BACKGROUNDOver the past two decades, the clinical presentation of renal masses has evolved, where the rising incidence of small renal masses (SRMs) and concomitant minimal invasive treatments have led to noteworthy changes in paradigm of kidney cancer. This study was to perform a proportional meta-analysis of observational studies on perioperative complications and oncological outcomes of partial nephrectomy (PN) and radiofrequency ablation (RFA).

METHODSThe US National Library of Medicine's life science database (Medline) and the Web of Science were exhaustly searched before August 1, 2013. Clinical stage 1 SRMs that were treated with PN or RFA were included, and perioperative complications and oncological outcomes of a total of 9 565 patients were analyzed.

RESULTSPatients who underwent RFA were significantly older (P < 0.001). In the subanalysis of stage T1 tumors, the major complication rate of PN was greater than that of RFA (laparoscopic partial nephrectomy (LPN)/robotic partial nephrectomy (RPN): 7.2%, open partial nephrectomy (OPN): 7.9%, RFA: 3.1%, both P < 0.001). Minor complications occurred more frequently after RFA (RFA: 13.8%, LPN/RPN: 7.5%, OPN: 9.5%, both P < 0.001). By multivariate analysis, the relative risks for minor complications of RFA, compared with LPN and OPN, were 1.7-fold and 1.5-fold greater (both P < 0.01), respectively. Patients treated with RFA had a greater local progression rate than those treated by PN (RFA: 4.6%, LPN/RPN: 1.2%, OPN: 1.9%, both P < 0.001). By multivariate analysis, the local tumor progression for RFA versus LPN/RPN and OPN were 4.5-fold and 3.1-fold greater, respectively (both P < 0.001).

CONCLUSIONSThe current data illustrate that both PN and RFA are viable strategies for the treatment of SRMs. Compared with PN, RFA showed a greater risk of local tumor progression but a lower major complication rate, which is considered better for poor candidates. PN is with no doubt the golden treatment for SRMs, and LPN has been widely accepted as the first option for nephron-sparing surgery by experienced urologists. RFA may be the best option for select patients with significant comorbidity.

Catheter Ablation ; adverse effects ; methods ; Humans ; Kidney Neoplasms ; surgery ; therapy ; Nephrectomy ; adverse effects ; methods

BACKGROUNDSome patients with exophytic renal masses less than 4 cm and suboptimal renal function, or a solitary kidney and bilateral renal tumors are considered for laparoscopic partial nephrectomy (LPN), which is feasible for early-stage renal tumors, although it is still considered technically difficult and time consuming. Shortening the time of the operation and renal warm ischemia are required urgently. In this study, we report our initial experiences of LPN, especially with some improved surgical techniques.

METHODSBetween July 2005 and October 2009, 74 patients with T(1a) renal tumor were treated by LPN, 39 using transperitoneal approach and 35 using retroperitoneal approach. In all cases, the tumor was removed with a margin of 0.5 cm. We compared glomerular filtration rate (GFR) preoperatively and postoperatively, and renal warm ischemia time between traditional ligature and Hem-o-lok methods.

RESULTSAll operations were completed successfully, and there was no conversion to open surgery. Mean operation time was 76 minutes (range, 68 - 120), mean time of renal warm ischemia was 23 minutes (range, 15 - 32), and mean blood loss was 65 ml (range, 40 - 300). No hemorrhage or urine leak was observed in two cases with the collecting system sewn. Thirteen cases used Hem-o-lok to clamp the suture instead of traditional ligature, and mean time of renal warm ischemia was (16.5 ± 2.3) minutes (range, 12 - 18). Mean postoperative hospital stay was 6.3 days (range, 5 - 12). Sixty-seven cases had renal clear cell carcinoma, six papillary renal cell carcinoma, and one renal collecting duct carcinoma. All the tumor margin specimens were negative. The mean follow-up was 30.6 months (range, 3 - 51), and no recurrence or metastasis was observed.

CONCLUSIONSLPN for pT(1) stage renal tumor was safe and feasible. Hem-o-lok instead of traditional ligature to clamp the suture when sewing the renal wound could shorten the warm ischemia time.

Adult ; Aged ; Female ; Humans ; Kidney Neoplasms ; surgery ; Laparoscopy ; adverse effects ; methods ; Male ; Middle Aged ; Nephrectomy ; adverse effects ; methods ; Treatment Outcome

The incidence of low-stage renal cell carcinoma is rising and is observed to demonstrate excellent prognosis following surgical treatment irrespective of method. However, several epidemiologic observational and population-based studies suggest that radical nephrectomy is associated with increased adverse renal outcomes such as chronic kidney disease (CKD) compared with partial nephrectomy. This is suggested in turn to lead to increased mortality via an increase in cardiovascular complications and mortality. Prospective data are scarce, and there are conflicting data as well on whether surgically induced CKD is as debilitating as medically induced CKD. Further research is needed to assess the presence and the extent of the relationship between nephrectomy, CKD, and noncancer mortality.
Carcinoma, Renal Cell/*surgery ; Humans ; Kidney Neoplasms/*surgery ; Nephrectomy/*adverse effects/methods ; Renal Insufficiency, Chronic/epidemiology/*etiology ; Risk Assessment/methods

Secondary to the widespread use of the modern imaging techniques of computed tomography, magnetic resonance imaging, and ultrasound, 70% of renal tumors today are detected incidentally with a median tumor size of less than 4 cm. Twenty years ago, all renal tumors, regardless of size were treated with radical nephrectomy (RN). Elective partial nephrectomy (PN) has emerged as the treatment of choice for small renal tumors. The basis of this paradigm shift is three major factors: (1) cancer specific survival is equivalent for T1 tumors (7 cm or less) whether treated by PN or RN; (2) approximately 45% of renal tumors have indolent or benign pathology; and (3) PN prevents or delays the onset of chronic kidney disease, a condition associated with increased cardiovascular morbidity and mortality. Although PN can be technically demanding and associated with potential complications of bleeding, infection, and urinary fistula, the patient derived benefits of this operation far outweigh the risks. We have developed a "mini-flank" open surgical approach that is highly effective and, coupled with rapid recovery postoperative care pathways associated with a 2-day length of hospital stay.
Elective Surgical Procedures/adverse effects/*methods ; Humans ; Incidental Findings ; Kidney Neoplasms/*surgery ; Length of Stay ; Nephrectomy/adverse effects/*methods ; Postoperative Complications/prevention & control ; Treatment Outcome

Secondary to the widespread use of the modern imaging techniques of computed tomography, magnetic resonance imaging, and ultrasound, 70% of renal tumors today are detected incidentally with a median tumor size of less than 4 cm. Twenty years ago, all renal tumors, regardless of size were treated with radical nephrectomy (RN). Elective partial nephrectomy (PN) has emerged as the treatment of choice for small renal tumors. The basis of this paradigm shift is three major factors: (1) cancer specific survival is equivalent for T1 tumors (7 cm or less) whether treated by PN or RN; (2) approximately 45% of renal tumors have indolent or benign pathology; and (3) PN prevents or delays the onset of chronic kidney disease, a condition associated with increased cardiovascular morbidity and mortality. Although PN can be technically demanding and associated with potential complications of bleeding, infection, and urinary fistula, the patient derived benefits of this operation far outweigh the risks. We have developed a "mini-flank" open surgical approach that is highly effective and, coupled with rapid recovery postoperative care pathways associated with a 2-day length of hospital stay.
Elective Surgical Procedures/adverse effects/*methods ; Humans ; Incidental Findings ; Kidney Neoplasms/*surgery ; Length of Stay ; Nephrectomy/adverse effects/*methods ; Postoperative Complications/prevention & control ; Treatment Outcome

OBJECTIVE: To discuss management of chylous leakage after retroperitoneoscopic upper-pole heminephrectomy for duplex kidney. METHODS: Between November 2004 and Februar y 2011, 39 patients underwent retroperitoneoscopic upper-pole heminephrectomy for duplex kidney, of these 5 patients had chylous leakage. The ages of the patients ranged from 32 to 60 years (mean 42). All the patients were treated conservatively, and the therapeutic effects were observed. RESULTS: Delayed chylous leakage in 5 patients occurred 5-31 days after surgery, and leakage occurred in 4 of the same 5 patients during the first 2 post-operative years. Chylous leakage after retroperitoneoscopic upper-pole heminephrectomy for duplex kidney preferentially occurred at the left side of duplex kidney. All the patients healed under conservative treatment. CONCLUSION Chylous leakage typically occurs after left retroperitoneoscopic upper-pole heminephrectomy for duplex kidney, and can be prevented by improving surgical technique; it can be completely relieved by conservative management with satisfactory results.
Adult ; Chylous Ascites ; etiology ; prevention & control ; therapy ; Female ; Humans ; Kidney ; abnormalities ; surgery ; Laparoscopy ; adverse effects ; methods ; Male ; Middle Aged ; Nephrectomy ; adverse effects ; methods ; Retroperitoneal Space

PURPOSE: To compare the perioperative outcomes of laparoscopic partial nephrectomy (LPN) and robotic partial nephrectomy (RPN) for moderately or highly complex tumors (RENAL nephrometry score> or =7). MATERIALS AND METHODS: A retrospective analysis was performed for 127 consecutive patients who underwent either LPN (n=38) or RPN (n=89) between 2007 and 2013. Perioperative outcomes were compared. RESULTS: There were no significant differences between the two groups with respect to patient gender, laterality, RENAL nephrometry score, or body mass index. The RPN group had a slightly higher RENAL nephrometry score (7.8 vs. 7.5, p=0.061) and larger tumor size (3.0 cm vs. 2.5 cm, p=0.044) but had a lower Charlson comorbidity index (3.7 vs. 4.4, p=0.017) than did the LPN group. There were no significant differences with respect to warm ischemia time, estimated blood loss, intraoperative complications, or operative time. Only one patient who underwent LPN had a positive surgical margin. There were statistically significant differences in surgical marginal width between the LPN and RPN groups (0.6 cm vs. 0.4 cm, p=0.001). No significant differences in postoperative complications were found between the two groups. Owing to potential baseline differences between the two groups, we performed a propensity-based matching analysis, in which differences in surgical margin width between the LPN and RPN groups remained statistically significant (0.6 cm vs. 0.4 cm, p=0.029). CONCLUSIONS: RPN provides perioperative outcomes comparable to those of LPN and has the advantage of healthy parenchymal preservation for complex renal tumors (RENAL score> or =7).
Adult ; Aged ; Carcinoma, Renal Cell/*surgery ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Neoplasms/*surgery ; Laparoscopy/adverse effects/*methods ; Male ; Middle Aged ; Nephrectomy/adverse effects/*methods ; Retrospective Studies ; Robotic Surgical Procedures/adverse effects/*methods ; Severity of Illness Index ; Treatment Outcome

PURPOSE: Although there is no clinical evidence of nephrotoxicity with the volatile anesthetics currently used in general anesthesia, a better agent should be needed in terms of preserving postoperative renal function in living kidney donors who have only single remaining kidney. The purpose of the current retrospective, single-center study was to evaluate and compare renal function of living kidney donors after nephrectomy under either sevoflurane or desflurane anesthesia. MATERIALS AND METHODS: From January 2006 through December 2011, a total of 228 donors undergoing video assisted minilaparotomy surgery nephrectomy for kidney donation were retrospectively enrolled in the current study. The donors were categorized into a sevoflurane group or desflurane group based on the type of volatile anesthetic used. We collected laboratory data from the patients preoperatively, immediately after the operation, on the first postoperative day and on the third postoperative day. We also compared renal function of the kidney donors after donor nephrectomy by comparing creatinine level and estimated glomerular filtration rate (eGFR). RESULTS: The decrease in renal function after surgery in both groups was the most prominent on the first postoperative day. There were no significant differences between the two groups in postoperative changes of creatinine or eGFR. CONCLUSION: Sevoflurane and desflurane can be used safely as volatile anesthetics in donors undergoing nephrectomy.
Adult ; Anesthesia, General/methods ; Anesthetics, Inhalation/adverse effects/*therapeutic use ; Female ; Humans ; Isoflurane/adverse effects/*analogs & derivatives/therapeutic use ; Kidney/*physiology ; Kidney Function Tests ; *Kidney Transplantation ; *Living Donors ; Male ; Methyl Ethers/adverse effects/*therapeutic use ; *Nephrectomy ; Postoperative Complications ; Retrospective Studies

PURPOSE: To investigate surgical outcomes between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) groups for a main stone sized 15 to 30 mm and located in the lower-pole calyx. MATERIALS AND METHODS: Patients who underwent PNL or RIRS for a main stone sized 15 to 30 mm and located in the lower-pole calyx were retrospectively reviewed. Each patient in the RIRS group was matched to one in the PNL group on the basis of calculated propensity scores by use of age, sex, body mass index, previous treatment history, stone site, maximum stone size, and stone volume. We compared perioperative outcomes between the unmatched and matched groups. RESULTS: Patients underwent PNL (n=87, 66.4%) or RIRS (n=44, 33.6%). After matching, 44 patients in each group were included. Mean patient age was 54.4+/-13.7 years. Perioperative hemoglobin drop was significantly higher and the hospital stay was longer in the PNL group than in the RIRS group. The operative time was significantly longer in the RIRS group than in the PNL group. Stone-free rates were higher and complications rates were lower in the RIRS group than in the PNL group without statistical significance. The presence of a stone located in the lower-anterior minor calyx was a predictor of stone-free status. CONCLUSIONS: RIRS and single-session PNL for patients with a main stone of 15 to 30 mm located in the lower-pole calyx showed comparable surgical results. However, RIRS can be performed more safely than PNL with less bleeding. Stones in the lower-anterior minor calyx should be carefully removed during these procedures.
Adult ; Aged ; Female ; Hemoglobins/metabolism ; Humans ; Kidney Calculi/pathology/*surgery ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Nephrectomy/adverse effects/*methods ; Nephrostomy, Percutaneous/adverse effects/*methods ; Prognosis ; Propensity Score ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo study the treatment technique for harvesting injury of donor blood vessels for the clinic application.

METHODSThe data of 32 renal transplantation patients with injury of graft blood vessels were retrospectively reviewed. 60 renal transplantation patients with non-injury during the same term were selected as the control group. The treatment techniques for harvesting injury of graft blood vessels mainly includes end-to-end anastomosis of graft artery, side-to-side anastomosis of branch artery, end-to-side anastomosis of branch artery to the main renal artery, reconstruction of multiple segmental arteries by using iliac arterial grafts from cadaveric donors or recipients on the workbench, repairs of injuries for the smaller segmental/polar arteries by using inferior epigastric artery, end-to-end anastomosis of the lower thick segmental/polar arteries with the iliac internal arterial by placing kidney upside down.

RESULTSThose injured included 28 arterial and 4 venous. Average bench surgery time was 42 minutes. Mean warm ischemic time was 31 minutes. No death occurred at an average follow-up of 3.5 years (1 - 5 years). There was no statistical difference in the 1-year graft survival, postoperative 1-year acute rejection, delayed graft function (DGF) and the incidence of constriction of vascular anastomosis rate (96.9%, 12.5%, 21.9%, 3.1%, respectively) compared with non-reconstructed kidneys during the same term (98.3%, 11.7%, 18.3%, 1.7%, P > 0.05, respectively).

CONCLUSIONThe flexible and appropriate application of different vascular reconstruction means and satisfactory surgery techniques play an important role in assuring quality of kidney with harvesting blood vessels injury and donor kidney availability.

Adolescent ; Adult ; Anastomosis, Surgical ; Female ; Humans ; Kidney ; blood supply ; surgery ; Kidney Transplantation ; methods ; Male ; Microsurgery ; Nephrectomy ; adverse effects ; Renal Artery ; injuries ; surgery ; Renal Veins ; injuries ; surgery ; Retrospective Studies ; Tissue Donors ; Tissue and Organ Harvesting ; adverse effects ; Transplantation, Homologous