Segmental ischemia and indocyanine green navigation: impact on perioperative parameters in laparoscopic vs. open partial nephrectomy.

The aim of this study is to compare perioperative parameters of laparoscopic partial nephrectomy and open partial nephrectomy in renal tumor management, and to evaluate the effect of using novel method of indocyanine green navigation in segmental ischemia on these parameters. The prospective study included 455 patients (89 laparoscopic partial nephrectomies, 366 open partial nephrectomies). Sub-groups (n=39, 32, 18) in Laparoscopic partial nephrectomy employed diverse ischemia techniques, including full warm ischemia, segmental ischemia with indocyanine green navigation and segmental ischemia without navigation. Parameters assessed encompassed estimated blood loss, operative time, warm ischemia time, and changes in estimated glomerular filtration rate. Covariate-balancing propensity scores ensured homogeneity. Statistical analysis included the Wilcoxon signed-rank test, for two matched groups. Twosided p-values were reported for all statistical tests, a p-value <0.05 was considered to be statistically significant. The findings of the conducted research indicate that open partial nephrectomy has revealed significant differences in estimated blood loss, operative time, and warm ischemia time, in favor of open partial nephrectomy. Laparoscopic partial nephrectomy offers advantages in preserving renal function and minimizing estimated Glomerular Filtration Rate decline compared to open partial nephrectomy. The utilization indocyanine green navigation, facilitates precise and limited ischemia, contributing to enhanced preservation of renal function. Surgeons must weigh these considerations for optimal renal tumor management

The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). INTERPRETATION: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden