MP59-19 RADICAL NEPHRECTOMY FOR RECURRENT RENAL CELL CARCINOMA: PATIENT SELECTION FOR LAPAROSCOPIC APPROACH Article Swipe

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Zachary Kozel , Amanda A. Myers , Paras Shah , Elie Kaplan-Marans , Sam Sohen , Manish Vira , Louis R. Kavoussi , Lee Richstone ·

YOU? · · 2018 · Open Access · · DOI: https://doi.org/10.1016/j.juro.2018.02.1871

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy VI1 Apr 2018MP59-19 RADICAL NEPHRECTOMY FOR RECURRENT RENAL CELL CARCINOMA: PATIENT SELECTION FOR LAPAROSCOPIC APPROACH Zachary Kozel, Amanda Myers, Paras Shah, Elie Kaplan-Marans, Sam Sohen, Manish Vira, Louis Kavoussi, and Lee Richstone Zachary KozelZachary Kozel More articles by this author , Amanda MyersAmanda Myers More articles by this author , Paras ShahParas Shah More articles by this author , Elie Kaplan-MaransElie Kaplan-Marans More articles by this author , Sam SohenSam Sohen More articles by this author , Manish ViraManish Vira More articles by this author , Louis KavoussiLouis Kavoussi More articles by this author , and Lee RichstoneLee Richstone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1871AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Local recurrence represents a growing clinical concern given the increasing utilization of partial nephrectomy (PN) for renal malignancies. Exempting those patients with familial tumor syndromes or pre-existing severe renal dysfunction, radical nephrectomy (RN) represents a widely utilized management strategy. The role of minimally invasive nephrectomy, while described for benign indications, is not as defined in cases of locoregional tumor recurrence. We sought to review our experience with laparoscopic completion nephrectomy following recurrence and to identify any risk factors associated with increased complications. METHODS We retrospectively reviewed patients who underwent extirpative therapy for RCC recurrence at a high volume tertiary center between 2006 and 2016, excluding those patients with solitary kidneys, benign pathology, or familial RCC. Recurrence was defined by imaging demonstrating a new lesion(s) within or immediately adjacent to the prior nephrectomy bed following PN. Definitive diagnosis of recurrence was assigned only after tissue diagnosis. Patient demographics, tumor characteristics, and perioperative and postoperative course variables were collected. Results were analyzed using Mann-Whitney U and chi-square tests. RESULTS We identified 33 patients who were scheduled for laparoscopic completion nephrectomy. Of these 33 patients, 12 (36%) required conversion to open with the most common causes being failure to progress (50%) and intraoperative hemorrhage (42%). Higher R.E.N.A.L scores of the original tumor as well as the presence of synchronous metastatic recurrences were found to be significantly associated with conversion to open radical nephrectomy. Additionally, conversion to open nephrectomy was found to significantly increase morbidity, resulting in higher rates of Clavien 3-5 complications (67% vs 7%, p<0.01), longer operative times (300 vs 151 minutes, p<0.01), and increased estimated blood loss (725 vs 200 ml, p=0.002). CONCLUSIONS Laparoscopic completion nephrectomy for true locoregional recurrence is a complex and technically-demanding procedure associated with a high rate of open conversion and significant postoperative morbidity, particularly in cases where laparoscopy is aborted. Although laparoscopy is feasible in this setting, careful preoperative patient selection may optimize surgical outcomes, as high nephrometry score of the initial tumor and the concomitant presence of metastatic relapse were found to be associated with risk of open conversion. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e788-e789 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Zachary Kozel More articles by this author Amanda Myers More articles by this author Paras Shah More articles by this author Elie Kaplan-Marans More articles by this author Sam Sohen More articles by this author Manish Vira More articles by this author Louis Kavoussi More articles by this author Lee Richstone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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Nephrectomy Medicine Renal cell carcinoma General surgery Kidney Internal medicine

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Type: article
Language: en
Landing Page: https://doi.org/10.1016/j.juro.2018.02.1871
PDF: https://www.auajournals.org/doi/pdf/10.1016/j.juro.2018.02.1871
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DOI: https://doi.org/10.1016/j.juro.2018.02.1871

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Title: MP59-19 RADICAL NEPHRECTOMY FOR RECURRENT RENAL CELL CARCINOMA: PATIENT SELECTION FOR LAPAROSCOPIC APPROACH

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Publication year: 2018

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Authors: Zachary Kozel, Amanda A. Myers, Paras Shah, Elie Kaplan-Marans, Sam Sohen, Manish Vira, Louis R. Kavoussi, Lee Richstone

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Landing page: https://doi.org/10.1016/j.juro.2018.02.1871

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Concepts: Nephrectomy, Medicine, Renal cell carcinoma, General surgery, Kidney, Internal medicine

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abstract_inverted_index.using	287
abstract_inverted_index.where	427
abstract_inverted_index.while	172
abstract_inverted_index.(42%).	328
abstract_inverted_index.Amanda	26, 50, 491
abstract_inverted_index.Author	115
abstract_inverted_index.Expand	540
abstract_inverted_index.Higher	329
abstract_inverted_index.Kozel,	25
abstract_inverted_index.Manish	34, 86, 519
abstract_inverted_index.Myers,	27
abstract_inverted_index.Sohen,	33
abstract_inverted_index.Volume	473
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abstract_inverted_index.center	226
abstract_inverted_index.common	318
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abstract_inverted_index.higher	370
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abstract_inverted_index.review	190
abstract_inverted_index.scores	331
abstract_inverted_index.severe	154
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abstract_inverted_index.Clavien	373
abstract_inverted_index.InEmail	123
abstract_inverted_index.METHODS	209
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abstract_inverted_index.Patient	272
abstract_inverted_index.RADICAL	12
abstract_inverted_index.RESULTS	293
abstract_inverted_index.Results	284
abstract_inverted_index.Therapy	8
abstract_inverted_index.Zachary	24, 41, 484
abstract_inverted_index.between	227
abstract_inverted_index.careful	438
abstract_inverted_index.complex	408
abstract_inverted_index.concern	133
abstract_inverted_index.defined	180, 244
abstract_inverted_index.factors	204
abstract_inverted_index.failure	321
abstract_inverted_index.growing	131
abstract_inverted_index.imaging	246
abstract_inverted_index.initial	452
abstract_inverted_index.partial	139
abstract_inverted_index.patient	440
abstract_inverted_index.radical	157, 355
abstract_inverted_index.relapse	460
abstract_inverted_index.therapy	217
abstract_inverted_index.199Issue	474
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abstract_inverted_index.Kavoussi	97, 527
abstract_inverted_index.SohenSam	78
abstract_inverted_index.Surgical	7
abstract_inverted_index.ToolsAdd	117
abstract_inverted_index.aborted.	430
abstract_inverted_index.adjacent	254
abstract_inverted_index.analyzed	286
abstract_inverted_index.articles	45, 54, 63, 72, 81, 90, 99, 109, 487, 494, 501, 508, 515, 522, 529, 536
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abstract_inverted_index.familial	149, 240
abstract_inverted_index.feasible	434
abstract_inverted_index.identify	201
abstract_inverted_index.increase	366
abstract_inverted_index.invasive	170
abstract_inverted_index.kidneys,	236
abstract_inverted_index.minutes,	386
abstract_inverted_index.optimize	443
abstract_inverted_index.original	334
abstract_inverted_index.p<0.01),	379, 387
abstract_inverted_index.patients	147, 213, 233, 297
abstract_inverted_index.presence	340, 457
abstract_inverted_index.progress	323
abstract_inverted_index.required	311
abstract_inverted_index.reviewed	212
abstract_inverted_index.setting,	437
abstract_inverted_index.solitary	235
abstract_inverted_index.surgical	444
abstract_inverted_index.tertiary	225
abstract_inverted_index.utilized	163
abstract_inverted_index.2018Page:	476
abstract_inverted_index.Copyright	479
abstract_inverted_index.Exempting	145
abstract_inverted_index.Kavoussi,	37
abstract_inverted_index.R.E.N.A.L	330
abstract_inverted_index.RECURRENT	15
abstract_inverted_index.Richstone	40, 107, 534
abstract_inverted_index.SELECTION	20
abstract_inverted_index.ShahParas	60
abstract_inverted_index.described	173
abstract_inverted_index.diagnosis	263
abstract_inverted_index.e788-e789	477
abstract_inverted_index.estimated	390
abstract_inverted_index.excluding	231
abstract_inverted_index.following	197, 260
abstract_inverted_index.increased	207, 389
abstract_inverted_index.lesion(s)	250
abstract_inverted_index.minimally	169
abstract_inverted_index.operative	381
abstract_inverted_index.outcomes,	445
abstract_inverted_index.p=0.002).	397
abstract_inverted_index.patients,	308
abstract_inverted_index.procedure	411
abstract_inverted_index.resulting	368
abstract_inverted_index.scheduled	300
abstract_inverted_index.selection	441
abstract_inverted_index.strategy.	165
abstract_inverted_index.syndromes	151
abstract_inverted_index.underwent	215
abstract_inverted_index.variables	281
abstract_inverted_index.CARCINOMA:	18
abstract_inverted_index.Definitive	262
abstract_inverted_index.Localized:	6
abstract_inverted_index.OBJECTIVES	126
abstract_inverted_index.Recurrence	242
abstract_inverted_index.ViraManish	87
abstract_inverted_index.associated	205, 350, 412, 465
abstract_inverted_index.chi-square	291
abstract_inverted_index.collected.	283
abstract_inverted_index.completion	195, 303, 400
abstract_inverted_index.conversion	312, 352, 358, 419
abstract_inverted_index.diagnosis.	271
abstract_inverted_index.experience	192
abstract_inverted_index.hemorrhage	327
abstract_inverted_index.identified	295
abstract_inverted_index.increasing	136
abstract_inverted_index.management	164
abstract_inverted_index.metastatic	343, 459
abstract_inverted_index.morbidity,	367, 423
abstract_inverted_index.pathology,	238
abstract_inverted_index.recurrence	128, 198, 220, 265, 405
abstract_inverted_index.represents	129, 160
abstract_inverted_index.2018MP59-19	11
abstract_inverted_index.CONCLUSIONS	398
abstract_inverted_index.Information	483
abstract_inverted_index.MyersAmanda	51
abstract_inverted_index.NEPHRECTOMY	13
abstract_inverted_index.concomitant	456
abstract_inverted_index.conversion.	470
abstract_inverted_index.extirpative	216
abstract_inverted_index.immediately	253
abstract_inverted_index.laparoscopy	428, 432
abstract_inverted_index.nephrectomy	140, 158, 196, 258, 361, 401
abstract_inverted_index.nephrometry	448
abstract_inverted_index.recurrence.	186
abstract_inverted_index.recurrences	344
abstract_inverted_index.significant	421
abstract_inverted_index.synchronous	342
abstract_inverted_index.utilization	137
abstract_inverted_index.INTRODUCTION	124
abstract_inverted_index.KozelZachary	42
abstract_inverted_index.LAPAROSCOPIC	22
abstract_inverted_index.Laparoscopic	399
abstract_inverted_index.Mann-Whitney	288
abstract_inverted_index.RichstoneLee	106
abstract_inverted_index.dysfunction,	156
abstract_inverted_index.indications,	176
abstract_inverted_index.laparoscopic	194, 302
abstract_inverted_index.locoregional	184, 404
abstract_inverted_index.nephrectomy,	171
abstract_inverted_index.nephrectomy.	304, 356
abstract_inverted_index.particularly	424
abstract_inverted_index.pre-existing	153
abstract_inverted_index.preoperative	439
abstract_inverted_index.Additionally,	357
abstract_inverted_index.Advertisement	478, 542, 543
abstract_inverted_index.Kaplan-Marans	70, 506
abstract_inverted_index.KavoussiLouis	96
abstract_inverted_index.Permissions©	481
abstract_inverted_index.UrologyKidney	4
abstract_inverted_index.accessJournal	2
abstract_inverted_index.complications	375
abstract_inverted_index.demographics,	273
abstract_inverted_index.demonstrating	247
abstract_inverted_index.malignancies.	144
abstract_inverted_index.perioperative	277
abstract_inverted_index.postoperative	279, 422
abstract_inverted_index.significantly	349, 365
abstract_inverted_index.CitationsTrack	120
abstract_inverted_index.Kaplan-Marans,	31
abstract_inverted_index.complications.	208
abstract_inverted_index.intraoperative	326
abstract_inverted_index.downloadLoading	545
abstract_inverted_index.retrospectively	211
abstract_inverted_index.characteristics,	275
abstract_inverted_index.2018MetricsAuthor	482
abstract_inverted_index.Kaplan-MaransElie	69
abstract_inverted_index.favoritesDownload	119
abstract_inverted_index.technically-demanding	410
abstract_inverted_index.ShareFacebookTwitterLinked	122
abstract_inverted_index.CitationsPermissionsReprints	121
abstract_inverted_index.2018FiguresReferencesRelatedDetails	472
abstract_inverted_index.Informationhttps://doi.org/10.1016/j.juro.2018.02.1871AboutPDF	116
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