Clinicopathological characteristics and typing of multilocular cystic renal neoplasm of low malignant potential

BACKGROUND Up until now,no research has been reported on the association between the cli-nical growth rate of multilocular cystic renal neoplasm of low malignant potential(MCRNLMP)and computed tomography(CT)imaging characteristics.Our study sought to examine the correlation between them,with the objective of distin-guishing unique features of MCRNLMP from renal cysts and exploring effective management strategies.AIM To investigate optimal management strategies of MCRNLMP.METHODS We retrospectively collected and analyzed data from 1520 patients,comprising 1444 with renal cysts and 76 with MCRNLMP,who underwent renal cyst decom-pression,radical nephrectomy,or nephron-sparing surgery for renal cystic disease between January 2013 and December 2021 at our institution.Detection of MC-RNLMP utilized the Bosniak classification for imaging and the 2016 World Health Organization criteria for clinical pathology.RESULTS Our meticulous exploration has revealed compelling findings on the occurrence of MCRNLMP.Precisely,it comprises 1.48%of all cases involving simple renal cysts,5.26%of those with complex renal cysts,and a noteworthy 12.11%of renal tumors coexisting with renal cysts,indicating a statistically significant difference(P=0.001).Moreover,MCRNLMP constituted a significant 22.37%of the patient po-pulation whose cysts demonstrated a rapid growth rate of≥2.0 cm/year,whereas it only represented 0.66%among those with a growth rate below 2.0 cm/year.Of the 76 MCRNLMP cases studied,none of the nine patients who underwent subsequent nephron-sparing surgery or radical nephrectomy following renal cyst decompression experienced recurrence or metastasis.In the remaining 67 patients,who were actively monitored over a 3-year postoperative period,only one showed suspicious recurrence on CT scans.CONCLUSION MCRNLMP can be tentatively identified and categorized into three types based on CT scanning and growth rate indicators.In treating MCRNLMP,partial nephrectomy is preferred,while radical nephrectomy should be minimi-zed.After surgery,active monitoring is advisable to prevent unnecessary nephrectomy.

Large renal carbuncle mimicking intra-abdominal neoplasm on Ga-67 scintigraphy: A case of fever of unknown origin

Fever of unknown origin is still a medical challenge. 67Ga single photon emission computed tomography/computed tomography images are commonly used to evaluate the final diagnosis of fever of unknown origin. We presented a case of fever of unknown origin undergone 67Ga scintigraphy and an intra-abdominal 67Ga avid tumor was detected which suspected to be a neoplasm. Further contrast enhanced computed tomography revealed that the lesion was a large renal carbuncle. We concluded that the contrast-enhanced CT or single photon emission computed tomography/computed tomography with contrast enhancement can be performed to further improve diagnostic performance.

Systematic review of ablative therapy for the treatment of renal allograft neoplasms

BACKGROUND To date,there are no guidelines on the treatment of solid neoplasms in the transplanted kidney.Historically,allograft nephrectomy has been considered the only reasonable option.More recently,nephron-sparing surgery (NSS) and ablative therapy (AT) have been proposed as alternative procedures in selected cases.AIM To review outcomes of AT for the treatment of renal allograft tumours.METHODS We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 Checklist.PubMed was searched in March 2019 without time restrictions for all papers reporting on radiofrequency ablation (RFA),cryoablation (CA),microwave ablation (MWA),high-intensity focused ultrasound (HIFU),and irreversible electroporation (IRE) of solid tumours of the kidney allograft.Only original manuscripts describing actual cases and edited in English were considered.All relevant articles were accessed in full text.Additional searches included all pertinent references.Selected studies were also assessed for methodological quality using a tool based on a modification of the Newcastle Ottawa scale.Data on recipient characteristics,transplant characteristics,disease characteristics,treatment protocols,and treatment outcomes were extracted and analysed.Given the nature and the quality of the studies available (mostly retrospective case reports and small retrospective uncontrolled case series),a descriptive summary was provided.RESULTS Twenty-eight relevant studies were selected describing a total of 100 AT procedures in 92 patients.Recipient age at diagnosis ranged from 21 to 71 years whereas time from transplant to diagnosis ranged from 0.1 to 312 mo.Most of the neoplasms were asymptomatic and diagnosed incidentally during imaging carried out for screening purposes or for other clinical reasons.Preferred diagnostic modality was Doppler-ultrasound scan followed by computed tomography scan,and magnetic resonance imaging.Main tumour types were: papillary renal cell carcinoma (RCC) and clear cell RCC.Maximal tumour diameter ranged from 5 to 55 mm.The vast majority of neoplasms were T1a N0 M0 with only 2 lesions staged T1b N0 M0.Neoplasms were managed by RFA (n = 78),CA (n = 15),MWA (n = 3),HIFU (n = 3),and IRE (n = 1).Overall,3 episodes of primary treatment failure were reported.A single case of recurrence was identified.Follow-up ranged from 1 to 81 mo.No cancer-related deaths were observed.Complication rate was extremely low (mostly < 10%).Graft function remained stable in the majority of recipients.Due to the limited sample size,no clear benefit of a single procedure over the other ones could be demonstrated.CONCLUSION AT for renal allograft neoplasms represents a promising alternative to radical nephrectomy and NSS in carefully selected patients.Properly designed clinical trials are needed to validate this therapeutic approach.

MSCT对乏脂肾血管平滑肌脂肪瘤与非透明细胞肾癌的鉴别诊断

目的分析乏脂肾血管平滑肌脂肪瘤(乏脂AML)与非透明细胞肾癌(肾乳头状细胞癌、嫌色细胞癌)的CT特征,提高病变的鉴别诊断效能。方法回顾性分析经手术病理证实乏脂AML19例、肾乳头状细胞癌(PRCC)16例及肾嫌色细胞癌(ChRCC)22例。测量肿瘤四期(平扫期、皮髓质期、实质期及排泄期)相同ROI的CT值及健侧肾皮质CT值,计算肿瘤强化百分比、多期相净增值、相对强化比并进行统计学分析。结果乏脂AML在平扫期及皮髓质期CT值高于PRCC与ChRCC的CT值,差异均有统计学意义(均P<0.05),在实质期及排泄期,乏脂AML与两者比较差异无统计学意义(均P>0.05)。乏脂AML在皮髓质期、实质期和排泄期的强化百分比高于PRCC、ChRCC,差异均有统计学意义(均P<0.05)。乏脂AML与PRCC、ChRCC在皮髓质期及实质期多期相净增值、相对强化比的差异均有统计学意义(均P<0.05),在排泄期差异无统计学意义(P>0.05)。结论乏脂AML与非透明细胞癌平扫及增强扫描有其特征性CT表现,强化百分比、多期相净增值、相对强化比可进一步提高AML与非透明细胞肾癌的诊断及鉴别诊断能力。

Robot-Assisted Nephrotomy as a Nephron-Sparing Approach for Completely Intraparenchymal Renal Tumors

Introduction: The diagnosis of small renal masses and the endophytic tumor approach have become challenging. This study aims to describe exclusively robot-assisted surgery as an alternative nephron-sparing approach for renal intraparenchymal tumors. Patients and Methods: We retrospectively analyzed all patients with completely endophytic tumors undergoing robot-assisted partial nephrectomy, treated under the Da Vinci System®, aided by intraoperative ultrasound. The patients’ demographic characteristics, perioperative and oncological outcomes were assessed. Results: From a total of 13 partial nephrectomies performed between 06/2010 and 10/2021, all patients underwent nephrotomy. The patients’ mean age was 52 years and the tumor measured mean 2.6 cm. Warm ischemia time was 24 minutes and histopathological analysis revealed that 12 patients had renal cell carcinoma. In a mean 36-month follow-up, no significant renal function alterations were found and no local or systemic recurrences occurred. Conclusion: Robot-assisted access is a safe and effective option for the nephron-sparing technique in completely intraparenchymal renal tumors.

超声灰阶比值鉴别≤4 cm的肾透明细胞癌和肾血管平滑肌脂肪瘤的价值

目的:探讨超声灰阶比值(UGSR)鉴别≤4 cm的肾透明细胞癌(ccRCC)和肾血管平滑肌脂肪瘤(RAML)的价值。方法:回顾分析≤4 cm的101例ccRCC和98例RAML超声影像资料,采用RADinfo系统测量病灶、肾皮质、肾窦的灰阶值,计算c-UGSR(病灶灰阶值/肾皮质灰阶值)和s-UGSR(病灶灰阶值/肾窦灰阶值)。构建受试者工作特征(ROC)曲线,计算c-UGSR、s-UGSR最佳阈值并分析联合诊断的诊断效能。评估两名研究者间UGSR一致性。结果:ccRCC和RAML病灶的c-UGSR分别为1.170(0.890,1.430)和1.840(1.458,2.283)(Z=-8.666,P<0.05),s-UGSR分别为0.680(0.500,0.825)和1.090(0.878,1.248)(Z=-8.585,P<0.05)。c-UGSR、s-UGSR诊断ccRCC的ROC曲线下面积(AUC)分别为0.856和0.852,最佳阈值分别为1.67和0.85,敏感度和特异度分别为92.1%和63.3%、80.2%和78.6%。两者联合诊断ccRCC的AUC为0.884,敏感度和特异度分别85.2%和80.6%。与c-UGSR、s-UGSR相比,两者联合诊断效能最大(Z=2.016、2.467,P均<0.05)。两名研究者间c-UGSR、s-UGSR一致性较好(ICC=0.810、0.845,P均<0.05)。结论:UGSR能更客观、准确评价≤4 cm的ccRCC和RAML,且可重复性较强。

Expression of Beta-Human Chorionic Gonadotropin Genes in Renal Cell Cancer and Benign Renal Disease Tissues

To study the expression of beta-human chorionic gonadotropin (βhCG) genes in renal cell carcinomas (RCC) and benign renal disease tissues, nested reverse transcription-polymerase chain reaction (RT-PCR) and restriction endonuclease analysis were employed to detect the expression of βhCG genes in 44 cases of RCC tissues and 24 cases of benign renal disease tissues It was found that 52% RCC samples revealed positive for βhCG mRNA expression Positive rate in advanced stage and poorly differentiated RCC was higher, but there was no significant difference The positive rate of βhCG mRNA expression was 54% in 24 cases of benign renal tissues, including 3 cases out of 6 polycystic kidneys, 7 cases out of 13 renal atrophies, 2 cases out of 2 oncocytomas and 1 case out of 2 pyonephrotic kidneys β7 was most frequently transcribed subtype gene independent on the histology These findings suggested βhCG gene transcription is not only involved in RCC but also in benign renal diseases

Expression of Progesterone and Estrogen Receptors in Human Renal Cell Carcinoma

Progesterone receptor(PR) and estrogen receptor(ER) were investigated in 29 specimens of renal cell carcinoma (RCC) and its autologous kidneys, 12 samples of control kidnerys with high sensitive and specific enzymelabelled histochemical techniques. The positive expression rates of PR in RCC, its autologous kidneys and control kidneys were 31.0%, 82.8% and 83.3% respectively, while the positive expression rates of ER of those tissues were 58.6%, 79.3% and 83.3%, respectively. It showed that the positive rate and the value of PR and ER in RCC were significantly less than those determined in the autologous kidneys and normal tissues(P<0.05) and no significant differences of PR and ER were found between autologous and normal kidneys(P>0.05). The level and positive rate of PR in stage Ⅰ were higher than those in stage Ⅱ to Ⅳ of RCC tissues (P<0.05). There was no relationship between the status of PR, ER and patient sex(P>0.05). Expression of PR in RCC had correlation to Robson stage closely. The positive rate of PR may be treated as a prognostic factor because it decreased as the stage rose. Our result provided an experimental basis for the application of hormonal therapy in RCC and emphasized that patients who may be benefited from hormonal therapy must have sufficient hormone receptors.

肾血管平滑肌脂肪瘤合并肾静脉瘤栓行保肾手术治疗1例并文献复习

目的 探讨肾血管平滑肌脂肪瘤合并肾静脉瘤栓行肾部分切除术加瘤栓取出术的治疗效果。方法 总结合肥市滨湖医院2021年10月收治的1例肾血管平滑肌脂肪瘤合并肾静脉瘤栓病人的手术治疗方案。结果 病人术前行腹部增强磁共振加三维重建提示左肾占位(大小约51 mm×36 mm×55 mm)、左肾静脉瘤栓,考虑血管平滑肌脂肪瘤。于2021年10月21日行左肾部分切除术+肾静脉瘤栓取出术,病人术后第1天复查肾功能肌酐提示113μmol/L,术后4 d拔出肾周引流管,1周后拆线出院。病理结果:左肾肿瘤及肾静脉瘤栓均为血管平滑肌脂肪瘤。术后3个月复查肾功能提示69μmol/L。结论 合并静脉瘤栓的肾错构瘤病人通过个体化治疗,制定详细手术方案,可行保肾手术,病人受益更大。

肾脏小乏脂血管平滑肌脂肪瘤的MSCT特征分析

目的:分析肾脏小乏脂血管平滑肌脂肪瘤(AML)的多层螺旋CT(MSCT)影像学特征,以提高术前诊断准确率。方法:回顾性分析20例经手术病理证实的肾脏小乏脂型AML患者的影像资料,所有患者均接受MSCT平扫及增强检查。由2名高年资影像诊断医师对所有患者的MSCT图像进行分析,总结肾脏小乏脂AML的影像学特征。结果:20例均为单肾发病,其中1例为右肾多发病灶。平扫期19例(95%)病灶相较于周围正常肾实质呈稍高密度。病灶实质的平均CT值为(47.88±12.11)HU,周围正常肾实质的平均CT值为(32.83±11.58)HU,两者间的差异具有统计学意义(P<0.05)。病灶在皮质期及实质期的平均CT值分别为(103.77±23.12)HU、(115.32±27.32)HU,两者间没有统计学差异(P>0.05)。13例(65%)病灶实质呈明显强化,15例(75%)病灶实质呈持续性强化,4例(20%)病灶实质呈渐进性强化,仅1例(5%)病灶实质呈“快进快出”的强化方式。14例(70%)可见“劈裂征”,16例(80%)可见“皮质掀起征”,12例(60%)两征同时出现。结论:小乏脂AML在MSCT图像上平扫密度显著高于周围正常肾实质、增强扫描呈持续强化的特点,以及病灶边缘的“劈裂征”、“皮质掀起征”等有助于定性诊断。

RENAL评分≥7分肾肿瘤行后腹腔镜肾动脉分支选择性阻断肾部分切除术的疗效

目的探讨RENAL评分≥7分肾肿瘤病人行后腹腔镜下肾动脉分支选择性阻断肾部分切除术的疗效。方法 2013年6月—2015年12月,在青岛大学附属医院和胶州市中心医院住院的RENAL评分≥7分的肾肿瘤病人63例,分别采用选择性肾动脉分支阻断及标准肾部分切除术进行治疗,比较两组手术时间、热缺血时间、切缘阳性率、输血率、术中出血量、术后并发症及住院时间,并比较两组术后不同时间肾功能。结果标准肾部分切除组手术时间较选择性肾动脉分支阻断组短,差异有统计学意义(t=4.859,P<0.05)。两组热缺血时间、切缘阳性率、输血率、术中出血量、术后并发症发生率及住院时间比较差异均无统计学意义(P>0.05)。术后1个月时选择性肾动脉分支阻断组患肾肾小球滤过率(eGFR)下降程度明显低于标准肾部分切除组,差异有统计学意义(t=2.687,P<0.05);术后12个月时两组患肾eGFR差异无统计学意义(P>0.05)。结论对RENAL评分≥7分肾肿瘤病人行后腹腔镜下肾动脉分支选择性阻断肾部分切除术可在术后早期最大限度地保护患肾功能,且不会增加术中出血量及术后并发症等,是一种安全有效的手术方法,值得临床推广。

Application of the revised Tumour Node Metastasis （TNM） staging system of clear cell renal cell carcinoma in eastern China： advantages and limitations

This study was designed to evaluate whether the revised 2010 Tumour Node Metastasis （TNM） staging system could lead to a more accurate prediction of the prognosis of renal cell carcinoma （RCC） patients. A total of 1216 patients who had undergone radical nephrectomy or partial nephrectomy for RCC from 2003 to 2011 were enrolled. All of the patients had pathologically confirmed clear cell RCC （ccRCC）. All cases were staged by both the 2002 and 2010 TNM staging systems after pathological review, and survival data were collected. Univariate and multivariate Cox regression models were used to evaluate cancer-specific survival （CSS） and progression-free survival （PFS） after surgery. Continuous variables, such as age and tumour diameter, were calculated as mean values and standard deviations （s.d.） or as median values. Survival was calculated by the Kaplan-Meier method, and the log-rank test assessed differences between groups. Statistically significant differences in CSS and PFS were noted among patients in T3 subgroups using the new 2010 staging system. Therefore, the revised 2010 TNM staging system can lead to a more accurate prediction of the prognosis of ccRCC patients. However, when using the revised 2010 staging system, we found that more than 92% of patients （288/313） with T3 tumours were staged in the T3a subgroup, and their survival data were not significantly different from those of patients with T2b tumours. In addition, T2 subclassification failed to independently predict survival in RCC patients.

Peliosis hepatis complicated by portal hypertension following renal transplantation

Peliosis hepatis(PH)is a vascular lesion of the liver that mimics a hepatic tumor.PH is often associated with underlying conditions,such as chronic infection and tumor malignancies,or with the use of anabolic steroids,immunosuppressive drugs,and oral contraceptives.Most patients with PH are asymptomatic,but some present with abdominal distension and pain.In some cases,PH may induce intraperitoneal hemorrhage and portal hypertension.This study analyzed a 46-year-old male who received a transplanted kidney nine years prior and had undergone long-term immunosuppressive therapy following the renal transplantation.The patient experienced progressive abdominal distention and pain in the six months prior to this study.Initially,imaging studies revealed multiple liver tumor-like abnormalities,which were determined to be PH by pathological analysis.Because the hepatic lesions were progressively enlarged,the patient suffered from complications related to portal hypertension,such as intense ascites and esophageal varices bleeding.Although the patient was scheduled to undergo liver transplantation,he suffered hepatic failure and died prior to availability of a donor organ.

S100A1、HSP60在透明细胞肾细胞癌高级别转化及预后预测中的作用

目的探讨S100A1、HSP60在透明细胞肾细胞癌(clear cell renal cell carcinoma,CCRCC)中的表达及在CCRCC高级别转化中的作用。方法应用组织芯片及免疫组化法检测100例单一核级别和22例高、低核级别并存的CCRCC中S100A1和HSP60的表达,分析其表达与CCRCC临床病理特征的关系。电镜下观察4例S100A1表达高低不同的CCRCC细胞超微结构特征。结果100例单一核级别CCRCC中,S100A1和HSP60的高表达率分别为43%(43/100)和27%(27/100),两者高表达均与肿瘤坏死、组织学类型及WHO/ISUP核分级相关,两者在单一核级别CCRCC中的表达呈正相关;生存分析显示,S100A1或HSP60高表达组患者术后生存期低于低表达组。22例高、低核级并存的CCRCC中,S100A1、HSP60在高、低级别成分中的表达差异有统计学意义(63.64%vs 27.27%,54.55%vs 18.18%)。电镜下见S100A1高表达肿瘤细胞常染色质丰富,胞质内见多少不一的脂滴空泡;S100A1蛋白阴性肿瘤细胞异染色质增多,块状或边聚,胞质内见较多脂滴空泡及脂质溶酶体。结论S100A1和HSP60在CCRCC中高表达是患者预后不良的重要指标;高、低核级成分并存的CCRCC中两种蛋白的表达与核分级密切相关;S100A1高表达细胞常染色质增多、转录活性增高;S100A1和HSP60表达呈正相关,两者可能对CCRCC的高级别转化具有共同驱动作用,S100A1和HSP60有可能成为肾细胞癌靶向治疗的候选基因。

基于CT图像的深度学习模型鉴别良恶性肾肿瘤

目的:探讨基于CT图像的深度学习模型对肾脏良、恶性肿瘤的鉴别诊断价值。方法:回顾性搜集2008-2020年经病理证实且符合本研究要求的798位患者(共805例肾肿瘤)的临床和三期(平扫、皮髓质期和实质期)腹部CT影像资料。其中,来自本院的418例肾癌和78例肾良性肿瘤的资料用于建立影像组学模型和内部验证,来自另外两个研究中心和一个公共数据库(癌症医学图像数据库TCIA)的262例肾癌和47例肾良性肿瘤的资料作为独立外部验证集。使用ITK-SNAP3.6.0软件,在三期CT图像中选择肿瘤边缘显示较清楚的一期图像,选取肿瘤最大层面及其上、下相邻层面,沿病灶边缘手动勾画ROI,再通过软件的空间调整技术,使另外两期CT图像上肿瘤的边缘与勾画的ROI的边缘最大程度地拟合。使用ResNet50网络中的卷积核作为特征提取器,分别提取3期图像上肾肿瘤的影像组学特征,并采用Mann-Whitney U检验进行特征的筛选。对于同一肾肿瘤,分别建立基于单期和3期CT图像的深度学习模型,并对各模型的预测效能进行外部验证。随后,将训练集中良、恶性肿瘤组的样本数按3种比例(1∶1、1∶2、1∶3)进行设置,分别用于极限学习机(ELM)分类模型的训练,建立基于多期CT图像的3种深度学习模型,并对模型进行外部验证。采用AUC曲线评估深度学习模型对良恶性肾肿瘤的鉴别诊断效能,采用综合判别改善指数(IDI)评估模型预测能力的改善情况。结果:基于多期CT图像的预测模型预测恶性肿瘤的AUC(0.84)大于基于单期(平扫、皮髓质期和实质期)图像的3个AUC(0.78、0.79、0.77)。良性与恶性肿瘤的样本数比例分别为1∶1、1∶2和1∶3时,基于多期图像的预测模型的AUC分别为0.85、0.84和0.86。基于多期图像的预测模型与基于单期图像的3个预测模型比较,IDI值分别为0.1215、0.1209和0.0094(P均>0.05)。结论:基于多期CT图像的深度学习模型对肾癌与肾良性肿瘤具有较好的鉴别诊断效能,改变训练集中肾良恶性肿瘤的样本比例对预测模型的诊断效能无显著影响。

Differentiation of Exophytic Renal Masses with Determination of the Angular Interface with Renal Parenchyma in US and CT

Purpose: To determine whether benign exophytic renal masses can be distinguished from malignant lesions by using the angular interface sign in ultrasonography (US) and computerized tomography (CT). Materials and Methods: A total of 71 cases with exophytic renal mass (2 cm or greater) were examined on the basis of angular interface in US (n = 23), CT (n = 21) and US + CT (n = 16) between January 2008 and June 2010 were included in this study. The renal interface relationships were examined by 2 radiologists and classified as having angular or wide interface. Results: No statistically significant difference was found between the findings of two readers. There was almost perfect interobserver agreement for the interface sign. For cystic lesions, the angular interface sign was determined in all but two Bosniak category 1 cases. Also, the angular interface sign was positive in all but one Bosniak category 2 - 3. For cystic lesions with solid component and pure solid lesions, in the benign group, the angular interface sign was positive in all except three cases (vascular malformation, oncocytoma and Xanthogranulomatous pyelonephritis). In the malignant group, the angular interface sign was determined in only two RCC cases;in other primary or metastatic malignant lesions there was a wide interface sign. Conclusion: Exophytic renal masses can be differentiated as malignant or benign with 87% accuracy using only the angular interface sign in US or CT and also in opposition to dynamic-contrast examinations. This method entails a lack of additional radiation or contrast media exposure, time-saving, and costeffectivity.

机器人肾癌伴静脉癌栓切除术专家共识

为推进肾癌伴静脉癌栓微创治疗规范化,中华医学会泌尿外科分会机器人学组于2022年11月组织国内专家就机器人肾癌伴静脉癌栓切除术主要热点和关键问题进行讨论并达成本共识,内容包括癌栓微创治疗的分级系统、术前评估及术前准备、手术要点及术后随访与治疗等。

机器人辅助腹腔镜肾癌根治性切除加下腔静脉癌栓取出术-学习曲线的进阶分析

随着微创手术技术的广泛普及和迅速发展,特别是腹腔镜和机器人技术的快速更新和崛起,为肾癌根治提供了更多的可能和更为优化的手术策略。然而,肾癌合并下腔静脉癌栓手术仍是一类风险极高的手术,通常需在狭窄体腔内完成重建,且对保留脏器功能的要求较高,需要术者拥有扎实的基本外科素养及强大的心理素质。那么,如何从普通泌尿外科医生成长到可以独立完成复杂癌栓手术?如何平稳的度过癌栓手术的学习曲线?本文通过总结我中心具有丰富经验的泌尿外科医生开展机器人辅助腹腔镜肾癌根治性切除加下腔静脉癌栓取出术的经验,结合部分年轻术者学习曲线过渡的经历,为机器人癌栓手术的教学和应用推广提供参考。

Partial Nephrectomy for Renal Cell Carcinoma: Risk Factors for Acute Post-Operative Hemorrhage and Impact on Subsequent Hospital Course and Complete Nephrectomy Rate. An Analysis of 200 Consecutive Cases

Purpose: Clinical guidelines recommend partial nephrectomy (PN) as the preferred method of surgical excision of the small renal tumor whenever feasible. PN has comparable cancer cure rates to that of radical nephrectomy in this setting, and decreased risk of chronic kidney disease. A recognized devastating complication following partial nephrectomy is acute post-operative hemorrhage (APOH) from the reconstructed kidney. Risk factors for hemorrhage following partial nephrectomy remain poorly elucidated, as does the impact of hemorrhage on subsequent hospital stay. Identification of risk factors for hemorrhage may lead to a better understanding of and reduction of this complication. Material and Methods: We utilized a prospectively managed database comprised of patients undergoing open partial nephrectomy at our institution by the same surgical team from January 2006 to July 2012. Clinicopathologic factors assessed APOH for their relationships, including patient age, gender, diabetes, smoking, hypertension, coronary artery disease, American Society of Anesthesia Score (ASA), tumor size, RENAL nephrotomy score, pathologic result, cancer margin status, operative time, and intra-operative blood loss. The impact of APOH on subsequent hospital course was evaluated and compared with the entire cohort. Results: Data were analyzed from 200 consecutive patients. We identified 7 patients (3.5%) who experienced APOH. Compared with the entire cohort, APOH resulted in an increased hospital length of stay (median, 5 days;range, 2-11 days, p = 0.001), an increased transfusion requirement (median, 6 units;range, 1-16 units. p = 0.001), a greater risk of selective angiographic embolization (median, 2 procedures;range, 0-3, p = 0.001), and completion nephrectomy (n = 2, p = 0.001). One patient in the APOH group experienced cardiac arrest and was resuscitated. Clinicopathologic factors associated

Robotic approach with neoadjuvant chemotherapy in adult Wilms’ tumor: A feasibility study report and a systematic review of the literature

Objective:The incidence of Wilms’tumor(WT)among adult individuals accounts for less than 1%of kidney cancer cases,with a prognosis usually less favorable when compared to younger individuals and an overall survival rate of 70%for the adult patients versus 90%for the pediatric cases.The diagnosis and treatment of WT are complex in the preoperative setting;neoadjuvant chemotherapy(NAC)or robotic surgery has rarely been described.This study aimed to review the literature of robotic surgery in WT and report the first adult WT management using both NAC and robotic strategy.Methods:We reported a case of WT managed in a multidisciplinary setting.Furthermore,according to Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations,a systematic review of the literature until August 2020 of WT treated with a robotic approach was carried out.Results:A 33-year-old female had a diagnosis of WT.She was scheduled to NAC,and according to the clinical and radiological response to a robotic radical nephrectomy with aortic lymph nodes dissection,she was managed with no intraoperative rupture,a favorable surgical outcome,and a follow-up of 25 months,which did not show any recurrence.The systematic review identified a total number of 230 cases of minimally invasive surgery reported in the literature for WT.Of these,approximately 15 patients were carried out using robotic surgery in adolescents while none in adults.Moreover,NAC has not been administered before minimally invasive surgery in adults up until now.Conclusion:WT is a rare condition in adults with only a few cases treated with either NAC or minimally invasive approach so far.The advantage of NAC followed by the robotic approach could lead to favorable outcomes in this complex scenario.Notwithstanding,additional cases of adult WT need to be identified and investigated to improve the oncological outcome.