Robotic salvage partial nephrectomy following surgical and ablative therapies.

IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY International Braz J Urol Pub Date : 2024-05-01 DOI:10.1590/S1677-5538.IBJU.2024.0117
Carol L Feng, Antonio Franco, Francesco Ditonno, Celeste Manfredi, Alexander K Chow, Riccardo Autorino
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Abstract

Purpose: Partial nephrectomies in the salvage setting after ablative or surgical therapy remain challenging cases that are underreported in the literature (1-5). The aim of this video is to demonstrate techniques for robotic salvage partial nephrectomy to manage recurrent renal cell carcinoma (RCC) after failed prior partial nephrectomy and primary cryotherapy.

Materials and methods: A 55-year-old man after previous robotic-assisted right partial nephrectomy presented with a 2.5 cm locally recurrent renal mass abutting the collecting system. A 59-year-old man with right renal cell carcinoma initially treated with cryoablation presented local recurrence. CT imaging demonstrated 2.6 cm right renal mass consistent with tumor recurrence at previous treatment site.

Results: Both procedures were completed in under 180 minutes. Clamp time was 22 minutes after the previous partial nephrectomy and 25 minutes after previous cryotherapy. There were no perioperative complications. Pathology in both cases demonstrated pT1a clear cell RCC with negative margins. Both patients have since no evidence of recurrent disease on follow-up imaging at 1 and 2 years, respectively.

Conclusions: Salvage robotic partial nephrectomy should be considered as a feasible treatment option after failure of initial therapy-surgical or ablative. A salvage procedure is often more challenging than its standard therapy-naïve counterpart due to development of dense inflammation after previous interventions. Despite this, robotic partial nephrectomies in the salvage setting can be safely carried out with good surgical outcomes, particularly when utilizing intraoperative ultrasound to identify tumor margins and key anatomy.

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手术和烧蚀疗法后的机器人肾部分切除术。
目的:消融或手术治疗后的挽救性肾部分切除术仍是具有挑战性的病例,文献中的报道不足(1-5)。本视频旨在展示机器人挽救性肾部分切除术的技术,以治疗既往肾部分切除术和原发性冷冻治疗失败后复发的肾细胞癌(RCC):一名 55 岁的男性曾接受过机器人辅助的右肾部分切除术,术后出现 2.5 厘米的局部复发性肾肿块,与集合系统相邻。一名 59 岁的男性右肾细胞癌患者最初接受了冷冻消融治疗,但出现了局部复发。CT 成像显示 2.6 厘米的右肾肿块与之前治疗部位的肿瘤复发一致:两个手术均在 180 分钟内完成。结果:两次手术均在 180 分钟内完成,上次肾部分切除术后的钳夹时间为 22 分钟,上次冷冻疗法后的钳夹时间为 25 分钟。围手术期未出现并发症。两个病例的病理结果均为pT1a透明细胞RCC,边缘阴性。两名患者分别在术后1年和2年的随访影像学检查中均未发现复发迹象:在初始治疗(手术或消融)失败后,挽救性机器人肾部分切除术应被视为一种可行的治疗方案。抢救性手术通常比标准治疗无效的手术更具挑战性,因为先前的介入治疗后会出现致密炎症。尽管如此,抢救性机器人肾部分切除术仍能安全进行,并取得良好的手术效果,尤其是在利用术中超声识别肿瘤边缘和关键解剖结构时。
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来源期刊
International Braz J Urol
International Braz J Urol UROLOGY & NEPHROLOGY-
CiteScore
4.60
自引率
21.60%
发文量
246
审稿时长
6-12 weeks
期刊介绍: Information not localized
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