Photo of Drew Wagner,

Drew Wagner

Beth Israel Deaconess Medical Center

Beth Israel Deaconess Medical Center
Phone: (617) 667-2898
Fax: (617) 667-2897

Drew Wagner

Beth Israel Deaconess Medical Center


  • Assistant Professor, Surgery, Harvard Medical School


Research Abstract

BACKGROUND: Laparoscopic radical nephrectomy (LRN) is commonly performed for T1 and T2 renal masses. Questions remain regarding the feasibility and safety of LRN in advanced renal cell carcinoma (RCC), particularly stage pT3, pT4, and cytoreduction for metastatic disease. We evaluated our experience with LRN in advanced RCC and compared it to a concurrent series of LRN in patients without advanced RCC.

METHODS: All patients undergoing LRN at a single academic institution between August 2006 and September 2008 were included. A retrospective analysis of a prospectively collected database was performed. Patients in group 1 had either pT3 disease or known metastatic RCC presenting for cytoreductive LRN. Group 2 patients had either pT1-2 or benign disease. All patients were placed on a LRN clinical pathway during the postoperative (PO) period. Results: There were 59 LRN performed. Group 1 consists of 22 patients with pT3 (n=18) and/or M1 (n=14). Group 2 consists of 37 patients with pT1-2 (n=29) or benign disease (n=8). Patient demographics and peri-operative data are displayed in table 1.

RESULTS: Significant differences were observed in ASA (p=0.0001), tumor size (p=0.03), operative time (p=0.02), and EBL (p=0.03). Age, length of stay, BMI, number of transfusions, and numbers of complications were not significantly different between groups. There were no intraoperative (IO) complications in group 1. In group 2, there were 2 IO complications (5.4%) including one colon thermal injury (oversewn without sequellae) and a brief period or ST depressions in one patient whose subsequent cardiac work-up was negative. Three PO complications were noted in group 1 (13.6%): new onset atrial fibrillation, corneal abrasion, and abscess at a port site managed with bedside drainage. In group 2, there were 7 PO complications (18.9%). Two patients required emergency room evaluation, one for nausea and one for chest pain secondary to dyspepsia. Additional PO complications in group 2 include: ileus (1), wound infection (1), subcutaneous hematoma at extraction site (2), both conservatively managed, and vertebral osteomyelitis from an epidural placed in a patient with chronic pain (1).

CONCLUSIONS: In experienced hands and in selected cases, LRN in patients with advanced RCC (T3 or M1) is safe.



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  • Ankerst DP, Xia J, Thompson IM, Hoefler J, Newcomb LF, Brooks JD, Carroll PR, Ellis WJ, Gleave ME, Lance RS, Nelson PS, Wagner AA, Wei JT, Etzioni R, Lin DW. Precision Medicine in Active Surveillance for Prostate Cancer: Development of the Canary-Early Detection Research Network Active Surveillance Biopsy Risk Calculator. Eur Urol 2015. PubMed
  • Danzig MR, Chang P, Wagner AA, Pierorazio PM, Allaf ME, McKiernan JM. Active Surveillance is Superior to Radical Nephrectomy and Equivalent to Partial Nephrectomy in Preserving Renal Function Among Patients with Small Renal Masses; Results from the DISSRM Registry. J Urol 2015. PubMed
  • Pierorazio PM, Johnson MH, Ball MW, Gorin MA, Trock BJ, Chang P, Wagner AA, McKiernan JM, Allaf ME. Five-year Analysis of a Multi-institutional Prospective Clinical Trial of Delayed Intervention and Surveillance for Small Renal Masses: The DISSRM Registry. Eur Urol 2015. PubMed
  • Alemozaffar M, Percy AA, Narayanan R, Minnillo BB, Steinberg P, Haleblian G, Gautam S, Matthes K, Wagner AA. Validation of a novel, tissue-based simulator for robotic assisted radical prostatectomy. J Endourol 2014. PubMed
  • Kaplan JR, Chang P, Percy AG, Wagner AA. Renal transposition during minimally invasive partial nephrectomy: a safe technique for excision of upper pole tumors. J Endourol 2013; 27:1096-100. PubMed
  • Williams SB, Kacker R, Alemozaffar M, Francisco IS, Mechaber J, Wagner AA. Robotic partial nephrectomy versus laparoscopic partial nephrectomy: a single laparoscopic trained surgeon's experience in the development of a robotic partial nephrectomy program. World J Urol 2011. PubMed
  • Thomas DM, Wagner AJ. Specific targets in sarcoma and developmental therapeutics. J Natl Compr Canc Netw 2010; 8:677-86. PubMed
  • Wagner AJ, Malinowska-Kolodziej I, Morgan JA, Qin W, Fletcher CD, Vena N, Ligon AH, Antonescu CR, Ramaiya NH, Demetri GD, Kwiatkowski DJ, Maki RG. Clinical activity of mTOR inhibition with sirolimus in malignant perivascular epithelioid cell tumors: targeting the pathogenic activation of mTORC1 in tumors. J Clin Oncol 2010; 28:835-40. PubMed
  • Raut CP, Wang Q, Manola J, Morgan JA, George S, Wagner AJ, Butrynski JE, Fletcher CD, Demetri GD, Bertagnolli MM. Cytoreductive surgery in patients with metastatic gastrointestinal stromal tumor treated with sunitinib malate. Ann Surg Oncol 2010; 17:407-15. PubMed
  • Davis IJ, McFadden AW, Zhang Y, Coxon A, Burgess TL, Wagner AJ, Fisher DE. Identification of the receptor tyrosine kinase c-Met and its ligand, hepatocyte growth factor, as therapeutic targets in clear cell sarcoma. Cancer Res 2010; 70:639-45. PubMed
  • Martin JE, Wagner AJ, Murphy GF, Pinkus GS, Wang LC. Granuloma annulare heralding angioimmunoblastic T-cell lymphoma in a patient with a history of epstein-barr virus-associated B-cell lymphoma. J Clin Oncol 2009; 27:e168-71. PubMed
  • M├╝hlenberg T, Zhang Y, Wagner AJ, Grabellus F, Bradner J, Taeger G, Lang H, Taguchi T, Schuler M, Fletcher JA, Bauer S. Inhibitors of deacetylases suppress oncogenic KIT signaling, acetylate HSP90, and induce apoptosis in gastrointestinal stromal tumors. Cancer Res 2009; 69:6941-50. PubMed
  • Dei Tos AP, Wagner AJ, Modena P, Comandone A, Leyvraz S. Epithelioid soft tissue tumors. Semin Oncol 2009; 36:347-57. PubMed
  • Bivalacqua TJ, Schaeffer EM, Alphs H, Mettee L, Wagner AA, Su LM, Pavlovich CP. Intraperitoneal Effects of Extraperitoneal Laparoscopic Radical Prostatectomy. Urology 2008; 72:273-7. PubMed
  • Sur RL,Wagner AA,Albala DM,Su LM. Critical role of the assistant in laparoscopic and robot-assisted radical prostatectomy. J Endourol 2008; 22:587-9; discussion 589-90. PubMed
  • Pavlovich CP,Trock BJ,Sulman A,Wagner AA,Mettee LZ,Su LM. 3-year actuarial biochemical recurrence-free survival following laparoscopic radical prostatectomy: experience from a tertiary referral center in the United States. J Urol 2008; 179:917-21; discussion 921-2. PubMed
  • Wagner AA, Link RE, Trock BJ, Sullivan W, Pavlovich CP. Comparison of open and laparoscopic radical prostatectomy outcomes from a surgeon's early experience. Urology 2007; 70:667-71. PubMed
  • Rassweiler J,Wagner AA,Moazin M,Gozen AS,Teber D,Frede T,Su LM. Anatomic nerve-sparing laparoscopic radical prostatectomy: comparison of retrograde and antegrade techniques. Urology 2006; 68:587-91; discussion 591-2. PubMed
  • Wagner AA,Solomon SB,Kavoussi LR. Imaging following cryoablation of a renal lesion. Nat Clin Pract Urol 2006; 2:52-7; quiz 58. PubMed