Search

Objective To evaluate the efficacy of Preoperative Aspects and Dimension Used for an Anatomical (PADUA) classification in the prediction of Warm Ischemia Time (WIT) during Laparoscopic Partial Nephrectomy (LPN).Methods Single centre retrospective study on 402 patients who underwent LPN between January 2011 and October 2013. WIT was correlated with each characteristics of the PADUA classification. Univariate and multivariate analysis were used to evaluated the independent predictive risk factors of WIT >20 minutes.Results The median WIT was 19.8 minutes (IQR 15-25). The PADUA risk groups (High vs Low: OR: 2.804; 95% CI 1.155-6.806; p-value <0.001; Intermediate vs Low: OR 0.971; 95% CI 0.185-5.092 p-value <0.001) and PADUA score as continuous variable (OR: 1.512; 95% CI 1.043-2.194; p-value <0.001) were the best independent risk factors of WIT >20 minutes. Another important factor related with WIT >20 minutes was a CKD stage 3 (p-value: 0.047; OR: 0.528; 95% CI:0.282-0.990).Conclusions This study reveal that tumor’ anatomical aspects may influence the WIT. The use of the nephrometry scoring systems should to be use by the surgeon in the planning of nephron sparing surgery (NSS) and should be considered for its inclusion in international guidelines.

Introduction Sunitinib therapy showed an improvement in survival of patients with metastatic renal cell carcinoma.Materials and Methods A 51-year-old man, with Eastern Cooperative Oncology Group Score (ECOG) of 0, presented at our Institute in March 2012 for macrohematuria and urinary retention. A computed tomography (CT) scan of the abdomen showed a right renal lesion. The lesion had a diameter of 15 cm and was developing towards the liver, in the absence of cleavage planes between the liver and kidney. A 12 mm finding, suspected as secondary lesion, was detected at the level of the VII hepatic segment. Neoadjuvant chemotherapy with Sunitinib was proposed.Results The patient underwent a ultrasound-guided biopsy, which confirmed the presence of Clear Cell Carcinoma. The patient began chemotherapy treatment in May 2012 according to the scheme SUNITINIB 50 mg daily for 4 weeks every 6 weeks. After four courses of treatment, according to RECIST criteria for solid tumors, 40% (9 cm vs 15 cm) regression of the primary tumor and 33% (8 mm vs 12 mm) regression of the secondary lesion were observed at a CT scan of the abdomen. In February 2013, Laparoscopic Adrenal-Sparing Radical Nephrectomy was performed. At a follow-up of 3 months, performed with a thorax and abdomen CT scans, there was a complete remission of hepatic secondary lesion and no areas of secondary localization of disease.Conclusions This case report showed the effectiveness of neoadjuvant chemotherapy with Sunitinib. The use of this chemotherapy agent can change the approach to the management of cRCC.