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At least 937 records · Page 52Linked to original sources

PubMed1999

Partial nephrectomy for unilateral renal carcinoma and a normal contralateral kidney: 10-year followup.

PURPOSE: The long-term results of partial nephrectomy for unilateral renal tumors in patients with a normal contralateral kidney are presented. MATERIALS AND METHODS: A total of 70 patients with incidentally discovered renal carcinoma underwent partial nephrectomy between 1979 and 1997. End points were local recurrence-free and disease-free survival. RESULTS: Median followup was 10 years (range 1 to 19). Of the 70 patients 69 (98.5%) had no local recurrence and 68 (97%) survived free of metastasis. Overall survival was 93%. Two patients died of metastatic kidney cancer and 3 died of other causes. Average tumor size was 3 cm. and most lesions (94%) were stage T1 or T2. CONCLUSIONS: Partial nephrectomy achieves the long-term local control and cure of small renal tumors in patients with a normal contralateral kidney.

Adult↗

PubMed1998

Partial nephrectomy for renal cell carcinoma can achieve long-term tumor control.

PURPOSE: Partial nephrectomy is becoming more widely accepted as alternative treatment for small renal cell carcinoma. To analyze its value in tumor control and its complication rate a retrospective study was done. MATERIALS AND METHODS: A total of 76 patients underwent kidney sparing surgery, which was required in 25 and in the presence of a normal contralateral kidney in 51. Tumor size varied between 0.9 and 15 cm. Simple enucleation was done in 4 and partial nephrectomy in all other cases. The patients were followed every 3 months during year 1, every 4 months during years 2 and 3, and every 6 months during years 4 and 5 postoperatively. Mean followup is 75 months. RESULTS: Eight patients had postoperative complications, most often hemorrhage. None of the patients had local recurrence, although in 3 systemic disease developed. CONCLUSIONS: Nephron sparing surgery is more challenging than radical nephrectomy and, therefore, can be more complicated. The selection of suitable candidates is the key to success. Many patients can benefit from nephron sparing surgery for small easily resectable renal cell carcinoma even in presence of a normal contralateral kidney. Randomized trials are needed to establish the definitive role of this approach in kidney cancer treatment.

Aged↗

PubMed2002

Laparoscopic live donor right nephrectomy: a new technique with preservation of vascular length.

PURPOSE: We report our initial experience with right laparoscopic live donor nephrectomy using a modified vascular clamp for achieving maximal length of the renal vein. MATERIALS AND METHODS: Since 1999, 34 patients have undergone laparoscopic live donor nephrectomy at Charité Hospital in Berlin, including 30 on the left and 4 on the right side. The right technique involves a 4-port transperitoneal laparoscopic approach with a muscle splitting lumbar incision for kidney extraction. To duplicate completely the comparable open operation a modified Satinsky atraumatic vascular clamp (Aesculap, Inc., Center Valley, Pennsylvania) was introduced through a 1 cm. lateral incision and placed across the vena cava, enabling harvest of the full length of the renal vein flush with the vena cava. The vena cavotomy is closed with a running suture placed in intracorporeal fashion. RESULTS: All procedures were successfully accomplished without technical or surgical complications. Mean operative time was 170 minutes. Mean renal warm ischemia time from endoscopic cross clamping of the renal vessels to cold perfusion on the bench was 2.1 minutes. In all 4 kidneys it was possible to harvest the whole length of the renal vein, so that the recipient operation was performed under optimal vascular conditions. All 4 kidneys were transplanted successfully in the recipients and showed immediate function. CONCLUSIONS: Right laparoscopic live donor nephrectomy is technically feasible, safe and a viable option for minimally invasive organ donation when left kidney donation is not desired. The Satinsky atraumatic vascular clamp enabled harvest of the whole right renal vein. We believe that this laparoscopic technique effectively duplicates the open operation with less morbidity.

Adult↗

PubMed2006

Partial nephrectomy for small renal masses: an emerging quality of care concern?

PURPOSE: The recent popularization of laparoscopic radical nephrectomy may beget underuse of partial nephrectomy. To evaluate this concern we used the SEER registry to characterize national practice patterns for the surgical management of small renal masses. MATERIALS AND METHODS: Between 1988 and 2001, 14,647 patients with primary tumor size 7 cm or less were treated surgically for locoregional kidney cancer. The proportion of patients treated with PN was determined and stratified by year of diagnosis and tumor size. Multivariate models were developed to identify independent determinants of PN use and overall survival following surgical treatment of kidney cancer. RESULTS: Overall 1,401 patients (9.6%) were treated with PN vs 13,246 (90.4%) who underwent total nephrectomy. For tumors 7 cm or less, the use of PN increased progressively between 1988 (4.6%) and 2001 (17.6%, p < 0.001). Despite this trend PN remained fairly uncommon even for the smallest renal masses. Among patients with tumors less than 2 cm, 14% underwent PN in 1988 to 1989 vs 42% in 2000 to 2001. For tumors 2 to 4 cm the corresponding proportions were 5% and 20%, respectively (p < 0.001). Younger patient age, smaller tumor size and more recent diagnostic year were independent determinants of PN use (all p values < 0.05). All cause mortality was similar for patients treated with PN vs TN (HR 0.9, 95% CI 0.8-1.1). CONCLUSIONS: Despite more frequent application during the last 2 decades, nationwide use of PN remains relatively uncommon, even for the smallest renal masses. Recognizing the favorable outcomes associated with preservation of renal parenchyma, our findings identify a possible quality of care concern that should be addressed by the urological community.

Aged↗

PubMed2006

Pediatric renal cell carcinoma: single institution 25-year case series and initial experience with partial nephrectomy.

PURPOSE: RCC represents less than 2% to 6% of pediatric renal tumors. Few reports of long-term outcomes exist. We sought to determine the presentation, treatment and outcome of patients at our institution. MATERIALS AND METHODS: We retrospectively reviewed the age, mode of presentation, mode of treatment, histological subtype, tumor grade, stage and survival of all patients with RCC from 1980 to 2005. RESULTS: A total of 15 patients were identified. Mean age at presentation was 7.9 years. Symptomatic presentations in nearly 75% of patients included gross hematuria, abdominal pain and polycythemia. The remaining 25% of cases were asymptomatic, and were identified by physical examination or incidentally on imaging. Surgical resection consisted of radical nephrectomy in 10 patients and partial nephrectomy in 5. Pathological analysis revealed papillary RCC in 8 patients and clear cell RCC in 7. Six patients had high stage disease. One patient with stage IV disease died 8 months postoperatively. The remaining 14 patients were alive at a mean followup of 4.9 years. All but 1 patient remain recurrence-free, including all of those who underwent nephron sparing surgery. CONCLUSIONS: To our knowledge this single institution series is the first to include children treated with partial nephrectomy. Pediatric patients with RCC tend to be older and more likely to present symptomatically compared to the typical patient with Wilms tumor. Hematuria and abdominal pain were the most common presentations, and papillary RCC was proportionately more common in this series. Our initial experience suggests that equivalent cure rates can be expected from a nephron sparing approach in appropriately selected cases.

Adolescent↗

PubMed2003

Laparoscopic application of radio frequency energy enables in situ renal tumor ablation and partial nephrectomy.

PURPOSE: To our knowledge we present the initial series of renal mass in situ laparoscopic radio frequency ablation. We also discuss the indications for and results of subsequent laparoscopic partial nephrectomy. MATERIALS AND METHODS: Laparoscopic radio frequency ablation was performed in 13 patients with a mean age of 59 years (range 18 to 81) and a total of 17 small enhancing renal masses. In 5 patients the tumor was subsequently excised completely, whereas in 7 it was left in situ after treatment. In 1 patient with 5 lesions only the largest lesion was excised, while the other 4 were left in situ. RESULTS: Mean tumor size was 1.96 cm. (range 0.9 to 3.6). Tumors that remained in situ tended to be endophytic and located in the mid pole. Pathological analysis revealed renal cell carcinoma in 10 patients, angiomyolipoma in 2 and oncocytoma in the patient with multiple lesions. None of the 8 patients with renal cell carcinoma who had at least 6 weeks of followup (mean 9.8 months, range 1.5 to 22) had any evidence of persistent tumor enhancement on surveillance computerized tomography or any other evidence of disease progression. There was 1 focal positive margin in a patient who underwent radio frequency ablation and excision of renal cell carcinoma but the patient remained disease-free 1 year after treatment. CONCLUSIONS: Early experience with laparoscopic radio frequency ablation in situ or combined with partial nephrectomy shows that it appears to be a safe method of managing small enhancing renal masses. Radio frequency assisted laparoscopic partial nephrectomy is reserved for easily accessible exophytic tumors, while strict surveillance is required for lesions remaining in situ after ablation. Additional followup is required to assess long-term effectiveness.

Adolescent↗

PubMed2002

Laparoscopic radical nephrectomy with level II vena caval thrombectomy: survival porcine study.

PURPOSE: Inferior vena caval tumor thrombus due to renal cell carcinoma generally precludes laparoscopic techniques for radical nephrectomy. We developed the technique of laparoscopic infrahepatic (level II) inferior vena caval thrombectomy in a survival porcine model. MATERIALS AND METHODS: Of the 7 female pigs used in the study 2 were acute and 5 were chronic animals which were allowed to survive for 6 weeks postoperatively. Laparoscopic right radical nephrectomy and inferior vena caval thrombectomy were performed in accordance with established open surgical principles, including vascular control and intracorporeal reconstruction of the vena cava and left renal vein. RESULTS: Complete removal of the simulated caval thrombus was successful in each case without intraoperative or postoperative complications. Average operative time was 160 minutes. Postoperatively inferior venacavography showed a patent vena cava and left renal vein in all animals. CONCLUSIONS: Laparoscopic radical nephrectomy was successful in an animal model simulating renal cell carcinoma with infrahepatic vena caval tumor thrombus. Clinical application of this technique appears possible.

Animals↗

PubMed2002

Renal cell carcinoma with tumor thrombus: is cytoreductive nephrectomy for advanced disease associated with an increased complication rate?

PURPOSE: We examined whether cytoreductive nephrectomy in patients with venous tumor thrombus and metastatic disease is associated with more complications than in those with thrombus without metastatic disease. MATERIALS AND METHODS: Between 1989 and 2000, 74 patients with renal vein extension, 87 with inferior vena caval extension and 491 without tumor thrombus underwent nephrectomy at our institution. Metastatic and nonmetastatic renal vein extension in 51 and 23 cases, inferior vena caval extension in 54 and 33, and nontumor thrombus in 171 and 320, respectively, were compared for symptoms at presentation, surgical data, mortality and complications. RESULTS: For nonmetastatic and metastatic inferior vena caval extension presenting symptoms, hospital stay, surgical time and the number of patients undergoing thoraco-abdominal incision, lymph node dissection, venacavotomy alone for thrombus and adrenal sparing surgery were similar. Five patients with thrombus died intraoperatively or postoperatively, including 3.1% with and 0.8% without thrombus (p = 0.03), while 3 had metastatic (2.3%) and 2 (2.6%) had nonmetastatic disease. The rate of postoperative complications was higher in thrombus cases overall but there was no difference in nonmetastatic and metastatic disease with thrombus. On multivariate analysis inferior vena caval thrombus (odds ratio 10.5), adjacent organ resection due to locally advanced tumor (odds ratio 6), partial nephrectomy (odds ratio 3.8), regional lymph node involvement (odds ratio 1.7) and lower preoperative hemoglobin (odds ratio 1.6) were independent variables predicting bleeding requiring transfusion. Inferior vena caval thrombus (odds ratio 1.7) and adjacent organ resection (odds ratio 2) were also associated with nonhemorrhagic complications. Systemic metastasis was not an independent risk factor in either analysis. CONCLUSIONS: To our knowledge there are no published data comparing surgical complications in patients with metastatic and nonmetastatic renal cell carcinoma who have gross tumor thrombus. Cytoreductive surgery in patients with thrombus and metastasis is not associated with an increase in the extent of surgery, morbidity or mortality compared with their counterparts with nonmetastatic disease.

Carcinoma, Renal Cell↗

PubMed1999

Partial nephrectomy with retroperitoneal laparoscopy.

PURPOSE: Laparoscopy has gradually gained acceptance for a variety of ablative procedures of the retroperitoneal organs, and the indications are being extended to more complex reconstructive and organ preserving procedures. We report our experience with retroperitoneal laparoscopic partial nephrectomy. MATERIALS AND METHODS: Retroperitoneal laparoscopic partial nephrectomy was performed for benign conditions in 6, equivocal solid masses in 4 and indeterminate cysts in 3 patients. If malignancy was suspected, laparoscopic sonography was used to assess the intrarenal anatomy and the mass. To facilitate parenchymal closure during nephron sparing surgery we used a hemostatic biological glue that consisted of gelatin, resorcinol and formaldehyde. RESULTS: Average operating time was 113 minutes and average blood loss was 72 ml. Histological examination revealed malignancy in 1 of the 3 cystic lesions and 2 of the 4 equivocal solid masses. There were 2 postoperative urinomas. CONCLUSIONS: Partial nephrectomy with retroperitoneal laparoscopy is feasible, and has a reasonable operating time and blood loss. Laparoscopic ultrasound was an important decision making aid during surgery. The use of biological glue simplified hemostasis and closure of the collecting system but good quality drainage of the collecting system is still required to decrease the risk of urinoma. The development of surgical tools that allow bloodless and nontraumatic section of the renal parenchyma is required to facilitate laparoscopic nephron sparing surgery. The ultrasonic scalpel needs further evaluation in this setting.

Adolescent↗

PubMed1999

Short and long-term morbidity of thoracoabdominal incision for nephrectomy: a comparison with the flank approach.

PURPOSE: A thoracoabdominal incision provides optimal exposure for radical nephrectomy, especially for large tumors. Intuitively it is perceived that the morbidity of a thoracoabdominal incision far exceeds that of a flank incision. We compare the morbidity of thoracoabdominal and flank incisions, which to our knowledge has not been reported previously. MATERIALS AND METHODS: A questionnaire assessing postoperative pain, use of pain medications and return to activities was sent to the last 100 renal donors who underwent nephrectomy at our institution through the 11th rib (flank incision, group 1) and the last 100 patients who underwent radical nephrectomy through the 8th to 10th rib (thoracoabdominal incision, group 2). A total of 52 group 1 and 42 group 2 questionnaires were returned. Pain was assessed at 4 periods using a visual analog scale. RESULTS: Length of stay was the same in both groups. There were no differences between groups in terms of pain severity on postoperative day 1, on day of discharge home, 1 month postoperatively and at the time of study (p >0.05). There were no significant differences between groups in times following surgery when pain completely disappeared, when pain medications were discontinued, and when the patient returned to daily activities and work (p >0.05). CONCLUSIONS: Morbidity was comparable for thoracoabdominal and flank incisions in terms of incisional pain, analgesic requirements after discharge home and return to normal activities.

Abdomen↗

PubMed1994

The long-term stone recurrence rate and renal function change in unilateral nephrectomy urolithiasis patients.

We evaluated the stone recurrence rate and long-term renal function in 50 patients with a solitary kidney 60 to 84 months (mean 70.6) after unilateral nephrectomy for urinary tract stone disease. Followup evaluation included a detailed history, physical examination, blood and urine biochemistry studies, urinalysis, urine culture, excretory urography, ultrasonography of the kidney and 131iodine-ortho-iodohippurate renography. The overall stone recurrence rate in unilateral nephrectomy urolithiasis patients was 30% (15 of 50). The mean interval until stone recurrence was 31.1 months (range 6 to 74) and the mean episodes of recurrence were 2.1 times per patient (range 1 to 5). Function of the remnant kidney in most patients was unchanged during followup. However, 2 of the 15 patients with recurrent stones had anuria during the acute attack of renal colic and, thus, required percutaneous nephrostomy urinary diversion, while 1 had proteinuria (3 gm. per day) and progressive renal failure 47 months after nephrectomy. The metabolic stone patients seemed to experience recurrence more easily than metabolic stone patients seemed to experience recurrence more easily than infection stone patients (37% versus 13%) but no statistically significant difference was noted (p = 0.198).

Adult↗

PubMed1994

Nephropathy in remnant kidneys: pathological proteinuria after unilateral nephrectomy.

It is a matter of dispute as to whether and to what extent hyperfiltrative nephropathy occurs in a contralateral remnant kidney after unilateral nephrectomy. This question was investigated in a retrospective progress observation using urinary electrophoresis among other methods. Of 106 patients who underwent nephrectomy between 1963 and 1984 because of unilateral kidney diseases, only 39 fulfilled all of the requisite criteria for a followup examination 2 to 23 years later. Whereas there was arterial hypertension or decreased kidney function in 4 cases (10.3%), pathological proteinuria was found in 32 of the remnant kidneys (82.1%): tubular in 13 (40.6%) and glomerular in 19 (59.4%). In contrast to that of arterial hypertension or decreased kidney function, this incidence is far greater than the expected risk in the normal population, which in our opinion indicates that hyperfiltrative nephropathy occurs in the contralateral remnant kidney after unilateral nephrectomy without causing relevant restriction of kidney function or increasing the arterial pressure.

Adult↗

PubMed1993

Laparoscopic nephrectomy without morcellation for renal cell carcinoma: report of initial 2 cases.

We recently developed a new laparoscopic procedure of nephrectomy for renal cell carcinoma and successfully removed the kidney in 2 patients. A carbon dioxide pneumoperitoneum is induced and 5 trocars are introduced into the abdominal cavity through the lateral abdominal wall. The kidney is removed en bloc together with the adrenal gland, perirenal fat and Gerota's fascia. The kidney is placed into a sack, which is pulled out through a 5 cm. incision in the abdominal wall without morcellation to allow for complete pathological examination. With this procedure right nephrectomy was performed in a 44-year-old man with a 2.5 cm. tumor in the right kidney and left nephrectomy was done in a 52-year-old man with a 2.5 cm. tumor in the left kidney. Operative time was 379 minutes and 464 minutes, respectively. There were no complications in either case. This procedure may be indicated in patients with small volume renal cell carcinoma.

Adult↗

PubMed1993

The challenge of kidney transplant nephrectomy.

During a 5-year-period 92 kidney transplant nephrectomies were performed and 87% of these kidneys were removed by a subcapsular technique. Surgical complications occurred in 4% of the cases. Renal allograft nephrectomy is a more complex and riskier operation than simple native nephrectomy.

Adult↗

PubMed1991

Planned delayed nephrectomy after ethanol embolization of renal carcinoma.

Planned delayed nephrectomy after preoperative ethanol infarction was done in 6 patients with renal carcinoma. Three patients had intracaval extension of tumor, 2 had renal vein but no vena caval extension and 1 had no renal vein or vena caval involvement. Nephrectomy was delayed 22 to 44 days after embolization. In the patients with inferior vena caval extension shrinkage of tumor thrombus after embolization allowed for easier surgical resection. Furthermore, delay of nephrectomy after preoperative infarction was of value in improving the clinical status of high risk patients.

Adult↗

PubMed1990

On the necessity of adrenal extirpation combined with radical nephrectomy.

Adrenal metastasis of renal cell carcinoma usually is an autopsy finding and seldom a clinical diagnosis. The incidence of ipsilateral suprarenal gland involvement also can be identified by histological examination of the organ with radical nephrectomy. The necessity of adrenalectomy performed in combination with nephrectomy is discussed. After a retrospective examination of our patients we discovered 8 adrenal metastases among 138 radical nephrectomies. Five patients who also had metastases in the lymph nodes (stages pN1 to pN2) died after an average of 26.4 months. Three patients without lymph node involvement are free of tumor. In these cases routine adrenalectomy must be regarded as a possible curative treatment.

Adrenal Gland Neoplasms↗

PubMed1990

Percutaneous nephrectomy in nonfunctioning kidneys: a preliminary report.

Nephrectomy is indicated for the removal of highly damaged kidneys. Several times patients are asymptomatic, and although the operation has a low morbidity rate they will refuse it. The development of new endourological techniques of percutaneous access to the kidney in experimental studies on liquefaction and aspiration of tissues, and the idea taken from the old resectoscope models using nonelectrical aids served to inspire our technique of percutaneous nephrectomy. Our patient presented with a nonfunctioning kidney due to ureteral obstruction and ultrasound demonstrated a severe decrease in renal parenchyma. Percutaneous access to the kidney was performed through the conventional manner and the remaining parenchyma was removed with biopsy and Lowsley forceps. Bleeding was minimum and a 22F nephrostomy Foley catheter was kept in place for 72 hours. As far as new instruments are developed, percutaneous nephrectomy represents a surgical option to remove nonfunctioning kidneys in highly selected patients.

Female↗

PubMed1990

A controlled study of the argon beam coagulator for partial nephrectomy.

An argon beam coagulator was evaluated in 25 canine partial nephrectomies to determine its hemostatic capabilities, safety and degree of thermal injury to renal parenchyma. Comparison was made with a control group of seven partial nephrectomies performed by standard technique. In both groups the procedure was performed without renal cooling or clamping of the renal artery. The argon beam coagulator was operated with a power output of 130 watts. Mean operative time for partial nephrectomy was 22 minutes in the control group versus 10 minutes when the argon coagulator was used (p less than 0.001). Mean blood loss was 276 cc by standard technique but only 135 cc with the argon coagulator (p less than 0.001). A regular eschar with a mean depth of tissue necrosis of 2.4 mm. was observed with the argon coagulator.

Animals↗