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Related Concept Videos

Tumor Immunotherapy01:27

Tumor Immunotherapy

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Immunotherapy is a treatment that boosts or manipulates the immune system to fight diseases, including cancer. For instance, by stimulating an immune response through vaccinations against viruses that cause cancers, like hepatitis B virus and human papillomavirus, these diseases can be prevented. Nonetheless, some cancer cells can avoid the immune system due to their rapid mutation and division. The immune response to many cancers involves three phases: elimination, equilibrium, and escape.
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Outcomes of Minimally Invasive Nephrectomy Following Immune-Checkpoint Inhibitor Therapy: A Multicenter Propensity

Alireza Ghoreifi1, Farshad Sheybaee Moghaddam1, Stephan Bronimann2

  • 1Department of Urology, University of Southern California, Los Angeles, California, USA.

Journal of Endourology
|February 27, 2025
PubMed
Summary
This summary is machine-generated.

Minimally invasive nephrectomy after immune checkpoint inhibitors shows improved perioperative outcomes. This approach offers reduced blood loss and shorter hospital stays compared to open surgery, with similar complication rates for selected advanced renal cell carcinoma patients.

Keywords:
immune checkpoint inhibitorsminimally invasive surgical proceduresnephrectomypropensity scorerenal-cell carcinoma

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Area of Science:

  • Urology
  • Surgical Oncology
  • Nephrology

Background:

  • Immune checkpoint inhibitors (ICIs) are increasingly used in advanced renal cell carcinoma (RCC) treatment.
  • Nephrectomy may be indicated following ICI therapy.
  • Outcomes of minimally invasive surgery (MIS) versus open nephrectomy in this context are not well-established.

Purpose of the Study:

  • To compare the outcomes of minimally invasive nephrectomy (MIS) versus open nephrectomy in patients treated with ICI therapy.
  • To identify factors associated with the choice of surgical approach.

Main Methods:

  • Multicenter retrospective cohort study of 158 patients undergoing nephrectomy after ICI therapy (2015-2023).
  • Propensity-score matching (PSM) was used to compare MIS (robotic or laparoscopic) with open nephrectomy.
  • Primary outcome: 90-day complications; Secondary outcomes: length of hospital stay (LOS), 90-day readmission.

Main Results:

  • After PSM (56 MIS, 36 open), MIS was associated with significantly lower estimated blood loss (100 vs 460 mL) and shorter LOS (2 vs 4 days).
  • 90-day complication and readmission rates were similar between MIS and open nephrectomy groups.
  • Non-metastatic RCC, smaller tumor size, and absence of IVC thrombus were associated with higher likelihood of MIS.

Conclusions:

  • Minimally invasive nephrectomy is a safe and effective approach for selected patients with advanced RCC following ICI therapy.
  • MIS offers superior perioperative outcomes, including reduced blood loss and shorter hospital stays, compared to open surgery.
  • Careful patient selection is crucial for optimizing outcomes in this patient population.