Journal article
Robotic Partial vs Radical Nephrectomy for Clinical T3a Tumors: A Narrative Review
Journal of endourology, Vol.37(9), pp.978-985
09/2023
DOI: 10.1089/end.2023.0173
PMCID: PMC10623454
PMID: 37358403
Abstract
T3a renal masses include a diverse group of tumors that invade the perirenal and/or sinus fat, pelvicalyceal system, or renal vein. The majority of cT3a renal masses represent renal cell carcinoma (RCC) and have historically been treated with radical nephrectomy (RN) given their aggressive nature. With the adoption of minimally invasive approaches to renal surgery, the combination of improved visualization, pneumoperitoneum and robotic articulation has allowed urologists to consider partial nephrectomy (PN) for more complex tumors. Herein, we review the existing literature regarding robotic-assisted PN (RAPN) and RARN in the management of T3a renal masses.
A literature search was performed using PubMed for articles evaluating the role of RARN and RAPN for T3a renal masses. Search parameters were limited to English language studies. Applicable studies were abstracted and included in this narrative review.
T3a RCC due to renal sinus fat or venous involvement is associated with approximately 50% lower cancer-specific survival than those with perinephric fat invasion alone. Computed tomography and magnetic resonance imaging (MRI) can both be used to stage cT3a tumors, however MRI is more accurate when assessing venous involvement. Upstaging to pT3a RCC during RAPN does not confer a worse prognosis than pT3a tumors treated with RARN; however, patients who undergo RAPN for T3a RCC with venous involvement have relatively higher rates of recurrence and metastasis. Intraoperative tools including drop-in ultrasound, near infrared fluorescence, and 3D virtual models improve the ability to perform RAPN for T3a tumors. In well-selected cases, warm ischemia times remain reasonable.
cT3a renal masses represent a diverse group of tumors. Depending on sub-stratification of cT3a, RARN or RAPN can be employed for treatment of such masses.
Details
- Title: Subtitle
- Robotic Partial vs Radical Nephrectomy for Clinical T3a Tumors: A Narrative Review
- Creators
- Thomas E Stout - University of Iowa Hospitals and ClinicsPaul T Gellhaus - University of Iowa Hospitals and ClinicsChad Robert Tracy - University of Iowa Hospitals and ClinicsRyan L Steinberg - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Journal of endourology, Vol.37(9), pp.978-985
- DOI
- 10.1089/end.2023.0173
- PMID
- 37358403
- PMCID
- PMC10623454
- NLM abbreviation
- J Endourol
- eISSN
- 1557-900X
- Language
- English
- Electronic publication date
- 06/26/2023
- Date published
- 09/2023
- Academic Unit
- Radiology; Urology
- Record Identifier
- 9984438858802771
Metrics
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