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


  • Associate 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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  • Althaus AB, Chang P, Mao J, Olugbade K, Taylor K, Dewey L, Percy A, Crociani C, McNally K, Wagner AA. Patient-Reported Quality of Life and Convalescence after Minimally Invasive Kidney Cancer Surgery. Urology 2020. PubMed
  • Liss MA, Newcomb LF, Zheng Y, Garcia MP, Filson CP, Boyer H, Brooks JD, Carroll PR, Cooperberg MR, Ellis WJ, Gleave ME, Martin FM, Morgan T, Nelson PS, Wagner AA, Thompson IM, Lin DW. Magnetic Resonance Imaging for the Detection of High-Grade Cancer in the Canary Prostate Active Surveillance Study. J Urol 2020. PubMed
  • Lin DW, Zheng Y, McKenney JK, Brown MD, Lu R, Crager M, Boyer H, Tretiakova M, Brooks JD, Dash A, Fabrizio MD, Gleave ME, Kolb S, Liss M, Morgan TM, Thompson IM, Wagner AA, Tsiatis A, Pingitore A, Nelson PS, Newcomb LF. 17-Gene Genomic Prostate Score Test Results in the Canary Prostate Active Surveillance Study (PASS) Cohort. J Clin Oncol 2020. PubMed
  • Aldhaam NA, Elsayed AS, Jing Z, Richstone L, Wagner AA, Rha KH, Yuh B, Palou J, Khan MS, Menon M, Roupret M, Balbay D, Hosseini A, Wiklund P, Gaboardi F, Maatman TJ, Mottrie A, Wijburg C, Stöckle M, Hemal A, Kim E, Kaouk J, Hussein AA, Guru KA. Neoadjuvant Chemotherapy is Not Associated with Adverse Perioperative Outcomes after Robot-Assisted Radical Cystectomy: A Case for Increased Use from the IRCC. J Urol 2019; 203:57-61. PubMed
  • Cahill LC, Wu Y, Yoshitake T, Ponchiardi C, Giacomelli MG, Wagner AA, Rosen S, Fujimoto JG. Nonlinear microscopy for detection of prostate cancer: analysis of sensitivity and specificity in radical prostatectomies. Mod Pathol 2019. PubMed
  • Srivastava A, Patel HD, Gupta M, Joice GA, Schwen Z, Alam R, Gorin MA, Johnson MH, Trock BJ, Chang P, Wagner AA, McKiernan JM, Allaf ME, Pierorazio PM. The incidence, predictors, and survival of disappearing small renal masses on active surveillance. Urol Oncol 2019. PubMed
  • Schenk JM, Newcomb LF, Zheng Y, Faino AV, Zhu K, Nyame YA, Brooks JD, Carroll PR, Cooperberg MR, Dash A, Filson CP, Gleave ME, Liss M, Martin FM, Morgan TM, Nelson PS, Thompson IM, Wagner AA, Lin DW. African American Race is Not Associated with Risk of Reclassification during Active Surveillance: Results from the Canary Prostate Cancer Active Surveillance Study (PASS). J Urol 2019. PubMed
  • Delto JC, Chang P, Hyde S, McAnally K, Crociani C, Wagner AA. Eliminating pseudoaneurysm and urine leak after robotic partial nephrectomy: results using the early unclamping technique. Urology 2019. PubMed
  • McKay RR, Ye H, Xie W, Lis R, Calagua C, Zhang Z, Trinh QD, Chang SL, Harshman LC, Ross AE, Pienta KJ, Lin DW, Ellis WJ, Montgomery B, Chang P, Wagner AA, Bubley GJ, Kibel AS, Taplin ME. Evaluation of Intense Androgen Deprivation Before Prostatectomy: A Randomized Phase II Trial of Enzalutamide and Leuprolide With or Without Abiraterone. J Clin Oncol 2019; 37:923-931. PubMed
  • Cahill LC, Fujimoto JG, Giacomelli MG, Yoshitake T, Wu Y, Lin DI, Ye H, Carrasco-Zevallos OM, Wagner AA, Rosen S. Comparing histologic evaluation of prostate tissue using nonlinear microscopy and paraffin H&E: a pilot study. Mod Pathol 2019. PubMed
  • Sotimehin AE, Patel HD, Alam R, Gorin MA, Johnson MH, Chang P, Wagner AA, McKiernan JM, Allaf ME, Pierorazio PM. Selecting Patients with Small Renal Masses for Active Surveillance: A Domain-Based Score from a Prospective Cohort Study. J Urol 2019. PubMed
  • Newcomb LF, Zheng Y, Faino AV, Bianchi-Frias D, Cooperberg MR, Brown MD, Brooks JD, Dash A, Fabrizio MD, Gleave ME, Liss M, Morgan TM, Thompson IM, Wagner AA, Carroll PR, Nelson PS, Lin DW. Performance of PCA3 and TMPRSS2:ERG urinary biomarkers in prediction of biopsy outcome in the Canary Prostate Active Surveillance Study (PASS). Prostate Cancer Prostatic Dis 2019. PubMed
  • Gupta M, Alam R, Patel HD, Semerjian A, Gorin MA, Johnson MH, Chang P, Wagner AA, McKiernan JM, Allaf ME, Pierorazio PM. Use of delayed intervention for small renal masses initially managed with active surveillance. Urol Oncol 2018; 37:18-25. PubMed
  • Rague J, Varda BK, Wagner AA, Lee RS. Delayed Return of Ejaculatory Function in Adolescent Males Treated With Retroperitoneal Lymph Node Dissection and Adjuvant Therapy for Paratesticular Rhabdomyosarcoma. Urology 2018. PubMed
  • Chang P, Renehan P, Taylor KN, Dewey LE, McAnally KC, Hyde S, Crociani CM, Carneiro A, Beaule LT, Wagner AA. Societal costs of localized renal cancer surgery. Can J Urol 2018; 25:9401-9406. PubMed
  • Alam R, Patel HD, Osumah T, Srivastava A, Gorin MA, Johnson MH, Trock BJ, Chang P, Wagner AA, McKiernan JM, Allaf ME, Pierorazio PM. Comparative effectiveness of management options for patients with small renal masses: a prospective cohort study. BJU Int 2018. PubMed
  • Mihalcik SA, Chipman JJ, Sanda MG, Regan MM, Kaplan ID, Wagner AA, Crociani CM, Chang P, . Predicting erectile function following external beam radiation therapy or brachytherapy for prostate cancer using EPIC-CP. 2018. PubMed
  • Varda BK, Cho P, Wagner AA, Lee RS. Collaborating with our adult colleagues: A case series of robotic surgery for suspicious and cancerous lesions in children and young adults performed in a free-standing children's hospital. J Pediatr Urol 2018. PubMed
  • Kearns JT, Faino AV, Newcomb LF, Brooks JD, Carroll PR, Dash A, Ellis WJ, Fabrizio M, Gleave ME, Morgan TM, Nelson PS, Thompson IM, Wagner AA, Zheng Y, Lin DW. Role of Surveillance Biopsy with No Cancer as a Prognostic Marker for Reclassification: Results from the Canary Prostate Active Surveillance Study. Eur Urol 2018. PubMed
  • Cooperberg MR, Brooks JD, Faino AV, Newcomb LF, Kearns JT, Carroll PR, Dash A, Etzioni R, Fabrizio MD, Gleave ME, Morgan TM, Nelson PS, Thompson IM, Wagner AA, Lin DW, Zheng Y. Refined Analysis of Prostate-specific Antigen Kinetics to Predict Prostate Cancer Active Surveillance Outcomes. Eur Urol 2018. PubMed
  • Abello A, Delto JC, Wagner AA, Das AK. An Unusual Presentation of Metastatic Urothelial Bladder Carcinoma With Rhabdoid Features Presenting as Obstructive Uropathy. Urology 2018. PubMed
  • McKay RR, Montgomery B, Xie W, Zhang Z, Bubley GJ, Lin DW, Preston MA, Trinh QD, Chang P, Wagner AA, Mostaghel EA, Kantoff PW, Nelson PS, Kibel AS, Taplin ME. Post prostatectomy outcomes of patients with high-risk prostate cancer treated with neoadjuvant androgen blockade. Prostate Cancer Prostatic Dis 2017. PubMed
  • Uzosike AC, Patel HD, Alam R, Schwen ZR, Gupta M, Gorin MA, Johnson MH, Gausepohl H, Riffon MF, Trock BJ, Chang P, Wagner AA, McKiernan JM, Allaf ME, Pierorazio PM. Growth Kinetics of Small Renal Masses on Active Surveillance: Variability and Results from the DISSRM Registry. J Urol 2017. PubMed
  • Lin DW, Newcomb LF, Brown MD, Sjoberg DD, Dong Y, Brooks JD, Carroll PR, Cooperberg M, Dash A, Ellis WJ, Fabrizio M, Gleave ME, Morgan TM, Nelson PS, Thompson IM, Wagner AA, Zheng Y, . Evaluating the Four Kallikrein Panel of the 4Kscore for Prediction of High-grade Prostate Cancer in Men in the Canary Prostate Active Surveillance Study. Eur Urol 2016. PubMed
  • Macleod LC, Ellis WJ, Newcomb LF, Zheng Y, Brooks JD, Carroll PR, Gleave ME, Lance RS, Nelson PS, Thompson IM, Wagner AA, Wei JT, Lin DW. Timing of Adverse Prostate Cancer Reclassification on First Surveillance Biopsy: Results from the Canary Prostate Cancer Active Surveillance Study. J Urol 2016. PubMed
  • Dovirak O, Mao J, Taylor K, Chang P, Wagner AA. How to Quantify Recovery After Laparoscopic Adrenalectomy: An Assessment of Patient-reported Health-related Quality of Life. Surg Laparosc Endosc Percutan Tech 2016; 26:290-4. PubMed
  • Wagner AA, Cheng PJ, Carneiro A, Dovirak O, Khosla A, Taylor KN, Crociani CM, McAnally KC, Percy A, Dewey LE, Sanda MG, Chang P. Clinical Use of EPIC for Clinical Practice (EPIC-CP) to Assess Patient-Reported Prostate Cancer Quality-of-Life Following Robot-Assisted Radical Prostatectomy. J Urol 2016. PubMed
  • Patel HD, Riffon MF, Joice GA, Johnson MH, Chang P, Wagner AA, McKiernan JM, Trock BJ, Allaf ME, Pierorazio PM. A Prospective, Comparative Study of Quality of Life among Patients with Small Renal Masses choosing Active Surveillance and Primary Intervention. J Urol 2016. PubMed
  • Quintana L, Ward A, Gerrin SJ, Genega E, Rosen S, Sanda MG, Wagner AA, Chang P, DeWolf WC, Ye H. Gleason Misclassification Rate is Independent of Number of Biopsy Cores in Systematic Biopsy. Urology 2016. PubMed
  • Sun MR, Brook A, Powell MF, Kaliannan K, Wagner AA, Kaplan ID, Pedrosa I. Effect of Stereotactic Body Radiotherapy on the Growth Kinetics and Enhancement Pattern of Primary Renal Tumors. AJR Am J Roentgenol 2016; 206:544-53. PubMed
  • Danzig MR, Chang P, Wagner AA, Allaf ME, McKiernan JM, Pierorazio PM. Active Surveillance for Small Renal Masses: A Review of the Aims and Preliminary Results of the DISSRM Registry. Current Urology Reports 2015; 17:4. PubMed
  • 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, Ghandour RA, Chang P, Wagner AA, Pierorazio PM, Allaf ME, McKiernan JM. Active Surveillance is Superior to Radical Nephrectomy and Equivalent to Partial Nephrectomy for Preserving Renal Function in Patients with Small Renal Masses: Results from the DISSRM Registry. J Urol 2015. PubMed
  • Althaus AB, Dovirak O, Chang P, Taylor KN, O'Halloran TD, Wagner AA. Aspirin and clopidogrel during robotic partial nephrectomy, is it safe? Can J Urol 2015; 22:7984-9. 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
  • Newcomb LF, Thompson IM, Boyer HD, Brooks JD, Carroll PR, Cooperberg MR, Dash A, Ellis WJ, Fazli L, Feng Z, Gleave ME, Kunju P, Lance RS, McKenney JK, Meng MV, Nicolas MM, Sanda MG, Simko J, So A, Tretiakova MS, Troyer DA, True LD, Vakar-Lopez F, Virgin J, Wagner AA, Wei JT, Zheng Y, Nelson PS, Lin DW, . Outcomes of Active Surveillance for the Management of Clinically Localized Prostate Cancer in the Prospective, Multi-Institutional Canary PASS Cohort. J Urol 2015. PubMed
  • Alemozaffar M, Narayanan R, Percy AA, Minnillo BB, Steinberg P, Haleblian G, Gautam S, Matthes K, Wagner AA. Validation of a novel, tissue-based simulator for robot-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 2013. 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
  • Mühlenberg 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