Xiaogong Li

Laparoscopic Radiofrequency Ablation of Renal Tumors: 32-Month Mean Follow-up Results of 106 Patients

OBJECTIVE To report our experience of laparoscopic radiofrequency ablation (RFA) on patients with renal tumors. RFA has been increasingly applied in the management of small renal tumors. However, it was performed mostly via percutaneous approach, with limited cases and a short follow-up period. METHODS From February 2006 to March 2008, laparoscopic RFA was performed on 106 renal tumors (size range: 0.9-5.5 cm) in 106 selected patients (74 men and 32 women, age range: 25-81 years). Initial contrast-enhanced computed tomography (CT) examination was performed seven days after the procedure, with subsequent CT assessment at three months, six months, and every six months thereafter. Serum creatinine measurement was conducted along with each time CT examination. RESULTS The mean follow-up period was 32 months (range: 12-48). All 106 tumors were biopsied before RFA, of which 90 were diagnosed as renal cell carcinoma (RCC) (84.90%). There was one incomplete ablation. One case with radiographic local recurrence was then proved by pathologic analysis of the nephrectomy specimen to have no cancer cells. The local tumor control rate was 98.1% (104/106). Of the 90 RCC cases, the disease-free survival rate was 97.8% (88/90); both the cancer-specific and the overall survival rate were 100%. No death or renal failure after the procedure has yet been found. CONCLUSIONS Our results showed that the laparoscopic RFA on small renal mass was safe, with outcomes of patients comparable with those by partial nephrectomy and percutaneous RFA. Further research and a longer follow-up period are needed to confirm our results.

Gender disparity of living donor renal transplantation in East China

Gender disparity among living kidney donors is common world wide, which demonstrates different social and economic problems in different countries. However, few data are available for China. Therefore, we retrospectively analyzed all 139 living donor renal transplants performed in our center between 2003 and 2010. The annual number of living donor renal transplants increased from six to 26 cases per year during the observation period. Among them, 69.2% of all kidney donors were females, whereas 79.5% of the recipients were male. The average age of recipients was 34.1 ± 7.6 yr and 94% (110/117) were younger than 44 yr. In contrast, 53% (62/117) of all donors were “middle‐aged” (45–59 yr) with an average donor age of 47.8 ± 9.2 yr. The first‐degree relatives accounted for the majority of the donor pool, as the most common donor‐recipient combination consisted of mother to son. In conclusion, there was a male and young preponderance among recipients, and a female and middle‐aged one among donors of living kidney transplants in our transplant center, which might be related to socio‐cultural as well as economic factors.

Single-center comparison of complications in laparoscopic and percutaneous radiofrequency ablation with ultrasound guidance for renal tumors.

OBJECTIVE To report on postoperative complications associated with laparoscopic radiofrequency ablation (LRFA) and percutaneous radiofrequency ablation (PRFA) in a single-center experience. METHODS We conducted a retrospective review of medical records for patients undergoing LRFA or PRFA between February 2006 and March 2010 at our center. Demographics, radiographic variables, and complication rates were compared between the 2 groups. Risk factors for postoperative complications after operation were analyzed with multivariate logistic regression. RESULTS Of a total 191 patients included in this study, 132 underwent LRFA and 59 underwent PRFA. There were no significant differences between the 2 groups with respect to age, gender, biopsy data, American Society of Anesthesiologists classification, body mass index, single kidney, tumor size, tumor number, glomerular filtration rate, follow-up, or RENAL nephrometry score. We observed complications in 16 LRFA procedures (12.1%) and 10 PRFA procedures (16.9%) (P = .369). There was no difference in the distribution of the complications between LRFA and PRFA groups. The complication (grades 1 and 2) rate in the LRFA group (7.6%) was not significantly different from that in the PRFA group (10.2%) (P = .550). The complication (grade 3a) rate in the LRFA group (4.5%) was not significantly different from that in the PRFA group (6.8%) (P = .522). A multivariate analysis disclosed that extra ablation time was the only predictor of postoperative complications. CONCLUSION Significantly more anterior tumors were approached laparoscopically, and significantly more posterior tumors were approached percutaneously. Complication rate was not significantly different between LRFA and PRFA. Extra ablation time was a significant risk factor associated with postoperative complications.

Zero Ischemia Laparoscopic Radio Frequency Ablation Assisted Enucleation of Renal Cell Carcinoma: Experience with 42 Patients

PURPOSE We evaluated the safety and efficacy of zero ischemia, radio frequency ablation assisted tumor enucleation for renal cell carcinoma. We report the incidence of complications, positive surgical margins, local recurrence, and progression-free and disease specific survival rates. MATERIALS AND METHODS We retrospectively reviewed data on 42 patients with renal cell carcinoma treated with zero ischemia laparoscopic radio frequency ablation assisted tumor enucleation between March 2006 and November 2009. Median age was 60 years (range 37 to 82) and 31 patients (73.8%) were male. The median greatest tumor dimension was 3.4 cm (range 1.8 to 6.1). The Mann-Whitney U, chi-square and Fisher exact tests were used to compare bleeding and complications. The paired t and Mann-Whitney U tests were used to compare glomerular filtration rates. The Kaplan-Meier method was used to calculate survival. RESULTS We found 32 tumors with a greatest dimension of 4 cm or less and 10 with a greatest dimension of 4 to 7 cm. Median blood loss was 82.5 ml (range 15 to 210). Overall 7 complications (16.6%) occurred, including postoperative fever in 4 cases (Clavien grade II) and prolonged urinary leakage in 3 (Clavien grade III). The PADUA (preoperative aspects and dimensions used for an anatomical) score was associated with prolonged urinary leakage (p = 0.03) but not with overall complications. No patient had positive surgical margins. The glomerular filtration rate did not differ before vs 12 months after surgery. Three-year cancer specific, cumulative and progression-free survival was 100%, 97.3% and 96.4%, respectively. CONCLUSIONS Zero ischemia, laparoscopic radio frequency ablation assisted tumor enucleation of renal cell carcinoma is a safe, effective nephron sparing treatment that provides excellent oncological and functional outcomes.

Laparoscopic Radiofrequency Ablation versus Partial Nephrectomy for cT1a Renal Tumors: Long-Term Outcome of 179 Patients.

Objectives: To compare the long-term functional and oncological results between laparoscopic radiofrequency ablation (LRFA) and laparoscopic partial nephrectomy (LPN) in selected clinical T1a (cT1a) renal tumor patients. Methods: We retrospectively analyzed the medical records of patients with cT1a renal tumors who had LRFA or LPN at our institution between February 2006 and February 2015. Students t test was used to compare the perioperative data between the two groups. Survival analyses were calculated using the Kaplan-Meier method. Results: A total of 179 patients were included in the study. Patients in the LRFA cohort were significantly older and had higher American Society of Anesthesiologists sore than in the LPN cohort. The LRFA group had a significantly lower mean blood loss than the LPN group (p = 0.03). The percent decrease of GFR in the LRFA group was significantly lower than in the LPN group (p = 0.021). The 5-year overall, cancer-specific and disease-free survival were 93.3 vs. 94.6%, 98.0 vs. 98.5% and 97.1 vs. 97.3%, for LRFA and LPN, respectively (all p value >0.05). Conclusions: The excellent perioperative results, long-term functional and oncological outcomes of LRFA confirm that this technique is safe, nephron sparing and oncologically effective for the treatment of cT1a renal tumors.

Radiofrequency ablation of synchronous bilateral renal cell carcinoma

Objectives:  The treatment of synchronous bilateral renal cell carcinoma is challenging. Radiofrequency ablation has been increasingly applied in the management of renal tumors. Herein, we report our experience of radiofrequency ablation on 12 patients with synchronous bilateral renal cell carcinoma.

Abdominal aortic transposition as a treatment alternative for posterior nutcracker syndrome.

The phenomenon of left renal vein (LRV) compression between the aorta and the superior mesenteric artery was first described as nutcracker syndrome (NCS) in 1972. As an analogy, posterior nutcracker syndrome refers to left renal venous hypertension secondary to compression of the retroaortic LRV between the aorta and the vertebral column. A 39-year-old woman presented with a 2-year history of recurrent left loin pain and a 3-month history of intermittent macroscopic hematuria. The urinalysis showed numerous red blood cells without dysmorphic changes. The coagulation result was normal. Ultrasonography and intravenous urogram showed normal-sized kidneys and a normal pelvicalyceal system. Cystoscopy showed grossly bloody efflux from the left ureteric orifice. Contrast computed tomography (CT) showed a retroaortic LRV with proximal dilation before it passed between the aorta and the vertebral column (Fig. 1a). The CT scan showed a dilated left ovarian vein without obvious pelvic varicose. Selective phlebography with pressure manometry through the femoral vein revealed an elevated 7 mmHg pressure gradient between the LRV and the inferior vena cava. Based on these findings, posterior nutcracker syndrome was diagnosed. Anterior transposition of the left renal vein was initially planned. A midline abdominal incision with subsequent complete mobilization of the left colon and small bowel gave access to the retroperitoneum. The left renal vein was completely mobilized. The left adrenal vein and the ovarian vein were ligated and divided. The wall of the dilated LRV was found to be extremely thin, with a high pressure (Fig. 1b). Transposition of the LRV would be relatively difficult and run a risk of postoperative blood leaking, with the possibility of a fatal outcome. Therefore, abdominal aortic transposition was carried out according to the informed consent signed before the surgery. After being mobilized from the surrounding tissues and clamped by two curved aorta clamps, the abdominal aorta was transected and re-anastomosed posterior to the LRV using a continuous 5-0 prolene suture (Fig. 1d). The clamped time was 19 min. The urinalysis 7 days after the procedure showed no red blood cells, and the routine blood test revealed hemoglobin 11.7 g/dL. The left renal vein was patent on the CT scan carried out 7 days after

MiR-199a-3p suppresses proliferation and invasion of prostate cancer cells by targeting Smad1

OBJECTIVES This study was intended to analyze effects of miR-199a-3p and Smad1 on proliferation, migration and invasion of prostate cancer (PCa) cells. RESULTS MiR-199a-3p was significantly decreased in PCa tissues in comparison to that in adjacent normal tissues (P < 0.05). Over-expressed miR-199a-3p markedly suppressed proliferation and invasion of PCa cells (P < 0.05). MiR-199a-3p was negatively correlated with Smad1 expression, and overexpression of Smad1 could antagonize the effects of miR-199a-3p on PCa cells. MATERIALS AND METHODS The PCa tissues and their adjacent normal tissues were collected from 54 PCa patients. Expressions of miR-199a-3p and Smad1 mRNA in tissues and cells were evaluated with real-time quantitative polymerase chain reaction (RT-qPCR), and immunohistochemistry assay was used to detect Smad1 protein expressions. The target relationship between miR-199a-3p and Smad1 was assessed by luciferase reporter assay. The PCa cell lines (i.e. PC-3 cells) were transfected with miR-199a-3p mimics and Smad1-cDNA. MTT and Transwell assays were applied to detect proliferative, migratory and invasive abilities of PCa cells. CONCLUSIONS MiR-199a-3p suppressed proliferation and invasion of PCa cells by targeting Smad1.Objectives This study was intended to analyze effects of miR-199a-3p and Smad1 on proliferation, migration and invasion of prostate cancer (PCa) cells. Results MiR-199a-3p was significantly decreased in PCa tissues in comparison to that in adjacent normal tissues (P < 0.05). Over-expressed miR-199a-3p markedly suppressed proliferation and invasion of PCa cells (P < 0.05). MiR-199a-3p was negatively correlated with Smad1 expression, and overexpression of Smad1 could antagonize the effects of miR-199a-3p on PCa cells. Materials and methods The PCa tissues and their adjacent normal tissues were collected from 54 PCa patients. Expressions of miR-199a-3p and Smad1 mRNA in tissues and cells were evaluated with real-time quantitative polymerase chain reaction (RT-qPCR), and immunohistochemistry assay was used to detect Smad1 protein expressions. The target relationship between miR-199a-3p and Smad1 was assessed by luciferase reporter assay. The PCa cell lines (i.e. PC-3 cells) were transfected with miR-199a-3p mimics and Smad1-cDNA. MTT and Transwell assays were applied to detect proliferative, migratory and invasive abilities of PCa cells. Conclusions MiR-199a-3p suppressed proliferation and invasion of PCa cells by targeting Smad1.

Improved Split Renal Function after Percutaneous Nephrostomy in Young Adults with Severe Hydronephrosis Due to Ureteropelvic Junction Obstruction

PURPOSE We evaluated percutaneous nephrostomy for adult kidneys with severe hydronephrosis due to ureteropelvic junction obstruction and less than 10% split renal function. MATERIALS AND METHODS In this retrospective analysis we included patients who underwent percutaneous nephrostomy for unilateral ureteropelvic junction obstruction of the kidneys with hydronephrosis and less than 10% split renal function at our hospital between May 2009 and January 2012. Adults (age 18 years or greater) were divided into those 35 years or younger (young adults) and older than 35 years (older adults). The percutaneous nephrostomy remained in situ a mean ± SD of 6.62 ± 2.55 weeks and patients underwent repeat renography before pyeloplasty. When there was no significant improvement in split renal function (10% or greater) and drainage (greater than 400 ml per day), nephrectomy was performed. Otherwise pyeloplasty was performed. Patients were followed by renography, ultrasound and contrast computerized tomography at 3 and 6 months, at 1 year and annually thereafter. RESULTS Of 53 patients 30 (56.6%) showed improvement after percutaneous nephrostomy drainage and urine output greater than 400 ml per day with percutaneous nephrostomy. Pyeloplasty was then performed. Of 29 young adults 24 (82.8%) showed improved split renal function vs 6 of 24 older adults (25%). Nephrectomy of the other 23 kidneys was performed. At a mean followup of 19.27 ± 7.82 months (range 12 to 36), no patient showed hypertension or urinary tract infection. CONCLUSIONS Split renal function detected by renography may not accurately predict recovered, poorly functioning kidneys, especially in young adults. First observing the recoverability of hydronephrotic kidneys by percutaneous nephrostomy drainage and then preserving select kidneys may be an effective method to manage poorly functioning kidneys due to ureteropelvic junction obstruction.

Dynamic Contrast-Enhanced CT Characterization of Xp11.2 Translocation/TFE3 Gene Fusions versus Papillary Renal Cell Carcinomas.

Purpose. To compare the differences of CT characteristics between renal cell carcinomas (RCCs) associated with Xp11.2 translocation/TFE3 gene fusions (Xp11.2 RCCs) and papillary cell renal cell carcinomas (PRCCs). Methods. CT images and clinical records of 64 patients (25 Xp11.2 RCCs, 15 type 1 and 24 type 2 PRCCs) were analyzed and compared retrospectively. Results. Xp11.2 RCC more frequently affected young (30.7 ± 8.7 years) women (16/25, 64%) with gross hematuria (12/25, 48%), while PRCC more frequently involved middle-aged (54.8 ± 11.1 years) men (28/39, 71.8%) asymptomatically. Xp11.2 RCC tended to be heterogeneous density with some showing circular calcification. Lesion sizes of Xp11.2 RCC (5.4 ± 2.2 cm) and type 2 PRCC (5.7 ± 2.5 cm) were significantly larger than that of type 1 PRCC (3.8 ± 1.8 cm). Xp11.2 RCC contained more cystic components (22/25, 88%) than type 1 PRCC (all solid) and type 2 PRCC (9/24, 36.0%). Type 1 PRCC (13/15, 86.7%) and Xp11.2 RCC (21/25, 84.0%) showed more clear boundary than type 2 PRCC (12/24, 50.0%). Conclusion. CT features including diameter, boundary, attenuation, nature, and circular calcification of the tumor, combined with demographic information and symptoms, may be useful to differentiate Xp11.2 RCC from different subtypes of PRCC.