Objective To evaluate the value of MRI and MDCT in detecting both inferior vena cava tumor thrombus and vena cava wall invasion in renal cell carcinoma. Methods Databases including PubMed, EMbase, The Cochrane Library, MEDLINE (Ovid), CBM, CNKI, VIP and WanFang Data were searched from January 2000 to February 2012. Relevant studies were screened on the basis of the inclusion and exclusion criteria, and then quality assessment and data extraction were conducted. Then heterogeneity test and meta-analysis were conducted using RevMan 5 and Meta-disc 1.4. Results A total of 6 trials involving 244 patients and 246 cases of renal cell carcinoma were included. The results of meta-analysis showed that, for the MRI group and the MDCT group, the sensitivity was 0.963 and 0.952, the specificity was 0.969 and 0.979, the value of +LR was 9.759 and 15.57, the value of −LR was 0.091 and 0.108, and the dOR was 198.71 and 251.54, respectively. There were no significant differences in pooled effect-size among groups (Pgt;0.05). The area under curve (AUC) of summary ROC curve analysis as well as Q index of the MDCT group were 0.981 8 and 0.940 7, respectively. Conclusion There is no significant difference in the value of MRI and MDCT in detecting inferior vena cava tumor thrombus induced by renal cell carcinoma. More original studies on vena cava wall invasion by tumor thrombus should be conducted in the future due to the limitation of current materials.
Objective The efficacy and morbidity of thoracoabdominal incision in comparison with flank incision for radical nephrectomy are unknown. This retrospective study was performed to compare the outcome of thoracoabdominal incision versus flank incision for radical nephrectomy in patients with large renal tumors. Methods A questionnaire assessing the time of postoperative pain, use of anodyne and return to daily activities and work was sent to patients who underwent radical nephrectomy through the 11th rib (flank incision, group A, 96 patients) or the 9th to 10th rib (thoracoabdominal incision, group B, 98 patients) from 2003 to 2008 at the Second Xiangya Hospital in Changsha, China. A case retrospective analysis assessing operation time, perioperative hemorrhage volume, size of tumors, success in the treatment of tumor thrombus in renal vein or vena cava, presence of drainage-tube, postoperative analgesia usage and length of stay was done for patients whose questionnaires were returned. Results The length of operation time and the presence of abdominal drainage-tube was shorter in the thoracoabdominal incision group (group B) than in the flank incision group (group A). The perioperative hemorrhage volume in group B was less than that in group A. The mean size of tumors in group A was smaller than that in group B (Plt;0.000 5). The success rate in the treatment of thrombus in renal vein or vena cava in group B was higher than that in group A (Plt;0.05). The length of off-bed time and of hospital stay were similar in both groups. There were no significant differences between the groups in pain severity postoperative day 1, on the day of discharge and 1 month postoperatively (Pgt;0.05). There were no significant differences between the groups in the time from surgery to the complete disappearence of pain, to the discontinuation of pain medication, and to the return to daily activities and work (Pgt;0.05). Conclusion The approach of thoracoabdominal incision provides better exposure. Morbidity is comparable for thoracoabdominal and flank incisions in terms of incisional pain, analgesic requirements after discharge and return to normal activities.
Objectives To systematically review the influence of positive margin on outcome after partial nephrectomy (PN). Methods CCRCT, PubMed, EMbase, Sinomed, WanFang Data and CNKI databases were electronically searched to collect clinical studies on influence of positive margin on outcome after PN from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.4 software. Results A total of 22 cohort studies involving 20 822 patients were included. The results of meta-analysis showed that positive margin after PN could increase the rate of postoperative local recurrence (OR=4.18, 95%CI 2.88 to 6.05, P<0.000 01), distant metastasis (OR=5.28, 95%CI 2.84 to 9.81,P<0.000 01) and total mortality (OR=1.54, 95%CI 1.19 to 1.99,P=0.0010). However, there were no differences on overall survival (OR=0.64, 95% CI 0.34 to 1.19, P=0.16), distant metastasis free survival (OR=0.70, 95%CI 0.26 to 1.84, P=0.46), cancer specific survival (OR=0.43, 95% CI 0.06 to 3.01, P=0.40) and disease-free survival (OR=0.81, 95%CI 0.35 to 1.85, P=0.61) between two groups. Conclusions Current evidence suggests that positive margin after PN may be associated with tumor progression, however, it may not affect patient survival. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
The background of abdominal computed tomography (CT) images is complex, and kidney tumors have different shapes, sizes and unclear edges. Consequently, the segmentation methods applying to the whole CT images are often unable to effectively segment the kidney tumors. To solve these problems, this paper proposes a multi-scale network based on cascaded 3D U-Net and DeepLabV3+ for kidney tumor segmentation, which uses atrous convolution feature pyramid to adaptively control receptive field. Through the fusion of high-level and low-level features, the segmented edges of large tumors and the segmentation accuracies of small tumors are effectively improved. A total of 210 CT data published by Kits2019 were used for five-fold cross validation, and 30 CT volume data collected from Suzhou Science and Technology Town Hospital were independently tested by trained segmentation models. The results of five-fold cross validation experiments showed that the Dice coefficient, sensitivity and precision were 0.796 2 ± 0.274 1, 0.824 5 ± 0.276 3, and 0.805 1 ± 0.284 0, respectively. On the external test set, the Dice coefficient, sensitivity and precision were 0.817 2 ± 0.110 0, 0.829 6 ± 0.150 7, and 0.831 8 ± 0.116 8, respectively. The results show a great improvement in the segmentation accuracy compared with other semantic segmentation methods.