Surgical Treatment of Completely Endophytic Renal Tumor: a Systematic Review
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Purpose of Review
An endophytic renal tumor represents a special surgical challenge in terms of location and safe removal. For this reason we wanted to review the existing literature on this subject.
In high-activity robotic centers, robot-assisted partial nephrectomy (RAPN) is a safe and efficacious surgical approach for completely endophytic renal tumors. As research innovation, the application of the radio-guided occult lesion localization technique (ROLL) facilitates the location and complete excision of the tumor during surgery.
There are few studies that specifically report the experience with completely endophytic renal tumors. The endophytic tumor is usually smaller than exophytic. Frequently it represents a high complexity value in the different Score systems reported in the last decade. This surgery should be performed by experienced urologists regardless of the surgical approach they prefer (open, laparoscopic, or robotic). It is necessary to develop new techniques for intraoperative easy localization and intraoperative evaluation of surgical margins.
KeywordsEndophytic tumor Intraparenchymal tumor Open partial nephrectomy Renal tumor Surgical treatment Robotic partial nephrectomy Laparoscopic partial nephrectomy
Compliance with Ethical Standards
Conflict of Interest
Javier Perez-Ardavin, Jose Vicente Sanchez-Gonzalez, Manuel Martinez-Sarmiento, Juan Jose Monserrat-Monfort, Jorge García-Olaverri, Francisco Boronat-Tormo, and César D. Vera-Donoso each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.Johnson DC, Vukina J, Smith AB, Meyer AM, Wheeler SB, Kuo TM, et al. Preoperatively misclassified, surgically removed benign renal masses: a systematic review of surgical series and United States population level burden estimate. J Urol. 2015;193(1):30–5. https://doi.org/10.1016/j.juro.2014.07.102.CrossRefPubMedGoogle Scholar
- 5.Smaldone MC, Egleston B, Hollingsworth JM, Hollenbeck BK, Miller DC, Morgan TM, et al. Understanding treatment disconnect and mortality trends in renal cell carcinoma using tumor registry data. Med Care. 2017;55:398–404. https://doi.org/10.1097/MLR.0000000000000657.CrossRefPubMedPubMedCentralGoogle Scholar
- 8.•• Kara O, Maurice MJ, Malkoc E, Ramirez D, Nelson RJ, Caputo PA, et al. Comparison of robot-assisted and open partial nephrectomy for completely endophytic renal tumours: a single centre experience. BJU Int. 2016;118(6):946–51. https://doi.org/10.1111/bju.13572 A big series showing similar results of open and robotic partial nephrectomy in endophytic tumors.CrossRefPubMedGoogle Scholar
- 9.• Autorino R, Khalifeh A, Laydner H, Samarasekera D, Rizkala E, Eyraud R, et al. Robot-assisted partial nephrectomy (RAPN) for completely endophytic renal masses: a single institution experience. BJU Int. 2014;113(5):762–8. https://doi.org/10.1111/bju.12455 First report of RAPN for endophytic renal tumors with an important number of patients.CrossRefPubMedGoogle Scholar
- 11.Betancourt Hernández JA, Vera Donoso C, Martinez-Sarmiento M, Monserrat JJ, Bello Jarque P, Boronat Tormo F. Application of the radio-guided occult lesion localization technique for renal lumpectomy: from the laboratory to the patient. Clin Nucl Med. 2017;42(11):e467–8. https://doi.org/10.1097/RLU.0000000000001811.CrossRefPubMedGoogle Scholar
- 12.•• Harke NN, Mandel P, Witt JH, Wagner C, Panic A, Boy A, et al. Are there limits of robotic partial nephrectomy? TRIFECTA outcomes of open and robotic partial nephrectomy for completely endophytic renal tumors. J Surg Oncol. 2018;118(1):206–11. https://doi.org/10.1002/jso.25103 A big cohort encouraging open or robotic partial nephrectomy in endophytic tumors achieving good TRIFECTA criteria.CrossRefPubMedGoogle Scholar
- 14.Zapala P, Dybowski B, Miazek N, Radziszewski P. Open partial nephrectomy for entirely intraparenchymal tumors: a matched case-control study of oncologic outcome and complication rate. Int Braz J Urol. 2017;43(2):209–15. https://doi.org/10.1590/S1677-5538.IBJU.2016.0040.CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Komninos C, Shin TY, Tuliao P, Kim DK, Han WK, Chung BH, et al. Robotic partial nephrectomy for completely endophytic renal tumors: complications and functional and oncologic outcomes during a 4-year median period of follow-up. Urology. 2014;84(6):1367–73. https://doi.org/10.1016/j.urology.2014.08.012.CrossRefPubMedGoogle Scholar
- 23.Ficarra V, Novara G, Secco S, Macchi V, Porzionato A, De Caro R, et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol. 2009;56(5):786–93. https://doi.org/10.1016/j.eururo.2009.07.040.CrossRefPubMedGoogle Scholar
- 24.• Mohapatra A, Potretzke AM, Weaver J, Anderson BG, Vetter J, Figenshau RS. Trends in the management of small renal masses: a survey of members of the Endourological Society. J Kidney Cancer VHL. 2017;4(3):10–9. https://doi.org/10.15586/jkcvhl.2017.82 eCollection 2017. This work shows the trends and evolution of surgical techniques among urologists in USA.CrossRefPubMedPubMedCentralGoogle Scholar