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Inderbir S Gill - One of the best experts on this subject based on the ideXlab platform.
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collaborative review of risk benefit trade offs between partial and Radical Nephrectomy in the management of anatomically complex renal masses
European Urology, 2017Co-Authors: Inderbir S Gill, Simon P Kim, Alessandro Volpe, Steven C Campbell, Brian R Lane, Hein Van Poppel, Marc C Smaldone, Alexander KutikovAbstract:Abstract Background While partial Nephrectomy (PN) is the recommended treatment for many small renal masses, anatomically complex tumors necessitate a clear understanding of the potential risks and benefits of PN and Radical Nephrectomy (RN). Objective To critically review the comparative effectiveness evidence of PN versus RN; to describe key trade-offs involved in this treatment decision; and to highlight gaps in the current literature. Evidence acquisition A collaborative critical review of the medical literature was conducted. Evidence synthesis Patients who undergo PN for an anatomically complex or large mass may be exposed to perioperative and potential oncologic risks that could be avoided if RN were performed, while patients who undergo RN may forgo long-term benefits of renal preservation. Decision-making regarding the optimal treatment with PN or RN among patients with anatomically complex or large renal mass is highly nuanced and must balance the risks and benefits of each approach. Currently, high-quality evidence on comparative effectiveness is sparse. Retrospective comparisons are plagued by selection biases, while the one existing prospective randomized trial, albeit imperfect, suggests that nephron-sparing surgery may not benefit all patients. Conclusions For anatomically complex tumors, PN preserves renal parenchyma but may expose patients to higher perioperative risks than RN. The risks and benefits of each surgical approach must be better objectified for identification of patients most suitable for complex PN. A prospective randomized trial is warranted and would help in directing patient counseling. Patient summary Treatment decisions for complex renal masses require shared decision-making regarding the risk trade-offs between partial and Radical Nephrectomy.
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prospective randomized comparison of transperitoneal versus retroperitoneal laparoscopic Radical Nephrectomy
The Journal of Urology, 2005Co-Authors: Mauricio Rubinstein, Anoop M Meraney, Inderbir S Gill, Mihir M Desai, Monish Aron, Mete Kilciler, Antonio Finelli, Ali Moinzadeh, Osamu Ukimura, Jihad H KaoukAbstract:ABSTRACTPurpose: We report on a prospective randomized comparison of transperitoneal versus retroperitoneal laparoscopic Radical Nephrectomy for renal tumor.Materials and Methods: Between June 1999 and June 2001, 102 consecutive eligible patients with a computerized tomography identified renal tumor were prospectively randomized to undergo either a transperitoneal (group 1, 50 patients) or retroperitoneal (group 2, 52 patients) laparoscopic Radical Nephrectomy with intact specimen extraction. Exclusion criteria for the study included body mass index greater than 35 or a history of prior major abdominal surgery in the quadrant of interest. Both groups were matched regarding age (63 versus 65 years, p = 0.69), BMI (29 versus 28, p = 0.89), American Society of Anesthesiologists class (2.7 versus 2.8, p = 0.37), laterality (right side 46% versus 48%, p = 0.85) and mean tumor size (5.3 versus 5.0 cm, p = 0.73).Results: All 102 procedures were technically successful without the need for open conversion. Compare...
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laparoscopic Radical Nephrectomy for cancer with level i renal vein involvement
The Journal of Urology, 2003Co-Authors: Mihir M Desai, Inderbir S Gill, Anup P Ramani, Surena F Matin, Jihad H Kaouk, Jose M CamperoAbstract:ABSTRACTPurpose: Venous involvement develops in 5% to 10% of patients with renal cell carcinoma and is generally considered a relative contraindication to laparoscopic Radical Nephrectomy. To our knowledge we report the initial clinical series of laparoscopic Radical Nephrectomy for renal cell carcinoma associated with level I renal vein thrombus.Materials and Methods: At our 2 institutions 8 patients each underwent laparoscopic Radical Nephrectomy for level I microscopic renal vein thrombus (group 1) and level I gross thrombus (group 2). In all 8 group 2 patients the level I thrombus was preoperatively diagnosed by computerized tomography. Mean renal tumor size in groups 1 and 2 was 7.8 and 12.4 cm., respectively. After controlling the renal artery the renal vein was secured by firing an endoscopic gastrointestinal anastomosis stapler on its collapsed, uninvolved proximal part adjacent to the vena cava. Intraoperative, postoperative and pathological parameters were assessed in the 2 groups.Results: In gr...
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financial analysis of open versus laparoscopic Radical Nephrectomy and nephroureterectomy
The Journal of Urology, 2002Co-Authors: Anoop M Meraney, Inderbir S GillAbstract:Purpose: Laparoscopic Radical Nephrectomy and nephroureterectomy are rapidly becoming established procedures in select patients with renal cell carcinoma and upper tract transitional cell carcinoma, respectively. We present a retrospective comparative analysis of laparoscopic versus open Radical Nephrectomy and nephroureterectomy from a financial standpoint. The effect of the learning curve on costs incurred was also evaluated.Materials and Methods: Detailed itemized cost data on 18 contemporary cases of open Radical Nephrectomy performed from September 1997 to July 1998 were compared with similar data on 20 initial laparoscopic cases performed from September 1997 to July 1998 and 15 more recent laparoscopic Radical Nephrectomy cases performed from August 1998 to July 1999. Financial data were also compared on 14 contemporary patients each who underwent open Radical nephroureterectomy from June 1997 to December 1999, initial laparoscopic Radical nephroureterectomy from June 1997 to December 1998 and more ...
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vaginal extraction of the intact specimen following laparoscopic Radical Nephrectomy
The Journal of Urology, 2002Co-Authors: Inderbir S Gill, Anoop M Meraney, Edward E Cherullo, Fred Borsuk, David P Murphy, Tommaso FalconeAbstract:Purpose: We report the detailed technique and results of transvaginal extraction of the intact laparoscopic Radical Nephrectomy specimen.Materials and Methods: Since June 2000, 10 select female patients with a median age of 67 years underwent transvaginal extraction of the intact specimen after laparoscopic Radical Nephrectomy. In 5 patients open surgery had previously been performed on the uterus, including transabdominal hysterectomy in 2 and cesarean section in 3. Laparoscopic Nephrectomy was performed via the transperitoneal and retroperitoneal approach in 5 cases each. After completion of the primary laparoscopic procedure a sponge stick was externally inserted into the sterile prepared vagina and tautly positioned in the posterior fornix. Laparoscopically a transverse posterior colpotomy was created at the apex of the tented up posterior fornix and the drawstring of the entrapped specimen was delivered into the vagina. After laparoscopic exit was completed the patient was placed in the supine lithot...
Mihir M Desai - One of the best experts on this subject based on the ideXlab platform.
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pd04 06 robot assisted Radical Nephrectomy and inferior vena cava thrombectomy surgical technique perioperative and oncologic outcomes
The Journal of Urology, 2017Co-Authors: Giuseppe Simone, Monish Aron, David Hatcher, Mariaconsiglia Ferriero, Francesco Minisola, Leonardo Misuraca, Gabriele Tuderti, Salvatore Guaglianone, Andre Luis De Castro Abreu, Mihir M DesaiAbstract:INTRODUCTION AND OBJECTIVES: Radical Nephrectomy with Inferior vena cava (IVC) thrombectomy for renal cancer is one of the most challenging urologic surgical procedures. We describe surgical technique and present perioperative and preliminary oncologic outcomes of our first 10 cases of completely intracorporeal robotassisted Radical Nephrectomy with IVC level II and III tumor thrombectomy. METHODS: Ten consecutive patients with renal tumor and IVC thrombus were treated between December 2013 and June 2015. Baseline, perioperative and follow-up data were collected in a prospectively maintained IRB approved database. Key steps of surgery include: a meticulous isolation of IVC; the isolation and sealing of all lumbar and collateral vessels, a full monolateral retroperitoneal dissection for staging purpose and to have a complete control of IVC; isolation of left renal vein, Tourniquet placement and infrarenal IVC control. IVC incision and thrombectomy; cava suture with 3/0 visi-black monocryl; restoration of IVC flow; Nephrectomy. This video shows a case of a double IVC thrombectomy and reports perioperative and early oncologic outcomes of first 10 patients treated RESULTS: All procedures were successfully completed; open conversion was never necessary. Median EBL was 686 cc (range 200 to 2000), perioperative transfusion rate was 40%. The 30-d and 90-d incidence of Clavien grade 1⁄43 complications was 10% and 10%, respectively. At a mean follow-up of 6.4 months the metastasis free survival rate and the cancer specific survival rate were 80% and 90%, respectively. CONCLUSIONS: Robotic IVC thrombectomy is a challenging surgical procedure. In tertiary referral centers this procedure is feasible, safe and associated with favorable perioperative outcomes. A longer follow-up and a larger population of patients are necessary to confirm the oncologic efficacy of this procedure
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prospective randomized comparison of transperitoneal versus retroperitoneal laparoscopic Radical Nephrectomy
The Journal of Urology, 2005Co-Authors: Mauricio Rubinstein, Anoop M Meraney, Inderbir S Gill, Mihir M Desai, Monish Aron, Mete Kilciler, Antonio Finelli, Ali Moinzadeh, Osamu Ukimura, Jihad H KaoukAbstract:ABSTRACTPurpose: We report on a prospective randomized comparison of transperitoneal versus retroperitoneal laparoscopic Radical Nephrectomy for renal tumor.Materials and Methods: Between June 1999 and June 2001, 102 consecutive eligible patients with a computerized tomography identified renal tumor were prospectively randomized to undergo either a transperitoneal (group 1, 50 patients) or retroperitoneal (group 2, 52 patients) laparoscopic Radical Nephrectomy with intact specimen extraction. Exclusion criteria for the study included body mass index greater than 35 or a history of prior major abdominal surgery in the quadrant of interest. Both groups were matched regarding age (63 versus 65 years, p = 0.69), BMI (29 versus 28, p = 0.89), American Society of Anesthesiologists class (2.7 versus 2.8, p = 0.37), laterality (right side 46% versus 48%, p = 0.85) and mean tumor size (5.3 versus 5.0 cm, p = 0.73).Results: All 102 procedures were technically successful without the need for open conversion. Compare...
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laparoscopic Radical Nephrectomy for cancer with level i renal vein involvement
The Journal of Urology, 2003Co-Authors: Mihir M Desai, Inderbir S Gill, Anup P Ramani, Surena F Matin, Jihad H Kaouk, Jose M CamperoAbstract:ABSTRACTPurpose: Venous involvement develops in 5% to 10% of patients with renal cell carcinoma and is generally considered a relative contraindication to laparoscopic Radical Nephrectomy. To our knowledge we report the initial clinical series of laparoscopic Radical Nephrectomy for renal cell carcinoma associated with level I renal vein thrombus.Materials and Methods: At our 2 institutions 8 patients each underwent laparoscopic Radical Nephrectomy for level I microscopic renal vein thrombus (group 1) and level I gross thrombus (group 2). In all 8 group 2 patients the level I thrombus was preoperatively diagnosed by computerized tomography. Mean renal tumor size in groups 1 and 2 was 7.8 and 12.4 cm., respectively. After controlling the renal artery the renal vein was secured by firing an endoscopic gastrointestinal anastomosis stapler on its collapsed, uninvolved proximal part adjacent to the vena cava. Intraoperative, postoperative and pathological parameters were assessed in the 2 groups.Results: In gr...
Houston R Thompson - One of the best experts on this subject based on the ideXlab platform.
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larger nephron size and nephrosclerosis predict progressive ckd and mortality after Radical Nephrectomy for tumor and independent of kidney function
Journal of The American Society of Nephrology, 2020Co-Authors: Aleksandar Denic, Houston R Thompson, Bradley C Leibovich, Hisham E Elsherbiny, Aidan F Mullan, Luisa Ricaurte Archila, Ramya Narasimhan, Walter K Kremers, Mariam P Alexander, John C LieskeAbstract:BACKGROUND Nephron hypertrophy and nephrosclerosis may be important determinants of CKD and mortality. However, studies of outcomes associated with these microstructural features have been limited to small tissue specimens from patients selected for either good kidney health or known kidney disease. METHODS To determine whether microstructural features are predictive of progressive CKD and mortality outcomes, we studied patients who underwent a Radical Nephrectomy for a tumor. Large wedge sections of renal parenchyma distal to the tumor were stained and scanned into high-resolution images; we annotated the cortex and all glomeruli to calculate glomerular volume, cortex volume per glomerulus, and percentage of globally sclerotic glomeruli. Morphometric measurements also included percentages of artery luminal stenosis and interstitial fibrosis/tubular atrophy (IF/TA) of the cortex. At follow-up visits every 6-12 months, we determined which patients experienced progressive CKD (defined as dialysis, kidney transplantation, or a 40% decline from postNephrectomy eGFR). Cox models for these outcomes were adjusted for age, sex, body mass index, hypertension, diabetes, smoking, eGFR, and proteinuria. RESULTS Among 936 patients (mean age, 64 years; postNephrectomy baseline eGFR, 48 ml/min per 1.73 m2), 117 progressive CKD events, 183 noncancer deaths, and 116 cancer deaths occurred during a median follow-up of 6.4 years. Larger glomerular volume, larger cortex per glomerulus, and higher percentage of globally sclerotic glomeruli or IF/TA predicted progressive CKD. Higher percentage IF/TA also predicted noncancer mortality. Microstructural features did not predict cancer mortality or recurrence. CONCLUSIONS After a Radical Nephrectomy, larger nephrons and nephrosclerosis predicted progressive CKD, and IF/TA predicted noncancer mortality. Morphometric analysis of renal parenchyma can predict noncancer clinical events in patients long after their Radical Nephrectomy.
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emulating target clinical trials of Radical Nephrectomy with or without lymph node dissection for renal cell carcinoma
Urology, 2020Co-Authors: Janine Bacic, Houston R Thompson, Stephen A Boorjian, Tao Liu, Bradley C Leibovich, Dragan Golijanin, Boris GershmanAbstract:Abstract Objective To emulate two target clinical trials of Radical Nephrectomy (RN) with lymph node dissection (LND) vs Radical Nephrectomy alone. Methods Using the National Cancer Database, we separately emulated an index trial of patients with cT1-3cN0cM0 renal cell carcinoma (RCC), designed to resemble EORTC 30881 (“index trial emulation”), and a hypothetical trial of patients at increased risk for lymph node metastases with cT1-4cN0-1cM0 RCC (“high-risk trial emulation”). A propensity score for LND was estimated using preoperative features (Model 1) or preoperative and pathologic features (Model 2). The associations of LND with overall survival (OS) were estimated using Cox regression with stabilized inverse probability weights. Results A total of 67,388 patients were included in the index trial emulation. Median follow-up was 49.2 (interquartile range 27.2-74.3) months. LND was not associated with improved OS when adjusting using either Model 1 (hazard ratio [HR] 1.26; 95% confidence interval [CI] 1.20-1.33; P Conclusion In observational analyses, that emulate target trials representing EORTC 30881 and a trial of LND in high-risk RCC, LND was not associated with improved OS.
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comparative effectiveness for survival and renal function of partial and Radical Nephrectomy for localized renal tumors a systematic review and meta analysis
The Journal of Urology, 2012Co-Authors: Simon P Kim, Christopher J Weight, Houston R Thompson, Nathan D Shippee, Brian A Costello, Stephen A Boorjian, Leona C Han, Hassan M Murad, Patricia J Erwin, George K ChowAbstract:Purpose: The relative effectiveness of partial vs Radical Nephrectomy remains unclear in light of the recent phase 3 European Organization for the Research and Treatment of Cancer trial. We performed a systematic review and meta-analysis of partial vs Radical Nephrectomy for localized renal tumors, considering all cause and cancer specific mortality, and severe chronic kidney disease.Materials and Methods: Cochrane Central Register of Controlled Trials, MEDLINE®, EMBASE®, Scopus and Web of Science® were searched for sporadic renal tumors that were surgically treated with partial or Radical Nephrectomy. Generic inverse variance with fixed effects models were used to determine the pooled HR for each outcome.Results: Data from 21, 21 and 9 studies were pooled for all cause and cancer specific mortality, and severe chronic kidney disease, respectively. Overall 31,729 (77%) and 9,281 patients (23%) underwent Radical and partial Nephrectomy, respectively. According to pooled estimates partial Nephrectomy correl...
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partial versus Radical Nephrectomy for 4 to 7 cm renal cortical tumors
The Journal of Urology, 2009Co-Authors: Houston R Thompson, Sameer Siddiqui, Paul RussoAbstract:Purpose: Recent observations suggest that partial Nephrectomy for small renal tumors may be associated with improved survival compared with Radical Nephrectomy. We evaluated survival in patients with 4 to 7 cm renal tumors in a bi-institutional collaboration.Materials and Methods: By combining institutional databases from Mayo Clinic and Memorial Sloan-Kettering Cancer Center we identified 1,159 patients with 4.1 to 7.0 cm sporadic, unilateral, solitary, localized renal masses who underwent Radical or partial Nephrectomy between 1989 and 2006. Patient outcome was compared using Cox proportional hazards regression models.Results: Of the 1,159 patients 873 (75%) and 286 (25%) were treated with Radical and partial Nephrectomy, respectively. Patients treated with partial vs Radical Nephrectomy were significantly more likely to have a solitary kidney (10% vs 0.2%) and chronic kidney disease (15% vs 7%, each p <0.001). Median followup in survivors was 4.8 years (range 0 to 19). There was no significant differen...
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Radical Nephrectomy for pt1a renal masses may be associated with decreased overall survival compared with partial Nephrectomy
The Journal of Urology, 2008Co-Authors: Houston R Thompson, Eugene D Kwon, Stephen A Boorjian, John C ChevilleAbstract:Purpose: We reviewed our surgical experience with small renal tumors, comparing overall survival in patients treated with Radical and partial Nephrectomy.Materials and Methods: Using our Nephrectomy registry we identified patients with sporadic, unilateral, solitary and localized renal masses 4 cm or less who underwent Radical or partial Nephrectomy between 1989 and 2003. Patients with a solitary kidney or impaired renal function at presentation were excluded, leaving 648 available for analysis. Overall survival was estimated using the Kaplan-Meier method and associations with death were evaluated using Cox proportional hazards regression.Results: At last followup 146 patients had died of any cause and 502 were alive at a median of 7.1 years. Radical and partial Nephrectomy was performed in 290 and 358 patients, respectively. In all patients Radical Nephrectomy was not significantly associated with death from any cause compared with partial Nephrectomy (RR 1.12, p = 0.52). However, there was a significant...
Ralph V Clayman - One of the best experts on this subject based on the ideXlab platform.
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a multi institutional study on the safety and efficacy of specimen morcellation after laparoscopic Radical Nephrectomy for clinical stage t1 or t2 renal cell carcinoma
Journal of Endourology, 2009Co-Authors: Alex O Lesani, Ralph V Clayman, Lee C Zhao, William K Johnston, Stuart J Wolf, Robert B NadlerAbstract:Abstract Introduction and Objective: Specimen morcellation during laparoscopic Radical Nephrectomy (LRN) for renal cell carcinoma (RCC) is controversial. We seek to evaluate the safety and efficacy...
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long term followup after laparoscopic Radical Nephrectomy
The Journal of Urology, 2002Co-Authors: Andrew J Portis, Yan Yan, Jaime Landman, Cathy Chen, Peter H Barrett, Donald D Fentie, Yoshinari Ono, Elspeth M Mcdougall, Ralph V ClaymanAbstract:Purpose: Laparoscopic Radical Nephrectomy has been shown to be less morbid than traditional open Radical Nephrectomy. The long-term oncological effectiveness of laparoscopic Radical Nephrectomy remains to be established.Materials and Methods: At 3 centers patients undergoing laparoscopic Radical Nephrectomy before November 1, 1996 with pathologically confirmed renal cell carcinoma were identified. A representative group of patients undergoing open Radical Nephrectomy for clinical T1, T2 lesions was also identified. Staging, operative details and postoperative course were reviewed. Followup consisted of review of clinical, laboratory and radiological records. Kaplan-Meier analysis was performed.Results: The study included 64 patients treated with laparoscopic and 69 treated with open Radical Nephrectomy with respective average ages of 60.6 and 61.3 years at surgery. On preoperative imaging open lesions were larger (6.2 cm., range 2.5 to 15) than laparoscopic Radical Nephrectomy lesions (4.3 cm., range 2 to...
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laparoscopic versus open Radical Nephrectomy a 9 year experience
The Journal of Urology, 2000Co-Authors: Matthew Dunn, Andrew J Portis, Elspeth M Mcdougall, Arieh L Shalhav, Abdelhamid M Elbahnasy, Cindy Heidorn, Ralph V ClaymanAbstract:Purpose: The laparoscopic approach for renal cell carcinoma is slowly evolving. We report our experience with laparoscopic Radical Nephrectomy and compare it to a contemporary cohort of patients with renal cell carcinoma who underwent open Radical Nephrectomy.Materials and Methods: From 1990 to 1999, 32 males and 28 females underwent 61 laparoscopic Radical nephrectomies for suspicious renal cell carcinoma. Clinical data from a computerized database were reviewed and compared to a contemporary group of 33 patients who underwent open Radical Nephrectomy for renal cell carcinoma.Results: Patients in the laparoscopic Radical Nephrectomy group had significantly reduced, estimated blood loss (172 versus 451 ml., p <0.001), hospital stay (3.4 versus 5.2 days, p <0.001), pain medication requirement (28.0 versus 78.3 mg., p <0.001) and quicker return to normal activity than patients in the open Radical Nephrectomy group (3.6 versus 8.1 weeks, p <0.001). The majority of laparoscopic specimens (65%) were morcellate...
Stephen A Boorjian - One of the best experts on this subject based on the ideXlab platform.
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emulating target clinical trials of Radical Nephrectomy with or without lymph node dissection for renal cell carcinoma
Urology, 2020Co-Authors: Janine Bacic, Houston R Thompson, Stephen A Boorjian, Tao Liu, Bradley C Leibovich, Dragan Golijanin, Boris GershmanAbstract:Abstract Objective To emulate two target clinical trials of Radical Nephrectomy (RN) with lymph node dissection (LND) vs Radical Nephrectomy alone. Methods Using the National Cancer Database, we separately emulated an index trial of patients with cT1-3cN0cM0 renal cell carcinoma (RCC), designed to resemble EORTC 30881 (“index trial emulation”), and a hypothetical trial of patients at increased risk for lymph node metastases with cT1-4cN0-1cM0 RCC (“high-risk trial emulation”). A propensity score for LND was estimated using preoperative features (Model 1) or preoperative and pathologic features (Model 2). The associations of LND with overall survival (OS) were estimated using Cox regression with stabilized inverse probability weights. Results A total of 67,388 patients were included in the index trial emulation. Median follow-up was 49.2 (interquartile range 27.2-74.3) months. LND was not associated with improved OS when adjusting using either Model 1 (hazard ratio [HR] 1.26; 95% confidence interval [CI] 1.20-1.33; P Conclusion In observational analyses, that emulate target trials representing EORTC 30881 and a trial of LND in high-risk RCC, LND was not associated with improved OS.
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comparative effectiveness for survival and renal function of partial and Radical Nephrectomy for localized renal tumors a systematic review and meta analysis
The Journal of Urology, 2012Co-Authors: Simon P Kim, Christopher J Weight, Houston R Thompson, Nathan D Shippee, Brian A Costello, Stephen A Boorjian, Leona C Han, Hassan M Murad, Patricia J Erwin, George K ChowAbstract:Purpose: The relative effectiveness of partial vs Radical Nephrectomy remains unclear in light of the recent phase 3 European Organization for the Research and Treatment of Cancer trial. We performed a systematic review and meta-analysis of partial vs Radical Nephrectomy for localized renal tumors, considering all cause and cancer specific mortality, and severe chronic kidney disease.Materials and Methods: Cochrane Central Register of Controlled Trials, MEDLINE®, EMBASE®, Scopus and Web of Science® were searched for sporadic renal tumors that were surgically treated with partial or Radical Nephrectomy. Generic inverse variance with fixed effects models were used to determine the pooled HR for each outcome.Results: Data from 21, 21 and 9 studies were pooled for all cause and cancer specific mortality, and severe chronic kidney disease, respectively. Overall 31,729 (77%) and 9,281 patients (23%) underwent Radical and partial Nephrectomy, respectively. According to pooled estimates partial Nephrectomy correl...
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surgical management complications and outcome of Radical Nephrectomy with inferior vena cava tumor thrombectomy facilitated by vascular bypass
Urology, 2008Co-Authors: Candace F Granberg, John C Cheville, Stephen A Boorjian, Bradley C Leibovich, Hartzell V Schaff, Thomas A Orszulak, Christine M Lohse, Michael L BluteAbstract:Objectives To describe the technique, complications, and outcomes of vascular bypass during Radical Nephrectomy and tumor thrombectomy for patients with renal cell carcinoma and venous tumor thrombus. The indications and results for venovenous bypass (VVB) versus cardiopulmonary bypass (CPB) were reviewed as well. Methods We identified 41 patients who had undergone Radical Nephrectomy and thrombectomy requiring VVB (n = 13) or CPB (n = 28) at our institution from 1970 to 2005 for renal cell carcinoma with venous tumor thrombus. The clinicopathologic variables and complication rates were compared between the VVB and CPB patients. The postoperative cancer-specific survival was estimated using the Kaplan-Meier method and compared using the log-rank test. Results The patients undergoing VVB experienced significantly shorter median bypass times ( P = 0.015), operative times ( P P P = 0.336), decreased blood/blood products transfused (median 2300 mL versus 4275 mL, P = 0.256), and decreased length of hospitalization (median 7 days versus 9 days, P = 0.078). The 5-year cancer-specific survival rate was not significantly different for patients undergoing VVB (29.8%) versus those treated with CPB (36.4%; P = 0.989). Conclusions VVB was associated with significantly shorter bypass, operative, and anesthesia times, as well as trends toward decreased blood loss and hospital stay. Although the choice of bypass technique must be individualized according to the assessment of the bulk of thrombus to be resected, our results support the continued use of VVB in the management of renal cell carcinoma with extensive venous tumor thrombus, when appropriate.
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Radical Nephrectomy for pt1a renal masses may be associated with decreased overall survival compared with partial Nephrectomy
The Journal of Urology, 2008Co-Authors: Houston R Thompson, Eugene D Kwon, Stephen A Boorjian, John C ChevilleAbstract:Purpose: We reviewed our surgical experience with small renal tumors, comparing overall survival in patients treated with Radical and partial Nephrectomy.Materials and Methods: Using our Nephrectomy registry we identified patients with sporadic, unilateral, solitary and localized renal masses 4 cm or less who underwent Radical or partial Nephrectomy between 1989 and 2003. Patients with a solitary kidney or impaired renal function at presentation were excluded, leaving 648 available for analysis. Overall survival was estimated using the Kaplan-Meier method and associations with death were evaluated using Cox proportional hazards regression.Results: At last followup 146 patients had died of any cause and 502 were alive at a median of 7.1 years. Radical and partial Nephrectomy was performed in 290 and 358 patients, respectively. In all patients Radical Nephrectomy was not significantly associated with death from any cause compared with partial Nephrectomy (RR 1.12, p = 0.52). However, there was a significant...
