The Benefit of Laparoscopic Partial Nephrectomy in High Body Mass Index Patients
Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Japanese Journal of Clinical Oncology
(Impact Factor: 2.02).
05/2012; 42(7):619-24. DOI: 10.1093/jjco/hys061
The aims of the present study were to evaluate the effect of body mass index on the surgical outcomes of open partial nephrectomy and laparoscopic partial nephrectomy, and to analyze whether higher body mass index patients may derive greater benefit from laparoscopic partial nephrectomy.
We reviewed 110 patients who underwent open partial nephrectomy and 47 patients who underwent laparoscopic partial nephrectomy at our institution. We analyzed the data to determine what kind of factor would be associated with prolonged operative time, increased estimated blood loss and prolonged ischemic time, and compared the result of open partial nephrectomy with that of laparoscopic partial nephrectomy.
A statistically significant correlation was observed between body mass index and operative time or estimated blood loss in open partial nephrectomy. Multivariate analysis also demonstrated that body mass index was an independent predictor for prolonged operative time and higher estimated blood loss in open partial nephrectomy, but not in laparoscopic partial nephrectomy. In the normal body mass index group (body mass index<25.0 kg/m2), although mean operative time in the laparoscopic partial nephrectomy group was significantly longer than that in the open partial nephrectomy group, the difference was relatively small. In the high body mass index group (body mass index≥25.0 kg/m2), the mean operative time of the two groups was not statistically different. The estimated blood loss of open partial nephrectomy was significantly higher than that of laparoscopic partial nephrectomy in both groups. In both operative procedures, tumor size was an independent predictor for prolonged ischemic time in multivariate analysis.
Body mass index was an independent predictor for prolonged operative time and higher estimated blood loss in open partial nephrectomy but not in laparoscopic partial nephrectomy. Laparoscopic partial nephrectomy was less influenced by body mass index and had a greater benefit, especially in high body mass index patients.
Available from: Wenjing Tao
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ABSTRACT: A large body of epidemiological evidence links obesity to increased cancer incidence, with some studies also indicating poorer survival in obese patients with cancer. Obese patients face several specific challenges related to diagnosis and treatment of cancer. Reduced participation in cancer screening programmes, lower tumour-marker expression and issues with medical imaging among obese individuals complicate cancer diagnosis. Chemotherapy and hormonal therapy in obese patients with cancer is affected by altered pharmacokinetics and hormone levels. In addition, the precision of radiotherapy might be adversely affected in this population by greater skin motility and increased motion of internal organs. Obese patients also face higher risk of minor complications after surgery. There is a need for additional research addressing issues specifically associated with the clinical management of obese patients with cancer, including comorbidity, polypharmacy, and problems related to sarcopenia and health-related quality of life. This Review summarizes the available literature addressing the clinical management of obese patients with cancer and discusses opportunities to improve the cancer care of these patients.
Nature Reviews Clinical Oncology 07/2013; 10(9). DOI:10.1038/nrclinonc.2013.120 · 14.18 Impact Factor
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ABSTRACT: Objective To assess the feasibility and outcomes of retroperitoneal laparoscope-assisted small incision partial nephrectomy for patients with complex T1 renal cell carcinomas (RCCs). Methods The clinical data of twenty-eight patients with complex T1 RCCs, who underwent retroperitoneal laparoscope-assisted small incision partial nephrectomy at our institution between Jul. 2010 and Dec. 2013, were retrospectively analyzed. The tumor diameter was (3.76±1.28) cm and the PADUA score was 9.07±1.25 in this group. There were 13 patients with endophytic tumors, 12 at T1b stage, 7 reniportal RCCs, and 2 cases of solitary kidney. Results All the patients successfully underwent operations, with no severe postoperative complications such as leakage of urine or massive hemorrhage. The operative time was (213.82±40.04) min, the renal cold ischemic time was (23.86±5.98) min, the estimated blood loss was (191.07±94.33) mL, the skin incision length was (9.48±1.56) cm, and the postoperative pain score was (1.11±0.31). Two patients developed transient hyperpyrexia postoperatively and were successfully managed with expectant treatment. And all the patients were discharged safely after a hospital stay of (11.54±3.98) days after surgery. The patients were followed up for (21.46±12.15) months. At the 1st month postoperation, the glomerular filtration rate (GFR) deceased by an average of (21.71±11.48)%. No recurrence or metastasis occurred during the follow-up. Conclusion Retroperitoneal laparoscope-assisted small incision partial nephrectomy is a safe, feasible method for complex T1 RCCs, especially for the larger, endophytic, and reniportal tumors. The method is easy to learn and has small incision, but the long term effect needs to be observed by large sample randomized studies. © 2015 Second Military Medical University Press. All rights reserved.
Academic Journal of Second Military Medical University 01/2015; 36(1):90-94. DOI:10.3724/SP.J.1008.2015.00090
Available from: jjco.oxfordjournals.org
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In a previous study, we described the relationship between operating time and obesity, particularly visceral obesity, in laparoscopic surgery. Operating time in laparoscopic surgery is affected by the experience and technique of the surgeon. Here, we investigated whether a difference in the surgeon's experience affects the operating time for laparoscopic radical nephrectomy in patients with visceral obesity.
From January 2006 to February 2012, 167 laparoscopic radical nephrectomies were performed at our institution. Visceral fat area was measured at the level of the umbilicus using computed tomography. A visceral fat area ≥ 100 cm(2) was used as the definition of visceral obesity. All laparoscopic radical nephrectomies were performed by six surgeons. Two of the six surgeons perform 50 cases or more laparoscopic surgeries every year and they were defined as the expert group. We analyzed the relationships between clinical findings, methods, surgeon experience, body mass index or visceral fat area and operating time.
The expert and non-expert surgeons performed 77 and 90 laparoscopic radical nephrectomies, respectively, and the median operating time was 167.0 ± 44.0 and 227.5 ± 60.6 min. Twenty-five patients underwent laparoendoscopic single-site nephrectomy by the expert surgeons. For all surgeons, visceral obesity was a significant factor for prolonged operating time. Multivariate analysis showed that visceral obesity and clinical T stage were independent risk factors for prolonged operating time for the non-expert surgeons [P = 0.004, hazard ratio (HR): 5.15, P = 0.037, HR:10.41]. However, for the expert surgeons, clinical T stage was the only independent risk factor for prolonged operating time (P = 0.039, HR: 4.33).
Visceral obesity was a factor of prolonged operating time in laparoscopic radical nephrectomy. The non-expert surgeons were particularly affected by visceral obesity.
Japanese Journal of Clinical Oncology 01/2015; 45(4). DOI:10.1093/jjco/hyv001 · 2.02 Impact Factor
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