Browsing by Subject "Renal mass"

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    Evaluation, diagnosis and surveillance of renal masses in the setting of VHL disease
    (SpringerLink, 2021-07) Chahoud, Jad; McGettigan, Melissa; Parikh, Nainesh; Boris, Ronald S.; Iliopoulos, Othon; Rathmell, W. Kimryn; Daniels, Anthony B.; Jonasch, Eric; Spiess, Philippe E.; Urology, School of Medicine
    This brief report focuses on the evaluation and diagnosis of clinically localized renal masses in children and adults with Von Hippel–Lindau (VHL) disease. Counseling considerations pertinent to the urologists, medical oncologists, and multidisciplinary teams involved in the care of these patients are addressed. As practice patterns regarding the evaluation and management of VHL tumors can vary considerably, this report aims to provide guidance on some of the controversies associated with the diagnostic evaluation and initial management of localized renal masses in VHL patients.
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    On-Clamp vs. Off-Clamp Robot-Assisted Partial Nephrectomy for cT2 Renal Tumors: Retrospective Propensity-Score-Matched Multicenter Outcome Analysis
    (MDPI, 2022-09-13) Brassetti, Aldo; Cacciamani, Giovanni E.; Mari, Andrea; Garisto, Juan D.; Bertolo, Riccardo; Sundaram, Chandru P.; Derweesh, Ithaar; Bindayi, Ahmet; Dasgupta, Prokar; Porter, James; Mottrie, Alexander; Schips, Luigi; Rah, Koon Ho; Chen, David Y. T.; Zhang, Chao; Jacobsohn, Kenneth; Anceschi, Umberto; Bove, Alfredo M.; Costantini, Manuela; Ferriero, Mariaconsiglia; Mastroianni, Riccardo; Misuraca, Leonardo; Tuderti, Gabriele; Kutikov, Alexander; White, Wesley M.; Ryan, Stephen T.; Porpiglia, Francesco; Kaouk, Jihad; Minervini, Andrea; Gill, Inderbir; Autorino, Riccardo; Simone, Giuseppe; Urology, School of Medicine
    We compared perioperative outcomes after on-clamp versus off-clamp robot-assisted partial nephrectomy (RAPN) for >7 cm renal masses. A multicenter dataset was queried for patients who had undergone RAPN for a cT2cN0cM0 kidney tumor from July 2007 to February 2022. The Trifecta achievement (negative surgical margins, no severe complications, and ≤ 30% postoperative estimated glomerular filtration rate (eGFR) reduction) was considered a surrogate of surgical quality. Overall, 316 cases were included in the analysis, and 58% achieved the Trifecta. A propensity-score-matched analysis generated two cohorts of 89 patients homogeneous for age, ASA score, preoperative eGFR, and RENAL score (all p > 0.21). Compared to the on-clamp approach, OT was significantly shorter in the off-clamp group (80 vs. 190 min; p < 0.001), the incidence of sRFD was lower (22% vs. 40%; p = 0.01), and the Trifecta rate higher (66% vs. 46%; p = 0.01). In a crude analysis, >20 min of hilar clamping was associated with a significantly higher risk of sRFD (OR: 2.30; 95%CI: 1.13−4.64; p = 0.02) and with reduced probabilities of achieving the Trifecta (OR: 0.46; 95%CI: 0.27−0.79; p = 0.004). Purely off-clamp RAPN seems to be a safe and viable option to treat cT2 renal masses and may outperform the on-clamp approach regarding perioperative surgical outcomes.