Resection Techniques During Robotic Partial Nephrectomy: A Systematic Review

CONTEXT: The resection technique used to excise tumor during robotic partial nephrectomy (RPN) is of paramount importance in achieving optimal clinical outcomes. OBJECTIVE: To provide an overview of the different resection techniques used during RPN, and a pooled analysis of comparative studies. EVIDENCE ACQUISITION: The systematic review was conducted according to established principles (PROSPERO: CRD42022371640) on November 7, 2022. A population (P: adult patients undergoing RPN), intervention (I: enucleation), comparator (C: enucleoresection or wedge resection), outcome (O: outcome measurements of interest), and study design (S) framework was prespecified to assess study eligibility. Studies reporting a detailed description of resection techniques and/or evaluating the impact of resection technique on outcomes of surgery were included. EVIDENCE SYNTHESIS: Resection techniques used during RPN can be broadly classified as resection (non-anatomic) or enucleation (anatomic). A standardized definition for these is lacking. Out of 20 studies retrieved, nine compared "standard" resection versus enucleation. A pooled analysis did not reveal significant differences in terms of operative time, ischemia time, blood loss, transfusions, or positive margins. Significant differences favoring enucleation were found for clamping management (odds ratio [OR] for renal artery clamping 3.51, 95% confidence interval [CI] 1.13-10.88; p = 0.03), overall complications (OR for occurrence 0.55, 95% CI 0.34-0.87; p = 0.01) major complications (OR for occurrence 0.39, 95% CI 0.19-0.79; p = 0.009), length of stay (weighted mean difference [WMD] -0.72 d, 95% CI -0.99 to -0.45; p < 0.001), and decrease in estimated glomerular filtration rate (WMD -2.64 ml/min, 95% CI -5.15 to -0.12; p = 0.04). CONCLUSIONS: There is heterogeneity in the reporting of resection techniques used during RPN. The urological community must improve the quality of reporting and research produced accordingly. Positive margins are not specifically related to the resection technique. Focusing on studies comparing standard resection versus enucleation, advantages with tumor enucleation in terms of avoidance of artery clamping, overall/major complications, length of stay, and renal function were found. These data should be considered when planning the RPN resection strategy. PATIENT SUMMARY: We reviewed studies on robotic surgery for partial kidney removal using different techniques to cut away the kidney tumor. We found that a technique called "enucleation" was associated with similar cancer control outcomes in comparison to the standard technique and had fewer complications, better kidney function after surgery, and a shorter hospital stay

Molecular imaging and carbonic anhydrase IX-targeted radioimmunotherapy in clear cell renal cell carcinoma

Item does not contain fulltextConventional imaging is suboptimal at evaluating disease status in renal cell carcinoma (RCC) because of poor sensitivity. Furthermore, there is an unmet need for the treatment of metastatic RCC, both in terms of improvement of progression-free survival and limitation of toxicity. For this reason, radionuclide imaging and radionuclide therapy are extensively investigated. This review provides an overview of the current progress in molecular imaging and radionuclide therapy in clear cell RCC and will focus on promising detection and therapy strategies targeting the carbonic anhydrase IX antigen, which is expressed in clear cell RCC

Inferior vena cava involvement in renal cell carcinoma: if you fail to plan, you're planning to fail

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Oncological safety of partial nephrectomy for pT3a renal cell carcinoma: reading between the lines

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Selecting the best candidates for non-surgical management of localized renal masses: the Occam's razor

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Optimizing postoperative follow-up in RCC patients: why does it always have to be black and white?

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Cryoablation of small renal masses in patients with solitary kidneys: worth crossing the road for?

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Screening programs for renal cell carcinoma: a systematic review by the EAU young academic urologists renal cancer working group.

Purpose To systematically review studies focused on screening programs for renal cell carcinoma (RCC) and provide an exhaustive overview on their clinical impact, potential benefits, and harms. Methods A systematic review of the recent English-language literature was conducted according to the European Association of Urology guidelines and the PRISMA statement recommendations (PROSPERO ID: CRD42021283136) using the MEDLINE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases. Risk-of-bias assessment was performed according to the QUality In Prognosis Studies (QUIPS) tool. Results Overall, nine studies and one clinical trials were included. Eight studies reported results from RCC screening programs involving a total of 159 136 patients and four studies reported screening cost-analysis. The prevalence of RCC ranged between 0.02 and 0.22% and it was associated with the socio-demographic characteristics of the subjects; selection of the target population decreased, overall, the screening cost per diagnosis. Conclusions Despite an increasing interest in RCC screening programs from patients and clinicians there is a relative lack of studies reporting the efficacy, cost-effectiveness, and the optimal modality for RCC screening. Targeting high-risk individuals and/or combining detection of RCC with other health checks represent pragmatic options to improve the cost-effectiveness and reduce the potential harms of RCC screening

Is Adjuvant Immunotherapy Worth for All Patients with Clear-cell Renal Cell Carcinoma at High Risk of Recurrence?

Introduction &amp; Objectives: In the KEYNOTE-564 trial, treatment with pembrolizumab showed a disease-free survival (DFS) benefit compared to placebo in patients with clear-cell renal-cell carcinoma (ccRCC) at a high risk of recurrence. Yet, overall survival (OS) data were still immature. In this scenario, both the EAU and ESMO weakly recommend to offer adjuvant pembrolizumab following surgery with curative intent in patients meeting the KEYNOTE-564 study criteria. In this study we sought to evaluate the proportion of contemporary patients who might be eligible for adjuvant pembrolizumab in a large multi-institutional European cohort. Moreover, we explore the theoretical prognosis of all patient categories meeting the KEYNOTE-564 study criteria using the Leibovich 2003 and ECOG-ACRIN 2805 (ASSURE) prognostic models. Materials &amp; Methods: After Ethical Committee approval, data from consecutive patients who underwent surgery for non-metastatic ccRCC at three high-volume referral Academic Centres between 2015 and 2021 were retrospectively collected. Patients were classified as eligible vs non- eligible for adjuvant pembrolizumab according to the KEYNOTE-564 study criteria. The theoretical estimated 5-year metastasis-free survival (MFS) according to the Leibovich 2003 model and estimated 5-year DFS according to the ASSURE model were calculated for each category of “eligible” patients. Results: Overall, 695 patients with ccRCC were included. Of these, 177/695 (26%) could have met the KEYNOTE-564 eligibility criteria, most of which (86% with a pT3a N0 stage). Patients with pTany pN+ disease represented 6% of eligible patients. Theoretically, “eligible” patients according to the KEYNOTE-564 study criteria showed a highly heterogenous prognosis according to the Leibovich 2003 and ASSURE models. Patients deemed at “intermediate-high risk” of recurrence may have a 5-y MFS ranging between 12% and 75% according to the Leibovich model, while a 5-y DFS ranging between 29% and 79% according to the ASSURE model. Similarly, patients deemed at “high risk” of recurrence may have a 5-y MFS ranging between 12% and 95% according to the Leibovich model, while a 5-y DFS ranging between 8% and 79% according to the ASSURE model. Conclusions: Approximately one out of four patients with ccRCC after surgery with curative intent would have been eligible for adjuvant immunotherapy according to the KEYNOTE-564 study criteria. Applying more granular prognostic models, the estimated 5-y DFS of “eligible” candidates might significantly vary, underlying the potential inherent heterogeneity of this disease. While waiting for robust OS data and future results of ongoing adjuvant trials, further steps are needed to optimize patient selection and improve the value proposition of adjuvant pembrolizumab for ccRCC at high risk of recurrence