; 146(1): 261-272, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31677114

RESUMO

PURPOSE: Partial nephrectomy has been persuaded as a widely accepted surgical procedure for T1a (≤ 4 cm) renal tumors. However, when treating T1b (4-7 cm) renal cell carcinoma (RCC), the "optimal" method of surgery is still debatable. The aim of the research is to evaluate the long-term oncological and renal functional outcomes of laparoscopic radical nephrectomy (LRN) versus laparoscopic partial nephrectomy (LPN) for patients with T1b RCC. MATERIALS AND METHODS: From March 1, 2003 to July 1, 2016, 331 patients were included in the current study. Patients presented with unilateral T1b RCC and underwent either LPN (n = 177) or LRN (n = 154). Relevant clinical data including follow-ups were acquired from patients. RESULTS: The operation time of the LPN group patients was longer than that of LRN group (94.3 min vs 88.3 min, p = 0.021) and LPN group patients required shorter stays in hospital (11.5 days vs. 13.4 days, p = 0.009). Contrast to LRN, level of eGFR was superior in LPN at the postoperative time of 1 day, 3 months, 6 months, 12 months and 24 months (all p < 0.001). Kaplan-Meier plots and log-rank tests showed that patients undergoing LPN had a much higher overall survival (OS) (p = 0.007), cancer-specific survival (CSS) (p = 0.006) and metastasis-free survival (MFS) (p = 0.008) than those receiving LRN. In comparison with the LRN group, multivariable Cox analysis indicated that patients of the LPN group had a 1.9-fold OS, 2.9-fold CSS and 2.3-fold MFS. CONCLUSIONS: For patients with T1b RCC, our findings revealed that OS, CSS and MFS are superior in patients receiving LPN than those treated with LRN. With the benefit of preserving renal function of LPN, which leads a less incidence risk of other systematic diseases, LPN may be the preferred option when condition permits for cases involving T1b RCC.


Assuntos
Carcinoma de Células Renais/fisiopatologia , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/fisiopatologia , Neoplasias Renais/cirurgia , Carcinoma de Células Renais/mortalidade , Feminino , Humanos , Neoplasias Renais/mortalidade , Laparoscopia/métodos , Laparoscopia/mortalidade , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Nefrectomia/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Resultado do Tratamento
7.
Urology ; 135: e1, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31604068

RESUMO

A 29-year-old female was referred to the urology clinic because of an incidentally found left renal mass discovered during workup for secondary erythrocytosis. Since 12 years of age, she has had headaches and poorly controlled hypertension refractory to trimodal antihypertensive therapy. Laboratory workup revealed markedly elevated aldosterone and renin levels. Computed tomography demonstrated a 3 cm left renal mass. The patient was admitted for intravenous blood pressure control. After partial nephrectomy, aldosterone and renin levels normalized. The patient was weaned off of blood pressure medications. Pathology was consistent with a juxtaglomerular cell tumor secreting renin (ie, reninoma).


Assuntos
Anti-Hipertensivos/farmacologia , Hipertensão/etiologia , Sistema Justaglomerular/patologia , Neoplasias Renais/complicações , Adulto , Aldosterona/sangue , Anti-Hipertensivos/uso terapêutico , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Hipertensão/sangue , Hipertensão/tratamento farmacológico , Sistema Justaglomerular/diagnóstico por imagem , Sistema Justaglomerular/metabolismo , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Nefrectomia , Renina/sangue , Renina/metabolismo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Urology ; 135: 88-94, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31585198

RESUMO

OBJECTIVE: To compare perioperative and oncologic outcomes for patients with clinical T1b renal cell carcinoma following treatment with microwave ablation (MW), partial nephrectomy (PN), or radical nephrectomy (RN). METHODS: Comprehensive clinical and pathologic data were collected for nonmetastatic renal cell carcinoma patients with cT1b tumors following MW, PN, or RN from 2000 to 2018. Local recurrence-free, metastasis-free, cancer-specific and overall survival were estimated using Kaplan-Meier method. Prognostic factors for complications and survival were determined using logistic regression and Cox hazard models, respectively. RESULTS: A total of 325 patients (40 MW, 74 PN, and 211 RN) were identified. Patients treated with MW were older with higher Charlson comorbidity indices compared to surgical patients. Median length of hospitalization was shorter for MW compared to surgical patients (1 day vs 4 days, P <.0001). Post-treatment estimated glomerular filtration rate decreased by median 4.5% for MW compared to 3.2% for PN (P = .58) and 29% for RN (P <.001). Median follow-up was 34, 35, and 49 months following MW, PN, and RN, respectively. Estimated 5-year local recurrence-free survival was 94.5% for MW vs 97.9% for PN (P = .34) and 99.2% for RN (P = .02). Two patients recurred after MW and underwent repeat ablation without subsequent recurrence. No difference in 5-year metastasis-free survival or cancer-specific survival was found among MW, PN, or RN. Four (10%) MW patients had high-grade complication. Only prior abdominal surgery predicted high-grade complication (OR 6.29, P = .017). CONCLUSION: Microwave ablation is a feasible alternative to surgery in select comorbid patients with clinical T1b renal cell carcinoma.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Ablação por Radiofrequência/efeitos adversos , Idoso , Carcinoma de Células Renais/mortalidade , Intervalo Livre de Doença , Estudos de Viabilidade , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Estimativa de Kaplan-Meier , Neoplasias Renais/mortalidade , Masculino , Micro-Ondas/uso terapêutico , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Nefrectomia/métodos , Complicações Pós-Operatórias/etiologia , Ablação por Radiofrequência/métodos , Reoperação/estatística & dados numéricos
9.
J Cancer Res Clin Oncol ; 146(1): 187-196, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606760

RESUMO

PURPOSE: No study has evaluated the prognostic impact of the age-adjusted Charlson comorbidity index (AACI) in those with renal cell carcinoma (RCC). This study aimed to evaluate the utility of the AACI for predicting long-term survival in patients with surgically treated non-metastatic clear cell RCC (ccRCC). METHODS: Data from 698 patients with non-metastatic ccRCC who underwent radical or partial nephrectomy as primary therapy from a multi-institutional Korean collaboration between 1988 and 2015 were retrospectively analyzed. Clinicopathological variables and survival outcomes of those with AACI scores ≤ 3 (n = 324), 4-5 (n = 292), and ≥ 6 (n = 82) were compared. RESULTS: Patients with a high AACI score were older and more likely to be female. They were also more likely to have diabetes or hypertension, a worse Eastern Cooperative Oncology Group performance status, and lower preoperative hemoglobin, albumin, serum calcium, and serum total cholesterol levels. Regarding pathologic features, a high AACI score was associated with advanced stage. Kaplan-Meier analyses revealed that AACI ≥ 6 was associated with shorter cancer-specific (log-rank test, P < 0.001) and overall survival (log-rank test, P < 0.001), but not with recurrence-free survival (log-rank test, P = 0.134). Multivariate Cox regression analyses identified an AACI score as an independent predictor of overall survival (hazard ratio, 6.870; 95% confidence interval, 2.049-23.031; P = 0.002). The AACI score was a better discriminator of overall survival than the Charlson comorbidity index score. CONCLUSIONS: AACI scores may enable more tailored, individualized management strategies for patients with surgically treated non-metastatic ccRCC.


Assuntos
Carcinoma de Células Renais/mortalidade , Neoplasias Renais/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/cirurgia , Comorbidade , Intervalo Livre de Doença , Feminino , Indicadores Básicos de Saúde , Humanos , Estimativa de Kaplan-Meier , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia/estatística & dados numéricos , Valor Preditivo dos Testes , República da Coreia/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida
10.
J Urol ; 203(2): 275-282, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31393812

RESUMO

PURPOSE: Data supporting complete metastasectomy of metastatic renal cell carcinoma were derived primarily from the era of cytokine therapy. Whether complete metastasectomy remains beneficial in patients who receive more recently approved systemic therapies has not been well studied. The objective of this study was to examine survival outcomes among patients treated with complete metastasectomy in the era of targeted therapy and checkpoint blockade availability. MATERIALS AND METHODS: We queried our institutional nephrectomy registry and identified 586 patients who underwent partial or radical nephrectomy of unilateral, sporadic renal cell carcinoma with a first occurrence of metastasis between 2006 and 2017. Of these patients 158 were treated with complete metastasectomy. Associations of complete metastasectomy with cancer specific and overall survival were assessed using Cox proportional hazards models. RESULTS: Median followup after the diagnosis of metastasis was 3.9 years, during which 403 patients died, including 345 of renal cell carcinoma. Of the patients treated with complete metastasectomy 147 (93%) did not receive any systemic treatment of the index metastatic lesion(s). Two-year cancer specific survival was significantly greater in patients with vs without complete metastasectomy (84% vs 54%, p <0.001). After adjusting for age, gender, and the timing, number and location of metastases complete metastasectomy was associated with a significantly reduced likelihood of death from renal cell carcinoma (HR 0.47, 95% CI 0.34-0.65, p <0.001). CONCLUSIONS: Complete surgical resection of metastases of renal cell carcinoma was associated with improved cancer specific survival in the post-cytokine era. It may be considered in appropriate patients after a process of shared decision making.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Metastasectomia/métodos , Nefrectomia , Idoso , Carcinoma de Células Renais/mortalidade , Citocinas/uso terapêutico , Feminino , Humanos , Neoplasias Renais/mortalidade , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Resultado do Tratamento
11.
Urology ; 135: 76-81, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31536739

RESUMO

OBJECTIVE: To determine whether use of renal mass biopsy may be associated with a reduction in surgery for patients with small, localized renal cell carcinoma (cT1aN0M0), especially among older patients and patients with greater comorbidity burden. METHODS: A total of 106,258 patients with cT1aN0M0 renal cell carcinoma from 2004 to 2015 were analyzed in the National Cancer Data Base. Multivariable logistic regression identified independent associations with nonsurgical management, receipt of biopsy, and pathologic upstaging. Marginal effects were derived by age and comorbidity. A sensitivity analysis was conducted in years identifying patients undergoing active surveillance (2010-2015). RESULTS: There was increased use of biopsy (8.0%-15.3%) and nonsurgical management (11.7%-15.6%) over time. Biopsy was significantly associated with use of nonsurgical management (OR 4.80 [95%CI 4.58-5.02], P <.001) as well as active surveillance (OR 1.87 [1.69-2.07], P <.001) in the sensitivity analysis. Individual predicted probability of undergoing nonsurgical management ranged from 3% to 92% (median 31.4% with use of biopsy) and increased with age and comorbidity. Pathologic tumor upstaging (≥pT3a) occurred more frequently for patients receiving biopsy compared to no biopsy (5.8% vs 3.3%, P <.001). After adjustment, biopsy remained a statistically significant predictor of upstaging (OR 1.31 [95%CI 1.24-1.38], P <.001). CONCLUSION: Overall, biopsy demonstrated a strong, independent association with reduced use of surgery for cT1aN0M0 kidney cancer, especially with increasing age and comorbidity. The potential association of renal mass biopsy with upstaging warrants caution, but it is uncertain whether it impacts prognosis relative to true perinephric fat invasion.


Assuntos
Carcinoma de Células Renais/terapia , Neoplasias Renais/terapia , Rim/patologia , Nefrectomia/estatística & dados numéricos , Conduta Expectante/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/patologia , Feminino , Humanos , Rim/cirurgia , Neoplasias Renais/diagnóstico , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Nefrectomia/métodos , Prognóstico , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
12.
Urology ; 135: 50-56, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31669270

RESUMO

OBJECTIVE: To describe and compare the management of WT and oncologic outcomes by patient age using a large national database. METHODS: The National Cancer Database was queried for patients with WT diagnosis from 2004 to 2013. Patients were grouped by age and compared: pediatric (<16 years), young adults (16-35 years) and adult (>35 years). Overall survival (OS) was the primary endpoint. Factors associated with OS were determined using multivariate analysis. RESULTS: The majority of patients were pediatric (n = 2686), followed by young adult (n = 91), and adult (n = 35). Five-year OS was significantly better for children vs young adults or adults (93.1% vs 79.1% vs 78.9%, respectively; P <.001), as was 10-year OS (91.5% vs 52.4% vs 70%; P <.001). On multivariate analysis, OS was significantly better for children vs young adult (HR 3.62; 95% CI 2.25-5.8; P <.001), and adult (HR 3.38; 95% CI, 1.49-7.7; P <.004). Other variables associated with worse OS included bilateral disease (HR 2.06; P = .003), stage II disease (HR 2.92; P = .036), stage IV disease (HR 4.1; P = .004), and positive lymph nodes (HR 1.97-4.90; P = .018). Patients >15 years were less likely to undergo lymph node sampling (OR 0.19; P <.001), radiation therapy (OR 0.62; P = .03), or chemotherapy (OR 0.38; P <.001). CONCLUSION: Adults with WT experience worse 5- and 10-year OS when compared to children with WT. Survival decrements in adults are likely multifactorial including modifiable factors such as inadequate staging due to low rates of lymph node sampling, and underutilization of adjuvant therapies.


Assuntos
Neoplasias Renais/terapia , Metástase Linfática/terapia , Padrões de Prática Médica/estatística & dados numéricos , Tumor de Wilms/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia Adjuvante/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Excisão de Linfonodo/estatística & dados numéricos , Linfonodos/patologia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Nefrectomia/métodos , Nefrectomia/estatística & dados numéricos , Prognóstico , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos/epidemiologia , Tumor de Wilms/mortalidade , Tumor de Wilms/patologia , Adulto Jovem
14.
Oncology ; 98(1): 1-9, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31514196

RESUMO

Cytoreductive nephrectomy (CN) followed by systemic therapy had been considered the standard of care for metastatic renal cell carcinoma (mRCC) patients since two clinical trials established its role during the cytokines era. With introduction of new and effective drugs, such as vascular endothelial growth factor-targeted therapies, the role of CN started to be challenged. Retrospective studies conducted during the targeted therapy era pointed to better outcomes when CN was associated with systemic treatment, although certain patients with poor risk features did not seem to benefit. Therefore, prospective clinical trials supporting CN were needed. Recently, with the publication of two randomized trials evaluating CN in the targeted therapy era, it has been made clear that patient selection and multidisciplinary discussion are of paramount importance in order to achieve the best outcomes. We reviewed the available literature on the role of CN among mRCC patients, commenting on how to apply the new evidence into clinical practice and providing future perspectives.


Assuntos
Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Procedimentos Cirúrgicos de Citorredução , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Nefrectomia , Biomarcadores , Carcinoma de Células Renais/metabolismo , Carcinoma de Células Renais/mortalidade , Citocinas/metabolismo , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/métodos , Prática Clínica Baseada em Evidências , Humanos , Neoplasias Renais/metabolismo , Neoplasias Renais/mortalidade , Metástase Neoplásica , Estadiamento de Neoplasias , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Prognóstico , Resultado do Tratamento
20.
Int Braz J Urol ; 45(6): 1129-1135, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808400

RESUMO

PURPOSE: To report our initial experience using a patient-specific 3D-printed renal tumor model for the surgical planning of a complex heminephrectomy in a horseshoe kidney. MATERIALS AND METHODS: We selected a clinical case for a complex laparoscopic surgery consisting in a 53 year-old male presenting a local recurrence of a renal tumor in a horseshoe kidney with aberrant vascularisation previously treated with a laparoscopic partial nephrectomy. He is now proposed for a laparoscopic left heminephrectomy. Along with conventional imaging, a real-size 3D-printed renal model was used to plan de surgical approach. The perioperative experience of the surgical team was recorded. RESULTS: The surgical team found the patient-specifi c 3D printed model useful for a better understanding of the anatomy and an easier surgical planning. CONCLUSION: The use of patient-specifi c 3D-printed renal models seem to be helpful for the surgical planning in complex renal tumors.


Assuntos
Carcinoma de Células Renais/cirurgia , Rim Fundido/cirurgia , Neoplasias Renais/cirurgia , Laparoscopia/métodos , Modelos Anatômicos , Impressão Tridimensional , Carcinoma de Células Renais/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Humanos , Imagem Tridimensional/métodos , Neoplasias Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Reprodutibilidade dos Testes , Resultado do Tratamento
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