Introduction: The average hospital length of stay after robotic-assisted partial nephrectomy (RAPN) is 3 days, with a current trend towards outpatient cases, although no population has been identified. The main objective of the study was to analyze the time to onset of post-operative complications, identify risk factors for significant early complications in order to define a population eligible for outpatient case. Material and method: The study included 3342 patients with clinically localized renal tumors who underwent RAPN surgery between 2010 and 2021. The primary endpoint was the occurrence of significant complications (SC) (Clavien Dindo > 2 [CD]). A CS-free survival analysis was performed. A multivariate logistic regression model was fitted to predict the risk of early significant complications (ESC) after RAPN. Results: The rates of total complications and SC were 14.99% and 3.59% respectively. Median time to SC was significantly longer at 3 days [3.9-5.7] versus 2 days [2.4-3] for total complications (P = 0.012). The majority of complications occurred within the first 72 h, and the risk factors for early SC (< 72 h) (ESC) were clamping time (P = 0.04) and ASA > 2 score (P = 0.007). Analysis of survival without ESC showed a significant impact of clamping time (P = 0.043) on complication-free survival. Conclusion: Using standard preoperative variables, we were able to determine that the only factor influencing the occurrence of postoperative ESC was ASA score > 2 and thus define it as a primary eligibility criterion for an indication of outpatient RAPN subject to a clamp time of less than 20 mins. (c) 2024 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BY license.

Renal cell carcinomas (RCC) are increasing worldwide and obesity is one of its recognized causal factor. Obesity thus could be differently associated with the different histologic types of renal tumors and also impact prognosis and patient care. PURPOSE:The primary objective was to evaluate an association between obesity and histological type of RCC. The secondary objective was to assess if there was an effect of obesity on tumor characteristics. METHODS:A multicenter comparative descriptive study was carried out in nearly 30 French hospitals. Histological features of operated RCC of patients included between 2007 and 2020 were compared according to their BMI. Obesity was defined as a BMI≥30kg/m2, with a P<0.05. RESULTS:In total, 6749 RCC were analyzed, including 1687 (25%) from obese patients. This population was more frequently diabetic (61% versus 41%, P<0.001) and hypertensive (27% versus 11%, P<0.001). Regarding histological evaluation, the obese group presented clearer cell carcinoma. Other types presented odd ratios below 1 on multivariate analysis, P<0.01 except for type II papillary RCC. Tumor size (pT) and nuclear ISUP grade were both lower when BMI was above 30kg/m2: 72.4% of size pT 1-2 versus 68.5% (P=0.026) and 50% of nuclear ISUP grade 1-2 versus 43.3% for the non-obese group (P<0.0001). There was no difference in survival due to an insufficient number of events. CONCLUSION:In this large cohort study, we report novel data on a positive association between obesity and histological type of RCC, in particular clear cell RCC. LEVEL OF EVIDENCE: 3:

Local recurrence after partial nephrectomy with negative margins (R0) remains a clinical concern in the management of non-metastatic renal cell carcinoma (RCC). We aimed to quantify its incidence and to identify independent predictors of recurrence in a large, contemporary, multicenter cohort. We retrospectively analyzed 2,438 patients from the UroCCR database who underwent R0 nephron-sparing surgery for cT1–cT3a/N0/M0 RCC between 2007 and 2022 across 24 French centers. The primary endpoint was histologically confirmed local recurrence (tumor bed or ipsilateral renal recurrence). Fine‑and‑Gray competing‑risk regression, with death treated as a competing event, was applied to determine independent predictors. After a median follow-up of 66 months (IQR:26–86), local recurrence occurred in 97 patients (3.9

OBJECTIVE:To compare outcomes of nephrectomy for left-sided (n = 70) vs right-sided (n = 118) renal tumours with caval thrombi. METHODS:In this retrospective analysis (June 2008-February 2023), we evaluated peri-operative variables, 30-day complications, estimated glomerular filtration rate (eGFR), and survival rates. RESULTS:Patients in the left-sided renal tumour group experienced significantly longer operating times (240 vs 193 min; P < 0.001), greater blood loss (1700 vs 1000 mL, P = 0.042), and more complications (53% vs 35%, P = 0.015). Postoperative renal function was worse in the left-sided vs the right-sided renal tumour group, with lower immediate postoperative eGFR (P = 0.035) and a higher dialysis rate (17% vs 6.8%, P = 0.026). However, overall survival and recurrence-free survival were similar (P = 0.8 and P = 0.43, respectively). CONCLUSIONS:Left-sided renal tumours with caval thrombi present a higher risk of complications and acute kidney injury requiring dialysis, potentially due to left renal vein ischaemia during surgery and anatomical proximity to the superior mesenteric artery. Thorough preoperative planning and limited clamping time are essential.

Background and objective: A renal mass biopsy (RMB) is not systematically recommended before surgical excision of a renal mass, although it has demonstrated elevated accuracy in determining renal masses with low morbidity. Our aim was to determine the diagnostic accuracy of an RMB, the clinical and tumoral factors associated with RMB practice, and the impact of an RMB on renal cell carcinoma management in a contemporary prospective national registry-UroCCR (2010-2021). Methods: We identified all patients with a single renal mass (pT1-4 N0-2 M0 or benign) who were treated surgically and stratified them according to the erformance of a prior RMB. Patients treated by active surveillance, percutaneous ablative treatment, or stereotaxic radiotherapy were excluded. Diagnostic accuracy of an RMB was determined in the RMB group. Clinical and tumoral factors associated with the practice of RMBs were analyzed using logistic regression. Key findings and limitations: In total, 9283 patients were included, who presented 1594 tumors (17%) with a prior RMB. RMBs were 92.4% contributive. The correlation between an RMB and excision in the determination of benign/malignant disease, histological subtype, and grade are, respectively, 96.9%, 86.4%, and 52.6%. The impact of an RMB versus no prior RMB was determined according to the rate of surgical excision for benign lesion and the rate of partial nephrectomy (63.9% vs 57.8%; p < 0.001). Conclusions and clinical implications: An RMB is performed rarely when its diagnostic performance is high. A prior RMB significantly changes the management of localized renal masses, with fewer surgical procedures for benign renal masses and conservative treatment in a higher proportion of patients. Patient summary: In a large and contemporary registry, we demonstrated that a renal mass biopsy has excellent diagnostic accuracy, significantly reduces renal surgery for benign masses and low-grade/stage renal cell carcinoma, and increases conservative surgical excision. (c) 2025 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

BackgroundThere is no definitive evidence of the prognosis impact of histological variants (HVs) in patients who undergo surgical resection of a nonmetastatic renal cell carcinoma (nm-RCC) with venous tumor thrombus (TT).ObjectiveTo investigate the impact of HVs on the prognosis of patients with nm-RCC with TT after radical surgery.Design, setting, and participantsPatients who underwent radical nephrectomy with the removal of the venous TT for an nm-RCC were included in a retrospective study.Outcome measurements and statistical analysisThree groups were identified: clear cell (ccRCC), papillary (pRCC), and chromophobe (chRCC) RCC. The primary outcome measures (disease-free and overall survival [OS]) were assessed using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate Cox proportional hazard models were used to study the impact of HVs on survival.Results and limitationsA total of 873 patients were included. The histological subtypes were distributed as follows: ccRCC in 780 cases, pRCC in 58 cases, and chRCC in 35 cases. At the time of data analysis, 612 patients were recurrence free and 228 had died. A survival analysis revealed significant differences in both OS and recurrence-free survival across histological subtypes, with the poorest outcomes observed in pRCC patients (p < 0.05). In a multivariable analysis, pRCC was independently associated with worse disease-free survival and OS (hazard ratio [HR]: 1.71; p = 0.01 and HR: 1.24; p = 0.04), while chRCC was associated with more favorable outcomes than ccRCC (HR: 0.05; p < 0.001 and HR: 0.02; p < 0.001). A limitation of the study is its retrospective nature.ConclusionsIn this multicentric series, HVs appeared to impact the medium-term oncological prognosis of kidney cancer with TT.Patient summaryThis study investigated the differences in oncological outcomes among histological variants (clear cell, papillary, and chromophobe) in a cohort of nonmetastatic renal cell carcinoma patients with venous tumor thrombus extension. We observed that these histological variants within this specific subgroup exhibit distinct outcomes, with papillary renal cell carcinoma being associated with the worst prognosis.

Recent studies suggested that the neutrophil-to-lymphocyte ratio (NLR) could play a key role in tumor initiation, progression and response to treatments. The main objective was to assess the prognostic value of the pre-operative NLR on recurrence-free survival (RFS) in patients with non-hereditary localized renal cell carcinoma. From the UroCCR database (NCT03293563), factors influencing the disease recurrence of consecutive patients who underwent nephrectomy for cT1-T4 N0M0 were analyzed using multi-variate cox regression and log-rank methods. We included 786 patients, among which 135 (17.2%) experienced a recurrence at a median time of 23.7 [8.5–48.6] months. RFS for patients with a pre-operative NLR of <2.7 was 94% and 88% at 3 and 5 years, respectively, versus 76% and 63% for patients with a NLR of ≥2.7 (p < 0.001, log-rank test). To predict the risk of post-operative recurrence, the NLR was combined with the UCLA integrated staging system (UISS), and we defined four groups of the UroCCR-61 predictive model. The RFS rates at 3 and 5 years were 100% and 97% in the very-low-risk group, 93% and 86% in the low-risk group, 78% and 68% in the intermediate-risk group and 63% and 46% in the high-risk group (p < 0.0001). The pre-operative NLR seems to be an inexpensive and easily accessible prognostic bio-marker for non-metastatic RCCs.

single port (SP) using c, Fisher's exact, and Mann-Whitney U test in the overall cohort and in a 1:1 propensity score-matched cohort, adjusting for baseline characteristics and surgeons. RESULTS: A total of 3,008 patients were included in this study: multiport (n[2,860, 95.08%) and single port (n[148, 4.92%). After propensity matching, 121 (50.00%) SP patients were matched with 121(50.00%) MP patients. Matched SP patients (59 years [IQR: 51, 68]) had similar median age when compared to the MP patients (60 years [IQR: 49, 69]). Compared to matched MP group, the matched SP had a longer median ischemia (16.0 mins [IQR: 11.5, 25.0] vs 13.2 mins [IQR: 10.0, 17.0]; p[0.0001). Although the EBL (50ml [IQR: 25, 100] vs 50ml [IQR: 50, 100]; p[0.002) and LOS (1 day [IQR: 1, 1] vs 1 day [IQR: 1, 2]; p[0.001) were the same, the mean rank sum was significantly lower in the single port groups. Operative time (138 mins [IQR: 113, 170] vs 128 mins [IQR: 90, 174]; p[0.140), positive margin rate (3.31% vs 7.44; p[0.254) and any complication rate (4.96% vs 9.09%; p[ 0.209) were similar between the two groups. CONCLUSIONS: SP partial nephrectomy presented longer ischemia time, lower EBL, lower LOS, similar operative time, similar positive margin and complication rates when compared to multi-port. This early data is encouraging. However, the role of SP requires further study and should evaluate safety and long-term data when compared to the standard multi-port technique.

The oncological impact of positive surgical margins (PSM) after robot-assisted partial nephrectomy (RAPN) is still under debate. We compared PSM and Negative Surgical Margins (NSM) in terms of recurrence-free survival (RFS), metastasis-free survival (MFS) and overall survival (OS) after RAPN, and we identified predictive factors of PSM. Multi-institutional study using the UroCCR database, which prospectively included 2166 RAPN between April 2010 and February 2021 (CNIL DR 2013-206; NCT03293563). Two groups were retrospectively compared: PSM versus NSM. Prognostic factors were assessed using Kaplan–Meyer curves with log-Rank test, cox hazard proportional risk model and logistic regression after univariate comparison. 136 patients had PSM (6.3%) and 2030 (93.7%) had NSM. During a median follow-up of 19 (9–36) months after RAPN, 160 (7.4%) recurrences were reported. Kaplan–Meier curves and analysis suggested that RFS, MFS and OS were not affected by a PSM (p = 0.68; 0.71; 0.88, respectively). In multivariate analysis predictors of PSM were a lower RENAL score (p = 0.001), longer warm ischemia time (WIT) (p = 0.003) and Chromophobe Renal Cell Carcinoma (chrRCC) (p = 0.043). This study found no impact of PSM on RFS, MFS or OS, and predictors of PSM were the RENAL score, WIT and chrRCC.

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance III (MP61)1 Sep 2021MP61-16 PROGNOSTIC IMPACT OF PREOPERATIVE AND POSTOPERATIVE NEUTROPHIL/LYMPHOCYTE RATIOS IN NON-METASTATIC KIDNEY CANCER (UROCCR N°61) Clément Allenet, Clément Klein, Benjamin Rouget, Jérome Rigaud, Alain Ravaud, Grégoire Robert, Franck Bladou, Grégoire Capon, Vincent Estrade, Peggy Blanc, and Jean-Christophe Bernhard Clément AllenetClément Allenet More articles by this author , Clément KleinClément Klein More articles by this author , Benjamin RougetBenjamin Rouget More articles by this author , Jérome RigaudJérome Rigaud More articles by this author , Alain RavaudAlain Ravaud More articles by this author , Grégoire RobertGrégoire Robert More articles by this author , Franck BladouFranck Bladou More articles by this author , Grégoire CaponGrégoire Capon More articles by this author , Vincent EstradeVincent Estrade More articles by this author , Peggy BlancPeggy Blanc More articles by this author , and Jean-Christophe BernhardJean-Christophe Bernhard More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002101.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The neutrophil to lymphocyte ratio (NLR) is an established marker of systemic inflammation and its value as a biomarker has been reported in other cancers. The aim of this study was to assess the prognostic value of pre- and post-operative NLR in non-metastatic kidney cancer. Its ease of obtaining could improve follow-up recommendations. METHODS: Single-center retrospective study from cases prospectively included after written consent in the French UroCCR database (CNIL DR 2013-206; NCT03293563). We included patients operated on for stage pT1-4N0M0 kidney cancer between May 2000 and January 2019. The associations between clinical, biological, pathological variables and pre- and post-operative NLRs were assessed in univariate and multivariate analyzes. An analysis of recurrence-free survival according to Kaplan Meier as a function of the pre- and post-operative NLR was performed and then stratified by the SSIGN and UISS score. RESULTS: A total of 789 patients were included. The mean follow-up on the cohort was 57.5±35 months and 137 patients presented with local or distant recurrence. The mean preoperative NLR was 4.2±4 in the recurrence group vs. 2.5±1.7 (p<0.001). The mean postoperative NLR was 4±2.9 vs 2.7±2.5 (p <0.001). The mean NLR at recurrence was 4.9±3.7. In multivariate analysis, the preoperative NLR> 2.7 was an independent risk factor for recurrence (OR 2.9 [1.1-7.8] p=0.034). We assessed recurrence-free survival based on NLR and it was significantly unfavorable when NLR was >2.7 preoperatively and postoperatively (p<0.001). CONCLUSIONS: The preoperative NLR >2.7 was significantly independently associated with the risk of disease recurrence. Moreover, the NLR was significantly increased on recurrence. It could therefore be a biomarker, economical and easy to use. Source of Funding: any © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1089-e1089 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clément Allenet More articles by this author Clément Klein More articles by this author Benjamin Rouget More articles by this author Jérome Rigaud More articles by this author Alain Ravaud More articles by this author Grégoire Robert More articles by this author Franck Bladou More articles by this author Grégoire Capon More articles by this author Vincent Estrade More articles by this author Peggy Blanc More articles by this author Jean-Christophe Bernhard More articles by this author Expand All Advertisement Loading ...