Abstract
Patients undergoing nephrectomy for central renal tumors suspicious for renal cell carcinoma (RCC) may carry a small risk of having transitional cell carcinoma (TCC) on final pathology, even in the absence of filling defects or abnormal cytology. We describe outcomes in such patients undergoing robotic nephrectomy for suspected RCC, with intraoperative specimen assessment to guide completion ureterectomy if TCC is present. Between September 2010 and August 2015, ten patients had central renal masses suspicious for RCC, which were not amenable to nephron-sparing surgery. Patients underwent a four-arm robotic nephrectomy technique using a GelPOINT® access port. Following hilar ligation, the ureter was divided between adjacent hem-o-lok clips, placed in an endocatch bag, and extracted through the GelPOINT incision for the frozen section analysis. If intraoperative assessment confirmed TCC, a robotic completion ureterectomy and a bladder cuff excision were performed. Of the ten patients with central tumors who underwent robotic nephrectomy for suspected RCC, four (40 %) had TCC on the frozen section analysis and underwent completion ureterectomy. Five patients had RCC, and one patient had an oncocytoma. Mean age was 63.1 years (49–76) and mean tumor size was 4.0 cm (1.9–7.6). Mean operating time was 246 min (135–328). All patients had negative margins. Mean length of stay was 2.5 days. No recurrences were documented at median 8.5 months follow-up. For patients undergoing robotic nephrectomy for central renal tumors, intraoperative specimen evaluation can help determine the need for minimally invasive completion ureterectomy.
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References
Siegel R, Naishadham D, Jemal A (2013) Cancer statistics. CA Cancer J Clin 63(1):11–30. doi:10.3322/caac.21166
Cai G, Liu X, Wu B (2011) Treatment of upper urinary tract urothelial carcinoma. Surg Oncol 20(1):43–55. doi:10.1016/j.suronc.2009.10.001
Smith AK, Stephenson AJ, Lane BR, Larson BT, Thomas AA, Gong MC, Jones JS, Campbell SC, Hansel DE (2011) Inadequacy of biopsy for diagnosis of upper tract urothelial carcinoma: implications for conservative management. Urology 78(1):82–86. doi:10.1016/j.urology.2011.02.038
Rogers CG, Ghani KR, Kumar RK, Jeong W, Menon M (2013) Robotic partial nephrectomy with cold ischemia and on-clamp tumor extraction: recapitulating the open approach. Eur Urol 63(3):573–578. doi:10.1016/j.eururo.2012.11.029
Hu JC, Silletti JP, Williams SB (2008) Initial experience with robot-assisted minimally-invasive nephroureterectomy. J Endourol 22(4):699–704. doi:10.1089/end.2007.0333
Cutress ML, Stewart GD, Zakikhani P, Phipps S, Thomas BG, Tolley DA (2012) Ureteroscopic and percutaneous management of upper tract urothelial carcinoma (UTUC): systematic review. BJU Int 110(5):614–628. doi:10.1111/j.1464-410X.2012.11068.x
Daneshmand S, Quek ML, Huffman JL (2003) Endoscopic management of upper urinary tract transitional cell carcinoma: long-term experience. Cancer 98(1):55–60. doi:10.1002/cncr.11446
Vashistha V, Shabsigh A, Zynger DL (2013) Utility and diagnostic accuracy of ureteroscopic biopsy in upper tract urothelial carcinoma. Arch Pathol Lab Med 137(3):400–407. doi:10.5858/arpa.2012-0136-OA
Truong LD, Krishnan B, Shen SS (2005) Intraoperative pathology consultation for kidney and urinary bladder specimens. Arch Pathol Lab Med 129(12):1585–1601. doi:10.1043/1543-2165(2005)129[1585:IPCFKA]2.0.CO;2
Krishnan B, Lechago J, Ayala G, Truong L (2003) Intraoperative consultation for renal lesions. Implications and diagnostic pitfalls in 324 cases. Am J Clin Pathol 120(4):528–535. doi:10.1309/CTVD-7XUY-3FJ7-MK98
Silver DA, Morash C, Brenner P, Campbell S, Russo P (1997) Pathologic findings at the time of nephrectomy for renal mass. Ann Surg Oncol 4(7):570–574
Babbar P, Hemal AK (2011) Robot-assisted urologic surgery in 2010–Advancements and future outlook. Urol Ann 3(1):1–7. doi:10.4103/0974-7796.75853
Eandi JA, Nelson RA, Wilson TG, Josephson DY (2010) Oncologic outcomes for complete robot-assisted laparoscopic management of upper-tract transitional cell carcinoma. J Endourol 24(6):969–975. doi:10.1089/end.2009.0340
Hemal AK, Stansel I, Babbar P, Patel M (2011) Robotic-assisted nephroureterectomy and bladder cuff excision without intraoperative repositioning. Urology 78(2):357–364. doi:10.1016/j.urology.2010.12.075
Nanigian DK, Smith W, Ellison LM (2006) Robot-assisted laparoscopic nephroureterectomy. J Endourol 20(7):463–465. doi:10.1089/end.2006.20.463 (discussion 465–466)
Chitale S, Mbakada R, Irving S, Burgess N (2008) Nephroureterectomy for transitional cell carcinoma–the value of pre-operative histology. Ann R Coll Surg Engl 90(1):45–50. doi:10.1308/003588408X242268
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Authors Leedor Lieberman, Ravi Barod, Alexander Tapper, Ramesh Kumar, and Craig Rogers declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. We performed a retrospective study. For this type of study, formal consent is not required.
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Lieberman, L., Barod, R., Tapper, A. et al. Robotic nephrectomy for central renal tumors with intraoperative evaluation of tumor histology. J Robotic Surg 10, 261–265 (2016). https://doi.org/10.1007/s11701-016-0596-6
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DOI: https://doi.org/10.1007/s11701-016-0596-6