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Brady Urology at Johns Hopkins Hospital: Positive Surgical Margins after Partial Nephrectomy: Cause for Concern? (blogspot.com)
Positive Surgical Margins after Partial Nephrectomy: Cause for Concern? (blogspot.com)
In this blog, Mohamad E. Allaf, Director of Minimally-Invasive and Robotic Surgery, reviews the data regarding positive surgical margins following partial nephrectomy for the treatment of renal cancer. (blogspot.com)
As kidney surgery evolved from radical to partial nephrectomy (PN), and then from open to minimally-invasive surgery, the definition of a safe margin also evolved. (blogspot.com)
Positive surgical margins after partial nephrectomy for renal cell carcinoma are rare. (blogspot.com)
A "gross" positive margin, meaning a positive margin noticed at the time of initial partial nephrectomy, should be addressed. (blogspot.com)
[1] The advent of newer imaging modalities contributes to early detection and prompts removal of the tumor either as partial or total nephrectomy. (ijpmonline.org)
The adoption of robotic assistance has contributed to the increased utilization of partial nephrectomy for the management of renal tumors. (biomedcentral.com)
However, partial nephrectomy can be technically challenging because of intraoperative hemorrhage, which limits the ability to identify the tumor margin and may necessitate the conversion to open surgery or radical nephrectomy. (biomedcentral.com)
To our knowledge, a comprehensive safety checklist does not exist to guide surgeons on the management of hemorrhage during robotic partial nephrectomy. (biomedcentral.com)
A treatment safety checklist for the management of hemorrhage during robotic partial nephrectomy was collaboratively developed based on prior experiences with intraoperative hemorrhage during robotic partial nephrectomy. (biomedcentral.com)
Reducing the risk of hemorrhage during robotic partial nephrectomy begins with reviewing the preoperative imaging for renal vasculature and tumor anatomy, with a focus on accessory vessels and renal tumor proximity to the renal hilum. (biomedcentral.com)
Safely performing robotic partial nephrectomy is dependent on attention to prevention of hemorrhage and rapid response to the challenge of intraoperative bleeding. (biomedcentral.com)
Preparation is essential for maximizing the chance of success during robotic partial nephrectomy. (biomedcentral.com)
During partial nephrectomy, in which part of the kidney is removed for a renal tumor, hemorrhage can be particularly troublesome because the kidney is a well perfused organ and renal cell carcinomas are associated with increased vascularity [ 1 ]. (biomedcentral.com)
Traditionally, partial nephrectomy had been performed via an open approach but there has been a steady trend toward a minimally invasive approach [ 2 ]. (biomedcentral.com)
As partial nephrectomy is increasingly performed with a minimally invasive approach, control of intraoperative hemorrhage can be more challenging than simple manual compression of the renal parenchyma with suturing, as can be done in open surgery. (biomedcentral.com)
Series on robotic partial nephrectomy report a reasonable blood loss (Table 1 ). (biomedcentral.com)
Thus, the existing literature does little to educate surgeons on how to deal with bleeding during robotic partial nephrectomy while clamped. (biomedcentral.com)
Table 1 Selected reports from 2009-2012 of estimated blood loss during robotic partial nephrectomy with hilar clamping. (biomedcentral.com)
The goal of this manuscript is to educate robotic surgeons in factors to minimize hemorrhage during robotic partial nephrectomy. (biomedcentral.com)
We then developed a safety and management checklist for "hemorrhage while clamped" during robotic partial nephrectomy. (biomedcentral.com)
Since that time, the authors have performed a total of over 1500 robotic partial nephrectomies. (biomedcentral.com)
To summarize the available evidence on renorrhaphy techniques and to assess their impact on peri‐operative outcomes after minimally invasive partial nephrectomy (MIPN). (bjuinternational.com)
Studies providing sufficient details on renorrhaphy techniques during laparoscopic or robot‐assisted partial nephrectomy and comparative studies focused on peri‐operative outcomes were included in qualitative and quantitative analyses, respectively. (bjuinternational.com)
Integrated overview of evidence‐based technical principles for renal reconstruction during minimally invasive partial nephrectomy and suggested standardized reporting of key renorrhaphy features in clinical studies on this topic. (bjuinternational.com)

[3] stated that more than 60% of nephrectomy specimens had pathology in non-neoplastic renal parenchyma which is responsible for the deterioration of renal function disproportionate to nephron loss in the postoperative era. (ijpmonline.org)
Therapeutic Living Donor Nephrectomy For Proximal Ureteral Pathology: A Longitudinal Case Series. (ucsf.edu)

Papillary adenomas are also benign renal neoplasms, but they arise from the renal tubular epithelium and almost always are located within the cortex. (medscape.com)
Other genetically linked conditions also increase the risk of RCC, including hereditary papillary renal carcinoma, hereditary leiomyomatosis, Birt-Hogg-Dube syndrome, hyperparathyroidism-jaw tumor syndrome, familial papillary thyroid carcinoma, von Hippel-Lindau disease and sickle cell disease. (wikipedia.org)

The tumour arises from the cells of the proximal renal tubular epithelium. (wikipedia.org)
The surgeon is essentially "on the clock" to unclamp the renal unit as soon as possible to prevent acute tubular necrosis and further loss of renal function. (biomedcentral.com)

Despite these reports , there is still a widespread belief among urologists that enucleation is unsafe with a high risk of incomplete tumor excision, especially for larger lesions. (blogspot.com)
Hemorrhage is further concerning as control can occupy valuable time during which the renal unit is ischemic due to renal vascular clamping during tumor excision. (biomedcentral.com)

Renal cell carcinoma (RCC) is a kidney cancer that originates in the lining of the proximal convoluted tubule, a part of the very small tubes in the kidney that transport primary urine. (wikipedia.org)
A diverse array of tumors can arise in the human kidney. (abdominalkey.com)
The classification of epithelial tumors of the kidney has in particular undergone substantial progress in the last two decades with major contributions from genetic typing of renal cell carcinomas (RCCs). (abdominalkey.com)
The specialist treats a number of conditions some of whom are End-Stage Renal Disease, Kidney Stones, Chronic Kidney Disease, and Polycystic Kidneys, etc. (medigence.com)

Enucleation is defined by incision of the renal parenchyma within a few millimeters of the tumor, and removal of the tumor by blunt dissection of the plane between the capsule of the tumor and the healthy renal tissue. (blogspot.com)
His expertise is in Robotic Constructive Urology, Renal transplantation, Transurethral Incision of Prostate, Congenital defects, and Genito-urinary fistulas. (medigence.com)

As a result of variations in its classic appearance, difficulty in standardizing diagnostic criteria, and entities that mimic oncocytoma, such as eosinophilic variant chromophobe renal cell carcinoma (RCC) and succinate dehydrogenase-deficient RCC, pathologic diagnosis remains a challenge. (medscape.com)
Oncocytosis is a rare condition characterized by multiple oncocytic tumors with histologic features, including renal oncocytoma, hybrid oncocytic tumor, and, occasionally, chromophobe RCC. (medscape.com)
With more than 95% confidence, the nested pattern, myxoid stroma, granular cytoplasm, and round nuclei are likely indicative of renal oncocytoma, whereas varying nuclear size, raisinoid nuclei, and reticular cytoplasm indicate a higher likelihood of chromophobe RCC. (medscape.com)

The ureteric bud grows laterally and invades the center of the metanephric blastema, the primordial renal tissue [4]. (esur2023.com)

During hilar exposure, an attempt is made to identify additional accessory renal arteries. (biomedcentral.com)
We identified factors to consider during review of preoperative imaging and renal hilar exposure. (biomedcentral.com)
Specific tumour features (i.e. size, hilar location, anatomical complexity, nearness to renal sinus and/or urinary collecting system), surgeon's experience, robot‐assisted technology, as well as the aim of reducing warm ischaemia time and the amount of devascularized renal parenchyma preserved represented the key factors driving the evolution of the renorrhaphy techniques during MIPN over the past decade. (bjuinternational.com)

Oncocytoma is the most common benign solid renal tumor and accounts for 3-7% of all primary renal neoplasms. (medscape.com)
Imaging characteristics of oncocytoma and RCC overlap, and differentiating an oncocytoma from an RCC and other solid renal neoplasms is not always possible with ultrasonography, CT scanning, or magnetic resonance imaging (MRI). (medscape.com)

Non-neoplastic renal parenchyma is overlooked majority of times and thus misses the opportunity to detect concomitant medical renal diseases which also predict the renal outcome in the postoperative era. (ijpmonline.org)
The peritoneum is a common site of metastases for gastrointestinal tumors that predicts a poor outcome. (stanford.edu)

It is now known that this classic triad of symptoms only occurs in 10-15% of cases, and is usually indicative that the renal cell carcinoma (RCC) is in an advanced stage. (wikipedia.org)

Renal cell carcinoma (RCC) is the most common subtype of adult renal tumors, and its detection rate in the early stages has been increased in the dawn of advanced imaging modalities. (ijpmonline.org)

Your urologist may arrange an ultrasound (USS) of the renal tract to assess the kidneys and and perform a flexible cystoscopy to exclude any other causes for the symptoms within the bladder. (essexurology.co.uk)

Organic Matrix Derived from Host-Microbe Interplay Contributes to Pathological Renal Biomineralization. (ucsf.edu)

This technique assists in detection and localization of the tumor, and CT scanning may help in characterizing the mass, especially if fat-containing lesions (eg, angiomyolipomas) are present. (medscape.com)

determination of tumor category and staging is the primary concern of oncopathologists. (ijpmonline.org)
Primary renal tumors account for 2%-3% of all human malignancy, and the major subtype is renal cell carcinoma (RCC). (ijpmonline.org)

For some cancers, including renal cell cancer (RCC), the implications of a positive surgical margin are less clearly defined. (blogspot.com)
Here, we take the opportunity to report an unusual association of heavy chain deposition disease (HCDD) with clear cell subtypes of renal cell carcinoma in a 48-year-old male of Indian ethnicity. (ijpmonline.org)
To the best of our knowledge, this is one of the first reports demonstrating concurrent heavy chain deposition disease (HCDD) with clear cell subtypes of renal cell carcinoma in a 48- year-old male of Indian ethnicity. (ijpmonline.org)
The role of genotyping and ancillary tools, in particular immunohistochemistry, in correctly classifying these tumors is highlighted in the section on Renal Cell Carcinoma. (abdominalkey.com)

For example, a large number of children who were dispensed ICS were nevertheless classified by the study (and apparently by their providers) as having wheezing but not asthma. (thrombininhibitors.com)

A positive surgical margin may reflect difficulties with a technical aspect of surgery or imply adverse tumor biology. (blogspot.com)
Sometimes the surgeon is certain that all tumor was removed at the time of surgery and can alleviate patient anxiety (frozen margins at the time of surgery can be helpful here). (blogspot.com)
During this stressful situation, it is imperative for the surgeon to have an organized approach to management of hemorrhage, as delayed management could lead to prolonged ischemic times, iatrogenic positive surgical margins from inadequate visualization, conversion to open surgery, or radical nephrectomy. (biomedcentral.com)

The Journey and Barriers to Treatment of Patients With Renal Nutcracker Syndrome. (ucsf.edu)
Patients with Beckwith-Wiedemann syndrome and Denys-Drash syndrome have an increased risk of developing Wilms tumor ( 5 , 6 ). (abdominalkey.com)
Wiedemann-Beckwith syndrome is related to abnormalities on chromosome 11p15 and characterized by multiple craniofacial anomalies, abdominal wall defects, and tumors of the genitourinary tract, liver, adrenal gland, and central nervous system among other abnormalities. (abdominalkey.com)

Wilms tumor is believed to arise from embryonic tissues called nephrogenic rests that fail to undergo normal involution ( 7 ). (abdominalkey.com)

This classic triad is 1: haematuria, which is when there is blood present in the urine, 2: flank pain, which is pain on the side of the body between the hip and ribs, and 3: an abdominal mass, similar to bloating but larger. (wikipedia.org)

Large oncocytomas are rare and can be difficult to distinguish from RCCs on the basis of clinical findings or imaging characteristics alone. (medscape.com)
6,7] There are surgical considerations and tumor characteristics that are related positive margins. (blogspot.com)

In the case of a positive surgical margins, some surgeons will advocate re-resection or salvage radical nephrectomy. (blogspot.com)

Patient treatment and prognosis depend on the specific histologic type of tumor. (medscape.com)

Laboratory workup revealed abnormal renal function with the rapid rise of creatinine from 1.04 mg/dL to 14.5 mg/dL within 3 days. (ijpmonline.org)

Neonatal Wilms tumor is rare. (abdominalkey.com)
Wilms tumor is rare in adults ( 3 ). (abdominalkey.com)

This could involve taking additional tumor or completion nephrectomy. (blogspot.com)

Unfortunately, different renal tumors can have similar histologic features, making differential diagnostics challenging. (medscape.com)

Specific discussions of etiology and pathogenesis are dealt with in each of the sections on individual tumors, rather than as a freestanding section, as is used elsewhere in this text. (abdominalkey.com)

Renal oncocytomas are slow-growing tumors that tend to be small, unilateral, and asymptomatic. (medscape.com)

This is a somewhat arbitrary designation, as most tumors can develop over a wide age range. (abdominalkey.com)

Wilms tumor often is greater than 5 cm in diameter, with an average size of 10 cm ( 3 ). (abdominalkey.com)

A "microscopic" positive margin, a margin noted by the pathologist under the microscope after the tumor has been removed, warrants careful consideration. (blogspot.com)

During the evaluation of resected specimens, oncopathologists check all the pathological parameters enlisted in the standard protocol for reporting such as histological subtypes, grade, stage, etc. [2] The majority of the times peritumoral and distant renal parenchyma is overlooked and the opportunity to identify concurrent familiar or unfamiliar medical renal diseases is missed. (ijpmonline.org)

Most Wilms tumor occurs in children between the ages of 2 and 4 years ( 3 ). (abdominalkey.com)

The ureteric bud divides and branches forming the collecting system (renal pelvis, infundibulae, calyces, and tubules) for urine drainage. (esur2023.com)

The purpose of this chapter is to familiarize the reader with the tumor types encountered in the human rather than to provide a comprehensive diagnostic reference, which is better handled in more comprehensive textbooks and monographs. (abdominalkey.com)

In this chapter, these will be covered using an approach that has become a standard one in dealing with this group of tumors. (abdominalkey.com)

Voided volume may not impact stone outcomes: Review of a large institutional nephrolithiasis cohort. (ucsf.edu)

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