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Objectives: To evaluate predictors of long‐term survival for patients with chronic kidney disease primarily due to surgery (CKD‐S). Patients with CKD‐S have generally good survival that approximates patients who do not have CKD even after renal cancer surgery (RCS), yet there may be heterogeneity within this cohort. Patients and Methods: From 1997 to 2008, 4 246 patients underwent RCS at our centre. The median (interquartile range [IQR]) follow‐up was 9.4 (7.3–11.0) years. New baseline glomerular filtration rate (GFR) was defined as highest GFR between nadir and 6 weeks after RCS. We retrospectively evaluated three cohorts: no‐CKD (new baseline GFR of ≥60 mL/min/1.73 m2); CKD‐S (new baseline GFR of <60 mL/min/1.73 m2 but preoperative GFR of ≥60 mL/min/1.73 m2); and CKD due to medical aetiologies who then require RCS (CKD‐M/S, preoperative and new baseline GFR both <60 mL/min/1.73 m2). Analysis focused primarily on non‐renal cancer‐related survival (NRCRS) for the CKD‐S cohort. Kaplan–Meier analysis assessed the longitudinal impact of new baseline GFR (45–60 mL/min/1.73 m2 vs <45 mL/min/1.73 m2) and Cox regression evaluated relative impact of preoperative GFR, new baseline GFR, and relevant demographics/comorbidities. Results: Of the 4 246 patients who underwent RCS, 931 had CKD‐S and 1 113 had CKD‐M/S, whilst 2 202 had no‐CKD even after RCS. Partial/radical nephrectomy (PN/RN) was performed in 54%/46% of the patients, respectively. For CKD‐S, 641 patients had a new baseline GFR of 45–60 mL/min/1.73 m2 and 290 had a new baseline GFR of <45 mL/min/1.73 m2. Kaplan–Meier analysis showed significantly reduced NRCRS for patients with CKD‐S with a GFR of <45 mL/min/1.73 m2 compared to those with no‐CKD or CKD‐S with a GFR of 45–60 mL/min/1.73 m2 (both P ≤ 0.004), and competing risk analysis confirmed this (P < 0.001). Age, gender, heart disease, and new baseline GFR were all associated independently with NRCRS for patients with CKD‐S (all P ≤ 0.02). Conclusion: Our data suggest that CKD‐S is heterogeneous, and patients with a reduced new baseline GFR have compromised survival, particularly if <45 mL/min/1.73 m2. Our findings may have implications regarding choice of PN/RN in patients at risk of developing CKD‐S. [ABSTRACT FROM AUTHOR]

Objective To compare extended pelvic lymph node dissection ( ePLND) with non-extended pelvic lymph node dissection (non- ePLND) and assess their influence on recurrence-free survival ( RFS) in patients undergoing radical cystectomy for bladder cancer., Methods Through a comprehensive search of the PubMed, Embase and Cochrane Library databases in September 2012, we performed a systematic review and cumulative meta-analysis of all comparative studies assessing the extent of pelvic lymph node dissection ( PLND) and its influence on RFS., Results Six studies with a total of 2824 patients were identified., Overall analysis showed a significantly better RFS rate in patients who had undergone ePLND than in those who had undergone non- ePLND (hazard ratio [ HR]: 0.65; P < 0.001)., A subgroup analysis found that, compared with non- ePLND, ePLND was associated with a better RFS rate for both patients with negative lymph nodes ( HR: 0.68; P = 0.007) and those with positive lymph nodes ( HR: 0.58; P < 0.001). When stratified by pathological T stage, ePLND provided additional RFS benefits for patients with pT3-4 disease ( HR: 0.61; P < 0.001), but not for patients with ≤ pT2 disease ( HR: 0.95; P = 0.81)., Conclusions The results of this meta-analysis indicate that ePLND provides a RFS benefit compared with non- ePLND. On subgroup analysis, ePLND provides better RFS not only for patients who had positive lymph nodes and pT3-4 disease, but also for patients with negative lymph nodes., Two randomized controlled trials on ePLND vs non- ePLND are awaited which should provide more clinically meaningful results. [ABSTRACT FROM AUTHOR]

What's known on the subject? and What does the study add? Laparoscopic nephrectomy is now considered to be the reference procedure for kidney cancer. It can be performed via a transperitoneal or retroperitoneal approach. Each approach has its advantages and disadvantages. No definitive conclusions regarding objective difference between the two approaches have been reached to date., This meta-analysis indicates that in appropriately selected patients, especially patients with posteriorly located renal tumors, the retroperitoneal approach may be faster and equally safe compared with the transperitoneal approach., Objective To evaluate the efficiency and safety of the retroperitoneal and transperitoneal approaches in laparoscopic radical/partial nephrectomy (RN/PN) for renal cell carcinoma., Methods A systematic search of PUBMED, EMBASE, and the Cochrane Library was performed to identify prospective randomized controlled trials and retrospective observational studies that compared the outcomes of the two approaches., Outcomes of interest included perioperative and postoperative variables, surgical complications and oncological variables., Results Twelve studies assessing transperitoneal laparoscopic RN (TLRN) vs retroperitoneal laparoscopic RN (RLRN) and six studies assessing transperitoneal laparoscopic PN (TLPN) vs retroperitoneal laparoscopic PN (RLPN) were included., The RLRN approach had a shorter time to renal artery control (weighted mean difference [WMD] 68.65 min; 95% confidence interval [CI] 40.80-96.50; P < 0.001) and a lower overall complication rate (odds ratio 2.12; 95% CI 1.30-3.47; P = 0.003) than TLRN. RLPN had a shorter operating time (WMD 48.85 min; 95% CI 29.33-68.37; P < 0.001) and a shorter length of hospital stay (WMD 1.01 days; 95% CI 0.39-1.63; P = 0.001) than TLPN., There were no significant differences between the retroperitoneal and transperitoneal approaches in other outcomes of interest., Conclusions This meta-analysis indicates that, in appropriately selected patients, especially patients with posteriorly located renal tumours, the retroperitoneal approach may be faster and equally safe compared with the transperitoneal approach., Despite our rigorous methodology, conclusions drawn from our pooled results should be interpreted with caution because of the inherent limitations of the included studies. [ABSTRACT FROM AUTHOR]