Neoplasms

Urinary Tract, Sexual Organs, and Pregnancy Conditions

All Conditions

Rare Diseases

Carcinoma, Renal Cell

Kidney Neoplasms

Carcinoma

Urologic Neoplasms

Urogenital Neoplasms

Urogenital Diseases

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

Kidney Diseases

Urologic Diseases

Male Urogenital Diseases

Adenocarcinoma

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Renal Cell Carcinoma

The investigators included all hospitalisations for LPN using CCAM(Classification Commune des actes médicaux) code (JAFC005) after removing the 83 hospitals using RAPN in 2017. LPN complications were from hospitals using exclusively LPN.

OPN has its own CCAM codes; they group laparotomy (JAFA019 / JAFA030) and lumbotomy (JAFA008 / JAFA024)

At the time of this study, RAPN did not have a specific coding. The investigators had contacted the hospitals with Vinci robotic surgical procedures in 2013 and the investigators included here PN from hospitalisations from the 25 centres using exclusively RAPN for more than five years. Thus, in this study, RAPN was performed by experts in robotic surgery.

partial nephrectomy

This paper evaluates the initial complications and the complications two years postoperatively necessitating re-hospitalisation for three surgical procedures for renal tumour partial nephrectomy .

This paper evaluates the initial complications and the complications two years postoperatively necessitating re-hospitalisation for three surgical procedures for renal tumour partial nephrectomy (open (OPN), standard laparoscopy (LPN) and robot assisted laparoscopy (RAPN)) in 2016-2017 in France (9119 initial hospitalisations included 4035 OPN, 1900 RAPN, 1709 LPN). The investigators have extracted for these all hospitalisations from the French national hospital data base (PMSI-MCO). The investigators concluded mini-invasive and robotic surgery had lower morbidity and a shorter initial hospitalisation.

Complications Associated With Partial Nephrectomy for Renal Cancer

Complications Associated With Partial Nephrectomy for Renal Cancer: PMSI French National Data

Complications were documented for the initial hospitalisation and any subsequent re-hospitalisation

Central Hospital, Nancy, France

Professor

Symptoms and General Pathology

Ischemia

Clear Cell Renal Cell Carcinoma

Anti-Inflammatory Agents

Antirheumatic Agents

Analgesics

All Drugs and Chemicals

Natriuretic Agents

Coagulants

Chrysarobin

Mannitol

Hemostatics

Fibrin Tissue Adhesive

Fluorophosphate

Diuretics

1. Inclusion criteria fulfilled:

   * Baseline Abdomen CT/MRI
   * Patient Age, Weight, Height, Co-Medication
   * Informed Consent
   * Baseline renal function (eGFR, renal scintigraphy, sCreatinine, creatinine clearance)
2. During hospitalization, one day before laparoscopic partial nephrectomy:

   * eGFR
   * sCreatinine
   * Hemoglobin
3. After surgery:

   * Assessment of eGFR 4 days after operation
   * Hb assessment every 6 H in the first 48 H
   * Assessment of adverse events
   * Histological Results
4. 6, 12, 24 months after intervention:

   * Creatinine Clearance (only performed at 6 months follow-up)
   * Tc-99m MAG3Dynamic Scintigraphy (only performed at 6 months follow-up)
   * eGFR
   * Assessment of adverse events
   * Assessment of possible recurrence
   * Assesment of kidney volume variation

1. Inclusion criteria fulfilled:

   * Baseline Abdomen CT/MRI
   * Patient Age, Weight, Height, Co-Medication
   * Informed Consent
   * Baseline renal function (eGFR, renal scintigraphy, sCreatinine, creatinine clearance)
2. During hospitalization, one day before robot assisted partial nephrectomy:

   * eGFR
   * sCreatinine
   * Hemoglobin
3. After surgery:

   * Assessment of eGFR 4 days after operation
   * Hb assessment every 6 H in the first 48 H
   * Assessment of adverse events
   * Histological Results
4. 6, 12, 24 months after intervention:

   * Creatinine Clearance (only performed at 6 months follow-up)
   * Tc-99m MAG3Dynamic Scintigraphy (only performed at 6 months follow-up)
   * eGFR
   * Assessment of adverse events
   * Assessment of possible recurrence
   * Assesment of kidney volume variation

The renal hilus is identified and both vein and artery are dissected. A laparoscopic ultrasound probe is introduced through a 12 mm port to define the tumor resection margins. A laparoscopic Satinsky clamp is used to induce total kidney ischemia, clamping both vein and artery. Athermal resection of the tumor is performed and titanium clips are used to close interlobar or arcuate arteries encountered during resection. The defect is closed with stitches secured by Hem-o-Lok clips and haemostatic glue. Ischemia is interrupted once renorrhaphy is completed

Laparoscopic partial nephrectomy

The renal hilus is carefully dissected, so that the arterial segmental branches are reached. Tumor resection margins are identified through ultrasound. Drop-in bulldog clamps are used to clamp segmental arterial branches and induce selective ischemia. Indocyanine green 0.2-0.3mg/KG is infused intravenously a few seconds after the selective ischemia is induced. The Firefly near infra-red fluorescence system is used to determine the extent of the ischemic area. The ischemic zone can now be tailored to the tumor by adding or removing bulldog clamps according to the vascular anatomical conditions. Athermal resection of the tumor is performed and titanium clips are used to close interlobar or arcuate arteries encountered during resection. The resection defect is closed with stitches secured by Hem-o-Lok clips and haemostatic glue. Selective ischemia will be interrupted once renorrhaphy is completed

Robot assisted partial nephrectomy

Endoscope, Scissor, Needleholder, Forceps, Suction unit, Ports, Tissel, CO2, Sutures, Needles, Scalpel, Ultrasound-Probe, Monitors

Conventional laparoscopic instruments

Da Vinci Robot, Console, Ports and Instruments; Suction unit, Forceps, Tisseel, Ultrasound Probe, Monitors

Da- Vinci Robot and conventional laparoscopic instruments

Agostino Mattei, Ass. Prof.

Currently, partial nephrectomy (PN) is considered as the gold standard treatment modality for small renal masses. In this setting, robot-assisted and conventional laparoscopic approaches are gaining more consensus every day. However, until now, no superiority of one technique over the other has yet been demonstrated, especially on postoperative function recovery.

This study compares oncological and functional outcomes after laparoscopic partial nephrectomy versus robot assisted partial nephrectomy.

Renal cell carcinoma (RCC) represents 2-3% of all cancers, with the highest incidence in Western countries. Due to increased detection of tumors by ultrasound (US) and computed tomography (CT), the number of incidentally diagnosed RCCs has increased. These tumors are usually smaller and of lower stage. Currently, partial nephrectomy (PN) is considered as the gold standard treatment modality for small renal masses. In this setting, robot-assisted and conventional laparoscopic approaches are gaining more consensus every day. However, until now, no superiority of one technique over the other has yet been demonstrated, especially on postoperative function recovery. This is a single center prospective randomized trial investigating the functional and oncological outcomes of minimally invasive (laparoscopic and robot-assisted) nephron sparing surgery. Patients will be assessed with renal scintigraphy and 24 hours creatinine clearance pre- and postoperatively. Furthermore, duration of the operation, resection and suturing times will be assessed. Renal function recovery is defined as primary endpoint; oncological outcome and positive surgical margin rate are defined as secondary measures. In addition, kidney volume variation will be calculated to describe the amount of healthy tissue preserved in both procedures.The aim of the study is to assess whether robot assisted partial nephrectomy in selective ischemia is superior to laparoscopic partial nephrectomy in global ischemia in terms of functional and oncological outcomes.

Assessment of Oncological and Functional Outcomes After Robot Assisted Partial Nephrectomy Versus Laparoscopic Partial Nephrectomy

Robot Assisted Partial Nephrectomy (RAPN) in Selective Ischemia Versus Laparoscopic Partial Nephrectomy (LPN) in Total Ischemia: Prospective Randomized Study to Assess Oncological and Functional Outcomes

Swiss Paraplegic Research, Nottwil

Luzerner Kantonsspital

Ass. Prof. Dr. med.

Antineoplastic Agents

Axitinib

Endothelial Growth Factors

Mitogens

Protein Kinase Inhibitors

Enzyme Inhibitors

Axitinib is an oral, potent, and selective inhibitor of vascular endothelial growth factor (VEGF) receptors 1, 2, 3 It will be supplied as 1 mg and 5 mg film coated tablets for oral administration in light protecting bottles of 60 tablets.

AXITINIB

Jean Jacques Patard, MD, PhD

Axitinib (AXITINIB) is an oral, potent, and selective inhibitor of vascular endothelial growth factor receptors 1, 2, and 3 which has achieved objective response rate of 44.2% in phase II study in cytokine-refractory metastatic renal-cell cancer patients.

Pre-surgical treatment with Axitinib could allow a substantial proportion of patients with large organ confined tumors to benefit from NSS.

The Objective is to determine the efficacy of Axitinib administered prior to surgery in patients with large organ confined tumors not primarily suitable for NSS (cT2aNoNxM0) for shifting from a radical nephrectomy indication to a nephron sparing procedure.

Radical nephrectomy (RN) is the current standard of care for large organ confined renal tumors.

Experience and surgical technical improvements have allowed the feasibility of Nephron Sparing Surgery (NSS) in tumors larger than 4 cm and up to 7cm. Very limited data exist regarding the feasibility and safety of NSS in tumors larger than 7cm.

It has been demonstrated that NSS compared to RN offers similar oncological outcome while better preserving renal function and thus improving overall survival.

The purpose of this study is to test the possibility of offering patients with large organ confined renal tumors, candidates for radical nephrectomy according to current guidelines the benefit of partial nephrectomy thanks to axitinib neo-adjuvant treatment.

Study of Axitinib for Downstaging Large Renal Tumors Not Primarily Suitable for Partial Nephrectomy (AXIPAN)

An Open-label, Non-randomized, Multicenter, Two Stage Designed Phase II Study of Axitinib for Downstaging Large Renal Tumors Not Primarily Suitable for Partial Nephrectomy (AXIPAN)

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Complications Associated With Partial Nephrectomy for Renal Cancer	NCT05168761	Renal Cancer Partial Nephrec...	partial nephrec...	-	Central Hospital, Nancy, France
Assessment of Oncological and Functional Outcomes After Robot Assisted Partial Nephrectomy Versus Laparoscopic Partial Nephrectomy	NCT02924922	Kidney Neoplasm...	Laparoscopic pa... Robot assisted ... Conventional la... Da- Vinci Robot... Mannitol	18 Years -	Luzerner Kantonsspital
Study of Axitinib for Downstaging Large Renal Tumors Not Primarily Suitable for Partial Nephrectomy (AXIPAN)	NCT02597322	cT2a N0NxM0 Ren...	AXITINIB	18 Years -	Assistance Publique - Hôpitaux de Paris
Assessment of Oncological and Functional Outcomes After Robot Assisted Partial Nephrectomy Versus Laparoscopic Partial Nephrectomy	NCT02924922	Kidney Neoplasm...	Laparoscopic pa... Robot assisted ... Conventional la... Da- Vinci Robot... Mannitol	18 Years -	Luzerner Kantonsspital
Study of Axitinib for Downstaging Large Renal Tumors Not Primarily Suitable for Partial Nephrectomy (AXIPAN)	NCT02597322	cT2a N0NxM0 Ren...	AXITINIB	18 Years -	Assistance Publique - Hôpitaux de Paris

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