nach oben

World Journal of Urology

Erschienen in:

01.06.2013 | Topic Paper

Expanding utilization of robotic partial nephrectomy for clinical T1b and complex T1a renal masses

verfasst von: Marco Borghesi, Riccardo Schiavina, Melanie Gan, Giacomo Novara, Alexandre Mottrie, Vincenzo Ficarra

Erschienen in: World Journal of Urology | Ausgabe 3/2013

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Partial nephrectomy is the standard of care for cT1a renal masses, offering equivalent oncologic outcomes and lower renal function impairment when compared to radical nephrectomy, with excellent overall survival results. Robot-assisted partial nephrectomy (RAPN) allows to perform a precise tumor excision, simplifying the reconstruction steps of the procedure, especially in the treatment of complex or large renal tumors. Aim of this study was to summarize the available perioperative, functional, and oncological outcomes of RAPN performed for complex and/or large (cT1b) renal cell carcinoma (RCC).

Materials and methods

We performed a nonsystematic review of the literature using a free-text protocol in the Medline database, using the terms “robot-assisted partial nephrectomy” and “robotic partial nephrectomy.” Two Authors reviewed separately to select RAPN series reporting data about complex and cT1b RCC. Other significant studies cited in the reference lists of the selected papers were also evaluated.

Evidence synthesis

According to the currently available evidences, RAPN offers promising results in terms of perioperative, functional, and oncological outcomes for the conservative management of complex or large renal tumors, even when compared with open and laparoscopic partial nephrectomy. Robot-assisted procedure allows surgeons to treat large and challenging renal masses, even if with higher warm ischemia time, operating time, and estimated blood loss in comparison with those obtained for the treatment of smaller lesions.

Conclusions

In the hands of experienced surgeons, RAPN is a safe and reproducible approach for the treatment of cT1b and more challenging renal tumors, and could represent the way to expand the indications for minimally invasive conservative approach to RCC.

MacLennan S, Imamura M, Lapitan MC et al (2012) Systematic review of oncological outcomes following surgical management of localized renal cancer. Eur Urol 61:972–993PubMedCrossRef

Kim SP, Thompson H, Boorjan SA et al (2012) Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis. J Urol 188:51–57PubMedCrossRef

Weight CG, Larson BT, Fergany AF et al (2010) Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol 183:1317–1323PubMedCrossRef

Van Poppel H, Da Pozzo L, Albrecht W et al (2011) A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 59:543–552PubMedCrossRef

Campbell SC, Novick AC, Belldegrun A et al (2009) Guideline for management of the clinical T1 renal mass. J Urol 182:1271–1279PubMedCrossRef

Ljungberg B, Cowan NC, Hanbury DC et al (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 2010(58):398–404CrossRef

Becker F, Van Poppel H, Hakenberg OW et al (2009) Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol 56(4):625–634PubMedCrossRef

Patel MN, Krane LS, Bhandari A et al (2010) Robot partial nephrectomy for renal tumors larger than 4 cm. Eur Urol 57:310–316PubMedCrossRef

Gupta GN, Boris R, Chung P et al (2011) Robot-assisted laparoscopic partial nephrectomy for tumors greater than 4 cm and high nephrometry score: feasibility, renal functional, and oncologic outcomes with minimum 1 year follow-up. Urol Oncol. doi:10.1016/j.urolonc.2010.10.008

10.

Sprenkle PC, Power N, Ghoneim T et al (2012) Comparison of open and minimally invasive partial nephrectomy for renal tumors 4–7 centimeters. Eur Urol 61:593–599PubMedCrossRef

11.

Benway BM, Bhayani SB, Rogers CG et al (2009) Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J Urol 182:866–873PubMedCrossRef

12.

Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844–853PubMedCrossRef

13.

Ficarra V, Novara G, Secco S et al (2009) Preoperative aspects and dimensions used for ana anatomical (PADUA) classification of renal tumors in patients who are candidates for nephron-sparing surgery. Eur Urol 56:786–793PubMedCrossRef

14.

Rogers CG, Metwalli A, Blatt AM et al (2008) Robotic partial nephrectomy for renal hilar tumors: a multi-institutional analysis. J Urol 180(6):2353–2356PubMedCrossRef

15.

Gong Y, Du C, Josephson DY et al (2010) Four-arm robotic partial nephrectomy for complex renal cell carcinoma. World J Urol 28(1):111–115PubMedCrossRef

16.

Dulabon LM, Kaouk JH, Haber GP et al (2011) Multi-institutional analysis of robotic partial nephrectomy for hilar versus nonhilar lesions in 446 consecutive cases. Eur Urol 59:325–330PubMedCrossRef

17.

Ficarra V, Bhayani S, Porter J et al (2012) Predictors of warm ischemia time and perioperative complications in a multicenter, international series of robot-assisted partial nephrectomy. Eur Urol 61:395–402PubMedCrossRef

18.

Simhan J, Smaldone MC, Tsai KJ et al (2012) Perioperative outcomes of robotic and open partial nephrectomy for moderately and highly complex renal lesions. J Urol 187:2000–2004PubMedCrossRef

19.

Long JA, Yakoubi R, Lee B et al (2012) Robotic versus laparoscopic partial nephrectomy for complex tumors:comparison of perioperative outcomes. Eur Urol 61:1257–1262PubMedCrossRef

20.

Ficarra V, Bhayani S, Porter J et al (2012) Robot-assisted partial nephrectomy for renal tumors larger than 4 cm: results of a multicenter, international series. World J Urol 30:665–670PubMedCrossRef

21.

Petros F, Sukumar S, Haber GP et al (2012) Multi-institutional analysis of robot assisted partial nephrectomy for renal tumors > 4 cm versus ≤ 4 cm in 445 consecutive patients. J Endourol 26:642–646PubMedCrossRef

Titel: Expanding utilization of robotic partial nephrectomy for clinical T1b and complex T1a renal masses
verfasst von: Marco Borghesi
Riccardo Schiavina
Melanie Gan
Giacomo Novara
Alexandre Mottrie
Vincenzo Ficarra
Publikationsdatum: 01.06.2013
Verlag: Springer-Verlag
Erschienen in: World Journal of Urology / Ausgabe 3/2013
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-013-1095-2

Neu im Fachgebiet Urologie

Ambulantisierung: Erste Erfahrungen mit dem Hybrid-DRG

02.05.2024 DCK 2024 Kongressbericht

Die Hybrid-DRG-Verordnung soll dazu führen, dass mehr chirurgische Eingriffe ambulant durchgeführt werden, wie es in anderen Ländern schon länger üblich ist. Die gleiche Vergütung im ambulanten und stationären Sektor hatten Niedergelassene schon lange gefordert. Aber die Umsetzung bereitet ihnen doch Kopfzerbrechen.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Harninkontinenz: Netz-Op. erfordert über lange Zeit intensive Nachsorge

30.04.2024 Harninkontinenz Nachrichten

Frauen mit Belastungsinkontinenz oder Organprolaps sind nach einer Netz-Operation keineswegs beschwerdefrei. Vielmehr scheint die Krankheitslast weiterhin hoch zu sein, sogar höher als von harninkontinenten Frauen, die sich nicht haben operieren lassen.

Adjuvante Immuntherapie verlängert Leben bei RCC

25.04.2024 Nierenkarzinom Nachrichten

Nun gibt es auch Resultate zum Gesamtüberleben: Eine adjuvante Pembrolizumab-Therapie konnte in einer Phase-3-Studie das Leben von Menschen mit Nierenzellkarzinom deutlich verlängern. Die Sterberate war im Vergleich zu Placebo um 38% geringer.

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Introduction

Materials and methods

Evidence synthesis

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2013

Prevention and management of complications following robot-assisted radical cystectomy: lessons learned after >250 consecutive cases

Microbial colonization and ureteral stent-associated storage lower urinary tract symptoms: the forgotten piece of the puzzle?

Guest editorial: robotic techniques in urologic oncology

A novel “intuitive” surgical technique for right robot-assisted retroperitoneal lymph node dissection for stage I testicular NSGCT

Prolapse surgery in octogenarians: are we pushing the limits too far?